1. Articles in category: Cardiology

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    1. Re-crossing the distal cell in bifurcation verified by using an enhanced stent visualization system and optical coherence tomography: a report of two cases

      Re-crossing the distal cell in bifurcation verified by using an enhanced stent visualization system and optical coherence tomography: a report of two cases

      The coronary guidewire re-crossing position before the final kissing balloon post-dilation is important to reduce the incidence of incomplete stent apposition in bifurcation lesions. Angiography and intravascular ultrasonography are unreliable at detecting the site of wire re-crossing. The high resolution of optical coherence tomography (OCT) offers the advantage of precise assessment of construction in bifurcation. However, the OCT technique still has some limitations, including the requirement for additional contrast and expense. We present two cases where the ClearStent Live system technique was used to estimate the wire location, which was verified by using OCT. In conclusion, ClearStent can be used ...

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    2. Bas-relief in three dimensional optical coherence tomography: a novel sign after subintimal scaffolding in a chronic total occlusion

      Bas-relief in three dimensional optical coherence tomography: a novel sign after subintimal scaffolding in a chronic total occlusion

      A 69-years-old female with stable angina underwent percutaneous intervention of a chronic total occlusion (CTO) in the proximal right coronary artery (RCA) ( Panel A, Supplementary material online , Video S1 ). Septal collaterals supplied the distal vessel (Rentrop 3, CC1) ( Supplementary material online , Video S2 ).

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    3. Impact of coronary plaque morphology assessed by optical coherence tomography on cardiac troponin elevation in patients with non-ST segment elevation acute coronary syndrome

      Impact of coronary plaque morphology assessed by optical coherence tomography on cardiac troponin elevation in patients with non-ST segment elevation acute coronary syndrome

      Objectives This study aimed to use optical coherence tomography (OCT) to study the relationship between plaque morphology prior to percutaneous coronary intervention (PCI) and post-PCI cardiac troponin (cTn) elevations in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Furthermore, the relationship between these findings and the adverse cardiac events during follow-up was assessed. Background Association between post-PCI cTn elevations and OCT findings in NSTE-ACS patients is unclear. Methods We evaluated 167 patients with stable or falling cTn values after admission who underwent PCI. Periprocedural myocardial injury (PMI) was defined as an cTn increase of more than 70× upper limit of ...

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    4. In-stent neoatherosclerosis and tissue characteristics of restenotic lesions following implantation of second generation drug-eluting stents in unrestricted coronary lesions: Optical frequency domain imaging study

      In-stent neoatherosclerosis and tissue characteristics of restenotic lesions following implantation of second generation drug-eluting stents in unrestricted coronary lesions: Optical frequency domain imaging study

      BACKGROUND Differences in stent platform, polymer coatings, and antirestenotic drugs among the current in use second-generation drug-eluting stents (G2-DESs) may induce significant variations in neointimal response and vascular healing, which may impact the prevalence of neoatherosclerosis (NA) and morphological appearance of the restenotic tissue. METHODS AND RESULTS Utilizing Optical frequency domain imaging, two independent reviewers, retrospectively compared the prevalence of neoatherosclerosis (NA), and the morphological differences, and tissue characteristics of 50 G2-DESs in-stent restenosis (ISR) lesions (35 everolimus-eluting stent [22 cobalt-chromium (CoCr), 13 platinum-chromium (PtCr)], and 15 biolimus-eluting stent [BES]) implanted liberally in unrestricted coronary lesions. More than half of ...

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      Mentions: Kazushige Kadota
    5. Role of optical coherence tomography in managing patients with ST elevation myocardial infarction

      Role of optical coherence tomography in managing patients with ST elevation myocardial infarction

      Stenting the culprit lesion in patients presenting with acute coronary syndrome (ACS) is the standard of care. Although plaque rupture on an atheromatous lesion is the most common underlying pathology, other mechanisms can also result in ACS presentation; some of which can be managed without stenting. Here we describe a case that was managed conservatively, after evaluating plaque erosion as the underlying mechanism and lack of obstructive lesion. This case highlights the importance of intracoronary imaging to assess the underlying mechanism in patients presenting with acute coronary syndrome.

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    6. Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents

      Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents

      Although reported in bare metal stents (BMS) and first-generation drug-eluting stents (DES), little is known about neoatherosclerosis in second-generation DES. We used optical coherence tomography to evaluate neoatherosclerosis among different stent generations. Overall, 274 in-stent restenosis (ISR) lesions (duration from implantation 56.9 ± 47.2 months) in 274 patients were assessed for the presence of neoatherosclerosis. Neoatherosclerosis was identified in 38.7% of lesions (106/274): 23.0% second-generation DES (38/165), 65.1% first-generation DES (54/83), and 53.8% BMS (14/26). In the neoatherosclerosis cohort (n = 106), more stent underexpansion or fracture/deformation was observed in second-generation ...

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      Mentions: Gary S. Mintz
    7. Paracentral acute middle maculopathy as a finding in patients with severe vision loss following phacoemulsification cataract surgery

      Paracentral acute middle maculopathy as a finding in patients with severe vision loss following phacoemulsification cataract surgery

      mportance Paracentral acute middle maculopathy (PAMM) as diagnosed by spectral domain optical coherence tomography (SD-OCT) may be associated with "patch off" visual loss post cataract surgery. Background To report a case series of severe vision loss due to PAMM after cataract surgery Design Retrospective case series. Participants Cases from five surgical centres (public and private) in Victoria, Australia. Methods Retrospective analysis of cases with unexplained “patch-off” vision loss post cataract surgery. All patients in our cohort had PAMM and presumed diagnosis of central retinal artery occlusion or transient retinal artery occlusion. Main Outcome Measures A review of the patient's ...

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    8. Practical Intravascular Ultrasound Versus and Optical Coherence Tomography

      Practical Intravascular Ultrasound Versus and Optical Coherence Tomography

      Practical Intravascular Ultrasound Versus and Optical Coherence Tomography (IVUS & OCT) is organized by Millbrook Medical Conferences and would be held on Jun 19, 2017 at University Hospital of South Manchester NHS Foundation Trust, Manchester, England, United Kingdom. The target audience for this medical meeting basically for Interventional Consultants, Registrars and Allied Cath Lab Professionals. Topics • IVUS technology and lesion assessment • OCT technology, artefact and image interpretation • Step by step approach to intra-coronary imaging in • planning and optimising stent deployment • Intra-coronary imaging in stent failure • IVUS and OCT case and pathology review with • image atlas • An emphasis on Hands on training ...

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    9. Is quantitative coronary angiography reliable in assessing the late lumen loss of the everolimus eluting bioresorbable polylactide scaffold in comparison with the cobalt chromium metallic stent?

      Is quantitative coronary angiography reliable in assessing the late lumen loss of the everolimus eluting bioresorbable polylactide scaffold in comparison with the cobalt chromium metallic stent?

      Aims: Immediately after stent/scaffold implantation, quantitative coronary angiography (QCA) with respect to optical coherence tomography (OCT) more severely underestimates the lumen diameter (LD) in Absorb than in XIENCE. This OCT-QCA discrepancy has not been evaluated at long-term follow-up. The present study aimed to assess the accuracy of QCA with reference to OCT in Absorb as compared to XIENCE.

       

       

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    10. The REMEDEE-OCT Study : An Evaluation of the Bioengineered COMBO Dual-Therapy CD34 Antibody–Covered Sirolimus-Eluting Coronary Stent Compared With a Cobalt-Chromium Everolimus-Eluting Stent in Patients With Acute Coronary Syndromes: Insights From Optical

      The REMEDEE-OCT Study : An Evaluation of the Bioengineered COMBO Dual-Therapy CD34 Antibody–Covered Sirolimus-Eluting Coronary Stent Compared With a Cobalt-Chromium Everolimus-Eluting Stent in Patients With Acute Coronary Syndromes: Insights From Optical

      Objectives The aim of the present study was to evaluate vascular healing of the bioengineered COMBO Dual Therapy Stent compared with a cobalt-chromium (CoCr) everolimus-eluting stent (EES) as assessed by optical coherence tomography in patients with acute coronary syndromes. Background CD34+ cells promote endothelial repair after vascular injury. The bioengineered COMBO Dual Therapy Stent combines CD34+ cell–capturing technology with abluminal sirolimus release, but more data from clinical studies evaluating the vascular response are needed. Methods In a prospective randomized multicenter clinical trial, 60 patients with acute coronary syndromes were randomized 1:1 to COMBO or CoCr EES implantation. The ...

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    11. Clinical Application of Optical Coherence Tomography in Patients with Non-ST-Elevation Acute Coronary Syndrome Combined with Intermediate Lesions

      Clinical Application of Optical Coherence Tomography in Patients with Non-ST-Elevation Acute Coronary Syndrome Combined with Intermediate Lesions

      Objective: This study aimed to evaluate the clinical significance and safety of optical coherence tomography (OCT) in patients with non-ST-elevation acute coronary syndrome (NSTEACS) combined with intermediate lesions. Methods: Sixty-five NSTEACS patients with intermediate lesions confirmed with coronary angiography at our department were included in this study. Among them, 33 patients received only standardized drug treatment (drug group) and the other 32 patients received percutaneous coronary intervention (PCI) according to the OCT examination based on drug treatment (OCT group). Major adverse cardiovascular events (MACEs), revascularization, success rate of OCT examination, related complications, and other patient situations in the two groups ...

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    12. Letter by Nadir Regarding Article, “Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients With Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS Study (Does Optical Cohere

      Letter by Nadir Regarding Article, “Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients With Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS Study (Does Optical Cohere

      read the article by Meneveau et al 1 with great interest. The authors concluded that in patients with non-ST-elevation myocardial infarction, optical coherence tomography-guided percutaneous coronary intervention (PCI) is associated with higher postprocedure fractional flow reserve (FFR) than PCI guided by angiography alone without an increase in periprocedural complications. Several concerns surround the use of FFR as a surrogate end point. The utility of FFR is firmly established in stable coronary artery disease but has been widely debated in patients with non-ST-elevation myocardial

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    13. Response by Meneveau and Ecarnot to Letter Regarding Article, “Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients With Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS

      Response by Meneveau and Ecarnot to Letter Regarding Article, “Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients With Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS

      We read with interest the letters by Vallurupalli and Uretsky and also Dr Nadir relating to the results of the DOCTORS study (Does Optical Coherence Tomography Optimize Results of Stenting). 1 We thank the authors for their insightful remarks. Vallurupalli and Uretsky raise an interesting point when they underline that a prolonged inflation time is superior to a rapid inflation/deflation technique in terms of both stent expansion and apposition. We acknowledge that we did not take stent inflation time into account in the case report form of the DOCTORS study. The arguments put forward by Vallurupalli and Uretsky suggest ...

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    14. Letter by Vallurupalli and Uretsky Regarding Article, “Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients With Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS Study (

      Letter by Vallurupalli and Uretsky Regarding Article, “Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients With Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS Study (

      We read with interest the results of the DOCTORS study (Does Optical Coherence Tomography Optimize Results of Stenting) of the use of optical coherence tomography to optimize stent implantation in non-ST-elevation myocardial infarction. 1 The finding that stent underexpansion detected by optical coherence tomography occurs in 42% of implants and often goes undetected by angiography is sobering and calls for the interventional …

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    15. Fully automated lumen segmentation of intracoronary optical coherence tomography images

      Fully automated lumen segmentation of intracoronary optical coherence tomography images

      Optical coherence tomography (OCT) provides high-resolution cross-sectional images of arterial luminal morphology. Traditionally lumen segmentation of OCT images is performed manually by expert observers; a laborious, time consuming effort, sensitive to inter-observer variability process. Although several automated methods have been developed, the majority cannot be applied in real time because of processing demands. To address these limitations we propose a new method for rapid image segmentation of arterial lumen borders using OCT images that involves the following steps: 1) OCT image acquisition using the raw OCT data, 2) reconstruction of longitudinal cross-section (LOCS) images from four different acquisition angles, 3 ...

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    16. Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

      Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

      Background Plaque rupture and erosion are the 2 most common mechanisms for acute coronary syndromes. However, the outcome of these 2 distinct pathologies in patients with acute coronary syndromes has never been studied. Methods and Results We retrospectively studied 141 patients with acute coronary syndromes who underwent optical coherence tomography ( OCT ) imaging of the culprit lesion prior to stenting from the Massachusetts General Hospital OCT Registry. Management (stent versus no stent), poststent OCT findings, and outcomes were compared. Among the 141 culprit lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%). Stent implantation was performed in ...

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    17. Early vascular responses after everolimus-eluting stent implantation assessed by serial observations of intracoronary optical coherence tomography

      Early vascular responses after everolimus-eluting stent implantation assessed by serial observations of intracoronary optical coherence tomography

      A recent OCT study revealed that the lack of stent strut endothelial coverage is associated with late stent thrombosis after drug-eluting stent implantation. However, the sequential changes of stent strut endothelial coverage in the extremely early period have never been reported. Serial OCTs were performed in 35 patients with 35 EES (everolimus-eluting stent)-treated de novo lesions at 0, 2, 4, and 12 weeks after EES implantation. Serial changes in quantitative parameters of the neointima (neointimal thickness, stent strut coverage, and apposition of each strut) were analyzed. Mean neointimal thickness significantly increased from 35.9 to 51.8 and 108 ...

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    18. Comparison of Coronary Intimal Plaques by Optical Coherence Tomography in Arteries With versus Without Internal Running Vasa Vasorum

      Comparison of Coronary Intimal Plaques by Optical Coherence Tomography in Arteries With versus Without Internal Running Vasa Vasorum

      It has been reported the internal running vasa vasorum was associated with plaque vulnerability, and microchannels in optical coherence tomography (OCT) are consistent pathologically with vasa vasorum. We investigated plaque vulnerability and incidence of slow flow during percutaneous coronary intervention (PCI) of the internal longitudinal running vasa vasorum. Subjects were 71 lesions undergoing OCT before PCI. Internal running vasa vasorum was defined as intraplaque neovessels running from the adventitia to plaque. Lesions with internal running vasa vasorum were found in 47% (33/71). Compared to lesions without internal running vasa vasorum, lesions with internal running vasa vasorum showed significantly higher ...

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    19. Optical coherence tomography evaluation of pulmonary arterial vasculopathy in Systemic Sclerosis

      Optical coherence tomography evaluation of pulmonary arterial vasculopathy in Systemic Sclerosis

      Our current understanding of the pathophysiology of pulmonary vascular disease is incomplete, since information about alterations of the pulmonary vasculature in pulmonary arterial hypertension (PAH) is primarily provided by autopsy or tissue specimens. The aim of this study was to compare the distal pulmonary vasculature of <2 mm in diameter in Systemic Sclerosis (SSc) patients with (n = 17) and without (n = 5) associated PAH using Optical Coherence Tomography during Right Heart catheterization. SSc-PAH patients showed significant thickening of Intima Media Thickening Area compared to patients without PAH (27 +/− 5.8% vs. 21 +/− 1.4%, p = 0.024). A good haemodynamic ...

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    20. Optical coherence tomography lumen morphology and vascular resistance measurements methods for blood vessel evaluations

      Optical coherence tomography lumen morphology and vascular resistance measurements methods for blood vessel evaluations

      A method and apparatus of automatically locating in an image of a blood vessel the lumen boundary at a position in the vessel and from that measuring the diameter of the vessel. From the diameter of the vessel and estimated blood flow rate, a number of clinically significant physiological parameters are then determined and various user displays of interest generated. One use of these images and parameters is to aid the clinician in the placement of a stent. The system, in one embodiment, uses these measurements to allow the clinician to simulate the placement of a stent and to determine ...

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    21. New technique yields healthier blood vessels after heart surgery

      New technique yields healthier blood vessels after heart surgery

      New technique yields healthier blood vessels after heart surgery February 17, 2017 Researchers from the Norwegian University of Science and Technology have investigated the effect of a new method that involves removing tissue around the veins to be transplanted with the veins during a cardiac bypass surgery. The idea is that this leads to less damage of vessel walls during transplant.

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    22. Mapping the human atria with optical coherence tomography

      Mapping the human atria with optical coherence tomography

      Atrial structure plays an important role in the mechanisms of atrial disease. However, detailed imaging of human atria remains limited due to many imaging modalities lacking sufficient resolution. We propose the use of optical coherence tomography (OCT), which has micrometer resolution and millimeter-scale imaging depth well-suited for the atria, combined with image stitching algorithms, to develop large, detailed atria image maps. Human atria samples (n = 7) were obtained under approved protocols from the National Disease Research Interchange (NDRI). One right atria sample was imaged using an ultrahigh-resolution spectral domain OCT system, with 5.52 and 2.72 μm lateral and ...

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    23. Accuracy of computed tomography angiography to identify thin-cap fibroatheroma detected by optical coherence tomography

      Accuracy of computed tomography angiography to identify thin-cap fibroatheroma detected by optical coherence tomography

      Background Thin-cap fibroatheroma (TCFA) is assumed to cause acute coronary syndromes. Objective To compare the accuracy of different models for diagnosing TCFA using parameters derived by CT, validated against optical coherence tomography (OCT). Methods One hundred twenty-nine plaques in 106 patients were analyzed using data acquired by 64-row CT with a reconstruction thickness of 0.67 mm and an increment of 0.33 mm. TCFA was defined by OCT as a plaque with lipid content in ≥2 quadrants and the thinnest part of the fibrous cap measuring ≤65 μm. The following parameters were obtained from CT: remodeling index (RI), proportion ...

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