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    1. 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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    2. 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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    3. 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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    4. 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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    5. 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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    6. 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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    7. 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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    8. 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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    9. 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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    10. 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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    11. 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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    12. 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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    13. 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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    14. 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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    15. 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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    16. 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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    17. Excimer laser for a highly stenotic saphenous vein graft: evidence of debulking by optical coherence tomography

      Excimer laser for a highly stenotic saphenous vein graft: evidence of debulking by optical coherence tomography

      A 73-year-old woman with a history of coronary artery bypass (saphenous vein graft [SVG] for left anterior descending artery [LAD] and right coronary artery) was admitted for non-ST-elevation acute coronary syndrome. Coronary angiography showed a proximal severe stenosis of the SVG for LAD that was the culprit lesion of the acute coronary syndrome (Figure 1A). Frequency-domain optical coherence tomography (FD-OCT) was performed using a non-occlusive technique and showed a highly fibrous stenosis of the SVG (MLA 0.7 mm) (Figure 1B-E) that was debulked with excimer laser coronary atherectomy (ELCA) (Figure 1-A’,B’). However, a thrombus occurred at the lesion ...

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    18. Visualisation of a coronary stent presenting late mechanical failure in an aberrant left circumflex artery with coronary computed tomography angiography and optical coherence tomography

      Visualisation of a coronary stent presenting late mechanical failure in an aberrant left circumflex artery with coronary computed tomography angiography and optical coherence tomography

      A 56-year-old male was admitted with NSTEMI and underwent percutaneous coronary intervention with bare metal (cobalt-chromium) stent implantation (3.0×24 mm, 16 atm, post-dilated with 3.0×20 mm non-compliant balloon, 20 atm) in the mid segment of an anomalous circumflex artery (retroaortic course from the right sinus of Valsalva). The patient remained asymptomatic for five years post-procedure, when he presented with mild atypical chest pain. Myocardial stress perfusion scintigraphy detected no transient ischaemia; however, due to his persisting symptoms, a coronary computed tomography angiography was performed. This revealed restenosis and chronic recoil in the implanted stent (Online Figure ...

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    19. Appearance of neointima according to stent type and restenotic phase: analysis by optical coherence tomography

      Appearance of neointima according to stent type and restenotic phase: analysis by optical coherence tomography

      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 ...

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    20. Volumetric assessment of lesion severity with optical coherence tomography: relationship with fractional flow reserve

      Volumetric assessment of lesion severity with optical coherence tomography: relationship with fractional flow reserve

      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 ...

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    21. Optical coherence tomography of longitudinal stent compression

      Optical coherence tomography of longitudinal stent compression

      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.

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    22. Multiple complex coronary atherosclerosis in diabetic patients with acute myocardial infarction: a three-vessel optical coherence tomography study

      Multiple complex coronary atherosclerosis in diabetic patients with acute myocardial infarction: a three-vessel optical coherence tomography study

      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 ...

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    23. Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l’Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study

      Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l’Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study

      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 ...

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    24. Optimising cardiovascular outcomes using optical coherence tomography-guided percutaneous coronary interventions

      Optimising cardiovascular outcomes using optical coherence tomography-guided percutaneous coronary interventions

      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 ...

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    1-24 of 76 1 2 3 4 »
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