1. Articles in category: Cardiology

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    1. Optical coherence tomography vs intravascular ultrasound in the evaluation of observer variability and reliability in the assessment of stent deployment: The OCTIVUS Study

      Optical coherence tomography vs intravascular ultrasound in the evaluation of observer variability and reliability in the assessment of stent deployment: The OCTIVUS Study

      Abstract Objectives : To compare the variability in the assessment of coronary stents among interventional cardiologists (readers) using Optical Coherence Tomography (OCT) and Intravascular ultrasound (IVUS). Background : IVUS is established and validated in the evaluation of coronary stent. For cardiologists without core lab expertise, the utility of IVUS is limited by image quality. OCT yields higher image resolution, however, the consistency with which these readers interpret OCT images has not been fully evaluated or compared with IVUS. Methods : OCT and IVUS image sets (5 pairs) obtained following stent placement were reviewed by readers with clinical experience with both modalities. Parameters assessed ...

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    2. Impact of coronary artery stent edge dissections on long-term clinical outcome in patients with acute coronary syndrome: An Optical Coherence Tomography Study

      Impact of coronary artery stent edge dissections on long-term clinical outcome in patients with acute coronary syndrome: An Optical Coherence Tomography Study

      Aims: The purpose of the present study was to assess the incidence, predictors and long term prognosis of stent edge dissections identified by (OCT) after the implantation of bare metal (BMS) and drug eluting stents (DES). Methods and results: We studied 74 patients who underwent percutaneous coronary intervention (PCI) because of an acute coronary syndrome. Edge dissections were found in 29 of 74 patients (39.1%). Independent predictors of edge dissections were: the presence of ST-elevation myocardial infarction (STEMI) (p=0.005, odds ratio 11.78; 95% Cl 2.06-67.10), the small reference lumen diameter ( p= 0.009, odds ...

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    3. The effect of coronary artery plaque composition, morphology and burden on Absorb bioresorbable vascular scaffold expansion and eccentricity — A detailed analysis with optical coherence tomography

      The effect of coronary artery plaque composition, morphology and burden on Absorb bioresorbable vascular scaffold expansion and eccentricity — A detailed analysis with optical coherence tomography

      Aims Suboptimal stent expansion correlates with adverse cardiac events. There is limited information regarding Absorb bioresorbable vascular scaffold (BVS) expansion characteristics. Optical coherence tomography (OCT) allows for high-resolution assessment of plaque morphology, composition and assessment of BVS expansion. This study evaluates coronary plaque composition, morphology and burden and their effect on Absorb BVS expansion using OCT. Methods and results Two thousand three hundred and thirty four frames totalling 462.6 mm of BVS from twenty OCT-guided BVS implantations were examined. 200 μm longitudinal cross-sections of each BVS were analysed for lumen contours and plaque characteristics. The relationship between each plaque ...

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    4. Side Branch Occlusion After Bioresorbable Vascular Scaffold Implantation Lessons From Optimal Coherence Tomography

      Side Branch Occlusion After Bioresorbable Vascular Scaffold Implantation Lessons From Optimal Coherence Tomography

      There are limited data regarding the side branch occlusion (SBO) after Absorb bioresorbable everolimus-eluting vascular scaffolds (BVS) 1.1 (Abbott Vascular, Santa Clara, California). Even though the second-generation BVS 1.1 has improved on the design of BVS 1.0, the increased strut thickness and width remain and potentially more frequently compromise small SB as compared to the new-generation drug-eluting stents with thin strut. A previous study 1 demonstrated that BVS had a higher incidence (10.5%) of post-procedural SBO compared with the everolimus-eluting metallic stent for SB with a reference vessel diameter ≤0.5 mm. Regarding SB with a ...

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    5. Calcified Nodule Mimicking Red Thrombus on Optical Coherence Tomography

      Calcified Nodule Mimicking Red Thrombus on Optical Coherence Tomography

      The single case report by Hao et al. 1 describing the unique pathological microstructure of a calcified nodule (CN) in an 89-year-old woman dying of congestive heart failure provides unique clues to advance our ability to interpret the images provided by intracoronary diagnostic techniques. The beauty of this report is that a detailed pathological analysis of the CN was combined with corresponding intravascular ultrasound (IVUS), optical coherence tomography (OCT), and coronary angioscopy findings. Of note, this CN was not complicated because it was completely covered by a continuous endothelial layer and had no trace of any residual superficial thrombus. Interestingly ...

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    6. Comparison of neointimal coverage and extra-stent lumen between sirolimus and everolimus-eluting stent using optical coherence tomography

      Comparison of neointimal coverage and extra-stent lumen between sirolimus and everolimus-eluting stent using optical coherence tomography

      The external lumen of a stent [defined as extra-stent lumen (ESL)] assessed by optical coherence tomography (OCT) may be related to the risk of thrombus formation after sirolimus-eluting stent (SES) implantation. An everolimus-eluting stent (EES) might provide relatively minimal inflammatory reaction and appropriate neointimal coverage. The purpose of this study was to compare the neointimal thickness and ESL between SES and EES. Patients who underwent OCT examination more than 7 months after either SES or EES implantation were enrolled. Stent area (SA), lumen area (LA), neointimal area (NIA) and neointimal thickness (NIT) of each strut were measured at 1-mm intervals ...

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      Mentions: Takayuki Okamura
    7. Optical Coherence Tomographic Observation of In-Stent Neoatherosclerosis in Lesions With More Than 50% Neointimal Area Stenosis After Second-Generation Drug-Eluting Stent Implantation

      Optical Coherence Tomographic Observation of In-Stent Neoatherosclerosis in Lesions With More Than 50% Neointimal Area Stenosis After Second-Generation Drug-Eluting Stent Implantation

      Background— Despite the enhanced properties of the second-generation drug-eluting stent (DES), its association with neoatherosclerosis has not been sufficiently evaluated. Therefore, we sought to evaluate and compare neoatherosclerosis in second-generation DESs to first-generation DESs. Methods and Results— A total of 212 DES-treated patients with >50% percent neointimal cross-sectional area stenosis were retrospectively enrolled from the Korean multicenter optical coherence tomography (OCT) registry. Within this population, 111 patients had a second-generation DES (40 zotarolimus, 36 everolimus, and 35 biolimus) and 101 patients had a first-generation (65 sirolimus and 36 paclitaxel) DES. Neoatherosclerosis on OCT was defined as neointima formation with the ...

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    8. Clinical Utility and Significance of Intravascular Ultrasound and Optical Coherence Tomography in Guiding Percutaneous Coronary Interventions

      Clinical Utility and Significance of Intravascular Ultrasound and Optical Coherence Tomography in Guiding Percutaneous Coronary Interventions

      Both intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can provide critical information that facilitates pre-interventional lesion assessment and post-interventional stent assessment and both have the potential to influence treatment strategy. Meta-analyses of randomized trials and observational studies comparing IVUS-guided percutaneous coronary intervention (PCI) with angiography-guided PCI revealed that IVUS-guided procedures reduce the incidence of target vessel revascularization, stent thrombosis, and myocardial infarction. Several IVUS criteria have been proposed to optimize stent implantation. Whether these criteria can be directly used to facilitate OCT-guided stent implantation needs to be clarified. Recent studies revealed several IVUS- and OCT-derived predictors of adverse events ...

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    9. OCT (Optical coherence tomography) evidence of a spontaneous healing of an intramural coronary hematoma

      OCT (Optical coherence tomography) evidence of a spontaneous healing of an intramural coronary hematoma

      A 57 year old, woman without cardiovascular risk factors was admitted for non ST-elevation myocardial infarction with a non-significant lesion of mid left anterior descending artery reveled by the coronarography. An Optical Coherence Tomography confirmed an extensive left anterior descending intramural hematoma, managed with medical treatment. An OCT control was performed at one year showing the complete healing of coronary hematoma.

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    10. Eccentric morphology of jailed side-branch ostium after stent crossover in coronary bifurcation lesions: A three-dimensional optical coherence tomographic analysis

      Eccentric morphology of jailed side-branch ostium after stent crossover in coronary bifurcation lesions: A three-dimensional optical coherence tomographic analysis

      Background Angiographic stenosis of a jailed side-branch ostium is usually observed after a single-stent crossover at coronary bifurcation lesions. However, the stenosis severity is typically overestimated due to the limited information obtained from two-dimensional morphology by angiography. We evaluated the actual stenosis of jailed side-branch ostium using three-dimensional (3D) optical coherence tomography (OCT). Methods Using 3D reconstructions of OCT data, we analyzed minimal lumen area (MLA) and eccentricity of the jailed side-branch ostium in 41 patients who were treated with single stent crossover at coronary bifurcation lesions and subsequently underwent serial OCT follow-up. Results The MLA of jailed side-branch ostium ...

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    11. Hypersensitivity Reaction in the US Food and Drug Administration-Approved Second-Generation Drug-Eluting Stents: Histopathological Assessment With Ex Vivo Optical Coherence Tomography

      Hypersensitivity Reaction in the US Food and Drug Administration-Approved Second-Generation Drug-Eluting Stents: Histopathological Assessment With Ex Vivo Optical Coherence Tomography

      A 55-year-old white man received 4 coronary stents, 3 Resolute zotarolimus-eluting stents (R-ZES; Medtronic, Santa Rosa, CA) and 1 XIENCE Xpedition (CoCr-EES; Abbott Vascular, Santa Clara, CA), for unstable angina pectoris 238 days antemortem. The patient was found dead and had recently been seen without any complaints. The patient had a history of hypertension, hyperlipidemia, and smoking. At the time of stent placement, coronary angiography revealed diffuse disease in the left anterior descending artery (LAD) with severe stenosis of the proximal LAD and moderate to severe stenosis of the mid LAD. Percutaneous coronary intervention was carried out, and 4 overlapping ...

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    12. Evaluation of Coronary Adventitial Vasa Vasorum Using 3D Optical Coherence Tomography - Animal and Human Studies

      Evaluation of Coronary Adventitial Vasa Vasorum Using 3D Optical Coherence Tomography - Animal and Human Studies

      Objectives This study sought to evaluate adventitial vasa vasorum (VV) in vivo with novel imaging technique of optical coherence tomography (OCT). Methods To verify OCT methods for quantification of VV, we first studied 2 swine carotid arteries in a model of focal angiogenesis by autologous blood injection, and compared microchannel volume (MCV) by OCT and VV by m-CT, and counts of those. In OCT images, adventitial MC was identified as signal-voiding areas which were located within 1 mm from the lumen-intima border. After manually tracing microchannel areas and the boundaries of lumen-intima and media-adventitial in all slices, we reconstructed 3D ...

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    13. Identification and quantification of macrophage presence in coronary atherosclerotic plaques by optical coherence tomography

      Identification and quantification of macrophage presence in coronary atherosclerotic plaques by optical coherence tomography

      Aims Vulnerable plaques are characterized by a high macrophage content. We investigated the optical coherence tomography (OCT) capability of identifying coronary plaque macrophage presence using tissue property indexes. Methods and results Fifteen epicardial coronary arteries were imaged by OCT and subsequently analysed by histology. Correlating OCT–histological sections were identified and regions of interest (ROIs) were selected on both atherosclerotic plaques and normal appearing vessel tracts. OCT-derived tissue property indexes named normalized standard deviation (NSD), signal attenuation, and granulometry index were applied on ROIs to identify inflamed ROIs defined as a macrophage percentage >10 by histology. Forty-three paired samples (OCT ...

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      Mentions: Francesco Prati
    14. Serial randomized comparison of strut coverage between everolimus- vs. 1-generation sirolimus-eluting stents

      Serial randomized comparison of strut coverage between everolimus- vs. 1-generation sirolimus-eluting stents

      Background There has not been sufficient data to evaluate the serial vascular healing pattern after everolimus-eluting stent (EES) implantation. Using optical coherence tomography (OCT), serial changes in strut coverage were compared between EES and 1 st -generation sirolimus-eluting stents (SES). Methods Sixty patients were randomly assigned to receive either EES (n=30) or 1 st -generation SES (n=30) for coronary artery disease. Serial OCT evaluation at post-procedure, and 3- and 12-month follow-ups were performed in 50 patients with 54 stents (25 patients with 28 EES vs. 25 patients with 26 SES). The percentage of uncovered struts was defined as ...

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    15. Optical coherence tomography surveillance following drug-eluting stent implantation

      Optical coherence tomography surveillance following drug-eluting stent implantation

      Drug-­eluting stents are currently used in the majority of percutaneous coronary interventions. Preclinical investigations and human autopsy studies have shown that the high efficacy of drug‐eluting stents in preventing restenosis is achieved at the expense of a delay in healing. Optical coherence tomography (OCT) represents a novel intracoronary imaging tool to evaluate vascular healing response after stent implantation. Owing to its outstanding resolution in the catheter near­‐field, quantitative morphometric measures were complemented by more qualitative description of neointimal tissue characterization. Clinical imaging studies employing these methodologies gained valuable insights into vascular healing responses after DES implantation and ...

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    16. Parameter estimation of atherosclerotic tissue optical properties from three-dimensional intravascular optical coherence tomography

      Parameter estimation of atherosclerotic tissue optical properties from three-dimensional intravascular optical coherence tomography

      We developed robust, three-dimensional methods, as opposed to traditional A-line analysis, for estimating the optical properties of calcified, fibrotic, and lipid atherosclerotic plaques from in vivo coronary artery intravascular optical coherence tomography clinical pullbacks. We estimated attenuation μ t and backscattered intensity I 0 from small volumes of interest annotated by experts in 35 pullbacks. Some results were as follows: noise reduction filtering was desirable, parallel line (PL) methods outperformed individual line methods, root mean square error was the best goodness-of-fit, and α -trimmed PL ( α -T-PL) was the best overall method. Estimates of μ t were calcified ( 3.84 ± 0.95     mm − 1 ...

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    17. In Vivo Evaluation of Fibrous Cap Thickness by Optical Coherence Tomography for Positive Remodeling and Low-attenuation Plaques Assessed by Computed Tomography Angiography

      In Vivo Evaluation of Fibrous Cap Thickness by Optical Coherence Tomography for Positive Remodeling and Low-attenuation Plaques Assessed by Computed Tomography Angiography

      Background Coronary plaques with positive remodeling (PR) and low-attenuation plaques (LAP) by computed tomography angiography (CTA) might be associated with plaque vulnerability. The purpose of this study was to assess the relation between coronary plaques with PR and LAP by CTA and fibrous cap thickness measured by optical coherence tomography (OCT). Methods We used CTA and OCT to assess 102 coronary plaques in patients with coronary artery disease (unstable angina pectoris, n = 24; stable angina pectoris, n = 78). Plaque characteristics were divided into three groups: 2-feature-positive plaques (PR and LAP; n = 32), 1-feature-positive plaques (PR or LAP; n = 20), and ...

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    18. A bi-directional assessment of spontaneous coronary artery dissection by three-dimensional flythrough rending of optical coherence tomography images

      A bi-directional assessment of spontaneous coronary artery dissection by three-dimensional flythrough rending of optical coherence tomography images

      A 71-year-old woman was admitted to our hospital due to unstable chest pain. Coronary angiography demonstrated a complex eccentric lesion with 80% narrowing of the right coronary arterial lumen ( Panel A ). Intravascular optical coherence tomography (IV-OCT) revealed typical characteristics of spontaneous coronary artery...

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    19. Optical Coherence Tomographic Evaluation of the Effect of Cigarette Smoking on Vascular Healing after Sirolimus-Eluting Stent Implantation

      Optical Coherence Tomographic Evaluation of the Effect of Cigarette Smoking on Vascular Healing after Sirolimus-Eluting Stent Implantation

      Cigarette smoking is known to be deleterious to patients with coronary artery disease, however the effect of smoking on vascular responses after coronary drug-eluting stent implantation is unknown. We sought to examine vascular response after sirolimus-eluting stent (SES) implantation in patients with ongoing smoking using optical coherence tomography (OCT), compared with former smokers and nonsmokers. We identified 181 SESs in 140 subjects who underwent follow-up OCT imaging. Subjects were divided into 3 groups: current smokers (n = 28), former smokers (n = 35), and nonsmokers (n = 77). Stent strut coverage, neointimal characteristics, and strut malapposition were evaluated. The incidence of uncovered stent ...

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    20. Intravascular optical coherence tomography light scattering artifacts: merry-go-rounding, blooming, and ghost struts

      Intravascular optical coherence tomography light scattering artifacts: merry-go-rounding, blooming, and ghost struts

      We sought to elucidate the mechanisms underlying two common intravascular optical coherence tomography (IV-OCT) artifacts that occur when imaging metallic stents: “merry-go-rounding” (MGR), which is an increase in strut arc length (SAL), and “blooming,” which is an increase in the strut reflection thickness (blooming thickness). Due to uncontrollable variables that occur in vivo , we performed an in vitro assessment of MGR and blooming in stented vessel phantoms. Using Xience V and Driver stents, we examined the effects of catheter offset, intimal strut coverage, and residual blood on SAL and blooming thickness in IV-OCT images. Catheter offset and strut coverage both ...

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    21. Co-registration of Optical Coherence Tomography and X-ray Angiography in Percutaneous Coronary Intervention. The Does Optical Coherence Tomography Optimize Revascularization (DOCTOR) Fusion Study

      Co-registration of Optical Coherence Tomography and X-ray Angiography in Percutaneous Coronary Intervention. The Does Optical Coherence Tomography Optimize Revascularization (DOCTOR) Fusion Study

      Background Intracoronary imaging provides accurate lesion delineation and precise measurements for sizing and positioning of coronary stents. During percutaneous coronary intervention (PCI), it may be challenging to identify corresponding segments between intracoronary imaging and angiography. Computer based online co-registration may aid the target segment identification. Methods The DOCTOR Fusion study was a prospective, single arm, observational study including patients admitted for elective PCI. Optical coherence tomography (OCT) was acquired pre-stent implantation for sizing of stents. The operator subsequently indicated on the angiogram the target area as identified by OCT. Computer based co-registration was performed on-line immediately after pre-stent acquisition to ...

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    22. Optical Coherence Tomography Evaluation of Overlapping Everolimus-Eluting Bioresorbable Vascular Scaffolds implantation guided by Enhanced Stent Visualization System

      Optical Coherence Tomography Evaluation of Overlapping Everolimus-Eluting Bioresorbable Vascular Scaffolds implantation guided by Enhanced Stent Visualization System

      In a porcine model, implantation of overlapping everolimus-eluting bioresorbable vascular scaffolds (BVS, Abbott Vascular, Santa Clara, California) resulted in delayed struts coverage and higher neointimal response [1] that might lead to important clinical consequences (scaffold thrombosis; in-scaffold restenosis). According to this, any effort to minimize BVS overlap area and the number of overlapping struts is desirable. A bench testing in an in vitro phantom model has shown how to minimize BVS overlap utilizing the platinum markers located at each BVS edge, where the ideal overlap should be achieved when BVS edge markers positioned at 90 degrees to each other, causing ...

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      Mentions: Carlo Di Mario
    23. Kounis Syndrome: Optical Coherence Tomography Findings

      Kounis Syndrome: Optical Coherence Tomography Findings

      A 59-year-old man, smoker and with a past history of hypertension, was admitted to the emergency department because of a generalized erythema and hypotension after taking an oral dose of amoxicillin/clavulanic acid for a toe cellulitis. At first medical contact, the patient presented with hypotension (70/40 mmHg), excessive sweating and a striking rash with urticaria on this back. The electrocardiogram showed ST-segment depression in leads III, aVF and V3-V6. After saline and aspirin administration the symptomatology was gradually relieved and the ST-segment changes normalized.

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      Mentions: Fernando Alfonso
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