1. Articles in category: Cardiology

    1-24 of 2686 1 2 3 4 ... 110 111 112 »
    1. Application of fractional flow reserve and optical coherence tomography examinations in a patient presenting with recurrent angina: a case report

      Application of fractional flow reserve and optical coherence tomography examinations in a patient presenting with recurrent angina: a case report

      Introduction We present the different roles of fractional flow reserve and optical coherence tomography in guiding treatment in a patient with recurrent chest pain. Case presentation A 66-year-old Chinese woman presented to our department for the third time for her recurrent chest pain. Her physical examination was unremarkable; her previous two angiography examinations indicated that there was a stenosis of 50 to 70% in her proximal left anterior descending coronary artery. Optimal medical therapy was applied, but her symptoms did not disappear. Coronary angiography was conducted again after admission, accompanied by fractional flow reserve and optical coherence tomography. A lesion ...

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    2. Very late stent thrombosis: the value of optical coherence tomography in defining aetiology and guiding treatment

      Very late stent thrombosis: the value of optical coherence tomography in defining aetiology and guiding treatment

      This case describes the use of optical coherence tomography (OCT) in a patient with ST elevation myocardial infarction due to very late stent thrombosis of a proximal right coronary artery drug eluting stent. OCT demonstrated late persistent stent malapposition to be the likely cause of stent thrombosis. It also guided the therapeutic strategy and averted further coronary stent implantation. 

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    3. An Unusual Complication After Bioresorbable Scaffold Implantation Visualization of Intramural Hematoma by Optical Coherence Tomography

      An Unusual Complication After Bioresorbable Scaffold Implantation Visualization of Intramural Hematoma by Optical Coherence Tomography

      A 68-year-old man was treated in our catheterization laboratory for ST-segment elevation myocardial infarction. He had undergone 3.5 × 18-mm bioresorbable vascular scaffold (BVS) implantation in the proximal left anterior descending coronary artery for stable angina in another institution 2 days before. At presentation, angiography showed a filling defect located >5 mm distally to the scaffolded segment ( Figure 1A ). An attempt at thrombus aspiration was performed, without retrieving any aspiration material, and the angiographic image remained unchanged ( Figure 1B ). Optical coherence tomography (OCT) was performed and revealed the absence of intraluminal thrombus, but the presence of an occlusive intramural hematoma ...

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    4. iMap-Intravascular Ultrasound Radiofrequency Signal Analysis Reflects Plaque Components of Optical Coherence Tomography-Derived Thin-Cap Fibroatheroma

      iMap-Intravascular Ultrasound Radiofrequency Signal Analysis Reflects Plaque Components of Optical Coherence Tomography-Derived Thin-Cap Fibroatheroma

      Background: The ability of iMap-intravascular ultrasound (IVUS) tissue characterization to detect thin-cap fibroatheroma (TCFA) identified on optical coherence tomography (OCT) has not yet been fully elucidated. Methods and Results: We evaluated 86 coronary lesions from 73 patients with stable angina pectoris using iMap-IVUS and OCT. We defined OCT-derived TCFA (OCT-TCFA) as lipid-rich plaque with a <65-μm-thick fibrous cap. The external elastic membrane (EEM) cross-sectional area (CSA), lumen CSA, plaque plus media (P+M) CSA, plaque burden and remodeling index were measured on gray-scale IVUS. Plaque components categorized on iMap-IVUS as fibrotic, lipidic, necrotic or calcified are presented as absolute ...

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    5. Neoatherosclerosis: mirage of an ancient illness or genuine disease condition?

      Neoatherosclerosis: mirage of an ancient illness or genuine disease condition?

      In-stent neoatherosclerosis has become the darling of the interventional cardiology community and is blamed for most stent thrombosis (ST) occurring late after drug-eluting stent (DES) implantation. Neoatherosclerosis accounted for only 33% of late and very late ST at autopsy following implantation of first-generation DES. 1 However, the clinical prevalence of neoatherosclerosis and its percentage of cases presenting with late and very late ST remains unknown. In the current issue of the journal, Taniwaki et al . propose a significant and biologically relevant association between the presence of in-stent neoatherosclerosis and the progression of native atherosclerosis in a cohort of 88 patients ...

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    6. OCT–Defined Morphological Characteristics of Coronary Artery Spasm Sites in Vasospastic Angina

      OCT–Defined Morphological Characteristics of Coronary Artery Spasm Sites in Vasospastic Angina

      Objectives The aim of this study was to define the morphological features of coronary artery spasm sites using optical coherence tomography (OCT) in patients with vasospastic angina (VSA). Background Plaque characteristics at coronary artery spasm sites have not been investigated systematically. Methods Sixty-nine consecutive patients (80 spasm sites) presenting with VSA who underwent OCT imaging were included in this study. Fibrous cap disruption was identified by the discontinuation of fibrous cap with or without intraplaque cavity formation. OCT-defined erosion was established by the presence of thrombus with or without lumen irregularity overlying an intact fibrous cap on multiple adjacent OCT ...

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    7. In-Stent Restenosis Caused by a Calcified Nodule: A Novel Pattern of Neoatherosclerosis

      In-Stent Restenosis Caused by a Calcified Nodule: A Novel Pattern of Neoatherosclerosis

      Neoatherosclerosis has been described as a cause of in-stent restenosis particularly in patients treated with drug-eluting stents. Although neoatherosclerosis may present as calcified plaques the occurrence of a “calcified nodule” within the stent has not been previously reported. We describe optical coherence tomography findings in patient presenting with a calcified nodule causing “undilatable” in-stent restenosis 2 years after implantation of a drug-eluting stent. The clinical and technical implications of this novel pattern of neoatherosclerosis are discussed.

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      Mentions: Fernando Alfonso
    8. OCT Medical Imaging Inc. Receives fast-track SBIR funding for “Clinical evaluation and development of a diagnostic multi-modal intravascular imaging system

      OCT Medical Imaging Inc. Receives fast-track SBIR funding for “Clinical evaluation and development of a diagnostic multi-modal intravascular imaging system

      Dr. Ram Ramalingam CEO of OCT Medical Imaging Inc., (OCTMI), a privately held medical device company announced that it has received a fast-tract Small Business Innovation Research (SBIR) grant from SBIR funding as National Heart Lung Blood institute (NHLBI) for “Clinical evaluation and development of a diagnostic multi-modal intravascular imaging system”. This fast-track SBIR grant worth 2.9 million dollar with potential support for two and half-year will be led by Dr. Ram Ramalingam, Co-founder of OCTMI and will involve clinicians from Columbia University Medical School (CUMS) and University of California Irvine Medical School (UCIMS), Orange, California. This milestone based ...

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    9. In-stent neointimal characteristics and late neointimal response after drug-eluting stent implantation: A preliminary observation

      In-stent neointimal characteristics and late neointimal response after drug-eluting stent implantation: A preliminary observation

      Background Progressive neointimal proliferation may lead to late restenosis and/or neoatherosclerosis after drug-eluting stent (DES) implantation. Late neointimal response may be different among different tissue characteristics. The aim of this study was to assess impact of in-stent neointimal characteristics on late neointimal response following DES implantation. Methods Serial (median 270 days and median 551 days after stent implantation) optical coherence tomography (OCT) examinations were performed in 42 stented lesions from 26 patients. In-stent neointimal tissue was categorized as either homogeneous or heterogeneous neointima based on the OCT appearance at 1st follow-up. Serial changes in neointimal area (NIA) were compared ...

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    10. Optimal threshold of postintervention minimum stent area to predict in-stent restenosis in small coronary arteries: An optical coherence tomography analysis

      Optimal threshold of postintervention minimum stent area to predict in-stent restenosis in small coronary arteries: An optical coherence tomography analysis

      Objectives The aim of this study was to determine the best threshold of postintervention minimum stent area (MSA) assessed by optical coherence tomography (OCT) to predict long-term in-stent restenosis (ISR) for 2.5 mm-diameter everolimus-eluting stents (EES). Background Percutaneous coronary intervention (PCI) for small coronary arteries remains challenging. Stent underexpansion is a strong predictor of late ISR. Methods We performed a retrospective analysis of 69 lesions in 69 patients undergoing PCI with 2.5 mm-diameter stents using OCT for the assessment of postintervention MSA and subsequent 9-month angiographic follow-up. Results The rates of angiographic ISR and target lesion revascularization were ...

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    11. Morphologic Features of Carotid Plaque Rupture Assessed by Optical Coherence Tomography

      Morphologic Features of Carotid Plaque Rupture Assessed by Optical Coherence Tomography

      BACKGROUND AND PURPOSE: Rupture of the plaque fibrous cap and subsequent thrombosis are the major causes of stroke. This study evaluated morphologic features of plaque rupture in the carotid artery by using optical coherence tomography in vivo. MATERIALS AND METHODS: Thirty-six carotid plaque s with high-grade stenosis were prospectively imaged by optical coherence tomography . “ Plaque rupture ” was defined as a plaque containing a cavity that had overlying residual fibrous caps. The fibrous cap thickness was measured at its thinnest part for both rupture d and non rupture d plaque s. The distance between the minimum fibrous cap thickness site and ...

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    12. Quantitative precision of optical frequency domain imaging: direct comparison with frequency domain optical coherence tomography and intravascular ultrasound

      Quantitative precision of optical frequency domain imaging: direct comparison with frequency domain optical coherence tomography and intravascular ultrasound

      No systematic validation study is available with optical frequency domain imaging (OFDI), directly compared with frequency domain optical coherence tomography (FD-OCT) and intravascular ultrasound (IVUS). Controversy also remains about the impact of different stent contour tracing methods by OFDI/FD-OCT. In vitro: coronary phantom models (1.51–5.04 mm) were imaged with OFDI, FD-OCT, and IVUS, demonstrating excellent quantitative precision with a slight overestimation of mean lumen diameter (difference 0.01–0.02 mm). In vivo: corresponding 64 OFDI/IVUS images of stented coronary segments from 20 swines were analyzed. Minimum lumen area by OFDI was larger than IVUS ...

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    13. Comparison of the performance of zotarolimus- and everolimus-eluting stents by optical coherence tomography and coronary angioscopy

      Comparison of the performance of zotarolimus- and everolimus-eluting stents by optical coherence tomography and coronary angioscopy

      Overall stent performance should be characterized by geometric luminal gain acquisition, neointimal coverage of the stent struts, and stabilization of the underlying inflammatory neoatheroma. The aim of this study was to compare the performance of zotarolimus-eluting stent (ZES), everolimus-eluting stent (EES) and bare metal stent (BMS) using optical coherence tomography (OCT) and coronary angioscopy. For 36 stented coronary lesions (BMS, 12 lesions; ZES, 11 lesions; EES, 13 lesions) in 27 patients, we calculated neointimal area and uncovered stent strut rate based on OCT findings at 10 months after stent placement. The grades of neointimal coverage and yellow color, both of ...

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    14. Stable coronary artery disease: revascularisation and invasive strategies

      Stable coronary artery disease: revascularisation and invasive strategies

      Stable coronary artery disease is the most common clinical manifestation of ischaemic heart disease and a leading cause of mortality worldwide. Myocardial revascularisation is a mainstay in the treatment of symptomatic patients or those with ischaemia-producing coronary lesions, and reduces ischaemia to a greater extent than medical treatment. Documentation of ischaemia and plaque burden is fundamental in the risk stratification of patients with stable coronary artery disease, and several invasive and non-invasive techniques are available (eg, fractional flow reserve or intravascular ultrasound) or being validated (eg, instantaneous wave-free ratio and optical coherence tomography). The use of new-generation drug-eluting stents and ...

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    15. Prediction of the filter no-reflow phenomenon in patients with angina pectoris by using multimodality: Magnetic resonance imaging, optical coherence tomography, and serum biomarkers

      Prediction of the filter no-reflow phenomenon in patients with angina pectoris by using multimodality: Magnetic resonance imaging, optical coherence tomography, and serum biomarkers

      Background Although the occurrence of no-reflow during percutaneous coronary intervention (PCI) has been shown to be associated with worse short- and long-term clinical outcomes, the clinical relevance of preventing flow deterioration by using the filter-based distal protection devices (DPDs) is controversial. We investigated predictors of the filter no-reflow (FNR) phenomenon during PCI by using multimodality, such as hyperintense plaques (HIPs) in the coronary artery on T1-weighted imaging (T1WI) non-contrast magnetic resonance, plaque composition by using optical coherence tomography (OCT), and serum biomarkers, in patients with angina pectoris. Methods and results Fifty lesions from 50 patients with angina were examined. All ...

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    16. Unruptured Thin-Cap Fibroatheroma with Overlying Platelet-Rich Thrombus in Left Main Coronary Artery – A Previously Unreported Culprit Lesion in Acute Coronary Syndrome

      Unruptured Thin-Cap Fibroatheroma with Overlying Platelet-Rich Thrombus in Left Main Coronary Artery – A Previously Unreported Culprit Lesion in Acute Coronary Syndrome

      In patients undergoing coronary angiography, thin-cap fibroatheroma are reported to be extremely rare in the left main coronary artery and, that too only as non-culprit lesions in patients with acute coronary syndrome. We report on a patient presenting with acute coronary syndrome and with angiographically documented isolated left main coronary artery disease as the culprit lesion. With optical coherence tomography imaging, we were able to demonstrate the presence of thin-cap fibroatheroma with overlying intraluminal white thrombus. The cap of the atheromatous lesion was unruptured. This phenomenon of unruptured thin-cap fibroatheroma in the left main coronary artery presenting as the culprit ...

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    17. Excimer Laser Angioplasty in Calcified Coronary Lesions: Evidence of Calcium Ablation by Optical Coherence Tomography

      Excimer Laser Angioplasty in Calcified Coronary Lesions: Evidence of Calcium Ablation by Optical Coherence Tomography

      During percutaneous coronary revascularization, calcified lesions can prove resistant to balloon expansion and cause stent underexpansion. We report on a patient with a calcified resistant lesion in whom adjunctive therapy with excimer laser enabled successful expansion of the stent. We document in this report using optical coherence tomography imaging, the calcium ablator effects of excimer laser, an effect which has not been demonstrated thus far, to our knowledge.

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    18. The effects of plaque morphology and material properties on peak cap stress in human coronary arteries

      The effects of plaque morphology and material properties on peak cap stress in human coronary arteries

      Heart attacks are often caused by rupture of caps of atherosclerotic plaques in coronary arteries. Cap rupture occurs when cap stress exceeds cap strength. We investigated the effects of plaque morphology and material properties on cap stress. Histological data from 77 coronary lesions were obtained and segmented. In these patient-specific cross sections, peak cap stresses were computed by using finite element analyses. The finite element analyses were 2D, assumed isotropic material behavior, and ignored residual stresses. To represent the wide spread in material properties, we applied soft and stiff material models for the intima. Measures of geometric plaque features for ...

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    19. Optical Coherence Tomography Guided Percutaneous Coronary Intervention With Nobori Stent Implantation in Patients With Non–ST-Segment–Elevation Myocardial Infarction (OCTACS) Trial

      Optical Coherence Tomography Guided Percutaneous Coronary Intervention With Nobori Stent Implantation in Patients With Non–ST-Segment–Elevation Myocardial Infarction (OCTACS) Trial

      Background— Incomplete strut coverage has been documented an important histopathologic morphometric predictor for later thrombotic events. This study sought to investigate whether optical coherence tomography (OCT)–guided percutaneous coronary intervention with Nobori biolimus-eluting stent implantation in patients with non–ST-segment–elevation myocardial infarction would provide improved strut coverage at 6 months in comparison with angiographic guidance only. Methods and Results— One hundred patients were randomized 1:1 to either OCT-guided or angio-guided Nobori biolimus-eluting stent implantation. Postprocedure OCT was performed in all patients. In the OCT-guided group, prespecified criteria indicating additional intervention were related to (1) stent underexpansion, (2) strut ...

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    20. Advances in three-dimensional coronary imaging and computational fluid dynamics: is virtual fractional flow reserve more than just a pretty picture?

      Advances in three-dimensional coronary imaging and computational fluid dynamics: is virtual fractional flow reserve more than just a pretty picture?

      Percutaneous coronary intervention (PCI) has shown a high success rate in the treatment of coronary artery disease. The decision to perform PCI often relies on the cardiologist’s visual interpretation of coronary lesions during angiography. This has inherent limitations, particularly due to the low resolution and two-dimensional nature of angiography. State-of-the-art modalities such as three-dimensional quantitative coronary angiography, optical coherence tomography and invasive fractional flow reserve (FFR) may improve clinicians’ understanding of both the anatomical and physiological importance of coronary lesions. While invasive FFR is the gold standard technique for assessment of the haemodynamic significance of coronary lesions, recent studies ...

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    21. Optical coherence tomography to evaluate coronary stent implantation and complications

      Optical coherence tomography to evaluate coronary stent implantation and complications

      Coronary optical coherence tomography (OCT) is now an established imaging technique in many catheterization laboratories worldwide. With its near-histological view of the vessel wall and lumen interface, it offers unprecedented imaging quality to improve our understanding of the pathophysiology of atherosclerosis, plaque vulnerability, and vascular biology. Not only is OCT used to accurately detect atherosclerotic plaque and optimize stent position, but it can further characterize plaque composition, quantify stent apposition, and assess stent tissue coverage. Given that its resolution of 15 μm is well above that of angiography and intravascular ultrasound, OCT has become the invasive imaging method of choice ...

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    22. Optical coherence tomography of traumatic aneurysms of the internal carotid artery: report of 2 cases

      Optical coherence tomography of traumatic aneurysms of the internal carotid artery: report of 2 cases

      The pathophysiology of extracranial traumatic aneurysm formation has not been fully elucidated. Intraarterial optical coherence tomography (OCT), an imaging modality capable of micrometer cross-sectional resolution, was used to evaluate patients presenting with saccular traumatic aneurysms of the internal carotid artery (ICA). Two consecutive trauma patients diagnosed with saccular traumatic aneurysms of the cervical ICA, per the institutional screening protocol for traumatic cerebrovascular injury, underwent digital subtraction angiography (DSA) with OCT. Optical coherence tomography demonstrated disruption of the intima with preservation and stretching of the more peripheral layers. In 1 patient the traumatic aneurysm was associated with thrombus formation and a ...

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