Aims: The features of neointima after bare metal stent (BMS) or drug-eluting stent (DES) implantation have not yet been fully characterised. The aim of this study was to investigate in-stent neointima characteristics according to stent type and restenotic phase. Methods and results: The study included 59 consecutive patients undergoing target lesion revascularisation for in-stent restenosis (ISR) evaluated by optical coherence tomography (OCT) during the early phase (≤1 year, n=30) and late phase (>1 year, n=29) after either BMS (n=37) or DES (n=22) implantation. The OCT signal patterns of tissues at the minimal lumen area were categorised ...

Aims: Frequency-domain optical coherence tomography (FD-OCT) provides a rapid tomographic scan of a coronary vessel, with an accurate reconstruction of its lumen profile. An FD-OCT-based metric that corresponds more closely with physiological significance of lesions may enable more precise guidance of interventional procedures. The aim of this feasibility study was to evaluate a new method for quantifying coronary lesion severity that estimates hyperaemic flow resistance of branched vessel segments imaged by FD-OCT. Methods and results: An analytical flow model was developed that relates fractional flow reserve (FFR) to the vascular resistance ratio (VRR), a measure of blood flow resistance derived ...

Coronary angiography of a 71-year-old male patient with unstable angina revealed subtotal distal left main artery (LMA) stenosis extending into the proximal left anterior descending artery (LAD) and 80% obstruction of the origin of the proximal left circumflex artery (LCX). The patient was treated with T-stenting at the bifurcation of the left anterior descending and left circumflex. During the procedure profound longitudinal stent compression was noticed, followed by OCT. (Figure 1) This novel complication is of great concern for operators and has the potential to affect current treatment of ostial lesions.

Aims: The main cause of acute myocardial infarction (AMI) is the disruption of a thin-cap fibroatheroma (TCFA) and subsequent thrombosis. Mortality increases in diabetic patients due to cardiovascular events; there may be differences in the vulnerable plaques between diabetic and non-diabetic patients. We used optical coherence tomography (OCT) to assess the incidence of vulnerable plaques in diabetic patients with AMI. Methods and results: OCT was performed in all three major coronary arteries of 70 AMI patients: 48 non-diabetic and 22 diabetic patients. The OCT criterion for TCFA was the presence of both a lipid-rich plaque composition and a fibrotic cap ...

Aims: Angiographic guidance for percutaneous coronary intervention (PCI) has substantial limitations. The superior spatial resolution of optical coherence tomography (OCT) could translate into meaningful clinical benefits. We aimed to compare angiographic guidance alone versus angiographic plus OCT guidance for PCI. Methods and results: Patients undergoing PCI with angiographic plus OCT guidance (OCT group) were compared with matched patients undergoing PCI with angiographic only guidance (Angio group) within 30 days. The primary endpoint was the one-year rate of cardiac death or myocardial infarction (MI). A total of 670 patients were included, 335 in the OCT group and 335 in the Angio ...

Cardiovascular outcomes following percutaneous coronary intervention (PCI) steadily improve due to progress of coronary stent technology1,2, antithrombotic therapy3,4, and the use of novel diagnostic approaches5. As angiography provides only limited information, it is tempting to employ intracoronary imaging to assess the post-procedural results with the intention to further optimise outcomes. Although intravascular ultrasound (IVUS) provides more detailed information than angiography alone, its uptake has been modest to guide PCI6,7. Meanwhile, a new and more promising technology – optical coherence tomography (OCT) – has become available. By utilising light instead of sound, it provides histologylike images of stents and the ...

Arherosclerosis is one of the major causes of morbidity and mortality in developed countries.  The major casue (86%) of cardiovascular death from heart attacks as well as the major cause (45%) of deaths from brain aneurysm are due to less obtrusive plaques known as vulnerable plaques that rupture suddenly and trigger a blood clot or thrombus that blocks blood flow.  Early detection of plaque lesions is the first and necessary step in prevent the lethal consquences of arherosclerosis.

Aims: Plaque rupture and subsequent thrombosis is known to be the most important pathology leading to acute coronary syndrome (ACS). We investigated by optical coherence tomography (OCT) whether in ACS there is an association of the location of the culprit plaque in the coronary tree with plaque rupture and/or thin cap fibroatheroma (TCFA). Methods and results: We included 74 patients presenting with ACS that underwent OCT study of the culprit lesion. The distance of the culprit lesion from the ostium was measured angiographically, and the presence of rupture and/or TCFA was assessed by OCT. Sixty-seven patients were analysed ...

AIM: To assess the reproducibility of quantitative analysis of optical frequency domain imaging (OFDI) acquired at different pullback speeds (20, 30, 40 mm/sec), as well as the impact of cardiac motion artefact on three-dimensional (3D) reconstructions. METHODS AND RESULTS: A total of 36 OFDI pullbacks were obtained pre- and post-stent implantation at the pullback speeds of 20, 30 and 40 mm/sec in non-diseased swine coronary arteries. The amount of x-ray contrast needed for blood clearance during OFDI imaging was recorded. Three-dimensional images of stented segments were rendered and artefacts on 3D images were assessed. Lumen areas (LA) were ...

Aims: The aim of the pilot SECRITT trial was to evaluate the safety and feasibility of sealing the high risk IVUS and optical coherence tomography-derived thin cap fibroatheroma (TCFA), with a dedicated nitinol self-expanding vShield device. Methods and results: After screening with angiography, fractional flow reserve (FFR), intravascular ultrasound virtual histology (IVUS-VH) and optical coherence tomography (OCT), 23 patients met enrolment criteria (presence of non-obstructive VH-derived TCFA lesion with thin cap on OCT) and were randomised to vShield (n=13) versus medical therapy (n=10). In the shielded group, baseline percent diameter stenosis was 33.2±13.5%, FFR was ...

Aims: The aim of this study was to assess the ability of optical coherence tomography (OCT) to guide recrossing during percutaneous coronary interventions in bifurcations and to reduce strut malapposition.

A 54-year-old man with non-ST elevation myocardial infarction (NSTEMI) underwent percutaneous coronary intervention (PCI) for a severe stenosis in the first marginal branch of the left circumflex coronary artery (LCx-OM1) (Figure 1).

Aims: To demonstrate the feasibility and potential usefulness of an offline fusion of matched optical coherence tomography (OCT) and intravascular ultrasound (IVUS)/virtual histology (IVUS-VH) images.

In this issue of EuroIntervention, Two interesting image reports describe OCT appearance of restenotic tissue of sirolimus-eluting stents and both refer to the "black hole" phenomenon that was first described as an observation in IVUS-studies of restenotic tissue of patients after radioactive stent implantion or brachytherapy. 

A 60-year-old man underwent sirolimus-eluting stent (SES) implantatoni.  At two months, intravascular ultrasound (IVUS) images showed homogenous echolucent appearance within the stent, recognized as a"black-hole" phenomeon.  Optical coherence tomography (OCT) images of the correspoinding segment demonstrated a layered structure composed of think inner layers with high-intensity signals and outer layers with low-intensity signals.

A 59-year old male with a history of controlled hyperlipidaemia, hypertension and diabetes mellitus presented with a recurrence of angina pectoris.  Previously, in August 2000, two overlapping 4 mm by 12 mm igaki-Tamai stents had been implanted in his proximal right  coronary artery...

In this chapter of Tools & Techniques, intracoronary imaging is discussed using a stepwise approach. The following is a summarized overview of its application in the cathlab. The complete, unabridged version with images is available online at www.eurointervention.org. Coronary angiography had traditionally be used in our cardiac catheterization le to lesions, sizing the vessels and guiding the implantation of coronary stents. Both intracoronary imaging techniques, IVUS and OCT, provided information able to improve guidance of interventional procedures and are indispensable to carry out clinical research.

Aims: To analyse and to compare the changes in the various optical coherence tomography (OCT), echo-genicity intravascular ultrasound virtual histology (VH) of the everolimus-eluting bioresorbable scaffold (ABSORB) degradation parameters during the first 12 months after ASOERB implantation.

Aims: The treatment of in-stent restenosis (ISR) remains a challenge with poor immediate results and higher restenosis rate than in de novo lesions. We propose, based on a consecutive series of patients treated with cutting balloon, a strategy of aggressive device selection based on the results of serial FD-OCT assessment.

Aims: Bioresorbable vascular scaffolds (BVS) present different mechanical properties as compared to metallic platform stents. Therefore, the standard procedural technique to achieve appropriate deployment may differ. Methods and results: Fifty-two lesions treated with 3x18 mm BVS were imaged with optical coherence tomography (OCT) post-implantation and screened for parameters suggestion non-optimal deployment.