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    1. Treatment of coronary bifurcation lesions with the Absorb bioresorbable vascular scaffold in combination with the Tryton dedicated coronary bifurcation stent: evaluation using two- and three-dimensional optical coherence tomography

      Treatment of coronary bifurcation lesions with the Absorb bioresorbable vascular scaffold in combination with the Tryton dedicated coronary bifurcation stent: evaluation using two- and three-dimensional optical coherence tomography

      Aims: The Tryton bifurcation stent has been developed to improve clinical outcomes after treatment of bifurcation lesions. Limited data are available on the use of the Absorb bioresorbable vascular scaffold (BVS) in bifurcation lesions with side branches >2 mm. We present here the acute procedural results and midterm clinical follow-up of the first-in-man combined use of the Tryton stent and the Absorb scaffold for the treatment of complex bifurcation lesions. Methods and results: Ten patients treated with the Tryton stent in combination with Absorb BVS were included in the current report. Offline two- and three-dimensional optical coherence tomography (OCT) analyses ...

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    2. Optical coherence tomography study of healing characteristics of paclitaxel-eluting balloons vs. everolimus-eluting stents for in-stent restenosis: the SEDUCE (Safety and Efficacy of a Drug elUting balloon in Coronary artery rEstenosis) randomised clinica

      Optical coherence tomography study of healing characteristics of paclitaxel-eluting balloons vs. everolimus-eluting stents for in-stent restenosis: the SEDUCE (Safety and Efficacy of a Drug elUting balloon in Coronary artery rEstenosis) randomised clinica

      Aims: Little is known about the respective healing responses and clinical efficacy and safety of drug-eluting balloons (DEB) and the second generation of drug-eluting stents (DES) when used to treat in-stent restenosis (ISR). In this study, we set out to compare prospectively the healing characteristics, as assessed by optical coherence tomography (OCT), of DEB versus DES after treatment of ISR in bare metal stents (BMS). Methods and results: Fifty patients with BMS ISR were randomised to treatment with a paclitaxel-eluting balloon vs. an everolimus-eluting stent (EES). The primary endpoint was the percentage of uncovered struts, assessed with OCT at nine ...

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    3. SEDUCEd by optical coherence tomography in drug-eluting balloon assessment

      SEDUCEd by optical coherence tomography in drug-eluting balloon assessment

      In everyday practice, percutaneous coronary intervention using a bare metal stent (BMS) is still frequently performed and the chance of incurring in-stent restenosis (ISR) is not negligible. Different treatment modalities for BMS ISR are still an important area of discussion. One of the most appealing is the drug-eluting balloon (DEB). This device has been proven angiographically and clinically superior to an uncoated balloon in BMS ISR1,2. Moreover, in the same type of lesion, DEBs have also shown angiographic and clinical results at least comparable to first-generation drug-eluting stents (DES), with a trend towards lower angiographic restenosis and lower ...

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    4. Optical coherence tomography assessment of a PLGA-polymer with electro-grafting base layer versus a PLA-polymer sirolimus-eluting stent at three-month follow-up: the BuMA-OCT randomised trial

      Optical coherence tomography assessment of a PLGA-polymer with electro-grafting base layer versus a PLA-polymer sirolimus-eluting stent at three-month follow-up: the BuMA-OCT randomised trial

      Aims: To compare stent strut coverage using optical coherence tomography (OCT) at three-month follow-up between a PLGA-polymer with electro-grafting base layer sirolimus-eluting stent (SES) (BuMA) and a PLA-polymer SES (EXCEL). Methods and results: This prospective, single-centre, non-inferiority randomised BuMA-OCT trial enrolled patients with de novo coronary artery lesions, treated with either the BuMA or the EXCEL stent. The study primary endpoint was OCT-evaluated stent strut coverage at three months. Secondary endpoints were neointimal thickness of stent struts, and incomplete stent apposition evaluated with OCT. A total of 80 patients were randomly assigned to receive the BuMA (n=40) or the ...

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    5. Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

      Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

      Aims: To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe. Methods and results: We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB. Among 852 ACS patients who had undergone invasive coronary angiography, 101 (11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI 3 flow without stenting. All of these patients then had repeat angiography with OCT (days 0-2 [Group 1 ...

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      Mentions: Francesco Prati
    6. Drug-eluting stent implantation in patients with acute coronary syndrome - the Activity of Platelets after Inhibition and Cardiovascular Events: Optical Coherence Tomography (APICE OCT) study

      Drug-eluting stent implantation in patients with acute coronary syndrome - the Activity of Platelets after Inhibition and Cardiovascular Events: Optical Coherence Tomography (APICE OCT) study

      Aims: To our knowledge, no randomised study has compared rates of uncovered stent struts in everolimus (EES) vs. new-generation zotarolimus-eluting (ZES-R) stents in acute coronary syndrome (ACS). The aim of our study was to evaluate the completeness of neointimal coverage with optical coherence tomography (OCT) in ACS patients treated with drug-eluting stents (DES) comparing EES versus new-generation ZES-R. Methods and results: All eligible ACS patients admitted to four Italian centres with a clinical indication for culprit lesion intervention were randomised 1:1 to EES or ZES-R. The primary study endpoint was the percentage of uncovered stent struts evaluated by optical ...

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    7. Optical coherence tomography and intravascular ultrasound of double kissing crush coronary bifurcation stenting

      Optical coherence tomography and intravascular ultrasound of double kissing crush coronary bifurcation stenting

      A 55-year-old male underwent percutaneous coronary intervention (PCI) of a Medina 1,1,1 circumflex (LCx) and a first obtuse marginal (OM1) bifurcation lesion. A double kissing crush technique was performed, utilising a 2.75×12 mm everolimus-eluting stent (EES) in OM1 and a XIENCE V 4.0×15 mm EES (Abbott Vascular, Santa Clara, CA, USA) in the LCx (Online Figure 1). Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) runs were performed (Online Figure 2, Online Figure 3, Moving image 1). 3D reconstruction of the OCT further clarified the reconstruction of the bifurcation carina and paving, in particular ...

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    8. Intricacies in the analysis and interpretation of optical coherence tomography findings

      Intricacies in the analysis and interpretation of optical coherence tomography findings

      The assessment of arterial wall healing following DES implantation with the use of optical coherence tomography (OCT) has become a standard in the systematic evaluation of coronary stents. As a result, the number of scientific manuscripts on stents and OCT has proliferated, and stent characteristics including strut coverage and malapposition are reported based on their association with stent thrombosis in observational studies1. In this issue of EuroIntervention, Kim and colleagues2 present the results of a randomised comparison between new-generation biodegradable biolimus-eluting stents… 

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    9. Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention

      Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention

      Aims: The Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) represents an important advance in percutaneous coronary intervention (PCI) technology. With increasing use of BVS, it is important to understand its expansion characteristics to ensure optimal scaffold deployment. Optical coherence tomography (OCT) has been shown to improve detection of intraprocedural complications compared with conventional intravascular imaging modalities. This study aimed to determine whether or not OCT, post successful angiographic BVS implantation, influenced decision making with regard to the need for further scaffold optimisation. Methods and results: Consecutive patients undergoing OCT-guided BVS implantation from August 2012 to March 2013 were reviewed to determine ...

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    10. Different serial changes in the neointimal condition of sirolimus-eluting stents and paclitaxel-eluting stents: an optical coherence tomographic study

      Different serial changes in the neointimal condition of sirolimus-eluting stents and paclitaxel-eluting stents: an optical coherence tomographic study

      Aims: Detailed long-term changes of the neointima in sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) are still unclear. Methods and results: We consecutively enrolled 14 patients (18 SES) and 12 patients (13 PES) who underwent optical coherence tomography (OCT) serially at eight months and 18 months after stent implantation. For 18 SES and 13 PES, OCT was used to visualise 2,486 and 1,361 stent struts at the eight-month and 2,199 and 1,309 stent struts at the 18-month follow-up, respectively. The OCT parameters, including incidence of uncovered and malapposed struts (uncovered and malapposed percentage), average neointimal hyperplasia ...

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    11. Randomised comparison of strut coverage between Nobori biolimus-eluting and sirolimus-eluting stents: an optical coherence tomography analysis

      Randomised comparison of strut coverage between Nobori biolimus-eluting and sirolimus-eluting stents: an optical coherence tomography analysis

      Aims: The aims of this study were to compare strut tissue coverage at six-month follow-up after Nobori biolimus-eluting stent (N-BES) versus sirolimus-eluting stent (SES) implantation. Methods and results: A total of 120 patients with a single stenotic lesion requiring revascularisation were randomly assigned to either N-BES (n=60) or SES (n=60). Baseline optical coherence tomography (OCT) was performed post stent implantation, and follow-up OCT was scheduled at six months. Post-intervention and follow-up OCT analyses were available in 51 (85.0%) and 52 (86.7%) patients, respectively. The primary endpoint was the percentage of uncovered struts at follow-up OCT in ...

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    12. 3D optical coherence tomography: new insights into the process of optimal rewiring of side branches during bifurcational stenting

      3D optical coherence tomography: new insights into the process of optimal rewiring of side branches during bifurcational stenting

      Aims: We describe three-dimensional optical coherence tomography (3D-OCT) guided bifurcation stenting and the clinical utility of 3D-OCT. Methods and results: Twenty-two consecutive patients who underwent OCT examination to confirm the recrossing position after stent implantation in a bifurcation lesion were enrolled. Frequency domain OCT images were obtained to check the recrossing position and 3D reconstructions were performed off-line. The recrossing position was clearly visualised in 18/22 (81.8%) cases. In 13 cases, serial 3D-OCT could be assessed both before and after final kissing balloon post-dilation (FKBD). We divided these cases into two groups according to the presence of the ...

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    13. Stent-related defects in patients presenting with stent thrombosis: differences at optical coherence tomography between subacute and late/very late thrombosis in the Mechanism Of Stent Thrombosis (MOST) study

      Stent-related defects in patients presenting with stent thrombosis: differences at optical coherence tomography between subacute and late/very late thrombosis in the Mechanism Of Stent Thrombosis (MOST) study

      Aims: Subacute, late, and very late stent thrombosis (ST) may occur after stent implantation, but they are characterised by different underlying pathophysiological mechanisms. We sought to appraise differences between subacute and late/very late ST at the thrombus site by optical coherence tomography (OCT). The Mechanism Of Stent Thrombosis (MOST) study was a prospective multicentre non-randomised registry which enrolled six subacute ST and six controls (subacute ST study), and 17 late/very late ST and 17 controls (late/very late ST study). Methods and results: Patients with subacute ST had a minimum stent area at the thrombus site of 2 ...

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    14. Comparison of paclitaxel-eluting vs. everolimus-eluting stents implanted simultaneously in different lesions of the same coronary artery: 12-month follow-up with optical coherence tomography

      Comparison of paclitaxel-eluting vs. everolimus-eluting stents implanted simultaneously in different lesions of the same coronary artery: 12-month follow-up with optical coherence tomography

      Aims: Optical coherence tomography (OCT) allows a detailed assessment of intimal coverage and strut apposition which are well known substrates for late thrombosis. This study sought to assess and compare long-term coverage and apposition of PES and EES implanted in different lesions of the same coronary artery (and in the same patient). Methods and results: A total of 30 patients were included. In these patients PES and EES were implanted in the same vessel in two similar lesions. The selection of the stent for each lesion was random. At 12 months, 30 PES were examined analysing 154±90 struts/stents ...

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    15. A novel procedure for imaging acute coronary syndrome lesions using frequency-domain optical coherence tomography

      A novel procedure for imaging acute coronary syndrome lesions using frequency-domain optical coherence tomography

      Description Next-generation OCT (frequency-domain optical coherence tomography, FD-OCT) facilitates high-speed pullbacks during image acquisition without necessitating transient balloon occlusion of the coronary artery 1 , 2 , 3 . However, a more robust catheter is necessary to facilitate high-speed pullbacks during FD-OCT. The profile diameter of the FD-OCT catheter is larger than that of the previous generation time-domain OCT (TD-OCT) imaging wire. A larger FD-OCT catheter could occlude severely stenotic lesions, causing insufficient distal contrast flushing. Subsequently, this causes insufficient blood clearance, resulting in poor OCT imaging. We investigated visualisation challenges of FD-OCT in the presence of severely stenotic lesions in an ex ...

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    16. A unique feature of thin flat thrombus visualised by optical coherence tomography

      A unique feature of thin flat thrombus visualised by optical coherence tomography

      Optical coherence tomography (OCT) has recently been developed as a high-resolution intravascular imaging modality, detecting small abnormal structures in the coronary lumen that could not be visualised by intravascular ultrasound (IVUS). A 77-year-old man died with acute myelogenous leukemia. After he died, the coronary artery was imaged by OCT (ImageWire; LightLab Imaging, Westford, MA, USA) and IVUS (Atlantis SR Pro, 40 MHz; Boston Scientific, Natick, MA, USA). OCT clearly demonstrated a thin flat structure in the coronary lumen ( Figure 1A , Moving image 1 ) but not in the IVUS image. This unique structural feature was demonstrated in corresponding histological images ( Figure ...

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    17. Optical coherence tomography-based evaluation of in-stent neoatherosclerosis in lesions with more than 50% neointimal cross-sectional area stenosis

      Optical coherence tomography-based evaluation of in-stent neoatherosclerosis in lesions with more than 50% neointimal cross-sectional area stenosis

      Aims: To use optical coherence tomography (OCT) to evaluate the time course, risk factors, and clinical implication of in-stent neoatherosclerosis. Methods and results: The neointimal characteristics of 152 lesions, 128 drug-eluting stents (DESs) and 24 bare metal stents (BMSs), with >50% percent cross-sectional area (CSA) neointimal stenosis were evaluated. Neoatherosclerosis was defined as neointima with presence of lipid or calcification. Neoatherosclerosis was observed in 54 lesions (35.5%, 35 DESs and 19 BMSs). Median time to follow-up was 70.7 months in lesions with neoatherosclerosis (longer than lesions without neoatherosclerosis [13.4 months, p<0.001]): 58.7 months in ...

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    18. IS CORONARY ANGIOGRAM STILL THE GOLD STANDARD FOR NON ST ELEVATION MI IMAGING?

      IS CORONARY ANGIOGRAM STILL THE GOLD STANDARD FOR NON ST ELEVATION MI IMAGING?

      Because of the discordant normal echocardiogram with the high elevation in troponin I and the ECG showing deep T waves inversion in the anterior leads, and in the absence of obvious coronary lesion, myocarditis was suspected. A cardiac magnetic resonance imaging scan (MRI) was performed the following day and was in favour of apical necrosis, showing an early inferoapical sub-endocardial perfusion defect and late transmural enhancement with no reflow. The patient was therefore rescheduled for coronary angiogram with intracoronary imaging. Optical coherence tomography (OCT) was performed in the left anterior descending coronary artery (LAD) using radial access (Terumo 6Fr introducer ...

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    19. Dynamics of vessel wall changes following the implantation of the Absorb everolimus-eluting bioresorbable vascular scaffold: a multi-imaging modality study at 6, 12, 24 and 36 months

      Dynamics of vessel wall changes following the implantation of the Absorb everolimus-eluting bioresorbable vascular scaffold: a multi-imaging modality study at 6, 12, 24 and 36 months

      Aims: To assess observations with multimodality imaging of the Absorb bioresorbable everolimus-eluting vascular scaffold performed in two consecutive cohorts of patients who were serially investigated either at 6 and 24 months or at 12 and 36 months. Methods and results: In the ABSORB multicentre single-arm trial, 45 patients (cohort B1) and 56 patients (cohort B2) underwent serial invasive imaging, specifically quantitative coronary angiography (QCA), intravascular ultrasound (IVUS), radiofrequency backscattering (IVUS-VH) and optical coherence tomography (OCT). Between one and three years, late luminal loss remained unchanged (6 months: 0.19 mm, 1 year: 0.27 mm, 2 years: 0.27 mm ...

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    20. Co-registration of fractional flow reserve and optical coherence tomography with the use of a three-dimensional angiographic roadmap: an opportunity for optimisation of complex percutaneous coronary interventions

      Co-registration of fractional flow reserve and optical coherence tomography with the use of a three-dimensional angiographic roadmap: an opportunity for optimisation of complex percutaneous coronary interventions

      Angiography of a 63-year-old male patient with unstable angina revealed a tight stenosis in the mid right coronary artery, proximal to a formerly implanted drug-eluting stent (DES). A motorised pullback of the pressure wire at 1 mm/sec during IV adenosine (140 μg/kg/min) permitted co-registration of the pressure-derived fractional flow reserve (FFR) signal along the angiographic roadmap, and the precise length (12 mm) of the segment where the pressure “jump” was derived. Additional OCT co-registration was performed revealing extensive spiral dissection at the proximal edge of the - See more at: http://www.pcronline.com/eurointervention/66th_issue/146/#sthash ...

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    21. In-stent neoatherosclerosis 10 years after bare metal stent implantation: ruptured vulnerable plaque by optical coherence tomography

      In-stent neoatherosclerosis 10 years after bare metal stent implantation: ruptured vulnerable plaque by optical coherence tomography

      In-stent neoatherosclerosis has recently been described as an important mechanism of late stent failure. A 56-year-old man with a single bare metal stent implantation ten years previously presented with new-onset chest pain. Coronary angiography revealed a right coronary artery with focal in-stent restenosis (Online Figure 1). Optical coherence tomography (OCT) demonstrated the presence of fibroatheroma throughout the entire length of the stent. At one point (panel C), a thin-cap fibroatheroma (TCFA) with plaque rupture is noted (Figure 1, Online Figure 2) - 

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    22. Flow disturbances in stent-related coronary evaginations: a computational fluid-dynamic simulation study

      Flow disturbances in stent-related coronary evaginations: a computational fluid-dynamic simulation study

      Aims: Angiographic ectasias and aneurysms in stented segments have been associated with late stent thrombosis. Using optical coherence tomography (OCT), some stented segments show coronary evaginations reminiscent of ectasias. The purpose of this study was to explore, using computational fluid-dynamic (CFD) simulations, whether OCT-detected coronary evaginations can induce local changes in blood flow. Methods and results: OCT-detected evaginations are defined as outward bulges in the luminal vessel contour between struts, with the depth of the bulge exceeding the actual strut thickness. Evaginations can be characterised cross ectionally by depth and along the stented segment by total length. Assuming an ellipsoid ...

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    23. Natural history of optical coherence tomography-detected non-flow-limiting edge dissections following drug-eluting stent implantation

      Natural history of optical coherence tomography-detected non-flow-limiting edge dissections following drug-eluting stent implantation

      Aims: Angiographic evidence of edge dissections has been associated with a risk of early stent thrombosis. Optical coherence tomography (OCT) is a high-resolution technology detecting a greater number of edge dissections -particularly non-flow-limiting- compared to angiography. Their natural history and clinical implications remain unclear. The objectives of the present study were to assess the morphology, healing response, and clinical outcomes of OCT-detected edge dissections using serial OCT imaging at baseline and at one year following drug-eluting stent (DES) implantation. Methods and results: Edge dissections were defined as disruptions of the luminal surface in the 5 mm segments proximal and distal ...

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    24. In vivo assessment of the three-dimensional haemodynamic micro-environment following drug-eluting bioresorbable vascular scaffold implantation in a human coronary artery: fusion of frequency domain optical coherence tomography and angiography

      In vivo assessment of the three-dimensional haemodynamic micro-environment following drug-eluting bioresorbable vascular scaffold implantation in a human coronary artery: fusion of frequency domain optical coherence tomography and angiography

      The biplane angiographic data, acquired after implantation of an everolimus-eluting bioresorbable vascular scaffold (Absorb™ BVS; Abbott Vascular, Santa Clara, CA, USA) in the right coronary artery of a 46-year-old patient, were separately fused with frequency domain optical coherence tomography (FD-OCT) and intravascular ultrasound (IVUS) data to reconstruct the three-dimensional (3-D) anatomy. The local shear stress (SS) distribution in the FD-OCT- and IVUS-based models was assessed using computational fluid dynamics. The FD-OCT-based reconstruction (Figure 1A) allowed imaging of the lumen irregularities in the scaffolded segment due to strut protrusion (Figure 1B), which caused recirculation zones around the struts (Figure 1C). In ...

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