1. Articles in category: Cardiology

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    1. A case of severely calcified neoatherosclerosis-embedded stent struts clearly documented with optical coherence tomography imaging

      A case of severely calcified neoatherosclerosis-embedded stent struts clearly documented with optical coherence tomography imaging

      A 65-year-old Japanese man using peritoneal hemodialysis due to diabetic nephropathy underwent a planned coronary angiography as a preoperative examination. Fourteen years earlier, he had undergone a percutaneous coronary intervention due to acute myocardial infarction and had been implanted with a bare-metal stent in the left anterior descending coronary artery. Although his condition had run a benign course without any recurrence of cardiovascular events, coronary angiography was performed 14 years later in preparation for a living-donor kidney transplantation. Coronary angiography revealed less than 50% restenosis (Figure A). Although Figure B indicates circumferentially covered stent struts, the homogeneous neointima pattern observed ...

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    2. Updates on PCI Guidelines and Trials From the European Society of Cardiology (ESC) Congress

      Updates on PCI Guidelines and Trials From the European Society of Cardiology (ESC) Congress

      Radial Access and Provisional T-Stenting Preferred for PCI: Another important procedural recommendation from the ESC was that radial access should be the preferred approach for coronary angiography and PCI (class I recommendation). While this approach has been a standard for many years in the European communities, it has now been codified as part of the ESC guidelines and may one day be part of the ACC/SCAI guidelines. For those addressing bifurcations with stenting, the ESC/EACTS guidelines upgraded provisional T-stenting for bifurcation lesions from class IIa to class I, and upgraded the use of optical coherence tomography (OCT) for ...

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    3. Diagnosis and treatment evaluation of in-stent restenosis of carotid artery stenting using optical coherence tomography

      Diagnosis and treatment evaluation of in-stent restenosis of carotid artery stenting using optical coherence tomography

      A 65-year-old man underwent balloon angioplasty and repeat carotid artery stenting (CAS) due to in-stent restenosis (ISR). Intravascular optical coherence tomography (OCT) showed a severe ISR with fibrotic neointimal growth ( figure 1 ). Post 6.0 × 30 mm balloon angioplasty, OCT showed intimal disruption and artery dissection ( figure 2 ). After the 8 × 40 mm stent fully expanded, OCT showed stent struts well apposed, but tissue protrusion from the spaces between stent struts can be observed ( figure 2 ). OCT allowed measurement of intimal hyperplasia after the CAS and observation of intimal disruption and stent strut apposition intraoperatively. 1 , 2

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    4. Feasibility of a porcine arteriovenous shunt model for assessment of acute thrombogenicity in bifurcation stenting technique by optical coherence tomography

      Feasibility of a porcine arteriovenous shunt model for assessment of acute thrombogenicity in bifurcation stenting technique by optical coherence tomography

      Background Double kissing (DK) crush stenting has been reported as a superior bifurcation stenting strategy compared to culotte stenting. However, the mechanism associated with the reduction of clinical events by DK crush stenting remains unclear. We therefore investigated the thrombogenicity of DK crush stenting and culotte stenting with both bare-metal stents (BMS) and drug-eluting stents (DES) and the feasibility of a novel porcine arteriovenous shunt model. Methods High-resolution intracoronary imaging with optical coherence tomography (OCT) evaluated the bifurcation stenting models for thrombogenicity. Results All porcine models retained continuous circulation without blood leakage. Thrombus was macroscopically demonstrated around the bifurcation in ...

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    5. MGH Receives NIH Grant for Unique Value of Real-TIme Shear Stress to Enhance Coronary Disease Management.

      MGH Receives NIH Grant for Unique Value of Real-TIme Shear Stress to Enhance Coronary Disease Management.

      Massachusetts General Hospital Receives a 2019 NIH Grant for $729,778 for Unique Value of Real-TIme Shear Stress to Enhance Coronary Disease Management. The principal investigator is Guillermo Tearney. The program began in 2018 and ends in 2020. Below is a summary of the proposed work. Management of CAD is hindered by our inability to investigate fundamental pathobiologic processes that lead to individual coronary plaque progression, destabilization, and adverse clinical events. A critical mechanism responsible for plaque behavior is local endothelial shear stress (ESS), the frictional force of blood flowing across the endothelium, which is governed by the artery’s ...

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    6. Optical Coherence Tomography Evaluation of Coronary Dissection and Intramural Hematoma

      Optical Coherence Tomography Evaluation of Coronary Dissection and Intramural Hematoma

      A 32-year-old female with elevated body mass index and no prior medical history presented with acute-onset central chest pain radiating to both arms. Electrocardiogram showed biphasic T-waves in the anterior leads and troponin level was elevated. Echocardiogram demonstrated preserved left ventricular function and no valvular abnormality. A diagnosis of non-ST elevation myocardial infarction (NSTEMI) was made. Coronary angiography revealed a smooth tapering stenosis in the mid left anterior descending (LAD) artery (Video 1), but no significant disease beyond (Figure 1, top center panel). The other coronary vessels were free of significant disease. Given her age and the somewhat unusual angiographic ...

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    7. Serial 3-Dimensional Optical Coherence Tomography Assessment of Jailed Side-Branch by Second-Generation Drug-Eluting Absorbable Metal Scaffold (From the BIOSOLVE-II Trial)

      Serial 3-Dimensional Optical Coherence Tomography Assessment of Jailed Side-Branch by Second-Generation Drug-Eluting Absorbable Metal Scaffold (From the BIOSOLVE-II Trial)

      Second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) is used for treating coronary lesions. However, the natural history of the jailed side-branch (SB) after DREAMS 2G implantation remains to be elucidated. The aim of this study is to investigate the effect of scaffold struts on jailed SBs as assessed by 3-dimensional (3D) optical coherence tomography (OCT) after implantation of DREAMS 2G. We enrolled the patients who received a DREAMS 2G implantation and where OCT was performed at post-procedure and 12-month follow-up in the BIOSOLVE-II trial. The area of the ostium of jailed SBs and number of compartments divided by scaffold struts ...

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    8. Fully Automated Lumen Segmentation Method for Intracoronary Optical Coherence Tomography

      Fully Automated Lumen Segmentation Method for Intracoronary Optical Coherence Tomography

      Background . Optical coherence tomography (OCT) is an innovative imaging technique that generates high-resolution intracoronary images. In the last few years, the need for more precise analysis regarding coronary artery disease to achieve optimal treatment has made intravascular imaging an area of primary importance in interventional cardiology. One of the main challenges in OCT image analysis is the accurate detection of lumen which is significant for the further prognosis. Method . In this research, we present a new approach to the segmentation of lumen in OCT images. The proposed work is focused on designing an efficient automatic algorithm containing the following steps ...

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    9. The relation between optical coherence tomography-detected layered pattern and acute side branch occlusion after provisional stenting of coronary bifurcation lesions

      The relation between optical coherence tomography-detected layered pattern and acute side branch occlusion after provisional stenting of coronary bifurcation lesions

      Background/Purpose. Layered pattern (presumed to be healed plaque after a thrombotic event) can be observed by optical coherence tomography (OCT). We sought to assess the ability of OCT-detected plaque composition to predict acute side branch (SB) occlusion after provisional bifurcation stenting. Methods This is a retrospective observational study using pre-intervention OCT in the main vessel to predict Thrombolysis in Myocardial Infarction (TIMI) flow grade ≤ 1 in a SB (diameter ≥ 1.5 mm) after provisional bifurcation stenting. OCT-detected layered pattern was defined as plaque with a superficial layer that had a different optical intensity and a clear demarcation from underlying ...

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    10. Impact of procedural characteristics on coronary vessel wall healing following implantation of second-generation drug-eluting absorbable metal scaffold in patients with de novo coronary artery lesions: an optical coherence tomography analysis

      Impact of procedural characteristics on coronary vessel wall healing following implantation of second-generation drug-eluting absorbable metal scaffold in patients with de novo coronary artery lesions: an optical coherence tomography analysis

      Aims Second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) is an alternative novel device for treating coronary lesions. However, the relationship between in-scaffold dimensions after implantation of DREAMS 2G and vessel healing and luminal results at follow-up is unknown. The aim of this study is, therefore, to investigate whether the expansion index after implantation of DREAMS 2G as assessed by optical coherence tomography (OCT) impacts late luminal status and healing of the vessel wall. Methods and results This study comprises of a total 65 out of 123 patients who were enrolled in the BIOSOLVE-II trial. We assessed both qualitative and quantitative ...

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    11. Zero contrast optical coherence tomography–guided percutaneous coronary intervention for in-stent restenosis of the saphenous vein graft using a non-contrast flush medium

      Zero contrast optical coherence tomography–guided percutaneous coronary intervention for in-stent restenosis of the saphenous vein graft using a non-contrast flush medium

      Percutaneous coronary intervention (PCI) is often denied for individuals with coronary artery disease who are prone to develop contrast-induced acute kidney injury . We report a 73-year-old, stage 3 chronic kidney disease patient (CKD), who underwent coronary artery bypass surgery and saphenous vein graft (SVG) stenting in the past, presented with in-stent restenosis (ISR) of SVG stent. Zero contrast optical coherence tomography (OCT) guided–PCI was successfully performed using low molecular weight dextran-40 (LMWD-40) as the flush medium. Our report suggests the safety and feasibility of LMWD-40–based OCT-guided zero contrast PCI in ISR of SVG in a CKD patient, although ...

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    12. A novel experimental thrombotic myocardial infarction and primary angioplasty model in atherosclerotic swine

      A novel experimental thrombotic myocardial infarction and primary angioplasty model in atherosclerotic swine

      We sought to develop a reproducible, percutaneous basic science and translational animal model for the generation of thrombotic occlusion acute myocardial infarction in adult atherosclerotic pigs. A vascular coil COOK TORNADO ® 38 inches (3–3.5 × 20–50 mm) was placed in the right coronary artery or the left anterior descending artery in 26 downsized spontaneously hypercholesterolemic pigs and left untreated until a thrombotic intracoronary occlusion was present. After the angiographic confirmation of total occlusion, we proceeded to crossing the newly formed thrombotic occlusion with a guidewire, followed by pre-dilatation with a semi compliant balloon, thrombus visualization with Optical Coherence ...

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    13. Influence of hemodynamical parameters on retinal vascular density measured by Optical Coherence Tomography (OCT-) angiography in patients admitted for acute coronary syndrome

      Influence of hemodynamical parameters on retinal vascular density measured by Optical Coherence Tomography (OCT-) angiography in patients admitted for acute coronary syndrome

      Background Retinal microvascularisation abnormalities have been suggested to reflect severity of cardiovascular diseases . In patients with acute coronary syndrome (ACS), a low retinal vascular density, measured by OCT-angiography, has been strongly associated with cardiovascular risk scores and altered LVEF, beyond the classical risk factors. However, the vascular and hemodynamic determinants of RVD and their evolution after the acute event remain to be investigated. Methods Our study prospectively included patients admitted in a university hospital for an ACS, from May to October 2017. Retinal vascular density (RVD), intraocular pressure (IOP) and hemodynamic parameters including mean arterial pressure (MAP), and cardiac output ...

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    14. Retinal optical coherence tomography angiography as a biomarker of acute kidney injury after acute coronary syndrome

      Retinal optical coherence tomography angiography as a biomarker of acute kidney injury after acute coronary syndrome

      Background Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) is frequent and associated with long-term renal impairment and mortality. Retinal vessel density (RVD) measured by OCT-Angiography could reflect the global cardiovascular burden of ACS patients and thus provide a fast and non-invasive assessment of the systemic microcirculation , that may be involved in CIN occurrence. Methods Between October 2016 and March 2017, 452 ACS patients were admitted in our coronary care unit . Retinal OCT-A was performed within two days after PCI. Patients were divided in two groups, according to Acute kidney injury (AKI) occurrence (KDIGO criteria ...

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    15. Intracoronary thrombus by Optical Coherence Tomography (OCT): Characterization, quantification and prognostic impact in patients with non-ST-elevation acute coronary syndrome. A DOCTORS substudy

      Intracoronary thrombus by Optical Coherence Tomography (OCT): Characterization, quantification and prognostic impact in patients with non-ST-elevation acute coronary syndrome. A DOCTORS substudy

      Background We evaluated the impact of thrombus burden as measured by Optical Coherence Tomography on the occurrence of periprocedural myocardial infarction (type IVa MI) in pts undergoing percutaneous coronary intervention (PCI) in non ST elevation acute coronary syndrome (NSTE-ACS). Methods Prospective multicenter study including pts treated for NSTE-ACS (< 72 h) undergoing PCI of the infarct related artery (IRA). OCT was performed before and after PCI. Thrombus burden was measured quantitatively by planimetry, and semi-quantitatively by the OCT thrombus score. Primary endpoint was the rate of type IVa MI. Secondary endpoints were the relationship between OCT characteristics of the IRA and ...

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    16. In vitro flow and optical coherence tomography comparison of two bailout techniques after failed after provisional T-stenting for bifurcation percutaneous coronary interventions

      In vitro flow and optical coherence tomography comparison of two bailout techniques after failed after provisional T-stenting for bifurcation percutaneous coronary interventions

      Background Provisional T-stenting with bailout side branch (SB) stenting is used to treat most coronary bifurcation stenoses . Purpose To evaluate, in vitro, two bailout side branch stenting techniques after failed provisional T-stenting. We aimed to compare flows and stent strut apposition of T And Protrusion (TAP) versus Reversed String (RS) bailout techniques using a flow simulator, optical coherence tomography (OCT), in silicon bifurcation phantoms with different angulations between branches. Methods Ten 30°-angle and ten 60°-angle silicon bifurcation phantoms were used. After performing provisional T-stenting, TAP and RS techniques were compared in 5 phantoms with 30° and 60° angles ...

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    17. Trends and outcomes of optical coherence tomography use: 877 patients single-center experience

      Trends and outcomes of optical coherence tomography use: 877 patients single-center experience

      Background Optical-coherence-tomography (OCT) is an emerging invasive coronary imaging with still undefined clinical value. Recent data have underlined daily impact of such technique in several clinical settings such as acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) guidance. We aimed at assessing the trends and outcomes of OCT use in a high-volume percutaneous coronary interventions (PCI)-center. Methods Over 6 years, 1025 coronary artery segments in 877 patients underwent OCT evaluation. Clinical and procedural characteristics were prospectively collected. Clinical setting for OCT were: “ Diagnostic OCT” (OCT for lesion evaluation after coronary angiography without further PCI); “ PCI-guidance OCT” (OCT as ...

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    18. Optical Coherence Tomography/Optical Frequency Domain Imaging: Imaging Application for Assessment of Human Carotid Plaque

      Optical Coherence Tomography/Optical Frequency Domain Imaging: Imaging Application for Assessment of Human Carotid Plaque

      Optical coherence tomography (OCT) is an intravascular imaging tool. Its high resolution facilitates detailed examination of intravascular morphological characteristics. In the coronary field, OCT systems are applied as practical clinical diagnostic method. In the carotid artery field, OCT is not covered by health insurance, and it is used as a research tool. We have published many reports on the morphological characteristics of carotid artery lesions on OCT or its application for carotid artery stenting. In this article, we review the application of OCT for carotid artery plaque and its usefulness.

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    19. Vascular Healing After Implantation of FANTOM Bioresorbable Scaffold in Stemi: A Fantom Stemi Study

      Vascular Healing After Implantation of FANTOM Bioresorbable Scaffold in Stemi: A Fantom Stemi Study

      The study will assess the safety and performance of the Fantom sirolimus eluting bioresorbable vascular scaffold (BVS) in the acute setting of myocardial infarction with unstable lesions and thrombogenic milieu.This is a prospective evaluation of clinical and patient related measures in STEMI patient who undergo urgent primary percutaneous coronary intervention (PCI) with stent implantation. Patients with culprit lesions with 2.5 - 3.5 mm diameter and located in one of the main coronary arteries will be included in the trial and prospectively observed. The study will comprise 20 patients, who will undergo additional evaluation with optical coherence tomography (OCT ...

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    20. Small HDL Subclass is Associated with Coronary Plaque Stability: An Optical Coherence Tomography Study in Patients with Coronary Artery Disease

      Small HDL Subclass is Associated with Coronary Plaque Stability: An Optical Coherence Tomography Study in Patients with Coronary Artery Disease

      Background The role of high-density lipoprotein (HDL) subclasses in atherosclerotic diseases remains an open question. Previous clinical trials have attempted to explore the predictive effect of HDL subspecies on cardiovascular risk. However, no studies have assessed the connections between these subclasses and characteristics of plaque microstructure. Objective To investigate the relationship of HDL subclasses and coronary plaque stability assessed by optical coherence tomography (OCT). Methods Morphological characteristics of 160 non-target lesions from 85 patients with coronary artery disease were assessed by OCT. High-density lipoprotein (HDL) subclass profiles were analyzed using non-denaturing polyacrylamide gel electrophoresis. Results The plasma levels of small ...

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    21. Comparison of visual assessment and computer image analysis of intracoronary thrombus type by optical coherence tomography

      Comparison of visual assessment and computer image analysis of intracoronary thrombus type by optical coherence tomography

      Background Analysis of intracoronary thrombus type by optical coherence tomography (OCT) imaging is highly subjective. We aimed to compare a newly developed image analysis method to subjective visual classification of thrombus type identified by OCT. Methods Thirty patients with acute ST elevation myocardial infarction were included. Thrombus type visually classified by two independent readers was compared with analysis using QCU-CMS software. Results Repeatability of the computer-based measurements was good. By using a ROC, area under curve values for discrimination of white and red thrombi were 0.92 (95% confidence intervals (CI) 0.83–1.00) for median attenuation, 0.96 ...

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    22. Covering our tracks – optical coherence tomography to assess vascular healing

      Covering our tracks – optical coherence tomography to assess vascular healing

      Over the better part of two decades, lessons learned from stent failure have led to technical advances that have resulted in current-generation metallic drug-eluting stents (DES) with very low rates of target lesion failure (TLF) and stent thrombosis 1 . Continued efforts have been directed at achieving iterative improvements in the design of DES to enhance adaptive vascular healing following vascular injury. By promoting early strut coverage with minimal neointimal hyperplasia but a functioning endothelial layer, stent thrombosis may be minimised and, by reducing the inflammatory response to the foreign

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