1. Articles in category: Cardiology

    1-24 of 4298 1 2 3 4 ... 177 178 179 »
    1. Accuracy of optical coherence tomography imaging in assessing aneurysmal remnants after flow diversion

      Accuracy of optical coherence tomography imaging in assessing aneurysmal remnants after flow diversion

      Background Optical coherence tomography (OCT) is an ultra-high resolution real-time intravascular imaging method that is gaining interest in cerebrovascular applications. Objective To compare, in a rabbit elastase aneurysm model, digital subtraction angiography (DSA) and OCT as diagnostic tools for the assessment of aneurysmal remnants and baseline characteristics of aneurysms after flow diverter (FD) implantation. Methods With Institutional Animal Care and Use Committee approval, saccular aneurysms were created in 28 rabbits and treated with Derivo FDs. DSA was performed before, and immediately after, stent implantation. As a follow-up, DSA and OCT were performed 28 days after device implantation. Results DSA and ...

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    2. CD4+/CD8+ ratio positively correlates with coronary plaque instability in unstable angina pectoris patients but fails to predict major adverse cardiovascular events

      CD4+/CD8+ ratio positively correlates with coronary plaque instability in unstable angina pectoris patients but fails to predict major adverse cardiovascular events

      Background: The association between CD4+/CD8+ ratio and coronary plaque instability in patients with unstable angina pectoris (UAP) has not been investigated. We sought to elucidate the correlation between CD4+/CD8+ ratio and plaque instability in this patient population. Methods: We enrolled 266 UAP patients who underwent pre-intervention optical coherence tomography (OCT) examination and percutaneous coronary intervention in our center from January 2016 to January 2018. Features of coronary plaques in the culprit arteries were classified as unstable plaque and stable plaque. Primary endpoint was occurrence of a major adverse cardiovascular event (MACE). Receiver operating characteristic (ROC) analyses were used ...

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    3. 30/80 MHz Bidirectional Dual-Frequency IVUS Feasibility Evaluated In Vivo and for Stent Imaging

      30/80 MHz Bidirectional Dual-Frequency IVUS Feasibility Evaluated In Vivo and for Stent Imaging

      Although intravascular ultrasound (IVUS) is an important tool in guiding complex coronary interventions, the resolution of existing commercial IVUS devices is considerably poorer than that of optical coherence tomography. Dual-frequency IVUS (DF IVUS), incorporating a second, higher frequency transducer, has been proposed as a possible method of overcoming this limitation. Although preliminary studies have shown that DF IVUS can produce complementary images, including large-scale morphology and high detail of superficial features, it has not yet been determined that this approach would be feasible in a more clinically relevant environment. The purpose of this study was to demonstrate the first in ...

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    4. The impact of therapeutic mediastinal radiation on stent healing in cancer patients: An optical coherence tomography study.

      The impact of therapeutic mediastinal radiation on stent healing in cancer patients: An optical coherence tomography study.

      Background: Cancer is a prothrombotic and proinflammatory state. Understanding stent healing in cancer patients could modify the approach to antiplatelet regimen and facilitate cancer treatment. Mediastinal radiation therapy brings an additional layer of complexity to an already challenging clinical scenario in cancer patients undergoing percutaneous coronary intervention (PCI). We sought to compare stent healing patterns with and without a history of mediastinal radiation therapy using optical coherence tomography (OCT) data. Methods: All cancer patients that underwent PCI and follow-up OCT less than 12 months post-PCI between 2009-2018 were retrospectively identified from our institutional cardiac catheterization laboratory registry. Stent healing, which ...

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    5. The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

      The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

      Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients ...

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    6. Degree of luminal narrowing and composition of thrombus in plaque erosion

      Degree of luminal narrowing and composition of thrombus in plaque erosion

      As the degree of luminal narrowing increases, shear stress increases, and high shear stress is known to activate platelets. However, the relationship between the degree of luminal narrowing and the composition of thrombus in patients with plaque erosion has not been studied. A total of 148 patients with plaque erosion and thrombus detected by optical coherence tomography were divided into tertiles based on the minimum lumen area (MLA) at the culprit lesion. Thrombus was categorized as platelet-rich or fibrin-rich. Among 148 patients, 50 (34%) were in the mild stenosis group, 49 (33%) were in the moderate stenosis group, and 49 ...

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    7. Assessment of Cardiac Allograft Vasculopathy from OCT Images: Automated Analysis is as Good as Expert-Guided Approach

      Assessment of Cardiac Allograft Vasculopathy from OCT Images: Automated Analysis is as Good as Expert-Guided Approach

      Purpose Cardiac Allograft Vasculopathy (CAV) is a frequent complication after heart transplantation (HTx). To help identify patients at risk of CAV, 3D quantitative analysis of coronary wall thickening is of major importance. Until now, substantial manual tracing effort was required. We report a fully automated approach using optical coherence tomography (OCT) imaging. Methods Lumen surface, intimal and medial layers were identified using our LOGISMOS segmentation framework. Coronary wall regions with layered appearance were automatically identified in each OCT frame using deep learning. These segmentation and classification approaches were newly combined in one fully automated system. The comparison between fully automated ...

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    8. Utility of imaging modalities in coronary lesions with borderline fractional flow reserve

      Utility of imaging modalities in coronary lesions with borderline fractional flow reserve

      Background Coronary intervention is routinely deferred in intermediate lesions with fractional flow reserve (FFR) ≥ 0.80. Patients with borderline FFR (0.80–0.85) who were initially deferred, have been shown to have higher risk of future interventions; however, the data is limited, and the long term prognosis in these patients remains unknown. We assessed the utility of adjunctive imaging modalities to determine the need for intervention in lesions with borderline FFR. Methods We retrospectively evaluated consecutive patients who underwent coronary angiography at Einstein Medical Center from January 2013 to April 2016. All patients with borderline FFR (0.80–0 ...

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    9. Automatic stent reconstruction in optical coherence tomography based on a deep convolutional model

      Automatic stent reconstruction in optical coherence tomography based on a deep convolutional model

      Intravascular optical coherence tomography (IVOCT) can accurately assess stent apposition and expansion, thus enabling the optimisation of a stenting procedure to minimize the risk of device failure. This paper presents a deep convolutional based model for automatic detection and segmentation of stent struts. The input of pseudo-3D images aggregated the information from adjacent frames to refine the probability of strut detection. In addition, multi-scale shortcut connections were implemented to minimize the loss of spatial resolution and refine the segmentation of strut contours. After training, the model was independently tested in 21,363 cross-sectional images from 170 IVOCT image pullbacks. The ...

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    10. Chronic Stent Recoil in Severely Calcified Coronary Artery Lesions. A Serial Optical Coherence Tomography Study

      Chronic Stent Recoil in Severely Calcified Coronary Artery Lesions. A Serial Optical Coherence Tomography Study

      Chronic second-generation drug-eluting stent recoil in severely calcified coronary lesions has not been studied. We aimed to evaluate chronic stent recoil by optical coherence tomography (OCT) in severely calcified lesions treated with thin strut stents after rotational atherectomy. In 28 lesions (26 patients with 23% on hemodialysis) treated with everolimus-eluting stents after rotational atherectomy, baseline and 8-month follow-up OCT were compared. Stent recoil was defined as >10% decrease in stent area from baseline to follow-up. Overall, there was no change in minimal stent area (6.0 mm 2 [5.0, 8.1] to 6.0 mm 2 [4.8, 8 ...

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    11. Longitudinal Monitoring of Flow-Diverting Stent Tissue Coverage After Implant in a Bifurcation Model Using Neurovascular High-Frequency Optical Coherence Tomography

      Longitudinal Monitoring of Flow-Diverting Stent Tissue Coverage After Implant in a Bifurcation Model Using Neurovascular High-Frequency Optical Coherence Tomography

      BACKGROUND Tissue growth over covered branches is a leading cause of delayed thrombotic complications after flow-diverter stenting (FDS). Due to insufficient resolution, no imaging modality is clinically available to monitor this phenomenon. OBJECTIVE To evaluate high-frequency optical coherence tomography (HF-OCT), a novel intravascular imaging modality designed for the cerebrovascular anatomy with a resolution approaching 10 microns, to monitor tissue growth over FDS in an arterial bifurcation model. METHODS FDS were deployed in a rabbit model (n = 6), covering the aortic bifurcation. The animals were divided in different groups, receiving dual antiplatelet therapy (DAPT) (n = 4), aspirin only (n = 1), and ...

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    12. Influence of neoatherosclerosis on prognosis and treatment response in patients with in-stent restenosis

      Influence of neoatherosclerosis on prognosis and treatment response in patients with in-stent restenosis

      Introduction and objectives Neoatherosclerosis is one of the causes of in-stent restenosis (ISR). Our objective was to evaluate the influence of neoatherosclerosis on prognosis and treatment response in patients with ISR. Methods This is a pooled analysis of the optical coherence tomography (OCT)-substudies of 2 multicenter, randomized clinical trials, RIBS IV and V, comparing treatment with paclitaxel-coated balloon vs everolimus-eluting stent in patients with ISR. OCT evaluation was performed at baseline and at 6 to 9 months. Neoatherosclerosis was defined in baseline OCT as neointima with calcified or lipid content. We evaluated the angiographic and OCT results at 6 ...

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    13. Coronary Artery Occlusion Caused by Intramural Hematoma Due to In-Stent Dissection

      Coronary Artery Occlusion Caused by Intramural Hematoma Due to In-Stent Dissection

      A 54-year-old man developed ST-segment elevation myocardial infarction 1 week after percutaneous coronary intervention of the left anterior descending artery. Optical coherence tomography at the emergent percutaneous coronary intervention revealed an intramural hematoma extending from the in-stent dissection. We highlight that in-stent dissection, although generally considered a benign finding, can extend and cause intramural hematoma, resulting in coronary artery occlusion.

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    14. How to Guide PCI?: A Network Meta-Analysis

      How to Guide PCI?: A Network Meta-Analysis

      Background: Traditional coronary angiography (CA) as a main technique has been used to determine the coronary artery anatomy and guide percutaneous coronary intervention (PCI). We mainly focused on whether the new techniques could improve the patients’ mortality, major adverse cardiovascular events (MACEs), and myocardial infarction. Methods: For the network meta-analysis, we searched the trials of different PCI guidances from MEDLINE, Current Contents Connect, Google Scholar, EMBASE, Cochrane Library, PubMed, Science Direct, and Web of Science. The last search date was December 10, 2018. Results: The analyses of all results found that there was no significant difference in mortality among the ...

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    15. Influence of neoatherosclerosis on prognosis and treatment response in patients with in-stent restenosis

      Influence of neoatherosclerosis on prognosis and treatment response in patients with in-stent restenosis

      Introduction and objectives Neoatherosclerosis is one of the causes of in-stent restenosis (ISR). Our objective was to evaluate the influence of neoatherosclerosis on prognosis and treatment response in patients with ISR. Methods This is a pooled analysis of the optical coherence tomography (OCT)-substudies of 2 multicenter, randomized clinical trials , RIBS IV and V, comparing treatment with paclitaxel-coated balloon vs everolimus-eluting stent in patients with ISR. OCT evaluation was performed at baseline and at 6 to 9 months. Neoatherosclerosis was defined in baseline OCT as neointima with calcified or lipid content. We evaluated the angiographic and OCT results at 6 ...

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    16. Acute mechanical performance of bioresorbable scaffolds compared with everolimus-eluting stents under optical coherence tomography guidance

      Acute mechanical performance of bioresorbable scaffolds compared with everolimus-eluting stents under optical coherence tomography guidance

      Objective The aim was to compare the acute mechanical performance of the ABSORB bioresorbable scaffold (BRS) with the everolimus-eluted stents (EES) after optical coherence tomography (OCT)-guided deployment. Background The intrinsic differences in biomechanical properties between BRS and EES and the thicker BRS struts can affect the BRS acute mechanical performance in terms of scaffold expansion and struts apposition. Materials and methods The authors compared the acute mechanical performance of 245 scaffolds with that of 82 everolimus-eluted EES. All scaffolds/stents were deployed under OCT guidance. OCT was used to assess the following acute mechanical performance indices: residual area stenosis ...

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    17. Colocalization of plaque macrophages and calcification in coronary plaques as detected by optical coherence tomography predicts cardiovascular outcome

      Colocalization of plaque macrophages and calcification in coronary plaques as detected by optical coherence tomography predicts cardiovascular outcome

      Both plaque macrophage infiltration [1] and calcification [2] are recently suggested characteristics of plaque vulnerability in coronary lesions. Each of these two morphologic characteristics may foster the other. [3, 4]. Thus, the aim herein, is to evaluate this interdependence using optical coherence tomography (OCT), which, due to its supreme resolution, has the ability to detect both features. A recent study defined colocalization of macrophages and calcification (ColocCaMa) as a distance < 100 µm between plaque macrophages and calcification. In this work an association was described between ColocCaMa and the more heavily calcified, but also less advanced and more vulnerable coronary lesions ...

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    18. Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series

      Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series

      Background: Evaluating prospectively the feasibility, accuracy and reproducibility of optical flow ratio (OFR), a novel method of computational physiology based on optical coherence tomography (OCT). Methods and results: Sixty consecutive patients (76 vessels) underwent prospectively OCT, angiography-based quantitative flow ratio (QFR) and fractional flow ratio (FFR). OFR was computed offline in a central core-lab by analysts blinded to FFR. OFR was feasible in 98.7% of the lesions and showed excellent agreement with FFR (ICCa = 0.83, r = 0.83, slope = 0.80, intercept = 0.17, kappa = 0.84). The area under curve to predict an FFR ≤ 0.80 was ...

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    19. Three-dimensional imaging of pulmonary arterial vasa vasorum using optical coherence tomography in patients after bidirectional Glenn and Fontan procedures

      Three-dimensional imaging of pulmonary arterial vasa vasorum using optical coherence tomography in patients after bidirectional Glenn and Fontan procedures

      Aims We evaluated pulmonary arterial (PA) vasa vasorum (VV) in Fontan candidate patients with a novel three-dimensional (3D) imaging technique using optical coherence tomography (OCT). Methods and results This prospective study assessed the development of adventitial VV in the distal PA of 10 patients with bidirectional Glenn circulation (BDG group, 1.6 ± 0.3 years) and Fontan circulation (Fontan group, 3.3 ± 0.3 years), and in 20 children with normal PA haemodynamics and morphology (Control group, 1.5 ± 0.3 years). We assessed the PA VV with two-dimensional (2D) cross-sectional, multi-planar reconstruction (MPR), and volume rendering (VR) imaging. VV ...

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    20. Does OCT Optimise Results of Stenting on the Left Main Stem

      Does OCT Optimise Results of Stenting on the Left Main Stem

      Angiographic evaluation of lesions of the left main stem presents particular challenges and high procedural complexity. The clinical sequelae of a suboptimal result in this context may be severe, and thus, it is recommended that patients with left-main lesions be considered for imaging-guided interventions by means of optimal coherence tomography (OCT) in non-ostial left main lesions. The investigators have previously demonstrated in a randomized trial of patients undergoing PCI for a lesion responsible for non ST elevation acute coronary syndromes that OCT provides useful clinical information beyond that obtained by angiography alone, and OCT-guidance for angioplasty in these patients yielded ...

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    21. SCAI Position Statement on Optimal Percutaneous Coronary Interventional Therapy for Complex Coronary Artery Disease

      SCAI Position Statement on Optimal Percutaneous Coronary Interventional Therapy for Complex Coronary Artery Disease

      The anatomic and clinical complexity of patients with coronary artery disease (CAD) is increasing in the United States. 1 - 3 While the terms “complex CAD” or “high‐risk CAD” have not been formally defined, they encompass both complex anatomic lesions and clinical parameters including advanced age, frailty, comorbidities, compromised hemodynamic status, depressed ventricular function and concomitant valvular disease. 4 - 6 Such features increase both the procedural complexity of percutaneous coronary intervention (PCI) and the risk of adverse patient outcomes. The direct relationship between CAD complexity and the appropriateness for coronary revascularization is also emphasized in current societal guidelines and appropriate ...

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    22. Intravascular Imaging for Venous Interventions

      Intravascular Imaging for Venous Interventions

      Purpose of Review This review surveys the clinical landscape of intravascular imaging for endovenous interventions. Recent Findings Endovascular imaging has become increasingly important for diagnosing venous pathology and guiding venous interventions. In particular, intravascular ultrasound (IVUS) provides 3D high-resolution cross-sectional imaging of vessel and surrounding tissues, often in anatomic locations inaccessible to surface ultrasound, namely the superior vena cava, inferior vena cava, and caval-iliac veins. Summary Current well-established indications for venous IVUS include diagnostic studies, venoplasty, transjugular intrahepatic portosystemic shunt (TIPS) creation, inferior vena cava filter placement, and transjugular liver biopsy. In the future, optical coherence tomography may play an ...

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