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    1. Iatrogenic Coronary Artery Dissection Induced During Invasive Absolute Coronary Blood Flow Measurement: Optical Coherence Tomography Findings

      Iatrogenic Coronary Artery Dissection Induced During Invasive Absolute Coronary Blood Flow Measurement: Optical Coherence Tomography Findings

      A 65-year-old woman with previous history of hypertension was referred to our institution due to effort angina with a positive exercise stress test. Coronary angiography showed normal coronary arteries. A vasospasm provocation test with methylergonovine was negative. With the aim of assessing the state of microvasculature, absolute coronary blood flow by thermodilution was performed as previously described.

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      Mentions: Fernando Alfonso
    2. Characteristics of Early Versus Late In-Stent Restenosis in Second- Generation Drug-Eluting Stents: An Optical Coherence Tomography Study

      Characteristics of Early Versus Late In-Stent Restenosis in Second- Generation Drug-Eluting Stents: An Optical Coherence Tomography Study

      Aims: In-stent restenosis (ISR) is an important cause of DES failure and target vessel revascularization. We evaluated differences between early and late-presenting restenosis in second-generation drug-eluting stents (DES) using optical coherence tomography (OCT). Methods and results: Overall, 171 cases of second-generation DES ISR with a follow-up OCT minimum lumen area <3.0mm2 were included; 33.3% of patients (n=57) had early ISR; and 67.7% (n=114) had late ISR (duration from stent implantation >1 year). Minimum stent area (MSA) <4.0mm2, neointimal thickness <100µm, and heterogeneous neointimal hyperplasia (NIH) were more prevalent in early ISR, whereas NIH ...

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    3. EuroIntervention Intravascular ultrasound and optical coherence tomography images for direct right coronary artery injury after tricuspid valve annuloplasty

      EuroIntervention Intravascular ultrasound and optical coherence tomography images for direct right coronary artery injury after tricuspid valve annuloplasty

      A 76-year-old female was admitted with dyspnoea and leg oedema. Echocardiography showed severe mitral and tricuspid valve regurgitation with marked right ventricular (RV) dilatation, and coronary angiography showed intact left and right coronary arteries (RCA) (Online Figure 1) . She was diagnosed with heart failure due to combined valvular disease and underwent tricuspid valve (the Kay bicuspidisation technique without ring) and mitral valve annuloplasty. After the operation, she suffered from myocardial infarction with ST-segment elevation in the inferior leads. Coronary angiography showed a total occlusion (arrow) at the middle portion of the RCA (Panel A, Moving image 1) . After passing a ...

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    4. Is quantitative coronary angiography reliable in assessing the late lumen loss of the everolimus eluting bioresorbable polylactide scaffold in comparison with the cobalt chromium metallic stent?

      Is quantitative coronary angiography reliable in assessing the late lumen loss of the everolimus eluting bioresorbable polylactide scaffold in comparison with the cobalt chromium metallic stent?

      Aims: Immediately after stent/scaffold implantation, quantitative coronary angiography (QCA) with respect to optical coherence tomography (OCT) more severely underestimates the lumen diameter (LD) in Absorb than in XIENCE. This OCT-QCA discrepancy has not been evaluated at long-term follow-up. The present study aimed to assess the accuracy of QCA with reference to OCT in Absorb as compared to XIENCE.

       

       

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    5. Comparing the vascular response in implantation of self-expanding, bare metal nitinol stents or paclitaxel-eluting nitinol stents in superficial femoral artery lesions: a serial optical frequency domain imaging study

      Comparing the vascular response in implantation of self-expanding, bare metal nitinol stents or paclitaxel-eluting nitinol stents in superficial femoral artery lesions: a serial optical frequency domain imaging study

      Aims: This study sought to investigate differences in vascular response between self-expanding bare metal nitinol stents (BMS) and paclitaxel-eluting nitinol stents (PES), in superficial femoral artery (SFA) disease, using optical frequency domain imaging (OFDI). Methods and results: Six months after stent implantation, follow-up quantitative vascular angiography (QVA) and OFDI assessment were scheduled to evaluate vascular response. Volume index (VI) was defined as volume divided by stent length. The primary endpoint was OFDI-derived late lumen area loss, defined as lumen VI post stent implantation minus lumen VI at follow-up. A total of 28 SFA lesions were analysed, with cases randomised to ...

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    6. EuroIntervention Automated characterisation of lipid core plaques in vivo by quantitative optical coherence tomography tissue type imaging

      EuroIntervention Automated characterisation of lipid core plaques in vivo by quantitative optical coherence tomography tissue type imaging

      Aims: Qualitative criteria for plaque tissue characterisation by OCT are well established, but quantitative methods lack systematic validation in vivo . High optical attenuation coefficient µ t has been associated with unstable plaque features, such as lipid core. The purpose of this study was to validate optical coherence tomography (OCT) attenuation imaging for tissue characterisation in vivo , specifically to detect lipid core in coronary atherosclerotic plaques, and to evaluate quantitatively the ability of OCT attenuation imaging to differentiate thin-cap (TCFA) and thick-cap fibroatheroma (FA). Methods and results: We prospectively enrolled 85 patients undergoing imaging of a native coronary segment by both OCT ...

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    7. Variability in the measurement of minimum fibrous cap thickness and reproducibility of fibroatheroma classification by optical coherence tomography using manual versus semi-automatic assessment

      Variability in the measurement of minimum fibrous cap thickness and reproducibility of fibroatheroma classification by optical coherence tomography using manual versus semi-automatic assessment

      Aims: The minimum fibrous cap thickness (FCT) is considered a major criterion of coronary plaque vulnerability according to autopsy studies. We aimed to assess the reproducibility in the measurement of the optical coherence tomography (OCT)-detected minimum FCT and the agreement in the classification of thin-cap fibroatheroma (TCFA), by a software-based semi-automatic method compared with the manual method. Methods and results: A total of 50 frames with fibroatheromas (FA) were randomly selected from the Integrated Biomarker Imaging Study-4 (IBIS-4). Two experienced OCT analysts independently measured the minimum FCT at two different time points, manually and by three different semi-automatic software-based ...

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    8. The OPTIS Integrated System: real-time, co-registration of angiography and optical coherence tomography

      The OPTIS Integrated System: real-time, co-registration of angiography and optical coherence tomography

      The efficacy of an IVUS-guided stent implantation strategy to improve acute results and clinical outcome has been described previously. OCT is another technique which allows high-resolution intracoronary imaging. However, the use of invasive imaging modalities to guide PCI has, as yet, played a limited role in current clinical practice. This may be partly explained by the expertise required for interpretation and clinical decision making. We present a novel technology which enables real-time co-registration of OCT images with angiography. This will simplify matching cross-sectional images to their geographic position on the angiogram, thereby facilitating imaging-guided PCI.

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    9. Two-year clinical, angiographic, and serial optical coherence tomographic follow-up after implantation of an everolimus-eluting bioresorbable scaffold and an everolimus-eluting metallic stent: insights from the randomised ABSORB Japan trial

      Two-year clinical, angiographic, and serial optical coherence tomographic follow-up after implantation of an everolimus-eluting bioresorbable scaffold and an everolimus-eluting metallic stent: insights from the randomised ABSORB Japan trial

      Aims: We sought to investigate two-year clinical and serial optical coherence tomography (OCT) outcomes after implantation of a fully bioresorbable vascular scaffold (BVS) or a cobalt-chromium everolimus-eluting stent (CoCr-EES). Methods and results: In the ABSORB Japan trial, 400 patients were randomised in a 2:1 ratio to BVS (N=266) or CoCr-EES (N=134). A pre-specified OCT subgroup (N=125, OCT-1 group) underwent angiography and OCT post procedure and at two years. Overall, the two-year TLF rates were 7.3% and 3.8% in the BVS and CoCr-EES arms (p=0.18), respectively. Very late scaffold thrombosis (VLST) beyond one ...

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    10. Culprit plaque morphology in STEMI – an optical coherence tomography study: insights from the TOTAL-OCT substudy

      Culprit plaque morphology in STEMI – an optical coherence tomography study: insights from the TOTAL-OCT substudy

      Aims: Our aim was to compare stenosis severity and plaque content between STEMI culprit lesions with intact fibrous cap (IFC) and those with plaque rupture (PR) in a prospective study. Methods and results: We evaluated 93 patients undergoing OCT and thrombectomy as part of a prospective substudy of the TOTAL (ThrOmbecTomy versus PCI ALone) trial. Culprit lesion morphology was assessable by OCT in 70/93 (75.3%). IFC was found in 31 (44.3%), PR in 34 (48.6%) and calcified nodule in five (7.1%) patients. Following thrombectomy, OCT demonstrated similar lumen area stenosis in IFC (79.3%) and ...

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    11. Optical coherence tomography visualisation of burst balloon catheter trapped by coronary stent

      Optical coherence tomography visualisation of burst balloon catheter trapped by coronary stent

      A 69-year-old man with prior anterior myocardial infarction underwent percutaneous coronary intervention for significant stenosis of the left anterior descending (LAD) artery. High-pressure inflation by non-compliant balloon was required because of severe calcification in the culprit lesion. The balloon ruptured during inflation and an angiographic filling defect appeared in the LAD. The balloon catheter was pulled out of the body and the tip and membranous part of the catheter was lost ( Panel A , black arrowhead). Although we attempted to retrieve…

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    12. Evaluation of vascular healing of polymer-free sirolimus-eluting stents in native coronary artery stenosis: a serial follow-up at three and six months with optical coherence tomography imaging

      Evaluation of vascular healing of polymer-free sirolimus-eluting stents in native coronary artery stenosis: a serial follow-up at three and six months with optical coherence tomography imaging

      Aims: Our aim was to assess vascular response after polymer-free sirolimus-eluting stent (SES) implantation by using an optical coherence tomography (OCT)-derived vascular healing score (HS), quantifying the deficiency of healing. Methods and results: In a prospective, multicentre, single-arm, open-label study, OCT examinations were performed at three months in 45 patients (47 lesions). Per protocol, 24 lesions which had not reached adequate vascular healing according to study criteria were scheduled for OCT examination at six months. The HS was calculated at two time points. Serial OCT imaging demonstrated that the proportion of covered stent struts increased from a median of ...

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    13. Early coverage of drug-eluting stents analysed by optical coherence tomography: evidence of the impact of stent apposition and strut characteristics on the neointimal healing process

      Early coverage of drug-eluting stents analysed by optical coherence tomography: evidence of the impact of stent apposition and strut characteristics on the neointimal healing process

      Aims: Previous studies have associated issues such as incomplete stent apposition with delayed healing and adverse events (stent thrombosis). The aim of this study was to evaluate the impact of strut apposition and stent type on the progression of stent strut coverage. Methods and results: We evaluated in vivo in porcine models the follow-up response and coverage characteristics of well-apposed and malapposed segments of drug-eluting stents (DES) (CYPHER, PROMUS Element and Orsiro) and the Absorb bioresorbable vascular scaffold (BVS) by optical coherence tomography (OCT) sequentially, at baseline, and at one week and four weeks of follow-up. Supporting results were provided ...

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    14. Absorb vs. DESolve: an optical coherence tomography comparison of acute mechanical performances

      Absorb vs. DESolve: an optical coherence tomography comparison of acute mechanical performances

      Aims: The aim of the study was to compare retrospectively the acute mechanical performance of the Absorb vs. DESolve scaffolds in terms of appropriate deployment with OCT. Methods and results: Final post-deployment OCT pullbacks of consecutive patients treated with either Absorb or DESolve were reviewed. The following parameters were calculated and compared: mean and minimal lumen area (MLA), residual in-scaffold area stenosis (RAS), incomplete strut apposition (ISA), tissue prolapse area, eccentricity index, asymmetry index, strut fracture and edge dissection. A total of 72 patients were included. The Absorb group consisted of 35 patients treated with 63 Absorb scaffolds and was ...

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    15. 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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    16. 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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    17. 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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    18. 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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    19. 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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    20. 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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    21. 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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    22. 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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    23. 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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    24. 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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