A 43-year-old man presented to his cardiologist’s office with a history of exertion-related chest pain. His past medical history included type 2 diabetes mellitus, hypercholesterolemia, smoking, and a family history of coronary artery disease. His physical examination was normal. After positive exercise-induced chest discomfort, the patient underwent coronary computed tomography angiography (CCTA), which showed marked and diffuse calcified coronary plaques (calcium score, 2011 HU; >90th percentile for age) and severe stenosis in the proximal right coronary artery (RCA) (Figure 1A). He was referred to our catheterization laboratory for an elective coronary angiogram, which confirmed proximal and mid RCA stenoses ...

A 70-year-old man presented with lifestyle-limiting intermittent claudication (Rutherford stage III) affecting the right lower extremity. Physical examination of the right lower limb revealed weak distal pulses and a diminished ankle-brachial index of 0.6. Peripheral angiogram showed diffuse 80% stenosis over the right distal superficial femoral artery (SFA). The HawkOne directional atherectomy system (Medtronic Peripheral) was used to restore blood flow by removing plaque. After placing a 7 mm SpiderFX device (Medtronic Peripheral), optical coherence tomography (OCT) was acquired to assess baseline plaque load (Figure 1). Several runs of directional atherectomy were done. Angiogram and OCT were then obtained ...

A 32-year-old female with elevated body mass index and no prior medical history presented with acute-onset central chest pain radiating to both arms. Electrocardiogram showed biphasic T-waves in the anterior leads and troponin level was elevated. Echocardiogram demonstrated preserved left ventricular function and no valvular abnormality. A diagnosis of non-ST elevation myocardial infarction (NSTEMI) was made. Coronary angiography revealed a smooth tapering stenosis in the mid left anterior descending (LAD) artery (Video 1), but no significant disease beyond (Figure 1, top center panel). The other coronary vessels were free of significant disease. Given her age and the somewhat unusual angiographic ...

We present a case of follow-up optical coherence tomography (OCT) in a patient with non-obstructive intraluminal clot protrusion treated with medical therapy. The follow-up OCT scan showed layered neointimal changes similar to images observed in stent failure. A 37-year-old male presented with self-aborted anterior ST-elevation myocardial infarction. Urgent coronary angiogram showed thrombotic lesion in the proximal left anterior descending (LAD) artery (Figure 1). Multiple passes of aspiration thrombectomy retrieved a large amount of red thrombi. A drug-eluting stent was deployed in view of residual stenosis and clots (Figure 2, Video 1). Final OCT showed intraluminal clot protrusion at the proximal ...

A 37-year-old male presented with self-aborted anterior STEMI. Urgent coronary angiogram showed thrombotic lesion in the proximal LAD artery. Multiple passes of aspiration thrombectomy retrieved a large amount of red thrombi. The following angiogram and OCT series detail the patient’s treatment with a drug-eluting stent and 5-month follow-up results, which showed residual layered neointimal pattern at the proximal stent edge.

A 54-year-old man presented with non-ST elevation myocardial infarction. Coronary angiogram showed two-vessel disease with severe stenosis in the mid left anterior descending (LAD) artery and proximal and distal left circumflex (LCX) artery (Figure 1). Percutaneous coronary intervention (PCI) to the LCX was performed under optical coherence tomography (OCT) guidance. A 3 x 40 mm drug-eluting stent (DES) was implanted in the LCX, but landed more proximally than intended due to breathing motion. As a result, there was gross malapposition of the proximal stent as shown by OCT (Figure 2). To facilitate delivery of a 4 mm non-compliant balloon across ...

A 22-year-old, obese male smoker with untreated hyperlipidemia and family history of coronary artery disease presented with chest pain and ST-segment elevation in anterolateral leads at ECG following heavy marijuana and alcohol abuse. Coronary angiography showed a moderate stenosis in the proximal left anterior descending (LAD) coronary artery along with distal embolization (Figure 1A; Video 1). No concomitant coronary stenoses were noted, and TIMI 3 flow was present in the LAD. Optical coherence tomography (OCT) revealed plaque erosion with massive thrombi involving the distal left main coronary artery (LMCA) and ostial to mid LAD (Figure 1A; Video 2), along with ...

A 56-year-old male smoker with hypertension was admitted with lateral ST-elevation myocardial infarction. Coronariography showed a thrombotic occlusion of the circumflex artery (CX) solved with two overlapped drug-eluting stents. Multiple irregular linear filling defects and intraluminal haziness on proximal and mid left descending artery (LAD), mimicking a spontaneous dissection (Figure 1A and Video 1), were shown. Therefore, an optical coherence tomography (OCT) was performed on the LAD (Figure 1B and Video 2); OCT showed multiple small channels divided by thin septa communicating with each other in a “Swiss cheese” appearance, corresponding with a recanalization of organized thrombi. Upon re-interrogating the ...

A 49-year-old male smoker was admitted with chest pain and electrocardiographic T-wave inversion in the anterior chest leads and elevated levels of biomarkers of myocardial damage. Transthoracic echocardiography revealed anteroapical hypokinesis. Coronariography showed normal coronary arteries. Therefore, based on electrocardiographic and wall-motion abnormalities, we selected the left anterior descending artery as the cause of the acute coronary syndrome and coronary imaging was performed. Three-dimensional optical coherence tomography (3D-OCT) with angiographic co-registration was performed and an ulcerated small plaque covered by thrombus was observed (Figures 1-3; Videos 1-2). The amount of thrombus was not excessive and the minimal luminal area was ...

Background. Given its high resolution, optical coherence tomography (OCT) may be a useful clinical tool to optimize stent deployment. Methods. We reviewed 100 patients with post-PCI OCT who had angiographically optimized coronary stent implantation to determine the frequency of further intervention based on OCT pathology. OCT pathology was classified as “significant” if an OCT finding prompted further intervention. Results. OCT pathology was found in 90% of patients and considered significant in 52%. Stent strut malapposition by OCT was the most common reason for prompting further treatment, with approximately one-half due to relative stent undersizing. Based on OCT findings, 42% underwent ...

Abstract: Objectives. The purposes of this study were: (1) to assess the feasibility of optical coherence tomography (OCT) for detecting neovascularization; and (2) to clarify the impact of plaque neovascularization on coronary vessel behavior over time. Background. Plaque neovascularization may be related to plaque vulnerability. Methods. In an ex vivo study, a total of 55 coronary plaques from 31 human cadavers were examined by OCT. Plaque neovascularization was diagnosed based on the presence or absence of microchannels (MCs) by OCT. In an in vivo study, we explored 83 major coronary arteries from 42 patients with angina pectoris. A total of ...

Background. The impact of contrast type on coronary imaging using optical coherence tomography (OCT) has received limited study. We compared OCT imaging obtained using the non-ionic, iso-osmolar iodixanol with the ionic, low-osmolar ioxaglate. Methods. Twenty-two vessels in 20 patients were imaged twice using manual injection of iodixanol and ioxaglate in random order. OCT images were analyzed at 1 mm intervals to determine lumen area, artifact diameter and area, as well as stent strut coverage and malapposition in OCT pullbacks that included stents. Results. There were no complications related to OCT imaging or to contrast administration. A total of 2184 cross-sections ...

Coronary artery aneurysm with dissection is an uncommon presentation of Loeys-Dietz syndrome (LDS). Diagnosis and management of patients with LDS who present with unstable clinical syndromes merit special attention given unique pathophysiology derangements associated with this disease entity. Clinical experience in treating such patients is limited to a few case reports, and an optimal catheter-based treatment approach is less well defined. Intravascular imaging techniques, particularly optical coherence tomography (OCT), are able to provide further insight about the morphology of lesions and guide-catheter based intervention. In this case report, we describe one such patient and highlight the key morphological characteristics of ...

Background. Insufficient stent expansion, vessel wall injury, and tissue prolapse, all frequently unrecognized by coronary angiography, are predictors of future major adverse cardiac event (MACE) after percutaneous coronary intervention (PCI). Optical coherence tomography (OCT) provides accurate visualization of these features of inadequate stent deployment, whereas reduced fractional flow reserve (FFR) values after PCI indicate functional significance of a residual intrastent stenosis. Objective. To investigate the relationship of OCT-derived intrastent lumen dimensions and FFR-derived hemodynamic relevance immediately after coronary stent implantation and to evaluate the clinical impact of these parameters at follow-up. Methods. In 66 stable patients with a coronary de ...

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 ...

Background. Endothelial progenitor cells (EPCs) and cytokines seem to play a pivotal role in arterial healing after stent implantation. Using optical coherence tomography (OCT) as a high-resolution imaging technique, we aimed to assess the influence of circulating EPCs and levels of Il-1 cytokines on stent coverage and in-stent proliferation. Methods. Eighty-nine patients were randomly treated with either Xience V drug-eluting stent (DES; n = 48) or bare-metal stent (BMS) postdilated with the SeQuent Please drug-eluting balloon (DEB; n = 41). EPC populations (CD34+/CD133+ and CD34+/CD133+/KDR+EPC) and cytokines (Il-1ra, Il-18, and Il-1α) were measured before percutaneous coronary intervention using ...

We report the application of a novel optical coherence tomography (OCT) flushing technique where OCT run was performed during transient complete atrioventricular block induced by intracoronary bolus of adenosine. This technique may allow lower hydraulic force needed for contrast flush and reduce artifacts, with consequently improved OCT imaging in demanding clinical scenarios.

Superficial femoral artery (SFA) disease accounts for approximately 40% of the symptomatic peripheral arterial disease and remains a common cause of critical limb ischemia and lower-extremity amputation. Optical coherence tomography (OCT) has been extensively studied in the coronary circulation; however, its use in the peripheral arterial circulation is scarce. We present two cases of OCT use as an ancillary imaging tool during SFA endovascular interventions

Tako-Tsubo cardiomyopathy is an entity of unknown etiology characterized by transient apical dyskinesia in patients with angiographically normal coronary arteries. However, atypical forms of Tako-Tsubo cardiomyopathy may also occur, affecting other myocardial segments. Optical coherence tomography has a unique resolution and may detect angiographically silent atherosclerotic coronary artery disease. In this report, we describe optical coherence tomography findings in a patient with atypical Tako-Tsubo cardiomyopathy presenting as transient mid-ventricular ballooning.

Background and Aims. Malapposition of stent struts to the arterial wall and suboptimal stent expansion have been linked with poor outcomes following percutaneous coronary intervention (PCI). The purpose of this study was to use optical coherence tomography (OCT) to investigate stent strut malapposition in relation to calcium distribution. Methods and Results. Twenty-three PCI patients underwent OCT before and after stent deployment. Patient and procedural details and lesion characteristics — including the extent and depth of calcification — were measured, and the number of malapposed struts following final postdilatation was quantified. Patient and lesion characteristics associated with malapposition were assessed using univariate and ...

Background. The presence of uncovered struts overlying side branch is considered to be a potential risk of stent thrombosis. The accuracy in detection of neointimal strut coverage at branch point by optical coherence tomography (OCT) has not been validated in comparison with histology. Methods. A total of 5 stents (3 drug-eluting stents and 2 bare-metal stents) were implanted in the bifurcation segment of normal coronary arteries in 4 domestic swine (weight, 25-40 kg). The animals underwent follow-up OCT at 30 days after stent implantation and were then sacrificed for histologic evaluation. The neointimal coverage of the non-apposed struts over the ...

Neoatherosclerosis is one of the multiple mechanisms that cause stent thrombosis, which is one of the rare but severe complications of drug-eluting stent implantation. This case study highlights the use of optical coherence tomography in identifying the precise mechanism of the stent thrombosis, which helped guide the appropriate intervention

The efficacy and safety of titanium -nitride-oxide-coated bioactive stents (BASs) were demonstrated in prior studies. In a prospective registry, we sought to explore the extent of neointimal coverage of stent struts by optical coherence tomography (OCT) at 30 days following the implantation of BASs in an unselected non-diabetic population. Methods. We enrolled 20 consecutive non-diabetic patients who underwent BAS implantation. OCT images were obtained at 30-day follow-up. Binary stent strut coverage was defined as the number of covered struts as a percentage of all analyzed struts. Results. Patients underwent OCT examination at an average of 30.5 ± 5.7 days ...

Frequency domain optical coherence tomography (FD-OCT) is a new intravascular imaging modality utilizing near-infrared light to generate high-quality images. It provides a unique and detailed view of the vessel wall and vessel lumen. FD-OCT has been increasingly used in coronary interventions; however, there is limited experience regarding the use of FD-OCT in the evaluation and treatment of peripheral arterial disease (PAD). We report three cases in which FD-OCT helped elucidate and guide femoral artery interventions and renal artery stenting. With the help of these cases, we depict how FD-OCT is uniquely positioned to be a promising imaging tool in the ...