1. Articles in category: Cardiology

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    1. Successful Stenting With Optical Frequency Domain Imaging Guidance For Spontaneous Coronary Artery Dissection

      Successful Stenting With Optical Frequency Domain Imaging Guidance For Spontaneous Coronary Artery Dissection

      A 51-year-old woman was urgently admitted because of chest pain. Emergent coronary angiography revealed diffuse stenosis from the proximal to distal portion of the right coronary artery (RCA) with Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 (Figure 1 ). No stenosis was seen in the left coronary artery. Intravascular ultrasound (IVUS) images revealed an intracoronary hematoma from the posterior descending artery (PDA) to the ostium of the RCA, but could not demonstrate the entry point of the hematoma (Figure 1 ). Optical frequency domain imaging (OFDI; Terumo, Tokyo, Japan) images clearly demonstrated, not only intracoronary hematoma from the PDA to the ...

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    2. IMPROVED ARTERIAL TISSUE DIFFERENTIATION BY SPECTROSCOPIC OPTICAL COHERENCE TOMOGRAPHY

      IMPROVED ARTERIAL TISSUE DIFFERENTIATION BY SPECTROSCOPIC OPTICAL COHERENCE TOMOGRAPHY

      Optical coherence tomography (OCT) is a relatively new imaging modality similar with ultrasound where the sound waves are replaced by ballistic photons. OCT provides images at high spatial resolution which allow for the identification of micron size morphological tissue structures. A high impact application is visualization of arterial wall and atherosclerotic plaques. Despite high spatial resolution to complete the transfer of this imaging modality into clinical environment there is a need for markers which would quantify the physiological condition of the sample. Finding the proper markers is a topic of high interest for many research groups. A potential marker suggested ...

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    3. Detection of Atherosclerotic Plaque from Optical Coherence Tomography Images Using Texture-Based Segmentation

      Detection of Atherosclerotic Plaque from Optical Coherence Tomography Images Using Texture-Based Segmentation

      Detection of atherosclerotic plaque from optical coherence tomography (OCT) images by visual inspection is difficult. We developed a texture based segmentation method to identify atherosclerotic plaque automatically from OCT images without any reliance on visual inspection. Our method involves extraction of texture statistical features (spatial gray level dependence matrix method), application of an unsupervised clustering algorithm (K-means) on these features, and mapping of the clustered regions: background, plaque, vascular tissue and an OCT degraded signal region in feature-space, back to the actual image. We verified the validity of our results by visual comparison to photographs of the vascular tissue with ...

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    4. Intra- and Inter-Frame Differential Doppler Optical Coherence Tomography

      Intra- and Inter-Frame Differential Doppler Optical Coherence Tomography

      Spectrometer based optical coherence tomography suffers from fringe washout for fast flow, a drawback for flow visualization, which is of interest for both lable-free optical angiography and flow quantification. We presented a method, which can be used to contrast very fast flows, while maintaining relatively low A-scan rates. It is based on introducing a phase shift of during acquisition such that the interference fringes associated to moving sample structures are recovered depending on the axial velocity. This enables the use of slower line scan cameras for measuring the fast blood flows within the large vessels in the region of the ...

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    5. One-Year Follow-Up Optical Coherence Tomography of a “Hybrid” Neocarina After T-Stenting With Small Protrusion Technique Using a Bioresorbable Vascular Scaffold and a Metallic Stent

      One-Year Follow-Up Optical Coherence Tomography of a “Hybrid” Neocarina After T-Stenting With Small Protrusion Technique Using a Bioresorbable Vascular Scaffold and a Metallic Stent

      A 75-year-old man with stable angina underwent coronary angiography demonstrating significant stenosis at the bifurcation of the left anterior descending coronary artery (LAD) with a diagonal branch (Figure 1 ). Following pre-dilation, a 3.5 × 28-mm bioresorbable vascular scaffold (BVS) (Absorb, Abbott Vascular, Santa Clara, California) was implanted in the LAD. This was followed by post-dilation with a 3.5-mm noncompliant balloon and subsequent “T kissing” inflation. Because of an extensive dissection in the proximal segment of the diagonal (Figure 1 ), a 2.5 × 28-mm everolimus-eluting stent (EES) was implanted using the T-stenting with small protrusion (TAP) technique followed by “T ...

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    6. Variable underlying morphology of culprit plaques associated with ST-elevation myocardial infarction: an optical coherence tomography analysis from the SMART trial

      Variable underlying morphology of culprit plaques associated with ST-elevation myocardial infarction: an optical coherence tomography analysis from the SMART trial

      Aims The objective was to assess in vivo culprit lesion morphologies that caused ST-segment elevation myocardial infarction (STEMI) using optical coherence tomography (OCT). Methods and results Culprit lesions in 80 patients presenting within 6 h of STEMI onset from the CompariSon of Manual Aspiration with Rheolytic Thrombectomy in patients undergoing primary PCI (SMART) trial were evaluated. Underlying morphology of 64 culprit lesions was identifiable by OCT and included 37 lesions with plaque rupture, 25 lesions without plaque rupture, and 2 lesions with calcified nodules. Patients with plaque rupture tended to be younger (64 ± 12 versus 70 ± 10 years, P = 0 ...

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    7. Comparison of optical coherence tomography and intravascular ultrasound for evaluation of coronary lipid-rich atherosclerotic plaque progression and regression

      Comparison of optical coherence tomography and intravascular ultrasound for evaluation of coronary lipid-rich atherosclerotic plaque progression and regression

      Aims Compared with intravascular ultrasound (IVUS), optical coherence tomography (OCT) has relative merits and demerits for detecting plaque characteristics. It remains unknown whether the IVUS and OCT evaluations of plaque progression/regression are consistent. We sought to analyse the correlations between IVUS and OCT evaluations of plaques at single time points, and compare temporal changes in the IVUS and OCT data. Methods and results Eighty-eight lipid-rich plaques from 65 patients with coronary artery disease were analysed with IVUS and OCT at baseline and 12-month follow-up. Fibrous cap thickness on OCT was negatively correlated with total atheroma volume on IVUS ( r ...

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    8. Optical coherence tomography: guided primary percutaneous coronary intervention in acute myocardial infarction. A bridge too far?

      Optical coherence tomography: guided primary percutaneous coronary intervention in acute myocardial infarction. A bridge too far?

      Primary percutaneous coronary intervention (PCI) is associated with a certain risk of post-procedural ischemic complications. Therefore, stent implantation technique in the acute myocardial infarction settings should be optimal to improve short- and long-term clinical outcomes. Optical coherence tomography (OCT) is a light-based imaging modality with an excellent resolution that enables in vivo visualization of the coronary artery structures reported only by the pathohistological studies. Consequently, OCT should help the operator in decision-making throughout the whole primary PCI procedure. OCT seems particularly useful in evaluating culprit lesions, assessing thrombus burden, selecting a proper stent type and size, optimizing the post-implantation result ...

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      Mentions: Dariusz Dudek
    9. Neointimal coverage and late apposition of everolimus-eluting bioresorbable scaffolds implanted in the acute phase of myocardial infarction: OCT data from the PRAGUE-19 study

      Neointimal coverage and late apposition of everolimus-eluting bioresorbable scaffolds implanted in the acute phase of myocardial infarction: OCT data from the PRAGUE-19 study

      Incomplete stent apposition and uncovered struts are associated with a higher risk of stent thrombosis. No data exist on the process of neointimal coverage and late apposition status of the bioresorbable vascular scaffold (BVS) when implanted in the highly thrombogenic setting of ST-segment elevation acute myocardial infarction ( STEMI ). The aim of this study was to assess the serial changes in strut apposition and early neointimal coverage of the BVS using optical coherence tomography (OCT) in selected patients enrolled in the PRAGUE-19 study. Intracoronary OCT was performed in 50 patients at the end of primary percutaneous coronary intervention for acute STEMI ...

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    10. Acute Coronary Syndrome in Patients With Normal Coronary Arteries: An Optical Coherence Tomography Study

      Acute Coronary Syndrome in Patients With Normal Coronary Arteries: An Optical Coherence Tomography Study

      To the Editor, Acute coronary syndrome (ACS) in patients with normal coronary arteries has a prevalence of between 8% and 25%.1,2 Several mechanisms have been implicated in its etiopathogenesis, including coronary vasospasm, hypercoagulable states, and embolization.2 Coronary angiography can assess the extent of stenosis but not the state of atheromatous plaques. The technique is therefore of limited use when complicated plaques are present, particularly in the absence of significant lesions.3 Atherosclerotic plaques can, however, be characterized by optical coherence tomography (OCT).2,3 Previous studies with this technique in ACS have focused on characterizing the substrates ...

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    11. Serial optical coherence tomography of drug-eluting stent in-stent restenosis treated with the Absorb bioresorbable scaffold: an effective treatment?

      Serial optical coherence tomography of drug-eluting stent in-stent restenosis treated with the Absorb bioresorbable scaffold: an effective treatment?

      Severe drug-eluting stent in-stent restenosis (ISR) in the left anterior descending (LAD) artery was treated with a 3.0×28 mm Absorb bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, CA, USA). Seven-month scheduled angiography demonstrated no significant change with a fully patent treated LAD vessel with TIMI (Thrombolysis In Myocardial Infarction) 1 flow in the septal branch (Figure 1A) . Potential advantages of the Absorb BVS for the treatment of ISR include avoidance of multiple permanent metallic stent layers, limus-based drug elution, and allowances to treat disease beyond the stent margins. Seven-month optical coherence tomography demonstrated incomplete healing, with ...

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    12. Intravascular Imaging of Coronary Calcification and Its Clinical Implications

      Intravascular Imaging of Coronary Calcification and Its Clinical Implications

      Calcium impacts the natural history and treatment of coronary artery disease in many ways. Intravascular imaging studies, mostly intravascular ultrasound, but more recently studies using optical coherence tomography, have been instrumental in increasing our understanding of the relationship between calcium and coronary atherosclerosis, the predictors, the natural history of this relationship, and the impact on treatment. On one hand, stable coronary lesions are associated with more calcium than unstable lesions; and the amount of calcium may affect the success of percutaneous coronary intervention. On the other hand, calcium correlates with plaque burden; unstable lesions are associated with focal calcium deposits ...

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    13. Impact of drug-eluting balloon (pre- or post-) dilation on neointima formation in de novo lesions treated by bare-metal stent: the IN-PACT CORO trial

      Impact of drug-eluting balloon (pre- or post-) dilation on neointima formation in de novo lesions treated by bare-metal stent: the IN-PACT CORO trial

      The efficacy of DEB in modifying the high restenosis risk associated with BMS implantation is doubtful. Optical coherence tomography (OCT) may allow precise assessment of neointimal formation after stent implantation. We performed a single-center, prospective, 1:2 randomized trial comparing BMS implantation alone (BMS group) vs. additional DEB (DEB group). DEB patients were further randomized 1:1 to DEB before stenting (pre-DEB group), or after stenting (post-DEB group). Primary endpoint was OCT-assessed neointimal hyperplasia (expressed both as mean in-stent neointimal area and as percentage obstruction of the mean stent area) at 6 months. Secondary endpoints were the percentage of uncovered ...

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      Mentions: Francesco Prati
    14. Neoatherosclerosis causing edge in-stent restenosis: optical coherence tomography findings

      Neoatherosclerosis causing edge in-stent restenosis: optical coherence tomography findings

      A patient presenting with ‘edge’ in-stent restenosis 12 years after the implantation of a bare-metal stent in the mid-left anterior descending coronary artery is described. Optical coherence tomography disclosed the presence of ruptured neoatherosclerosis at the stent edge. The value of this imaging technique to unravel this unique underlying anatomic substrate is discussed. The therapy of choice for patients presenting with edge in-stent restenosis (ISR) is reviewed.

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      Mentions: Fernando Alfonso
    15. Early and late optical coherence tomography findings following everolimus-eluting bioresorbable vascular scaffold implantation in myocardial infarction: a preliminary report

      Early and late optical coherence tomography findings following everolimus-eluting bioresorbable vascular scaffold implantation in myocardial infarction: a preliminary report

      Introduction: Although bioresorbable vascular scaffolds (BVS) have been used with promising results in patients with stable and unstable angina, little is known about the acute vascular response following BVS implantation in myocardial infarction. We present angiographic and OCT findings from the first patients undergoing bioresorbable vascular scaffold (BVS) implantation for non-ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI) in our institution. Methods: The first 5 patients with NSTEMI and the first 5 patients with STEMI who underwent BVS implantation in our institution, followed by optical coherence tomography (OCT) imaging of the treated culprit vessel, were included in this series ...

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    16. UC Irvine Receives a 2015 NIH grant for Combined OCT/US/PAT System for Intravascular Imaging

      UC Irvine Receives a 2015 NIH grant for Combined OCT/US/PAT System for Intravascular Imaging

      University of California Irvine Receives a 2015 NIH grant for Combined OCT/US/PAT System for Intravascular Imaging. The principal investigator is Zhongping Chen. The program begain in 2015 and ends in 2019. Below is a summary of the propose work.

      Atherosclerosis is a progressive disease that is characterized by the accumulation of lipids, cholesterol, fibrous constituents, monocytes, and various other inflammatory cells in the arterial wall. Atherosclerosis is one of the major causes of morbidity and mortality in developed countries. The major cause of deaths from heart attacks (86%) and brain aneurysm (45%) are due to "vulnerable plaques" that ...

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    17. VA North Texas Health Care System Receives NIH Grant for Prasugrel for Prevention of Early Saphenous Vein Grant Thrombosis.

      VA North Texas Health Care System Receives NIH Grant for Prasugrel for Prevention of Early Saphenous Vein Grant Thrombosis.

      VA North Texas Health Care System Receives a 2015 NIH Grant for Prasugrel for Prevention of Early Saphenous Vein Grant Thrombosis. The principal investigator is Emmanouil Brilakis. The program began in 2012 and ends in 2016. Below is a summary of the proposed work. Early aortocoronary saphenous vein bypass graft (SVG) failure is common and is associated with high morbidity and mortality. Aspirin significantly reduces the incidence of early saphenous vein graft failure, whereas clopidogrel use provided conflicting results in small randomized studies. Prasugrel is a novel thienopyridine that provides more rapid, consistent, and intense platelet inhibition than clopidogrel. However ...

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    18. Texas Engineering Experiment Station Receives NIH Grant for Morphological and Molecular Imaging System for In Vivo Atherosclerosis Research

      Texas Engineering Experiment Station Receives NIH Grant for Morphological and Molecular Imaging System for In Vivo Atherosclerosis Research

      Texas Engineering Experiment Station Receives a 2015 NIH Grant for Morphological and Molecular Imaging System for In Vivo Atherosclerosis Research. The Principal invesigator is Brian Applegate. The program began in 2012 and ends in 2017. Below is a summary of the proposed work.

      Atherosclerosis is the leading cause of morbidity and mortality in the United States and is characterized as a systemic, progressive disease process in which the arterial wall thickens through a process of inflammation, oxidative stress, and dyslipidemia. This process leads to plaque formation and flow limitation in the vessel lumen. The sudden rupture of this arterial plaques ...

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    19. First Optical Coherence Tomography Follow-up of Coronary Bifurcation Lesions Treated by Drug-Eluting Balloons

      First Optical Coherence Tomography Follow-up of Coronary Bifurcation Lesions Treated by Drug-Eluting Balloons

      Background. A strategy of percutaneous bifurcation intervention with provisional bare-metal stent (BMS) implantation followed by drug-eluting balloon (DEB) treatment represents a valuable opportunity in patients not compliant with long-duration dual-antiplatelet therapy. We used optical coherence tomography (OCT) to assess coronary bifurcation lesions treated by BMS and DEB, and secondarily, to better explore the association between stent geometry and tissue coverage. Methods. Twelve patients underwent frequency-domain OCT 6 months after undergoing percutaneous bifurcation intervention with BMS implantation followed by kissing DEB. The same type of BMS was correspondingly implanted in silicone bifurcation models and scanned by microcomputed tomography. Results. Overall, a ...

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    20. Relationship Between Subclinical Cardiac Troponin I Elevation and Culprit Lesion Characteristics Assessed by Optical Coherence Tomography in Patients Undergoing Elective Percutaneous Coronary Intervention

      Relationship Between Subclinical Cardiac Troponin I Elevation and Culprit Lesion Characteristics Assessed by Optical Coherence Tomography in Patients Undergoing Elective Percutaneous Coronary Intervention

      Background— The prevalence of subclinical, cardiac troponin I (cTnI) elevation in stable patients undergoing elective percutaneous coronary intervention and its relationship to culprit lesion characteristics assessed by optical coherence tomography (OCT) are unknown. Methods and Results— We studied 206 native de novo culprit coronary lesions from 206 patients with stable angina pectoris who underwent OCT before elective percutaneous coronary intervention. Patients were divided into 2 groups according to the presence (cTnI group; n=47; 22.8%) or absence (non-cTnI group; n=159; 77.2%) of cTnI ≥0.03 ng/mL at admission. The clinical and OCT findings were compared between ...

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    21. Slow-Flow Phenomenon After Paclitaxel-Coated Balloon Angioplasty: Findings From Optical Coherence Tomography and Coronary Angioscopy

      Slow-Flow Phenomenon After Paclitaxel-Coated Balloon Angioplasty: Findings From Optical Coherence Tomography and Coronary Angioscopy

      In case 1, a 60-year-old man underwent a 4.0-mm × 12-mm bare-metal stent (BMS) implantation in the proximal left anterior descending coronary artery. Six months after BMS implantation, a coronary angiogram demonstrated in-stent restenosis (ISR) at the proximal portion of the stent (Figure 1 ). Frequency-domain optical coherence tomography (FD-OCT) revealed homogeneous neointima (Figure 1 ) and coronary angioscopy (CAS) revealed white neointimal coverage at the ISR site (Figure 1 ). The lesion was dilated using a 3.5 × 13-mm conventional balloon catheter at 16 atm. After balloon angioplasty, Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was achieved, and intracoronary electrocardiography did ...

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    22. Endovascular therapy for fibromuscular dysplasia of the bilateral external iliac arteries visualized with optical coherence tomography

      Endovascular therapy for fibromuscular dysplasia of the bilateral external iliac arteries visualized with optical coherence tomography

      Background : Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic, degenerative vascular disease that most frequently affects renal and carotid arteries in women aged 30–50 years, and rarely complicating arteries of the lower limbs. Case Report : A 60-year-old woman was admitted with intermittent claudication of both legs. We performed pelvic and bilateral lower-extremities angiography, which revealed that the bilateral external iliac arteries (EIAs) had the ‘string of beads’ appearance with a diagnosis of FMD. Endovascular therapy (EVT) was performed for the bilateral EIAs. Optical coherence tomography (OCT) images showed thickening and thinning of the middle layer, while three-dimensional OCT images showed ...

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    23. One-year coverage by optical coherence tomography of a bioresorbable scaffold neocarina: is it safe to discontinue dual antiplatelet therapy?

      One-year coverage by optical coherence tomography of a bioresorbable scaffold neocarina: is it safe to discontinue dual antiplatelet therapy?

      This is a case reporting on the 1-year coverage status of side-branch bioresorbable vascular scaffold (BVS) struts protruding in main vessels. The 1-year optical coherence tomography demonstrated a tissue neocarina forming over protruding BVS struts, although the coverage was widely inhomogeneous and perhaps still incomplete in some portions, thus leading to cautious extension of dual antiplatelet therapy beyond one year.

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