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    1. Optical coherence tomography-based assessment of bifurcation stenting using the Axxess™ Biolimus A9™-eluting stent system

      Optical coherence tomography-based assessment of bifurcation stenting using the Axxess™ Biolimus A9™-eluting stent system

      Bifurcation lesions are associated with increased procedural complications and worse long-term outcome. Multiple techniques are available, including the dedicated drug-eluting Axxess™ stent system (Biosensors International Ltd., Singapore, Singapore), providing complete bifurcation support without covering the carina. Low rates of restenosis in both main vessel (MV) and side branch (SB) have been demonstrated. High-resolution imaging techniques such as intravascular optical coherence tomography (IV-OCT) may help the positioning and implantation of the Axxess device, as angiographic guidance alone may be insufficient. A Medina 1,1,1 bifurcation lesion was treated using the Axxess device and BioMatrix™ stents (Biosensors International Ltd.) in the ...

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    2. Flow-limiting thrombosis after intracoronary coil embolisation: optical coherence tomography during acute myocardial infarction

      Flow-limiting thrombosis after intracoronary coil embolisation: optical coherence tomography during acute myocardial infarction

      A 75-year-old female was transferred to our hospital with sudden onset chest pain radiating to the left arm. She had a history of hypertension, chronic kidney disease treated with regular haemodialysis, and a prior anterior myocardial infarction. Electrocardiography upon admission showed ST-segment elevation in broad anterior leads. Previous coronary angiography had illustrated chronic total occlusion (CTO) at the mid-left anterior descending artery (LAD) and collateral flow from the 2nd diagonal branch (DB) to the distal LAD through the 3rd DB. Percutaneous

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    3. Coronary bifurcation treated with the hybrid mini-crush approach: a potential application of three-dimensional optical coherence tomography to optimise stent apposition - See more at: http://www.pcronline.com/eurointervention/91st_issue/volume-11/number-8

      Coronary bifurcation treated with the hybrid mini-crush approach: a potential application of three-dimensional optical coherence tomography to optimise stent apposition - See more at: http://www.pcronline.com/eurointervention/91st_issue/volume-11/number-8

      A 55-year-old male underwent an exercise treadmill test which was positive at stage 1. Coronary angiography (Figure 1A, Moving image 1) demonstrated a long segment of disease in the proximal-mid left anterior descending (LAD) artery. A fractional flow reserve study was positive at 0.71, with no localising lesion on hyperaemic pullback. In addition, >5 mm disease was present in the ostial-proximal first diagonal. A hybrid mini-crush approach was adopted. The LAD was predilated with a 3.0 mm non-compliant (NC) balloon. A 2.25×24 mm Promus PREMIER (Boston Scientific, Marlborough, MA, USA) drug-eluting stent (DES) was implanted in ...

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    4. The impact of in-stent neoatherosclerosis on long-term clinical outcomes: an observational study from the Kobe University Hospital optical coherence tomography registry

      The impact of in-stent neoatherosclerosis on long-term clinical outcomes: an observational study from the Kobe University Hospital optical coherence tomography registry

      Aims: Although pathological studies have indicated the development of neoatherosclerosis (NA) after stenting, its risk factors and impact on future clinical events remain unclear. We aimed to clarify the possible risk factors for NA development and to evaluate the impact of NA in a large Japanese observational OCT database of patients with coronary heart disease. Methods and results: One hundred and seventy-five consecutive patients (314 lesions) who underwent OCT examination >1 year after bare metal or drug-eluting stent implantation were enrolled. We assessed the presence of NA by follow-up OCT and compared adverse clinical events between NA+ and NA– patients ...

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    5. Bioresorbable vascular scaffold treatment induces the formation of neointimal cap that seals the underlying plaque without compromising the luminal dimensions: a concept based on serial optical coherence tomography data

      Bioresorbable vascular scaffold treatment induces the formation of neointimal cap that seals the underlying plaque without compromising the luminal dimensions: a concept based on serial optical coherence tomography data

      Aims: To evaluate the implications of an Absorb bioresorbable vascular scaffold (Absorb BVS) on the morphology of the superficial plaques. Methods and results: Forty-six patients who underwent Absorb BVS implantation and 20 patients implanted with bare metal stents (BMS) who had serial optical coherence tomographic examination at baseline and follow-up were included in this analysis. The thin-capped fibroatheromas (TCFA) were identified in the device implantation regions and in the adjacent native coronary segments. Within all regions, circumferential locations of TCFA and calcific tissues were identified, and the neointimal thickness was measured at follow-up. At six to 12-month follow-up, only 8 ...

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    6. Novel sirolimus-eluting stent with a biodegradable polymer in the all-comers population - 1-year results with angiographic and OCT analysis

      Novel sirolimus-eluting stent with a biodegradable polymer in the all-comers population - 1-year results with angiographic and OCT analysis

      Aims: First generation drug-eluting stents inhibit physiological healing process of the vessel wall, lengthen inflammatory reactions and adversely affect the restoration of correctly functioning endothelium. It is believed that one possible cause of these adverse events might be the negative influence of the permanent presence of polymer used for stent coating. This scenario could possibly be averted by the use of a biodegradable polymer. Methods and results: Prolim (Balton, Poland) is a balloon expandable, stainless steel (316L), sirolimus-eluting stent dedicated for coronary lesions. The strut thickness is 0.115 mm. Prolim stent is covered with a biodegradable structure containing a ...

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    7. Incidence and potential mechanism of resolved, persistent and newly acquired malapposition three days after implantation of self-expanding or balloon-expandable stents in a STEMI population: insights from optical coherence tomography in the APPOSITION II

      Incidence and potential mechanism of resolved, persistent and newly acquired malapposition three days after implantation of self-expanding or balloon-expandable stents in a STEMI population: insights from optical coherence tomography in the APPOSITION II

      Aims: The aim of the current study was to investigate the frequency and mechanisms of sequential incomplete stent apposition (ISA) changes such as persistent, resolved or newly acquired ISA during the first three days after primary PCI (pPCI) in a matched segment-level analysis, with the comparison between self-expanding and balloon-expandable stents assessed by optical coherence tomography (OCT). Methods and results: The current analysis is a substudy of the APPOSITION II study that included 69 patients (self-expanding: 35, balloon-expandable: 34) using serial optical coherence tomography (OCT) post procedure and three days after pPCI. In order to evaluate a temporal change in ...

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    8. Target lesion evaluation by multiple modalities in vivo: near-infrared spectroscopy (NIRS), virtual histology intravascular ultrasound, optical coherence tomography, and angioscopy

      Target lesion evaluation by multiple modalities in vivo: near-infrared spectroscopy (NIRS), virtual histology intravascular ultrasound, optical coherence tomography, and angioscopy

      A 60-year-old man presented with ischaemic heart failure. We conducted coronary angiography (CAG) after improvement of the heart failure. On CAG, there was a hazy stenosis in the proximal left anterior descending artery (Figure 1, Moving image 1) . The lesion was observed by four modalities: near-infrared spectroscopy (NIRS), virtual histology intravascular ultrasound (VH-IVUS), optical coherence tomography (OCT), and angioscopy. NIRS detected lipid core plaque with echolucency on greyscale IVUS. VH-IVUS showed necrotic core plaque (Figure 1, Moving image 1) . OCT showed lipid-rich plaque, and angioscopy showed yellow intima (Figure 1, Moving image 1) . All modalities could detect lipid content and ...

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    9. Comparative analysis method of permanent metallic stents (XIENCE) and bioresorbable poly-L-lactic (PLLA) scaffolds (Absorb) on optical coherence tomography at baseline and follow-up

      Comparative analysis method of permanent metallic stents (XIENCE) and bioresorbable poly-L-lactic (PLLA) scaffolds (Absorb) on optical coherence tomography at baseline and follow-up

      Aims: Fully bioresorbable Absorb poly-L-lactic-acid (PLLA) scaffolds (Abbott Vascular, Santa Clara, CA, USA) are a novel approach for the treatment of coronary narrowing. Due to the translucency of the material (PLLA), the optical coherence tomography (OCT) measurement methods used in the ABSORB trials were unique but not applicable for permanent metallic stents. When the Absorb scaffold and metallic stents are compared in the context of randomised trials, it is challenging to compare the two devices using the conventional methods. The primary purpose of this report is to explain the biases in conventional methodologies applied for metallic stents and for PLLA ...

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    10. Impact of the orbital atherectomy system on a coronary calcified lesion: quantitative analysis by light attenuation in optical coherence tomography

      Impact of the orbital atherectomy system on a coronary calcified lesion: quantitative analysis by light attenuation in optical coherence tomography

      A 64-year-old female with chronic kidney disease was scheduled to undergo stenting of a severely calcified lesion in the left anterior descending coronary artery following “preparation” of the lesion by orbital atherectomy performed with the Diamondback 360 Coronary Orbital Atherectomy System (OAS), 1.25 mm Classic Crown (Cardiovascular Systems, Inc., St. Paul, MN, USA) (Figure 1A) (pre- and post-OAS angiography: Figure 1B-1C and Figure 1B’-1C’ , respectively). The first run was performed at 80,000 rpm for 25 s followed by the second run at 120,000 rpm for 25 s. A 2.75×38 mm everolimus-eluting stent (XIENCE; Abbott ...

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    11. Comparison of neointimal coverage between everolimus-eluting stents and sirolimus-eluting stents: an optical coherence tomography substudy of the RESET (Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial)

      Comparison of neointimal coverage between everolimus-eluting stents and sirolimus-eluting stents: an optical coherence tomography substudy of the RESET (Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial)

      Aims: The aim of the present study was to compare vascular healing response between the first-generation sirolimus-eluting stent (SES) and the second-generation everolimus-eluting stent (EES) by using optical coherence tomography (OCT). Methods and results: The RESET was a prospective, multicentre, randomised, open-label trial comparing EES and SES. Of the 3,197 patients enrolled in the RESET, nine-month follow-up OCT after stent implantation was performed in 100 patients (48 EES-treated lesions in 44 patients and 62 SES-treated lesions in 56 patients), thus constituting the OCT substudy population. The percentage of uncovered struts per lesion (8±15% vs. 14±19%, p=0 ...

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    12. Serial optical coherence tomography imaging of ACS-causing culprit plaques

      Serial optical coherence tomography imaging of ACS-causing culprit plaques

      Aims: The aim of this study was to understand better the mechanisms of repair of plaque complications causing acute coronary syndrome. Methods and results: We used OCT in the acute phase and at follow-up (one to seven months) to investigate the plaque healing in 10 culprit plaques: five ruptured fibrous cap (RFC) and five intact fibrous cap (IFC) which were not treated with stent deployment and caused ST-segment elevation myocardial infarction (n=8) and non-STEMI (n=2). At follow-up OCT, the margins of the evacuated cavity in RFC plaques showed a smooth surface and a morphology similar to that of ...

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    13. Calcified plaque ablated by rotational atherectomy visualised by optical coherence tomography

      Calcified plaque ablated by rotational atherectomy visualised by optical coherence tomography

      This paper also includes accompanying supplementary data published online at: http://www.pcronline.com/eurointervention/86th_issue/62 Calcification is visualised by optical coherence tomography (OCT) as a well-delineated, signal-poor region with sharp borders. A 63-year-old female patient with stable angina underwent percutaneous coronary intervention. OCT (C7 Dragonfly™, ILUMIEN™ OCT system; St. Jude Medical, St. Paul, MN, USA) showed lumen narrowing with heavily calcified plaque (Figure 1A) . Rotational atherectomy (RA) was performed using a 2 mm burr (Rotablator™ Rotational Atherectomy System; Boston Scientific, Marlborough, MA, USA). After RA, OCT clearly visualised the calcified segment ablated by the 2 mm burr as

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    14. Severe spasm of the left main and spontaneous intramural haematoma: a serial optical coherence tomography study

      Severe spasm of the left main and spontaneous intramural haematoma: a serial optical coherence tomography study

      A 41-year-old woman developed acute myocardial infarction after salbuterol abuse. Coronary angiography showed narrowing of the left main (LM) and of the proximal left anterior descending artery (LAD), and a hazy subocclusion of the mid LAD. Manual and rheolytic thrombectomy were performed without retrieving thrombus and improving flow. Due to haemodynamic instability, we deployed a drug-eluting stent (DES) and performed a first optical coherence tomography (OCT) scan, demonstrating severe spasm of the distal LM, and an extensive intramural haematoma of the proximal LAD, possibly squeezed proximally and distally by stent implantation (Figure 1, top row) . We hypothesised intramural haematoma since ...

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    15. Cholesterol crystals identified using optical coherence tomography and virtual histology intravascular ultrasound

      Cholesterol crystals identified using optical coherence tomography and virtual histology intravascular ultrasound

      The deposition and accumulation of lipid within the arterial wall leads to the development and progression of atherosclerotic plaques. Cholesterol crystals (CCs) are formed from these lipid pools and both augment the inflammatory response and promote plaque rupture, possibly through inducing mechanical instability. Accordingly, identification of these structures is important for plaque risk stratification. Optical coherence tomography (OCT) and virtual histology intravascular ultrasound (VH-IVUS) are invasive imaging modalities that permit plaque characterisation. Validation studies using these techniques have demonstrated their reliability to identify plaque constituents, including lipid and calcification. CCs are thought to be identifiable on OCT as linear, high-backscattering ...

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    16. COmplex coronary Bifurcation lesions: RAndomized comparison of a strategy using a dedicated self-expanding biolimus-eluting stent versus a culotte strategy using everolimus-eluting stents: primary results of the COBRA trial

      COmplex coronary Bifurcation lesions: RAndomized comparison of a strategy using a dedicated self-expanding biolimus-eluting stent versus a culotte strategy using everolimus-eluting stents: primary results of the COBRA trial

      Aims: We aimed to compare healing responses with optical coherence tomography, and clinical and angiographic outcome after treatment of coronary bifurcation lesions with a dedicated stent versus aconventional culotte technique. Methods and results: Forty patients with true and complex coronary bifurcation lesions were randomly assigned to treatment with the Axxess™ bifurcation stent in the proximal main vessel (MV) and additional BioMatrix™ stents in the branches (Biosensors Europe SA, Morges, Switzerland), versus a culotte technique using XIENCE™ stents (Abbott Vascular, Santa Clara, CA, USA). The primary endpoint of percentage of uncovered struts at nine months was similar with the dedicated strategy ...

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    17. OCT for bifurcation stenting: what have we learned?

      OCT for bifurcation stenting: what have we learned?

      Treatment of bifurcation lesions by percutaneous coronary intervention (PCI) shows major variation in complexity. Intravascular optical coherence tomography (OCT) provides high-resolution images of the pathoanatomy, thrombus, wires and stent positions during the procedure. This information may prove crucial in optimising PCI results and clinical outcomes after complex bifurcation treatment. Mounting evidence confirms the feasibility of OCT in bifurcations, and specific steps where OCT may be advantageous in guiding bifurcation PCI have been identified. Awaiting major clinical outcome trials, OCT has already entered the European guidelines for myocardial revascularisation. This paper aims to provide an overview of the potential clinical use ...

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    18. New implication of three-dimensional optical coherence tomography in optimising bifurcation PCI

      New implication of three-dimensional optical coherence tomography in optimising bifurcation PCI

      With the advance of optical coherence tomography (OCT) technology, three-dimensional (3D) reconstruction based on the optical coherence tomography has become feasible. In bifurcation lesions, 3D OCT may guide positioning of the wire through the appropriate (distal) cells. The early studies suggested that such a guidance strategy could reduce the incidence of malapposition in bifurcation lesions. The pre-installed “real-time” 3D OCT on the console will promote the utilisation of 3D assessment in bifurcation treatment and possibly establish the clinical benefit of such guidance in the near future when investigated in a prospective study.

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    19. 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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    20. Frequency domain optical coherence tomography to assess non-ostial left main coronary artery

      Frequency domain optical coherence tomography to assess non-ostial left main coronary artery

      Aims: The aim of this study was to assess the feasibility of unprotected non-ostial left main (LM) imaging by frequency domain optical coherence tomography (FD-OCT). Methods and results: We conducted a retrospective analysis of OCT studies performed to image lesions located in the non-ostial LM. OCT studies were analysed to detect the number of artefact frames in the different LM/bifurcation segments. OCT cross-sectional images were used to assess area measures. OCT longitudinal reconstructions were used to obtain the LM length. Standard quantitative coronary angiography (QCA) was used as the reference methodology. A total of 54 patients with non-ostial LM ...

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      Mentions: St. Jude Medical
    21. Optical coherence tomography appraisal of residual thrombus burden in patients with ST-segment elevation myocardial infarction undergoing intraprocedural versus post-stenting prolonged bivalirudin infusion. Rationale and design of the MATRIX (Minimizing A

      Optical coherence tomography appraisal of residual thrombus burden in patients with ST-segment elevation myocardial infarction undergoing intraprocedural versus post-stenting prolonged bivalirudin infusion. Rationale and design of the MATRIX (Minimizing A

      Aims: Residual thrombus accumulation around stent struts has been observed after the end of primary PCI and may represent a risk factor for acute stent thrombosis. The aim of this study is to test whether a strategy of prolonged bivalirudin infusion may reduce thrombosis of stent struts as compared to an intraprocedural only administration in subjects undergoing primary PCI. Methods and results: One hundred and sixty patients will be selected from the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) study with all the following inclusion criteria: a) STEMI patients undergoing primary PCI with stent implantation, b ...

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    22. STACCATO (Assessment of Stent sTrut Apposition and Coverage in Coronary ArTeries with Optical coherence tomography in patients with STEMI, NSTEMI and stable/unstable angina undergoing everolimus vs. biolimus A9-eluting stent implantation): a randomised co

      STACCATO (Assessment of Stent sTrut Apposition and Coverage in Coronary ArTeries with Optical coherence tomography in patients with STEMI, NSTEMI and stable/unstable angina undergoing everolimus vs. biolimus A9-eluting stent implantation): a randomised co

      Aims: To compare tissue coverage in coronary lesions stented with durable fluoropolymer-coated everolimus-eluting stents (EES) vs. biodegradable polymer-coated biolimus A9-eluting stents (BES). Methods and results: Sixty-four patients (64 lesions) with de novo coronary artery lesions were randomised to percutaneous treatment with XIENCE® EES (Abbott Vascular, Santa Clara, CA, USA) vs. BioMatrix™ BES (Biosensors, Morges, Switzerland). The primary endpoint was the percentage of uncovered struts, as assessed with OCT, at nine months. The average percentage of uncovered struts was significantly lower with EES (4.3±4.8% vs. 8.7±7.8% with BES, p=0.019). There was no difference ...

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    23. Long-term invasive follow-up of the everolimus-eluting bioresorbable vascular scaffold: five-year results of multiple invasive imaging modalities

      Long-term invasive follow-up of the everolimus-eluting bioresorbable vascular scaffold: five-year results of multiple invasive imaging modalities

      Aims: The Paradise Ultrasound Renal Denervation System is a next-generation catheter-based device which was used to investigate whether the target ablation area can be controlled by changing ultrasound energy and duration to optimise nerve injury while preventing damage to the arterial wall. Methods and results: Five ultrasound doses were tested in a thermal gel model. Catheter-based ultrasound denervation was performed in 15 swine (29 renal arteries) to evaluate five different doses in vivo , and animals were euthanised at seven days for histopathologic assessment. In the gel model, the peak temperature was highest in the low power-long duration (LP-LD) dose, followed ...

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    24. Bioresorbable vascular scaffold treatment induces the formation of neointimal cap that seals the underlying plaque without compromising the luminal dimensions: a concept based on serial optical coherence tomography data

      Bioresorbable vascular scaffold treatment induces the formation of neointimal cap that seals the underlying plaque without compromising the luminal dimensions: a concept based on serial optical coherence tomography data

      Aims: To evaluate the implications of an Absorb bioresorbable vascular scaffold (Absorb BVS) on the morphology of the superficial plaques. Methods and results: Forty-six patients who underwent Absorb BVS implantation and 20 patients implanted with bare metal stents (BMS) who had serial optical coherence tomographic examination at baseline and follow-up were included in this analysis. The thin-capped fibroatheromas (TCFA) were identified in the device implantation regions and in the adjacent native coronary segments. Within all regions, circumferential locations of TCFA and calcific tissues were identified, and the neointimal thickness was measured at follow-up. At six to 12-month follow-up, only 8 ...

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    1-24 of 109 1 2 3 4 5 »
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