1. Articles in category: Cardiology

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    1. Synergistic mechanism of coincidence of two subacute stent thromboses: Insights from multiple imaging observations

      Synergistic mechanism of coincidence of two subacute stent thromboses: Insights from multiple imaging observations

      In the drug-eluting stent era, stent thrombosis is uncommon but still a life-threatening complication after percutaneous coronary intervention. There are several types of risk factors associated with stent thrombosis, which could work synergistically to produce thrombus. We report the case of subacute stent thrombosis. A 66-year-old male was hospitalized due to ST-segment elevation myocardial infarction and received emergency percutaneous coronary intervention to the obtuse marginal branch and the posterolateral artery. Five days later, he complained of chest pain. Emergency coronary angiography was performed and revealed stent thromboses in both the obtuse marginal branch and the posterolateral artery. Remarkably, in this ...

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    2. Gender-based in vivo comparison of culprit plaque characteristics and plaque microstructures using optical coherence tomography in acute coronary syndrome

      Gender-based in vivo comparison of culprit plaque characteristics and plaque microstructures using optical coherence tomography in acute coronary syndrome

      Introduction: Women perform worse after acute coronary syndrome (ACS) than men. The reason for these differences is unclear. The aim was to ascertain gender differences in the culprit plaque characteristics in ACS. Methods: Patients with ACS undergoing percutaneous coronary intervention for the culprit vessel underwent optical coherence tomography (OCT) imaging. Culprit plaque was identified as lipid rich,fibrous, and calcific plaque. Mechanisms underlying ACS are classified as plaque rupture, erosion,or calcified nodule. A lipid rich plaque along with thin-cap fibroatheroma (TCFA) was a vulnerable plaque. Plaque microstructures including cholesterol crystals, macrophages, and microvessels were noted. Results: A total of ...

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    3. Vascular Response of Orsiro vs. Xience Drug-Eluting Stents for Treating Coronary Bifurcation Lesions

      Vascular Response of Orsiro vs. Xience Drug-Eluting Stents for Treating Coronary Bifurcation Lesions

      This study aims to compare vessel response and clinical outcomes of a biodegradable-polymer, ultra-thin strut, drug-eluting stent (Orsiro, Biotronik) and a durable-polymer, thin-strut, drug-eluting stent (Xience, Abbott) for the treatment of coronary bifurcation lesions with two-stent double-kissing crush technique. How the differences in stent platforms affect vessel healing process will be examined by optical coherence tomography.

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    4. Longitudinal Morphological and Functional Characterization of Human Heart Organoids Using Optical Coherence Tomography

      Longitudinal Morphological and Functional Characterization of Human Heart Organoids Using Optical Coherence Tomography

      Organoids play an increasingly important role as in vitro models for studying organ development, disease mechanisms, and drug discovery. Organoids are self-organizing, organ-like three-dimensional (3D) cell cultures developing organ-specific cell types and functions. Recently, three groups independently developed self-assembling human heart organoids (hHOs) from human pluripotent stem cells (hPSCs). In this study, we utilized a customized spectral-domain optical coherence tomography (SD-OCT) system to characterize the growth of hHOs. Development of chamber structures and beating patterns of the hHOs were observed via OCT and calcium imaging. We demonstrated the capability of OCT to produce 3D images in a fast, label-free, and ...

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    5. Automated Clinical Decision Support for Coronary Plaques Characterization from Optical Coherence Tomography Imaging with Fused Neural Networks

      Automated Clinical Decision Support for Coronary Plaques Characterization from Optical Coherence Tomography Imaging with Fused Neural Networks

      Deep Neural Networks (DNNs) are nurturing clinical decision support systems for the detection and accurate modeling of coronary arterial plaques. However, efficient plaque characterization in time-constrained settings is still an open problem. The purpose of this study is to develop a novel automated classification architecture viable for the real-time clinical detection and classification of coronary artery plaques, and secondly, to use the novel dataset of OCT images for data augmentation. Further, the purpose is to validate the efficacy of transfer learning for arterial plaques classification. In this perspective, a novel time-efficient classification architecture based on DNNs is proposed. A new ...

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    6. Patterns of Early Coronary Artery Changes in Pediatric Heart Transplant Recipients Detected Using Optical Coherence Tomography

      Patterns of Early Coronary Artery Changes in Pediatric Heart Transplant Recipients Detected Using Optical Coherence Tomography

      Background: Cardiac allograft vasculopathy, the leading cause of graft failure in pediatric heart transplant recipients, is characterized by diffuse and concentric coronary intimal thickening. Early treatment yields better outcomes. While coronary angiography is the standard for cardiac allograft vasculopathy screening and diagnosis, it only identifies luminal narrowing, which occurs in more severe disease. Coronary optical coherence tomography (OCT) is a high-definition intravascular imaging modality that may offer earlier diagnosis. We used OCT to investigate coronary intimal thickening in pediatric transplant recipients and examined its (1) location (ie, vessel type and location) and (2) nature (ie, characteristics of cross-sectional and longitudinal ...

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    7. Healed neointima of in-stent restenosis lesions in patients with stable angina pectoris: an intracoronary optical coherence tomography study

      Healed neointima of in-stent restenosis lesions in patients with stable angina pectoris: an intracoronary optical coherence tomography study

      The phenomenon to heal neointimal rupture or thrombus after coronary stenting occurs as well as in native coronary artery. We investigated clinical characteristics and neointimal vulnerability of healed neointima by optical coherence tomography (OCT). We treated 67 lesions by percutaneous coronary intervention for in-stent restenosis (ISR) and conducted OCT examinations. Healed neointima was defined as neointima having one or more layers with different optical densities and a clear demarcation from underlying components. ISR with healed neointima was found in 49% (33/67) of the lesions. Compared to ISR without healed neointima, ISR with healed neointima showed significantly longer stent age ...

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    8. Technical Feasibility on the Use of Optical Coherence Tomography in the Evaluation of Pediatric Pulmonary Venous Stenosis

      Technical Feasibility on the Use of Optical Coherence Tomography in the Evaluation of Pediatric Pulmonary Venous Stenosis

      Pulmonary vein stenosis (PVS) in children is a morbid disease and limited progress has been made in improving outcomes for this heterogenous group of patients. Evaluation is currently limited to imaging techniques that fail to provide an adequate overview of the intraluminal and luminal pathology perpetuating our limited understanding of this condition. Optical coherence tomography (OCT) is an imaging modality which provides intraluminal profiling with microstructural detail through optical reflective technology. We sought to evaluate whether its use was technically feasible in pediatric PVS and whether the imaging data provided potentially useful outputs for clinical utility. Eleven patients were prospectively ...

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    9. Comprehensive Assessment of High-Risk Plaques by Dual-Modal Imaging Catheter in Coronary Artery

      Comprehensive Assessment of High-Risk Plaques by Dual-Modal Imaging Catheter in Coronary Artery

      Coronary plaque destabilization involves alterations in microstructure and biochemical composition; however, no imaging approach allows such comprehensive characterization. Herein, the authors demonstrated a simultaneous microstructural and biochemical assessment of high-risk plaques in the coronary arteries in a beating heart using a fully integrated optical coherence tomography and fluorescence lifetime imaging (FLIm). It was found that plaque components such as lipids, macrophages, lipids+macrophages, and fibrotic tissues had unique fluorescence lifetime signatures that were distinguishable using multispectral FLIm. Because FLIm yielded massive biochemical readouts, the authors incorporated machine learning framework into FLIm, and ultimately, their approach enabled an automated, quantitative imaging ...

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    10. Retrospective analysis of OCT on MB characteristics and 1-year follow-up of the ISR incidence after the DES implantation in patients with MB

      Retrospective analysis of OCT on MB characteristics and 1-year follow-up of the ISR incidence after the DES implantation in patients with MB

      We used optical coherence tomography (OCT) to analyze the "half-moon" like phenomenon and its characteristics and observe 1-year follow-up of the in-stent restenosis (ISR) incidence after the drug eluted stent (DES) implantation in patients with the myocardial bridge (MB). Patients were retrospectively analyzed from January 2013 to December 2019. We used OCT to check 45 patients with MB and found a visible muscle layer (VML) around the vessel adventitia with the same or high density compared to the vessel media layer. There was not any significant difference in maximal thickness, maximal arch, and total length between the half-moon layer and ...

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    11. Detection of myocardial bridge by optical coherence tomography

      Detection of myocardial bridge by optical coherence tomography

      Myocardial bridge (MB) is less commonly documented by angiography than autopsy. Optical coherence tomography (OCT) may be useful to detect angiographically undetectable MB. To investigate OCT characteristics of MB, 86 LAD vessels were imaged by OCT. MB was defined as presence of intermediate optical intensity, “fine” layer surrounding coronary artery by OCT. Frequency and characteristics of the angio-detectable and angio-undetectable but OCT-detectable MB were investigated. In a subset of patients with angio-detectable MB, cyclic changes in coronary arterial dimensions were analyzed. OCT detected MB in 44 of 86 (51%). Arc of the MB was significantly larger (334.8 ± 58.5 ...

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    12. Optical Coherence Tomography-OCT for Characterization of Non-Atherosclerotic Coronary Lesions in Acute Coronary Syndromes

      Optical Coherence Tomography-OCT for Characterization of Non-Atherosclerotic Coronary Lesions in Acute Coronary Syndromes

      Cardiovascular diseases are the main cause of death worldwide, with coronary artery disease being the predominant underlying etiology. The most prevalent coronary lesions are represented by the atherosclerotic plaques, in more than 85% of cases, but there are several other non-atherosclerotic lesions such as spontaneous coronary artery dissection and/or hematoma and spontaneous recanalization of coronary thrombus, which are less common, approximately 5% of cases, but with similar clinical manifestations as well as complications. There are insufficient data regarding the pathological mechanism, true prevalence and optimal treatment of these kind of coronary lesions. Optical coherence tomography (OCT) is an intracoronary ...

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    13. Avinger Announces $7.6 Million Registered Direct Offering

      Avinger Announces $7.6 Million Registered Direct Offering

      Avinger, Inc. (NASDAQ:AVGR) (the "Company"), a commercial-stage medical device company marketing the first and only intravascular image-guided, catheter-based system for diagnosis and treatment of Peripheral Artery Disease (PAD), today announced that it has entered into a definitive agreement with certain institutional investors for the issuance and sale in a registered direct offering of an aggregate of 7,600 shares of Series D convertible preferred stock (the "Preferred Stock") and warrants to purchase up to an aggregate of 16,150,000 shares of common stock for gross proceeds of $7.6 million. The shares of Preferred Stock will have a ...

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      Mentions: Avinger
    14. Stent detection with very thick tissue coverage in intravascular OCT

      Stent detection with very thick tissue coverage in intravascular OCT

      Coronary stenting or percutaneous coronary intervention (PCI) is widely used to treat coronary artery disease. Improper deployment of stents may lead to post-PCI complication, in-stent restenosis, stent fracture and stent thrombosis. Intravascular optical coherence tomography (OCT) with micron-scale resolution provides accurate in vivo assessment of stent apposition/malapposition and neointima coverage. However, manual stent analysis is labor intensive and time consuming. Existing automated methods with intravascular OCT mainly focused on stent struts with thin tissue coverage. We developed a deep learning method to automatically analyze stents with both thin (≤0.3mm) and very thick tissue coverage (>0.3mm), and an ...

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    15. Incidence and characteristics of incomplete stent apposition in calcified lesions: An optical coherence tomography study

      Incidence and characteristics of incomplete stent apposition in calcified lesions: An optical coherence tomography study

      Background: Persistent or late acquired incomplete stent apposition (ISA) may be associated with late or very late stent thrombosis following drug-eluting stent implantation. Presence of calcium at the target lesion may increase the risk of ISA even after rotational atherectomy (RA) followed by stenting with high pressure balloon inflation. The aim of this study is to examine the incidence and characteristics of ISA in heavily calcified lesions. Methods: A total of 52 heavily calcified coronary artery lesions requiring RA plus stenting were selected and studied. After successful ablation followed by stent implantation, optical coherence tomography (OCT) was performed to assess ...

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    16. Type E coronary artery dissection caused by intravascular lithotripsy balloon rupture; vessel anatomy and characteristics in a lithoplasty complication case as detailed by optical coherence tomography: a case report

      Type E coronary artery dissection caused by intravascular lithotripsy balloon rupture; vessel anatomy and characteristics in a lithoplasty complication case as detailed by optical coherence tomography: a case report

      Background: Intravascular lithotripsy is a new method used to treat calcified coronary lesions (CCLs). Percutaneous coronary intervention of CCLs has conventionally been classified as a complex procedure. In the majority of calcified cases, atherectomy is required for sufficient plaque modification prior to stent implantation. Intravascular lithotripsy has been shown to be safe and effective in clinical trials, but as worldwide usage increases, cases of complications are beginning to emerge. Case summary: We describe a 71-year-old woman, who after an episode of non-ST-elevation acute coronary syndrome underwent coronary angiography. The culprit vessel was identified to be a severely stenosed left anterior ...

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    17. ST-elevation myocardial infarction in a 39-year-old patient with “normal” coronary arteries as a thrombotic complication of COVID-19

      ST-elevation myocardial infarction in a 39-year-old patient with “normal” coronary arteries as a thrombotic complication of COVID-19

      We report the case of a 39-year-old male without traditional risk factors for coronary artery disease (CAD), i.e. smoking, hypercholesterolemia, hypertension, diabetes mellitus, familial history of premature CAD, admitted with anterior ST-segment elevation myocardial infarction and concurrent coronavirus disease-2019 infection. Coronary angiography showed high intracoronary thrombus burden and thrombotic occlusion of the proximal segment of left anterior descending artery, while optical coherence tomography revealed intact endothelium after thromboaspiration. Learning objective: : Coronavirus disease-2019 (COVID-19) may predispose to thrombotic complications in both the venous and the arterial circulation. ST-segment elevation myocardial infarction (STEMI), rarely, may be the main clinical presentation of ...

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    18. Effects of TCFA on stent neointimal coverage at 9 months after EXCEL drug-eluting stent implantation assessed by OCT

      Effects of TCFA on stent neointimal coverage at 9 months after EXCEL drug-eluting stent implantation assessed by OCT

      Background: The aim of this study was to investigate the effects of thin-cap fibroatheromas (TCFAs) on stent neointimal coverage at the 9‑month follow-up after EXCEL stent implantation assessed by optical coherence tomography (OCT). Methods: A total of 93 patients with non-ST elevation acute coronary syndrome (NSTEACS) who underwent EXCEL stent implantation were prospectively enrolled in the study and divided into a TCFA group (n = 47) and a non-TCFA group (n = 46) according to whether EXCEL stents covered the TCFAs. A TCFA was defined as a plaque with lipid content in more than one quadrant and fibrous cap thickness measuring ...

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    19. Impact of directional coronary atherectomy followed by drug-coated balloon strategy to avoid the complex stenting for bifurcation lesions

      Impact of directional coronary atherectomy followed by drug-coated balloon strategy to avoid the complex stenting for bifurcation lesions

      Although the simple single stenting rather than complex double stenting is recommended on percutaneous coronary intervention (PCI) for bifurcation lesions, double stenting cannot always be avoided. We investigated the impact of directional coronary atherectomy (DCA), followed by drug-coated balloon (DCB) treatment to reduce the number of stents and avoid complex stenting in PCI for bifurcation lesions and short-term patency. DCA treatment without stents was attempted for 27 bifurcation lesions in 25 patients, of those, 26 bifurcation lesions in 24 patients were successfully treated and 3-month follow-up angiography and optical coherence tomography (OCT) were performed. Sixteen lesions (59.3%) were related ...

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    20. Coronary angiography-based shear stress computation to identify high-risk coronary artery plaques: Are we there yet?

      Coronary angiography-based shear stress computation to identify high-risk coronary artery plaques: Are we there yet?

      In the last number of years there has been increasing interest in identifying coronary artery plaques likely to destabilize and cause a future major adverse cardiac event (MACE), with the ultimate goal to inform, and possibly enable, preemptive intervention strategies to prevent that individual plaque's adverse natural history. Intravascular imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the most precise and accurate methods to characterize the plaque, the arterial wall, and the blood flow patterns surrounding the plaque area. These methods have been the basis for computational fluid dynamics (CFD) calculations of local endothelial or wall ...

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    21. Analysis of Fibrotic Plaques in Angiographic Manifest Cardiac Allograft Vasculopathy in Long-term Heart Transplanted Patients Using Optical Coherence Tomography

      Analysis of Fibrotic Plaques in Angiographic Manifest Cardiac Allograft Vasculopathy in Long-term Heart Transplanted Patients Using Optical Coherence Tomography

      Background: The development and progression of cardiac allograft vasculopathy documented by coronary angiography (CAV angio ) after heart transplantation (HTx) has prognostic relevance. Yet there are limited data regarding the role of concomitant intracoronary imaging in the presence CAV angio . In particular, atherosclerotic plaques might represent a potential target for prevention, but their impact on stenosis is understudied. Methods: We used high-resolution intracoronary optical coherence tomography (OCT) to quantify and compare findings of intimal hyperplasia (IH) and plaque morphologies in HTx patients (fibrotic plaque, lipid plaque, and calcified plaque). OCT findings were related to the presence of CAV angio as well ...

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    22. Optical Coherence Tomographic Features of Pancoronary Plaques in Patients With Acute Myocardial Infarction Caused by Layered Plaque Rupture Versus Layered Plaque Erosion

      Optical Coherence Tomographic Features of Pancoronary Plaques in Patients With Acute Myocardial Infarction Caused by Layered Plaque Rupture Versus Layered Plaque Erosion

      Atherosclerotic plaque instability could occur on the basis of healed plaque which has a layered appearance on optical coherence tomography. This study aimed to investigate pancoronary plaque features of layered plaque rupture (LPR) and layered plaque erosion (LPE) in patients with acute myocardial infarction. Among 388 patients with acute myocardial infarction who underwent preintervention optical coherence tomography imaging of three coronary arteries, 190 patients with layered culprit plaque (49.0%) were identified and further divided into 2 groups: LPR group and LPE group. Clinical characteristics, pancoronary plaque features and clinical outcomes were compared between the 2 groups. Patients with LPR ...

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    23. Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography

      Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography

      Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous clinical entity, encompassing multiple different causes, and a cause of substantial morbidity and mortality. Current guidelines suggest a multimodality imaging approach in establishing the underlying cause for MINOCA, which is considered a working diagnosis. Recent studies have suggested that an initial workup consisting of cardiac magnetic resonance and invasive coronary imaging can yield the diagnosis in most patients. Cardiac magnetic resonance is particularly helpful in excluding nonischemic causes that can mimic MINOCA including myocarditis and Takotsubo cardiomyopathy, as well as for long‐term prognostication. Additionally, intracoronary imaging with intravascular ultrasound ...

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