1. Articles in category: Cardiology

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    1. Twenty-four months follow-up of a “biodegradable” model for coronary artery bifurcations management. Insights from optical coherence tomography of a new interventional strategy

      Twenty-four months follow-up of a “biodegradable” model for coronary artery bifurcations management. Insights from optical coherence tomography of a new interventional strategy

      A 53-year-old smoker, hypertensive male was admitted at our Department for an acute coronary syndrome. Echocardiography showed an anteroseptal ipokinesia of the left ventricular wall with mild reduction of the ejection fraction (48%). Coronarography showed a complex Medina-type 1,1,1 bifurcation lesion with subocclusion of the left anterior descending artery (LAD) involving the first-diagonal branch (DIA1) (Fig. 1A, B). After predilatation with a 2.0 mm balloon on DIA1 and a 3.0 mm on mid-LAD, we implanted a 3.5/18 mm bioresorbable vascular scaffold (BVS-Absorb, Abbott, US) on the LAD.

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    2. Highmark Health’s VITAL Program to Evaluate Avinger’s Novel Treatment for Peripheral Artery Disease

      Highmark Health’s VITAL Program to Evaluate Avinger’s Novel Treatment for Peripheral Artery Disease

      Highmark Health, Allegheny Health Network (AHN) andAvinger, Inc. (NASDAQ:AVGR) announced a collaboration today to evaluate Pantheris™, Avinger’s novel image-guided atherectomy device for the treatment of peripheral artery disease (PAD). The partnership is part of Highmark Health’s VITAL (Verification of Innovation by Testing, Analysis and Learning) Innovation Program. Pantheris, which recently received 510(k) clearance from the United States Food & Drug Administration (FDA), represents an important leap forward in atherectomy, a minimally invasive treatment for PAD in which a catheter-based device is used to remove plaque from a blood vessel. Lumivascular technology utilized in the Pantheris system allows ...

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      Mentions: FDA Avinger
    3. Angiographically intermediate left main bifurcation disease assessment by frequency domain optical coherence tomography (FD-OCT)

      Angiographically intermediate left main bifurcation disease assessment by frequency domain optical coherence tomography (FD-OCT)

      High-risk atherosclerotic plaques as thin cap fibroatheroma (TCFA) are frequently located in coronary regions with low shear stress [1,2], as coronary bifurcation and in particular left main (LM) bifurcation [3]. Previous invasive imaging studies on LM plaque characterization by intravascular ultrasound (IVUS) reported that LM carina is usually spared and that the disease is generally extended from LM into the distal branches [4]. Frequency domain-optical coherence tomography (FD-OCT) is a high resolution imaging modality that allows high-quality visualization of inner vessel wall structure and accurate measurement of vascular microstructures such as the fibrous cap [5].

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    4. A new novolimus-eluting bioresorbable scaffold for large coronary arteries: an OCT study of acute mechanical performance

      A new novolimus-eluting bioresorbable scaffold for large coronary arteries: an OCT study of acute mechanical performance

      Aims To evaluate the acute performance of a novolimus-eluting bioresorbable scaffold (BRS) with a nominal diameter of 4.0 mm (DESolve® XL) using optical coherence tomography (OCT) in terms of appropriate scaffold deployment. Methods and results Ten patients (55.6% male, mean age 60.0 y) undergoing OCT-guided scaffold implantation were enrolled consecutively in this retrospective study. Using data from the final pullback, the following indexes were calculated: mean and minimum area, residual area stenosis, incomplete strut apposition, tissue prolapse, eccentricity and symmetry indexes, strut fracture, and edge dissection. The clinical indication for the procedure was acute coronary syndrome in ...

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    5. Optical Coherence Tomography of De Novo Lesions and In-Stent Restenosis in Coronary Saphenous Vein Grafts (OCTOPUS Study)

      Optical Coherence Tomography of De Novo Lesions and In-Stent Restenosis in Coronary Saphenous Vein Grafts (OCTOPUS Study)

      Background: The OCTOPUS registry prospectively evaluates the procedural and long-term outcomes of saphenous vein graft (SVG) PCI. The current study assessed the morphology of de novo lesions and in-stent restenosis (ISR) in patients undergoing PCI of SVG. Methods and Results: Optical coherence tomography (OCT) of SVG lesions in consecutive patients presenting with stable CAD and ACS was carried out. Thirty-nine patients (32 de novo and 10 ISR lesions) were included in the registry. ISR occurred in 5 BMS and 5 DES. There were no differences in the presence of plaque rupture and thrombus between de novo lesions and ISR. Lipid-rich ...

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    6. Impact of chronic kidney disease stages on atherosclerotic plaque components on optical coherence tomography in patients with coronary artery disease

      Impact of chronic kidney disease stages on atherosclerotic plaque components on optical coherence tomography in patients with coronary artery disease

      The progression of coronary atherosclerosis has been influenced by the presence of chronic kidney disease (CKD). This study investigated the impact of CKD stages on coronary plaque components observed on optical coherence tomography (OCT). We investigated 296 native coronary lesions with stable angina pectoris treated with stent implantation. All lesions were divided into the three groups according to the values of estimated glomerular filtration rate (eGFR, mL min −1 1.73 m −2 ): the non-CKD group (eGFR ≥60, n = 142), CKD group (15 ≤ eGFR < 60, n = 126), and end-stage kidney disease (ESKD) group (eGFR <15 and/or hemodialysis, n = 28 ...

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    7. In-stent accordion phenomenon

      In-stent accordion phenomenon

      A 60-year-old female underwent successful stenting of the proximal to distal right coronary artery (RCA). Follow-up angiography was performed 16 months after the index procedure. It revealed moderate in-stent restenosis in the mid-RCA (Fig. 1A). Optical coherence tomography (OCT) was performed to evaluate it. After insertion of the guidewire (SION blue, Asahi Intecc, Nagoya, Japan) into the distal RCA, a short-segment stenosis appeared in the proximal RCA where zotarolimus-eluting stents (Resolute integrity, Medtronic, Minneapolis, MN) were implanted (Fig.

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    8. Everolimus-Eluting Bioresorbable Vascular Scaffolds implanted in Coronary Bifurcation Lesions

      Everolimus-Eluting Bioresorbable Vascular Scaffolds implanted in Coronary Bifurcation Lesions

      Background Limited data are available on bioresorbable vascular scaffolds (BVS) performance in bifurcations lesions and on the impact of BVS wider struts on side-branch impairment. Methods Patients with at least one coronary bifurcation lesion involving a side-branch ≥2 mm in diameter and treated with at least one BVS were examined. Procedural and angiographic data were collected and a dedicated methodology for off-line quantitative coronary angiography (QCA) in bifurcation was applied (eleven-segment model), to assess side-branch impairment occurring any time during the procedure. Two- and three-dimensional QCA was used. Optical coherence tomography (OCT) analysis was performed in a subgroup of patients ...

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    9. Coronary plaque rupture with subsequent thrombosis typifies the culprit lesion of non-ST-segment-elevation myocardial infarction, not unstable angina: non-ST-segment-elevation acute coronary syndrome study

      Coronary plaque rupture with subsequent thrombosis typifies the culprit lesion of non-ST-segment-elevation myocardial infarction, not unstable angina: non-ST-segment-elevation acute coronary syndrome study

      Recently, unstable angina pectoris (UAP) and non-ST-segment-elevation myocardial infarction (NSTEMI) have been considered together because they exhibit indistinguishable clinical and electrocardiogram features, and constitute non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). However, no optical coherence tomography (OCT) studies have reported the association between vulnerable plaque morphology and clinical characteristics in NSTE-ACS patients based on assessment of clinical symptoms and myocardial necrosis. The aim of this study was to investigate the differences in clinical characteristics and plaque morphology assessed by OCT between patients with UAP and NSTEMI. Preinterventional OCT images of 84 NSTE-ACS patients were studied, 19 with NSTEMI and 65 with UAP ...

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    10. Prevalence of parameters of suboptimal scaffold deployment following angiographic guided bioresorbable vascular scaffold implantation in real world practice - an optical coherence tomography analysis

      Prevalence of parameters of suboptimal scaffold deployment following angiographic guided bioresorbable vascular scaffold implantation in real world practice - an optical coherence tomography analysis

      Aim To assess the prevalence of suboptimal bioresorbable vascular scaffold (BVS, Abbott Vascular, Santa Clara, California) deployment in real world practice with intracoronary optical coherence tomography (OCT) imaging. Methods Consecutive patients who underwent percutaneous coronary intervention using BVS and the final optimization assessed with OCT imaging in two tertiary care centers between December 2012 and February 2015 were evaluated for parameters of suboptimal scaffold deployment by OCT. Results Overall, 36 scaffolds were implanted in 27 patients during this period. Mean age of the population was 54.7 ± 8.2 years and 19 (70.4%) were type B2/C lesions. The ...

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    11. Angiographically minimal but functionally significant coronary lesion confirmed by optical coherence tomography

      Angiographically minimal but functionally significant coronary lesion confirmed by optical coherence tomography

      A 48-year-old man visited our hospital due to exertional chest pain. His resting electrocardiogram exhibited a T wave inversion in the inferior leads. A transthoracic echocardiogram showed a preserved left ventricular systolic function without any regional wall motion abnormalities. Multi-detector computed tomography was performed to evaluate the existence of any coronary artery disease and it revealed a significant stenosis in the right coronary artery; however, there was a minimal atherosclerotic lesion in the left coronary artery (Fig. 1A). The right coronary angiogram showed a significant stenosis in the mid portion of the right coronary artery and percutaneous coronary intervention for ...

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    12. Assessment of Coronary Artery Lesion Using Optical Coherence Tomography Versus IntraVascular Ultrasound for BiorEsorbable Vascular Scaffold Implantation

      Assessment of Coronary Artery Lesion Using Optical Coherence Tomography Versus IntraVascular Ultrasound for BiorEsorbable Vascular Scaffold Implantation

      The primary objective is to determine whether IVUS- (vs. OCT-) guided BVS implantation is non-inferior to achieve a large in-scaffold minimal lumen area (primary endpoint) measured by OCT at 1-year follow-up.

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    13. Guidewire shadow artifacts in optical coherence tomography

      Guidewire shadow artifacts in optical coherence tomography

      BACKGROUND: Because of the high resolution made possible by optical coherence tomography (OCT), previously indistinguishable guidewire artifacts are recognized during coronary imaging, and these affect image interpretation. This study aimed to assess the effect of guidewire size and structure on the artifacts produced and to introduce a novel guidewire specifically for OCT imaging that produces fewer artifacts. Elimination or minimization of guidewire artifacts supports optimal OCT imaging. METHODS: Silicon tubes simulating the coronary arteries were used to assess guidewire shadow artifacts in OCT imaging. The angles of artifacts produced by 4 types of guidewires were evaluated, including our newly designed ...

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    14. Evaluation of the characterization of thrombi in vitro by optical coherence tomography

      Evaluation of the characterization of thrombi in vitro by optical coherence tomography

      Aim The purpose of this study was to provide a new assessable method of the optical coherence tomography (OCT) in characterization of thrombi with different concentrations of red blood cell (RBC). Methods and results A series of thrombus models were constructed by using human blood in vitro. The thrombi were made by using human blood with different concentration of RBC (from 1% to 35%). Then tip of an FD-OCT catheter was put on the top of the thrombus to scan. After OCT being performed, all the acquired images were processed by a newly developed software to analyze the RBC levels ...

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    15. Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients

      Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients

      Objectives To determine security and benefits of high pressure postdilatation (HPP) of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) of complex lesions whatever its indication is. Background Acute scaffold disruption has been proposed as the main limitation of BVS when they are overexpanded. However, clinical implications of this disarray are not yet clear and more evidence is needed. Methods A total of 25 BVS were deployed during PCI of 14 complex lesions after mandatory predilatation. In all cases HPP was performed with NC balloon in a 1:1 relation to the artery. After that, optical coherence tomography (OCT ...

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    16. Estimation of the flow resistances exerted in coronary arteries using a vessel length-based method

      Estimation of the flow resistances exerted in coronary arteries using a vessel length-based method

      Flow resistances exerted in the coronary arteries are the key parameters for the image-based computer simulation of coronary hemodynamics. The resistances depend on the anatomical characteristics of the coronary system. A simple and reliable estimation of the resistances is a compulsory procedure to compute the fractional flow reserve (FFR) of stenosed coronary arteries, an important clinical index of coronary artery disease. The cardiac muscle volume reconstructed from computed tomography (CT) images has been used to assess the resistance of the feeding coronary artery (muscle volume-based method). In this study, we estimate the flow resistances exerted in coronary arteries by using ...

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    17. Acute stent recoil and optimal balloon inflation strategy: an experimental study using real-time optical coherence tomography

      Acute stent recoil and optimal balloon inflation strategy: an experimental study using real-time optical coherence tomography

      Aims: Our aim was to evaluate stent expansion and acute recoil at deployment and post-dilatation, and the impact of post-dilatation strategies on final stent dimensions. Methods and results: Optical coherence tomography (OCT) was performed on eight bare metal platforms of drug-eluting stents (3.0 mm diameter, n=6 for each) during and after balloon inflation in a silicone mock vessel. After nominal-pressure deployment, a single long (30 sec) vs. multiple short (10 sec x3) post-dilatations were performed using a non-compliant balloon (3.25 mm, 20 atm). Stent areas during deployment with original delivery systems were smaller in stainless steel stents ...

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    18. Matrix Metalloproteinase-9 as a Marker for Plaque Rupture and a Predictor of Adverse Clinical Outcome in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study

      Matrix Metalloproteinase-9 as a Marker for Plaque Rupture and a Predictor of Adverse Clinical Outcome in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study

      Objectives: The present study sought to clarify the relationship between matrix metalloproteinase-9 (MMP-9) levels and plaque morphology demonstrated by optical coherence tomography (OCT), and to examine their prognostic impacts in patients with acute coronary syndrome (ACS). Methods: MMP-9 levels were measured for patients with ACS (n = 249). Among 249 patients, 120 with evaluable OCT images were categorized into patients with ruptured plaques (n = 65) and those with nonruptured plaques (n = 55) on the basis of culprit lesion plaque morphology demonstrated by OCT. Results: MMP-9 levels on admission were significantly higher in the rupture group than in the nonrupture group (p ...

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    19. Dynamic single gold nanoparticle visualization by clinical intracoronary optical coherence tomography

      Dynamic single gold nanoparticle visualization by clinical intracoronary optical coherence tomography

      The potential use of Gold Nanoparticles (GNPs) as contrast agents for clinical intracoronary frequency domain Optical Coherence Tomography (OCT) is here explored. The OCT contrast enhancement caused by GNPs of different sizes and morphologies has been systematically investigated and correlated with their optical properties. Among the different GNPs commercially available with plasmon resonances close to the operating wavelength of intracoronary OCT (1.3 µm), Gold Nanoshells (GNSs) have provided the best OCT contrast due to their largest scattering cross section at this wavelength. Clinical intracoronary OCT catheters are here demonstrated to be capable of three dimensional visualization and real-time tracking ...

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      Mentions: Fernando Alfonso
    20. Massachusetts General Hospital Receives NIH Grant for Cardiac MRI-Tractography In Vivo: Integrated Imaging of Structure and Function

      Massachusetts General Hospital Receives NIH Grant for Cardiac MRI-Tractography In Vivo: Integrated Imaging of Structure and Function

      Massachusetts General Hospital Receives a 2016 NIH Grant for $742,986 for Cardiac MRI-Tractography In Vivo: Integrated Imaging of Structure and Function. The principal investigator is David Sosnovik. The program began in 2013 and ends in 2017. Below is a summary of the proposed work. Pressure overload of the left and right ventricles initially leads to adaptive hypertrophy. This, however, is frequently followed by maladaptive hypertrophy, heart failure and death. We hypothesize here that changes in 3D myocardial fiber architecture play a significant role in the deleterious transition from adaptive to maladaptive hypertrophy and heart failure. We further hypothesize that ...

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