1. Articles in category: Cardiology

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    1. Avinger Receives FDA Clearance of Next Generation Pantheris Device

      Avinger Receives FDA Clearance of Next Generation Pantheris Device

      The Pantheris Lumivascular Atherectomy System is the first-ever image-guided atherectomy device for treatment of peripheral artery disease Avinger, Inc. (NASDAQ:AVGR), a leading developer of innovative treatments for peripheral artery disease (PAD), announced today that the Company received 510(k) clearance from the U.S. Food & Drug Administration (FDA) for its next generation Pantheris® Lumivascular atherectomy system, the first-ever image-guided atherectomy device for the treatment of peripheral artery disease. Lumivascular is the only technology that combines real-time intravascular imaging with highly effective catheters for the treatment of PAD. Peripheral artery disease is projected to affect more than 21 million people ...

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      Mentions: FDA Avinger
    2. A New Framework for the Integrative Analytics of Intravascular Ultrasound and Optical Coherence Tomography Images

      A New Framework for the Integrative Analytics of Intravascular Ultrasound and Optical Coherence Tomography Images

      The integrative analysis of multimodal medical images plays an important role in the diagnosis of coronary artery disease by providing additional comprehensive information that cannot be found in an individual source image. Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (IV-OCT) are two imaging modalities that have been widely used in the medical practice for the assessment of arterial health and the detection of vascular lumen lesions. IV-OCT has a high resolution and poor penetration, while IVUS has a low resolution and high detection depth. This paper proposes a new approach for the fusion of intravascular ultrasound and optical coherence tomography ...

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    3. Optical coherence tomography in STEMI with bioresorbable scaffold: possible cause of coronary flow impairment? A sub-study from the Prague 19 trial

      Optical coherence tomography in STEMI with bioresorbable scaffold: possible cause of coronary flow impairment? A sub-study from the Prague 19 trial

      This study assessed the Optical Coherence Tomography (OCT) impact on the coronary flow in ST-elevation myocardial infarction (STEMI) after bioresorbable scaffold implantation. Only few data about OCT use in STEMI are available and coronary flow before and after OCT is not well studied yet. 54 patients with OCT performed at the end of procedure from the Prague 19 trial were selected and coronary flow was evaluated as TIMI frame count (TFC) before and just after OCT. Significant increase in TIMI frame count after OCT [from 9.5 (6.75–12.25) to 11.5 (8–15.25) frames; p = 0 ...

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    4. Implantation of bioresorbable scaffolds under guidance of optical coherence tomography: feasibility and pilot clinical results of a systematic protocol

      Implantation of bioresorbable scaffolds under guidance of optical coherence tomography: feasibility and pilot clinical results of a systematic protocol

      Background: We hypothesise that a comprehensive optical coherence tomography (OCT)-guided implantation protocol for bioresorbable scaffolds (BRS) might improve expansion and apposition, thus translating into better clinical outcomes, particularly reducing thrombotic events. Methods: Patients considered suitable for BRS therapy in de novo coronary lesions underwent OCT. The predominant type of plaque was classified as lipidic, fibrous or calcific, undergoing tailored plaque preparation accordingly. After proper sizing, BRS was deployed and final OCT was acquired. Post-dilation was only performed if suboptimal deployment. Procedural and 12 months clinical follow-up are reported. Results: 29 patients (41 lesions) considered clinically and angiographically suitable for ...

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    5. Quantitative measurement of lipid rich plaque by coronary computed tomography angiography: A correlation of histology in sudden cardiac death

      Quantitative measurement of lipid rich plaque by coronary computed tomography angiography: A correlation of histology in sudden cardiac death

      Background and aims Recent advancements in coronary computed tomography angiography (CCTA) have allowed for the quantitative measurement of high-risk lipid rich plaque. Determination of the optimal threshold for Hounsfield units (HU) by CCTA for identifying lipid rich plaque remains unknown. We aimed to validate reliable cut-points of HU for quantitative assessment of lipid rich plaque. Methods 8 post-mortem sudden coronary death hearts were evaluated with CCTA and histologic analysis. Quantitative plaque analysis was performed in histopathology images and lipid rich plaque area was defined as intra-plaque necrotic core area. CCTA images were analyzed for quantitative plaque measurement. Low attenuation plaque ...

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      Mentions: Renu Virmani
    6. In vivo optical coherence tomography imaging and histopathology of healed coronary plaques

      In vivo optical coherence tomography imaging and histopathology of healed coronary plaques

      Background and aims The aims of this study were to assess agreement between optical coherence tomography (OCT) and histopathology for healed coronary plaques (HCPs) in human coronary arteries ex vivo , and to evaluate the prevalence and characteristics of HCPs in vivo . Methods Ex vivo OCT images were co-registered with histopathology in 144 cross-sections with ≥50% stenosis. Of these, 30 randomly selected pairs were employed to define morphological features of OCT for HCPs (OCT-derived HCPs); the remaining 114 pairs were used to evaluate the accuracy of OCT in detecting histologically-defined HCPs. In a clinical study, 60 target lesions from 60 patients ...

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    7. Multimodality Imaging to Detect Vulnerable Plaque in Coronary Arteries and Its Clinical Application (Book Chapter)

      Multimodality Imaging to Detect Vulnerable Plaque in Coronary Arteries and Its Clinical Application (Book Chapter)

      Postmortem studies have described the association between the thin-cap fibroatheroma (TCFA) and the occurrence of acute coronary syndrome (ACS). Both noninvasive and invasive techniques have been refined and used as a research tool to visualize the plaque at a high risk of disruption. There has been a considerable effort to develop the imaging modalities that offer detailed visualization of coronary pathology and accurately predict the adverse cardiac outcomes. This chapter provides an overview of the current and experimental coronary imaging methods to detect vulnerable plaque and discuss the potential implication of multimodality imaging in clinical practice.

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    8. The Effectiveness of Excimer Laser Angioplasty to Treat Coronary In-Stent Restenosis With Peri-stent Calcium as Assessed by Optical Coherence Tomography

      The Effectiveness of Excimer Laser Angioplasty to Treat Coronary In-Stent Restenosis With Peri-stent Calcium as Assessed by Optical Coherence Tomography

      Aims: We evaluated the effectiveness of excimer laser coronary angioplasty (ELCA) to treat in-stent restenosis (ISR) due to peri-stent calcium-related stent under-expansion as assessed by optical coherence tomography (OCT). Methods and results: We studied 81 patients (81 lesions with ISR, stent under-expansion, and peri-stent calcium >90°) who underwent OCT imaging both pre- and post-percutaneous coronary intervention and compared lesions treated with ELCA (n=23) vs without ELCA (n=58). ELCA use was associated with more calcium fracture (ELCA: 61%, non-ELCA: 12%, p<0.01), . larger final minimum lumen area (ELCA: 4.76 mm2 [3.25, 5.57], non-ELCA: 3.46 ...

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    9. A serial three- and nine-year optical coherence tomography evaluation of neoatherosclerosis progression after sirolimus- and paclitaxel-eluting stents implantation

      A serial three- and nine-year optical coherence tomography evaluation of neoatherosclerosis progression after sirolimus- and paclitaxel-eluting stents implantation

      Background: Early-generation drug-eluting stents (DES) have been shown to accelerate neoatherogenesis. Limited optical coherence tomography (OCT) data on the very long-term neoatherosclerosis progression after DES implantation are available. Aim: The aim of this study was a serial OCT evaluation of neoatherosclerosis at 3 and 9 years after implantation of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). Methods: Consecutive patients undergoing elective PCI with SES (Cypher, Cordis) or PES (Taxus, Boston Scientific) were included in this single-centre, longitudinal study. OCT analysis was performed after 3 and 9 years by the independent core laboratory. Results: A total of 39 OCT recordings were ...

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    10. Bioresorbable vascular scaffolds for a long diffuse coronary lesion: insights from optical coherence tomography at 25-month follow-up

      Bioresorbable vascular scaffolds for a long diffuse coronary lesion: insights from optical coherence tomography at 25-month follow-up

      A 57-year-old man with crescendo angina had a long segment of diffuse lesion in the left anterior descending artery (LAD) (Fig. 1A). Surgical revascularisation was precluded due to poor distal targets, so the patient underwent percutaneous coronary intervention. Overlapping drug eluting stents (DESs) would have resulted in a full metal jacket, which poses long-term risk of stent thrombosis and restenosis, which are often difficult to treat. Considering these issues, we used three overlapping bioresorbable vascular scaffolds (BVS) following adequate lesion preparation (Fig. 1B–D). At the LAD/first-diagonal (D1) bifurcation we used a short DES that overlapped the BVS to ...

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    11. Bifurcation and Ostial Optical Coherence Tomography Mapping (BOOM) – Case Description of a Novel Bifurcation Stent Technique

      Bifurcation and Ostial Optical Coherence Tomography Mapping (BOOM) – Case Description of a Novel Bifurcation Stent Technique

      Stent placement guided by angiography alone is often inexact, but of increased importance with bifurcation percutaneous coronary intervention (PCI). We describe a novel technique using optical coherence tomography (OCT)-guided angiographic co-registration termed “Bifurcation and Ostial OCT Mapping” (BOOM). The technique is based on the precise identification and mapping of the side-branch ostium using co-registration to minimize protrusion of stent struts into the main branch while ensuring full coverage of the ostium in the side-branch.

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    12. Optimizing Percutaneous Coronary Intervention in Calcified Lesions Insights From Optical Coherence Tomography of Atherectomy

      Optimizing Percutaneous Coronary Intervention in Calcified Lesions Insights From Optical Coherence Tomography of Atherectomy

      Optimal coronary stent implantation is among the few successful strategies in preventing stent failures, notably in-stent restenosis and stent thrombosis. 1 Understanding the intravascular milieu is a prerequisite for optimization of percutaneous coronary intervention (PCI). Calcified lesions limit stent expansion, the most robust predictor of target lesion revascularization, and are thus associated with worst outcomes. 2 Coronary angiography is a poor discriminator of calcium distribution and thickness. Reliance on angiography to guide PCI and define procedural success in severe coronary calcification is associated with poor outcomes. 3 Both intravascular ultrasound and optical coherence tomography (OCT) enable detailed evaluation of cross-sectional ...

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    13. Clinical impact of optical coherence tomography findings on culprit plaque in acute coronary syndrome: The OCT‐FORMIDABLE study registry

      Clinical impact of optical coherence tomography findings on culprit plaque in acute coronary syndrome: The OCT‐FORMIDABLE study registry

      Background Aim of this study was to evaluate the clinical impact of the culprit plaque features assessed by optical coherence tomography (OCT) in patients with acute coronary syndrome (ACS). Methods The OCT‐FORMIDABLE register enrolled retrospectively all consecutive patients who perform OCT on culprit plaque in patients with ACS in nine European centres. The primary endpoint was the prevalence of culprit plaque rupture (CPR) in patients experiencing major adverse cardiovascular events (MACEs). Secondary endpoint was the prevalence necrotic core with macrophage infiltrations (NCMI) in the patients experiencing MACEs. Results Two‐hundred and nine patients were included in the study. Mean ...

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    14. In vivo tissue characterization of human atherosclerotic plaques by optical coherence tomography: A directional coronary atherectomy study with histopathologic confirmation

      In vivo tissue characterization of human atherosclerotic plaques by optical coherence tomography: A directional coronary atherectomy study with histopathologic confirmation

      Background The histopathological validation of optical coherence tomography (OCT) in visualizing atherosclerotic plaques has been reported only in ex vivo studies. We sought to evaluate the accuracy of OCT in tissue characterization in vivo . Methods and results A total of 25 patients with stable angina pectoris who underwent directional coronary atherectomy (DCA) were included in the investigation, whereby OCT was performed before and after a single debulking. The debulked region was determined on OCT and classified into fibrous tissue, lipid, calcification, thrombus, and macrophage accumulation, which were compared with histology. Changes in OCT signal intensity in the deeper intimal region ...

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    15. Coronary Stent Thrombosis (Book Chapter)

      Coronary Stent Thrombosis (Book Chapter)

      Stent thrombosis is a rare complication of percutaneous coronary intervention and carries a poor prognosis. Recent improvements in stent technology and new antiplatelet therapies have reduced the incidence of stent thrombosis. Coronary stent thrombosis has been defined by the Academic Research Consortium criteria. Four types of thrombosis are defined according to the time of occurrence from stent implantation: acute (<24 h), subacute (<30 days), late (between 1 month and 1 year), and very late (>1 year). Management consists primarily of urgent restoration of antegrade coronary flow. The concurrent management of platelet aggregation is of paramount importance; compliance with the regimen ...

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    16. Automatic analysis of bioresorbable vascular scaffolds in intravascular optical coherence tomography images

      Automatic analysis of bioresorbable vascular scaffolds in intravascular optical coherence tomography images

      The bioresorbable vascular scaffold (BVS) is a new generation of bioresorbable scaffold (BRS) for the treatment of coronary artery disease. A potential challenge of BVS is malapposition, which may possibly lead to late stent thrombosis. It is therefore important to conduct malapposition analysis right after stenting. Since an intravascular optical coherence tomography (IVOCT) image sequence contains thousands of BVS struts, manual analysis is labor intensive and time consuming. Computer-based automatic analysis is an alternative, but faces some difficulties due to the interference of blood artifacts and the uncertainty of the struts number, position and size. In this paper, we propose ...

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    17. Role of optical coherence tomography guided percutaneous coronary intervention to assess stent malapposition in de-novo coronary lesions

      Role of optical coherence tomography guided percutaneous coronary intervention to assess stent malapposition in de-novo coronary lesions

      ntra-coronary imaging has revolutionized Percutaneous Coronary Intervention (PCI) by detailed imaging of stented segment. The aim of the present study was to evaluate major stent malapposition by Optical Coherence Tomography (OCT) following standard PCI procedure. Twenty eligible patients for PCI, having reference vessel diameter (RVD) of 2.5 mm to 4.0 mm with ≥ 70% diameter stenosis (DS), lesion length ≤ 40 mm, and more than TIMI-1 flow were included in the study. Patients with cardiogenic shock , left main disease , bypass graft, in-stent restenosis , thrombotic , heavily calcified , chronic total occlusion lesions, TIMI- 0 to 1- coronary blood flow and serum creatinine ...

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      Mentions: St. Jude Medical
    18. Conavi Medical Announces FDA 510(k) Clearance of the Novasight Hybrid System with Simultaneous Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) Capabilities

      Conavi Medical Announces FDA 510(k) Clearance of the Novasight Hybrid System with Simultaneous Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) Capabilities

      Conavi TM Medical Inc. ( www.conavi.com ) is pleased to announce that it has received 510(k) clearance from the US Food and Drug Administration (FDA) for its Novasight TM Hybrid System. The system enables simultaneous imaging of coronary arteries with both intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT). IVUS or OCT are typically used by interventional cardiologists to image coronary anatomy during angioplasty and stenting procedures. "This is the world's first intravascular imaging system for clinical use with the capability to acquire both IVUS and OCT images using a single catheter. IVUS and OCT are the two ...

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    19. Role of optical coherence tomography in identifying sub-optimal stent positioning and predicting major adverse cardiac events in a comparative study with angiography: a CLIO-OPCI II sub-study

      Role of optical coherence tomography in identifying sub-optimal stent positioning and predicting major adverse cardiac events in a comparative study with angiography: a CLIO-OPCI II sub-study

      Background Quantitative coronary angiography (QCA) is the gold standard for evaluating correct stenting, despite its limitation in recognizing features indicative of suboptimal deployment. This subanalysis of the CLI-OPCI II registry addressed the role of optical coherence tomography (OCT) to verify whether suboptimal OCT deployment occurs in the presence of an optimal angiographic result. Patients and methods We retrospectively analyzed 125 lesions in the 105 patients with major adverse cardiac events of the CLI-OPCI II . Every lesion was evaluated with OCT and angiography , including visual and QCA assessment. Optimal angiographic result was defined as residual stenosis of less than 30% at ...

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    20. Bioresorbable vascular scaffold restenosis treated with sirolimus-eluting balloon: Optical coherence tomography findings

      Bioresorbable vascular scaffold restenosis treated with sirolimus-eluting balloon: Optical coherence tomography findings

      A 60-year-old man was admitted for unstable angina. Two-years ago he was treated with two bioresorbable vascular scaffolds (BVSs) on the proximal and distal segments of the left anterior descending coronary artery ( Figure 1 A, white arrows). Coronary angiography showed critical in-scaffold restenosis of the proximal BVS ( Figure 1 B, yellow arrow). Optical coherence tomography revealed heterogeneous tissue filling the BVS ( Figure 2 , A, B and D) with areas depicting bright neointimal hyperplasia with dorsal attenuation and marked shadowing of the underlying BVS struts. There was no evidence of scaffold disruption and neoatherosclerosis was considered the cause of late BVS ...

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      Mentions: Fernando Alfonso
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