1. Articles in category: Cardiology

    1-24 of 4360 1 2 3 4 ... 180 181 182 »
    1. Diagnosis of Intraplaque Hemorrhage by High-Definition Intravascular Ultrasound and Optical Coherence Tomography

      Diagnosis of Intraplaque Hemorrhage by High-Definition Intravascular Ultrasound and Optical Coherence Tomography

      A 67-year-old woman, a heavy smoker and with hypothyroidism, presented with a non–STsegment elevation myocardial infarction with negative T waves on the inferior leads. Coronary angiography revealed a focal stenosis in the mid right coronary artery (arrow in Figure 1A) but no other coronary lesions. High-definition (60-MHz) intravascular ultrasound (IVUS) (ACIST Medical Systems, Eden Prairie, Minnesota) revealed a large hyperechoic noncalcific plaque encompassing a well-delineated, crescent-shaped area showing a striking hypoechogenicity (echolucent “black” area) (yellow asterisks in Figures 1B and 1C [white asterisk denotes wire artifact]). The immediately adjacent plaque had a more reflective pattern with marked speckling (Figures ...

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      Mentions: Fernando Alfonso
    2. The frequency and clinical characteristics of in-stent restenosis due to calcified nodule development after coronary stent implantation

      The frequency and clinical characteristics of in-stent restenosis due to calcified nodule development after coronary stent implantation

      The purpose of this study was to evaluated the clinical characteristics of calcified nodule-like in-stent restenosis (ISR) lesions using optical coherence tomography (OCT) in vivo. A total of 124 ISR lesions that were treated with a repeat coronary intervention under OCT guidance were included in this analysis. ISR neointimal morphology was classified as “calcified nodule-like ISR”, that appeared as a high-backscattering protruding mass with an irregular surface covered by signal-rich bands, or “non-calcified nodule-like ISR”. The maximum arc and thickness of calcium behind the stent struts was also measured. Of the 124 ISR lesions, calcified nodule-like ISR was observed in ...

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      Mentions: Kenichi Fujii
    3. Idiopathic ventricular fibrillation or myocardial infarction? Impact of optical coherence tomography on therapeutic decisions

      Idiopathic ventricular fibrillation or myocardial infarction? Impact of optical coherence tomography on therapeutic decisions

      A female patient (47 years old) was referred from a district hospital for Implantable Cardioverter-Defibrillator (ICD) insertion as secondary prevention. Cardiac arrest occurred one week earlier in the course of ventricular fibrillation with an effective defibrillation. It was preceded by the chest pain. ECG showed elevation of ST-segment in inferior leads. Coronary angiography exam did not show stenosis of coronary vessels (Fig. 1A, 1B, 1C). Her medical history revealed mitral and tricuspid valve surgery related to insufficiency 10 years before. No risk factors of ischemic heart disease. While hospitalized she underwent echocardiography, which found akinesis of the basal inferior wall ...

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    4. https://doi.org/10.1093/eurheartj/ehaa632

      https://doi.org/10.1093/eurheartj/ehaa632

      A 56-year-old man with stable angina pectoris underwent implantation of a 3.5 mm × 28-mm Absorb bioresorbable vascular scaffold (BVS; Abbott Vascular, Santa Clara, CA, USA) in the left anterior descending coronary artery ( Panels A and B ). Optical coherence tomography (OCT) before ( Panel E ) and after implantation ( Panel F ) showed significant signal attenuation at the culprit site suggesting lipid-rich plaque, and fully apposed BVS struts ( Panel F and Supplementary material online , Video S1 ). Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel continued for a year, followed by aspirin monotherapy. Follow-up angiography after 2 years showed a patent, scaffolded segment...

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    5. Rediscover a Missed Culprit Lesion with Optical Coherence Tomography in Acute Coronary Syndrome: a Simple Stationary Pullback Method

      Rediscover a Missed Culprit Lesion with Optical Coherence Tomography in Acute Coronary Syndrome: a Simple Stationary Pullback Method

      A 54-year-old male was admitted to the hospital due to severe chest pain. He suffered from diabetes mellitus for 20 years and was an ex-smoker. The 12 leads electrocardiography showed ST-segment elevation in inferior leads. High sensitivity troponin level was elevated, and underwent coronary angiography. The echocardiogram showed basal inferior hypokinesia with normal left ventricular systolic function. The coronary angiography demonstrated an insignificant stenosis with vague plaque ulceration at the proximal portion of right coronary artery ( Figure 1A , asterisk). The automatic motorized pullback of optical coherence tomography (OCT) was performed at 10 mm/sec with simultaneous injection of a contrast ...

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    6. Z-shape phenomenon of optical coherence tomography catheter: potential cause of coronary perforation

      Z-shape phenomenon of optical coherence tomography catheter: potential cause of coronary perforation

      A 75-year-old female underwent coronary intervention with rotational atherectomy (RA) due to severely calcified lesions in the left anterior descending artery (Panel A , yellow arrows). After RA with a 1.5 mm burr, multiple cracks were successfully created without any complications (Panel B ). To optimize stent deployment in the calcified lesion, we attempted to use optical coherence tomography (OCT). Despite effective lesion modification and support of a guide extension catheter, an OCT catheter (Dragonfly OPTIS, Abbott Vascular, Santa Clara, CA, USA) could not advance through the lesion with its lens part bent toward a side branch (Panel C , a white ...

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    7. Optical Coherence Tomography for the Diagnosis of Exercise-Related Acute Cardiovascular Events and Inconclusive Coronary Angiography

      Optical Coherence Tomography for the Diagnosis of Exercise-Related Acute Cardiovascular Events and Inconclusive Coronary Angiography

      Objectives . The aim of this study is to assess the utility of optical coherence tomography (OCT) in patients with exercise-related acute coronary syndrome (ACS) presenting with inconclusive angiographic findings. Background . Regular physical activity reduces the incidence of cardiovascular events. Nevertheless, the risk of ACS or sudden cardiac death (SCD) increases during sport. In adults older than 35 years, exercise-related ACS or SCD is associated with plaque rupture, but not infrequently patients present ambiguous angiographic findings. Methods . Between September 2015 and January 2020, patients admitted for ACS or SCD triggered by physical exertion and with coronary stenosis ≤50% were included in ...

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    8. Prognostic impact of healed coronary plaque in non-culprit lesions assessed by optical coherence tomography

      Prognostic impact of healed coronary plaque in non-culprit lesions assessed by optical coherence tomography

      Background and Aims We sought to investigate the characteristics and prognostic impact of healed plaque (HP) detected by optical coherence tomography (OCT) in non-culprit segments in treated vessels. Methods OCT analysis included HP having a different optical intensity with clear demarcation from underlying plaque, thin-cap fibroatheroma (TCFA), and minimal lumen area. Non-culprit lesion (NCL) was defined as a plaque with >90º arc of disease (≥0.5mm intimal thickness), length ≥2 mm, and location >5 mm from the stent edges. Major adverse cardiac event (MACE) included cardiac death, myocardial infarction (MI), or ischemia-driven revascularization (IDR). Results We studied a total of ...

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    9. Unexpected Findings and Tailored Treatments of In-Stent Restenosis: Novel Insights from Optical Coherence Tomography

      Unexpected Findings and Tailored Treatments of In-Stent Restenosis: Novel Insights from Optical Coherence Tomography

      A 68-year-old man was admitted to our hospital with unstable angina. His medical history was remarkable for an acute myocardial infarction one year ago, treated with a zotarolimus-eluting stent (3.5×30 mm) in the mid right coronary artery. Coronary angiography showed a diffused in-stent restenosis (ISR) with haziness and filling defects (Figure 1A, Video 1). In order to identify the underlying mechanisms of ISR, optical coherence tomography (OCT) was performed due to its high resolution. OCT showed a large, recanalized thrombus with multiple channels divided by thin septa (longitudinal view and Figure 1C-1E) in the setting of an undersized ...

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    10. Assessment of the conventional radial artery with optical coherent tomography after the snuffbox approach

      Assessment of the conventional radial artery with optical coherent tomography after the snuffbox approach

      Background: This study aimed to evaluate acute injuries of the radial artery (RA) using optical coherence tomography (OCT) in patients who underwent coronary intervention via the snuffbox approach. Methods: Forty-six patients, who underwent coronary intervention and assessment of the conventional RA using OCT via the snuffbox approach, were enrolled from two university hospitals between August 2018 and August 2019. Results: The mean age of the patients was 65.1 years. In this study population, 6-French (Fr) sheaths were used. The mean diameter of the conventional RA was 2.89 ± 0.33 mm, and the mean lumen area of the conventional ...

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    11. Atherosclerotic Plaque Tissue Characterization: An OCT-Based Machine Learning Algorithm With ex vivo Validation

      Atherosclerotic Plaque Tissue Characterization: An OCT-Based Machine Learning Algorithm With ex vivo Validation

      There is a need to develop a validated algorithm for plaque characterization which can help to facilitate the standardization of optical coherence tomography (OCT) image interpretation of plaque morphology, and improve the efficiency and accuracy in the application of OCT imaging for the quantitative assessment of plaque vulnerability. In this study, a machine learning algorithm was implemented for characterization of atherosclerotic plaque components by intravascular OCT using ex vivo carotid plaque tissue samples. A total of 31 patients underwent carotid endarterectomy and the ex vivo carotid plaques were imaged with OCT. Optical parameter, texture features and relative position of pixels ...

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    12. Optical Coherence Tomography Facilitating Early Withdrawal of Antiplatelet Agents in a High–Bleeding Risk Patient

      Optical Coherence Tomography Facilitating Early Withdrawal of Antiplatelet Agents in a High–Bleeding Risk Patient

      Optical coherence tomography (OCT) can guide percutaneous coronary interventions to optimize results, thus minimizing the risk of stent thrombosis. We present the case of a cancer patient, paroxysmal atrial fibrillation, and unstable angina who underwent OCT–guided complex percutaneous coronary intervention and who required early discontinuation of antiplatelet therapy because of major bleeding. 

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    13. Looking in the mirror: An unusual optical coherence tomography image

      Looking in the mirror: An unusual optical coherence tomography image

      A 75-year-old male underwent primary angioplasty of a subocclusive proximal to medial left anterior descending artery (LAD) stenosis, involving the origin of the first diagonal (D1). A provisional stenting technique was used, with two guidewires in the distal LAD and D1 and implantation of 3 mm×30 mm and 2.75 mm×28 mm drug-eluting stents (DES) in the LAD. Withdrawal of the jailed D1 guidewire caused a deep intubation of the guide catheter into the LAD. The subsequent angiogram was notable for a suspicious haziness proximal to the stents ( Figure 1 A , arrow). We decided to perform optical coherence ...

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    14. Effect of Transcatheter Aortic Valve Replacement on Retinal Layer Thickness Measured by Optical Coherence Tomography

      Effect of Transcatheter Aortic Valve Replacement on Retinal Layer Thickness Measured by Optical Coherence Tomography

      Transcatheter aortic valve replacement (TAVR) is associated with clinically significant cerebral microembolism and cognitive status changes. There are no data on the impact of TAVR on retinal layers. We assessed the influence of TAVR on the retinal nerve fiber layer, ganglion cell complex (GCC), and macular thickness (MT) measured by spectral domain optical coherence tomography (SD-OCT). Elderly patients (n = 50) with severe aortic stenosis undergoing TAVR were included in this study (mean age: 78.5 ± 6.9 years). Retinal nerve fiber layer, GCC, and MT were measured with SD-OCT by an ophthalmologist before and on the first day and in ...

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    15. Role of Intravascular Imaging in the Diagnosis and Treatment of Spontaneous Coronary Artery Dissection

      Role of Intravascular Imaging in the Diagnosis and Treatment of Spontaneous Coronary Artery Dissection

      Purpose of Review The objective of this article is to review the role of intracoronary imaging in the management of patients with spontaneous coronary artery dissection (SCAD). In this review article, we discuss the types of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) and their relative strengths and weaknesses. Additionally, we discuss in detail the findings on IVUS and OCT and how these modalities can be used for optimization of percutaneous coronary intervention (PCI) in SCAD cases. Recent Findings While coronary angiography is the first-line investigation for diagnosis of SCAD, it remains inconclusive in a considerable ...

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    16. Left anterior descending artery dissection: a rare sequela of blunt chest trauma

      Left anterior descending artery dissection: a rare sequela of blunt chest trauma

      Traumatic coronary artery (CA) dissection is an extremely rare sequela of blunt chest trauma. Diagnosis of CA dissection in the setting of chest trauma is challenging. While conventionally coronary angiography has been the diagnostic tool of choice, modern imaging techniques such as optical coherence tomography can further improve diagnostic accuracy and help optimise treatment strategy. The ideal treatment modality for managing CA dissection has not been established with case reports revealing a range of treatment strategies ranging from CA bypass grafting to a completely conservative management. Here we present a case report of a 68‐year‐old man who suffered ...

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    17. Comparison between different approaches to evaluate fibrous cap thickness in sequential OCT studies

      Comparison between different approaches to evaluate fibrous cap thickness in sequential OCT studies

      BACKGROUND: In this in vivo human study we tested the reproducibility for optical coherence tomography (OCT) assessment of lumen area (LA) and plaque components measurements, such as lipid arc extension and fibrous cap thickness (FCt). METHODS: We tested the variability of LA, lipid arc and FCt assessments in two repeated OCT pullbacks from the same diseased coronary segment matched using fiduciary anatomical landmarks. In particular, for the reliability of minimal FCt measurement we compared four different approaches based on continuous (longitudinal) or segmental (spot) individuation of smaller thickness: 1) comparison of single minimal FCt individuated alongside all plaque extension in ...

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      Mentions: Francesco Prati
    18. Optical coherence tomography predictors of target vessel myocardial infarction after provisional stenting in patients with coronary bifurcation disease

      Optical coherence tomography predictors of target vessel myocardial infarction after provisional stenting in patients with coronary bifurcation disease

      Background Provisional side branch (SB) stenting is correlated with target vessel myocardial infarction (TVMI) in patients with coronary bifurcation lesions. However, the mechanisms underlying this association remain unknown. Objectives To determine the correlation between SB lesion length with vulnerable plaques and TVMI using optical coherence tomography (OCT). Background The correlation between SB lesion length with vulnerable plaques and TVMI is unknown. Methods A total of 405 patients with 405 bifurcation lesions who underwent preprocedure OCT imaging of both the main vessel (MV) and the SB were enrolled. Patients were divided into long SB lesion (SB lesion length ≥10 mm) and ...

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    19. Optical coherence tomography assessment of macrophages accumulation in non-ST-segment elevation acute coronary syndromes

      Optical coherence tomography assessment of macrophages accumulation in non-ST-segment elevation acute coronary syndromes

      Aims To investigate in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) the prevalence and the features of optical coherence tomography (OCT)-detected macrophages accumulation in culprit plaques as compared with nonculprit plaques (NCP). Methods The study is a post-hoc analysis of a prospective study aimed at evaluating the relationship between aortic inflammation as assessed by 18 F-fluorodeoxyglucose-PET and features of coronary plaque vulnerability as assessed by OCT. We enrolled 32 patients with first NSTE-ACS who successfully underwent three-vessel OCT. Results The median age was 65 (54–72) years and 27 patients (84%) were men. Culprit plaques were clinically defined ...

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    20. Circadian variations in pathogenesis of ST-segment elevation myocardial infarction: an optical coherence tomography study

      Circadian variations in pathogenesis of ST-segment elevation myocardial infarction: an optical coherence tomography study

      Previous studies have reported a circadian variation in the onset of ST-segment elevation myocardial infarction (STEMI). However, underlying mechanisms for the circadian variation have not been fully elucidated. We investigated the relationship between onset of STEMI and the underlying pathology using optical coherence tomography (OCT). Patients with a diagnosis of STEMI were selected from a multicenter OCT registry. Patients were divided into 4 groups based on the estimated time of onset (00:00–05:59, 06:00–11:59, 12:00–17:59, or 18:00–23:59). Underlying pathologies of MI (plaque rupture, plaque erosion, and calcified plaque) were ...

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    21. Nonculprit Lesion Plaque Morphology in Patients With ST-Segment–Elevation Myocardial Infarction: Results From the COMPLETE Trial Optical Coherence Tomography Substudys

      Nonculprit Lesion Plaque Morphology in Patients With ST-Segment–Elevation Myocardial Infarction: Results From the COMPLETE Trial Optical Coherence Tomography Substudys

      Background: Complete revascularization with routine percutaneous coronary intervention of nonculprit lesions after primary percutaneous coronary intervention improves outcomes in ST-segment–elevation myocardial infarction. Whether this benefit is associated with nonculprit lesion vulnerability is unknown. Methods: In a prospective substudy of the COMPLETEs trial (Complete vs Culprit-Only Revascularization to Treat Multi-Vessel Disease After Early PCI for STEMI), we performed optical coherence tomography of at least 2 coronary arteries before nonculprit lesion percutaneous coronary intervention in 93 patients with ST-segment–elevation myocardial infarction and multivessel disease; and the ST-segment–elevation myocardial infarction culprit vessel if there was unstented segment amenable to imaging ...

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