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    1. Five-Year Optical Coherence Tomography Follow-Up of an Everolimus-Eluting Bioresorbable Vascular Scaffold: Changing the Paradigm of Coronary Stenting?

      Five-Year Optical Coherence Tomography Follow-Up of an Everolimus-Eluting Bioresorbable Vascular Scaffold: Changing the Paradigm of Coronary Stenting?

      A 58-year-old man, included in cohort A of the Bioabsorbable Vascular Solutions First in Man Clinical Investigation: A Clinical Evaluation of the Bioabsorbable Vascular Solutions Everolimus Eluting Coronary Stent System in the Treatment of Patients With Single de Novo Native Coronary Artery Lesions (ABSORB) trial,1 had undergone implantation of a bioresorbable everolimus-eluting scaffold (BVS; Abbott Vascular, Santa Clara, CA) in June 2006 because of stable angina class III with a positive exercise test (Figure 1). He had a positive family history for coronary artery disease. At implantation, his total cholesterol was 207 mg/dL, his low-density lipoprotein level was ...

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    2. Spontaneous Coronary Artery Dissection: New Insights From the Tip of the Iceberg? [Editorials]

      Spontaneous Coronary Artery Dissection: New Insights From the Tip of the Iceberg? [Editorials]

      Spontaneous coronary artery dissection (SCAD) is a rare clinical entity of unknown cause that typically affects young women without coronary risk factors.1–5 Initial reports were scarce and based on autopsy findings after episodes of sudden cardiac death, suggesting that the condition had a dismal prognosis.1,2 An intimal tear was seldom found in autopsy series and, therefore, primary disruption with bleeding of vasa vasorum and intramedial hemorrhage was proposed as the underlying mechanism.1,2 Alternatively, an intimal tear may lead to separation of coronary wall layers and, eventually, to a double lumen. Pressure-driven expansion of the ...

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    3. Extrinsic Compression of the Left Anterior Descending Coronary Artery by Rib in a Patient With Progressive Left Ventricular Remodeling

      Extrinsic Compression of the Left Anterior Descending Coronary Artery by Rib in a Patient With Progressive Left Ventricular Remodeling

      A 78-year-old man with a history of dilated cardiomyopathy diagnosed 5 years previously was admitted to our clinic with accelerating chest pain and dyspnea. The initial ECG showed sinus tachycardia and left bundle-branch block. Laboratory tests revealed elevated levels of troponin T (0.409 ng/mL), creatinine kinase (218 U/L), and creatinine kinase-MB isoenzyme (9.8 μg/L). The peak level of creatinine kinase-MB isoenzyme was 41.9 μg/L. Transthoracic echocardiography revealed a more progressed left ventricular remodeling in comparison with an echocardiography conducted 2 years previously. Compared with the previous study, the end-diastolic dimension of the left ...

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    4. Letter by Perez de Prado et al Regarding Article, "Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography" [Correspondence]

      Letter by Perez de Prado et al Regarding Article, "Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography" [Correspondence]

      To the Editor: We read with great interest the article by Gutiérrez-Chico et al,1 which reports delayed coverage of incompletely apposed and nonapposed side-branch struts with respect to well-apposed struts in drug-eluting stents as assessed by optical coherence tomography. The relationship between incomplete stent apposition and delayed strut coverage has previously been explored. However, the study of fate of nonapposed side-branch struts is quite original. These struts, placed across the origin of side branches, have systematically been excluded from analysis in most of the published optical coherence tomography studies. Intuitively, they were deemed not suitable to be covered. These ...

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    5. Response to Letter Regarding Article, “Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography”

      Response to Letter Regarding Article, “Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography”

      We appreciate the interest shown by Dr Pérez de Prado and colleagues in our article.1 Nonapposed side-branch struts have been excluded from most optical coherence tomography (OCT) studies, probably not because they were deemed “unsuitable to be covered,” but because incorporating nonapposed side-branch struts into the standard analysis increases its complexity and cost. Not surprisingly, experimental models and clinical OCT studies coincide to report that most nonapposed side-branch struts are covered as well-apposed struts, but the former are in disadvantage with respect to the latter to get covered. However, the coverage of nonapposed side-branch struts might not “come necessarily ...

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    6. Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography

      Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography

      Background— Pathology studies on fatal cases of very late stent thrombosis have described incomplete neointimal coverage as common substrate, in some cases appearing at side-branch struts. Intravascular ultrasound studies have described the association between incomplete stent apposition (ISA) and stent thrombosis, but the mechanism explaining this association remains unclear. Whether the neointimal coverage of nonapposed side-branch and ISA struts is delayed with respect to well-apposed struts is unknown. Methods and Results— Optical coherence tomography studies from 178 stents implanted in 99 patients from 2 randomized trials were analyzed at 9 to 13 months of follow-up. The sample included 38 sirolimus-eluting ...

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    7. Current Capabilities and Challenges for Optical Coherence Tomography as a High-Impact Cardiovascular Imaging Modality

      Current Capabilities and Challenges for Optical Coherence Tomography as a High-Impact Cardiovascular Imaging Modality
      Impact, the ability to have a long-lasting significant influence in the field, has become the focus not only of the National Institutes of Health and the National Science Foundation but also of science in general. An article in this issue, "Optical Coherent Tomographic Analysis of In-Stent Neoatherosclerosis After Drug-Eluting Stent Implantation," deals with 2 high-impact areas of cardiology: extending the diagnostic capabilities of cardiovascular optical coherence tomography (OCT) and the cause of late drug-eluting stent failure.1 With respect to the latter, the article looks at atherosclerotic progression after drug-eluting stent placement and late development of different plaque morphologies, predominantly ...
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    8. Optical Coherence Tomographic Analysis of In-Stent Neoatherosclerosis After Drug-Eluting Stent Implantation

      Optical Coherence Tomographic Analysis of In-Stent Neoatherosclerosis After Drug-Eluting Stent Implantation
      Background— We report findings from optical coherence tomography (OCT) of in-stent neoatherosclerosis as a cause of drug-eluting stent (DES) failure. Methods and Results— Optical coherence tomography and grayscale and virtual histology intravascular ultrasound were performed in 50 patients (30 stable, 20 unstable angina) with 50 DES in-stent restenosis lesions and intimal hyperplasia >50% of stent area. Median follow-up time was 32.2 months. Overall, 26 lesions (52%) had at least 1 OCT-defined in-stent thin-cap fibroatheroma (TCFA)–containing neointima and 29 (58%) had at least 1 in-stent neointimal rupture. Patients presenting with unstable angina showed a thinner fibrous cap (55 µ ...
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    9. Strut Coverage and Late Malapposition With Paclitaxel-Eluting Stents Compared With Bare Metal Stents in Acute Myocardial Infarction: OCT Substudy of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)

      Strut Coverage and Late Malapposition With Paclitaxel-Eluting Stents Compared With Bare Metal Stents in Acute Myocardial Infarction: OCT Substudy of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)
      Background— The safety of drug-eluting stents in ST-segment elevation myocardial infarction (STEMI) continues to be debated. Pathological studies have demonstrated an association between uncovered struts and subsequent stent thrombosis. Optical coherence tomography can detect stent strut coverage in vivo on a micron-scale level. We therefore used optical coherence tomography to examine strut coverage in patients with STEMI treated with paclitaxel-eluting stents (PES) and bare metal stents (BMS). Methods and Results— In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, patients with STEMI were randomized 3:1 to PES or BMS implantation. In a formal substudy ...
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    10. High Levels of Systemic Myeloperoxidase Are Associated With Coronary Plaque Erosion in Patients With Acute Coronary Syndromes: A Clinicopathological Study

      High Levels of Systemic Myeloperoxidase Are Associated With Coronary Plaque Erosion in Patients With Acute Coronary Syndromes: A Clinicopathological Study

      Background— Systemic levels of myeloperoxidase predict prognosis in patients with acute coronary syndromes and are considered a marker of plaque vulnerability. It is not known whether myeloperoxidase is associated with different coronary morphologies (ie, rupture or erosion of the culprit lesion) in patients with acute coronary syndrome. Methods and Results— Twenty-five consecutive patients (aged 67±11 years; 15 men [60%]; 13 [52%] with non–ST-segment elevation acute coronary syndrome and 12 [48%] with acute ST-segment elevation myocardial infarction) were enrolled. Optical coherence tomography classified the culprit lesion as ruptured in 18 (72%) or eroded in 7 patients (28%) and detected ...

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    11. Evaluation of the Second Generation of a Bioresorbable Everolimus Drug-Eluting Vascular Scaffold for Treatment of De Novo Coronary Artery Stenosis: Six-Month Clinical and Imaging Outcomes

      Evaluation of the Second Generation of a Bioresorbable Everolimus Drug-Eluting Vascular Scaffold for Treatment of De Novo Coronary Artery Stenosis: Six-Month Clinical and Imaging Outcomes

      Background— The first generation of the bioresorbable everolimus drug-eluting vascular scaffold showed signs of shrinkage at 6 months, which largely contributed to late luminal loss. Nevertheless, late luminal loss was less than that observed with bare metal stents. To maintain the mechanical integrity of the device up to 6 months, the scaffold design and manufacturing process of its polymer were modified. Methods and Results— Quantitative coronary angiography, intravascular ultrasound with analysis of radiofrequency backscattering, and as an optional assessment, optical coherence tomography (OCT) were performed at baseline and at a 6-month follow-up. Forty-five patients successfully received a single bioresorbable everolimus ...

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    12. Intracoronary Optical Coherence Tomography and Histology at 1 Month and 2, 3, and 4 Years After Implantation of Everolimus-Eluting Bioresorbable Vascular Scaffolds in a Porcine Coronary Artery Model. An Attempt to Decipher the Human OCT Images in the ABSO

      Intracoronary Optical Coherence Tomography and Histology at 1 Month and 2, 3, and 4 Years After Implantation of Everolimus-Eluting Bioresorbable Vascular Scaffolds in a Porcine Coronary Artery Model. An Attempt to Decipher the Human OCT Images in the ABSO

      Background—With the use of optical coherence tomography (OCT), alterations of the reflectance characteristics of everolimus-eluting bioresorbable vascular scaffold (BVS) struts have been reported in humans. In the absence of histology, the interpretation of the appearances of the struts by OCT remains speculative. We therefore report OCT findings with corresponding histology in the porcine coronary artery model immediately after and at 28 days and 2, 3, and 4 years after BVS implantation. Methods and Results—Thirty-five polymeric BVS (3.0x12.0 mm) were singly implanted in the main coronary arteries of 17 pigs that underwent OCT and were then euthanized ...

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    13. Comparisons of Baseline Demographics, Clinical Presentation, and Long-Term Outcome Among Patients With Early, Late, and Very Late Stent Thrombosis of Sirolimus-Eluting Stents

      Comparisons of Baseline Demographics, Clinical Presentation, and Long-Term Outcome Among Patients With Early, Late, and Very Late Stent Thrombosis of Sirolimus-Eluting Stents
      Background— Stent thrombosis (ST) after sirolimus-eluting stent implantation has not yet been adequately characterized, mainly because of its low incidence. Methods and Results— The Registry of Stent Thrombosis for Review and Reevaluation (RESTART) is a Japanese nationwide registry of sirolimus-eluting stent–associated ST comprising 611 patients with definite ST (early [within 30 days; EST], 322 patients; late [between 31 and 365 days; LST], 105 patients; and very late [>1 year; VLST], 184 patients). Baseline demographics, clinical presentation, and long-term outcome of sirolimus-eluting stent–associated ST were compared among patients with EST, LST, and VLST. Baseline demographics were significantly different according ...
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    14. Cardiovascular Risk Prediction in Patients With Stable and Unstable Coronary Heart Disease

      Cardiovascular Risk Prediction in Patients With Stable and Unstable Coronary Heart Disease
      The American Heart Association estimates that 1 in 3 American adults have cardiovascular (CV) disease, including 16.8 million individuals with ischemic heart disease, 8 million individuals with peripheral arterial disease, and 6.5 million individuals with ischemic stroke.1 In 2005, CV disease accounted for 35% of all deaths in the United States. Given the high prevalence of CV disease and its associated morbidity and mortality, prevention of recurrent events in patients with established CV disease is a major public health objective. A fundamental tenet of preventive medicine is to initiate interventions appropriate to the level of risk for ...
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    15. Assessment of the Plaque With Echo Signal Attenuation by Optical Coherence Tomography

      Backgrounds. The plaque with echo signal attenuation without calcification (EA) has been reported to be related with worse angiographic and clinical outcome after percutaneous coronary intervention (PCI). We sought to evaluate the plaque morphology with EA by OCT, and to evaluate the relationship between OCT-derived characteristics of the plaque with EA and coronary flow during PCI. Methods and Results. Ninety-seven lesions with consecutive 89 patients with acute coronary syndrome (ACS n=47, 48%) and stable angina pectoris (SAP n=50, 52%), who underwent both pre- and post-procedural IVUS and OCT imagings, were investigated. EA was defined as showing echo signal ...
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    16. Comparative Analysis of Vascular Responses Following Stent Implantation in the Lesion Wth Acute Coronary Syndrome Between Paclitaxel-Eluting and Bare-Metal Stent Using Optical Coherence Tomography

      Background: Safety and feasibility of drug-eluting stent in the lesion with acute coronary syndrome (ACS) is still controversial. Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality, which is expected to visualize microscopic vascular response to coronary intervention. The purpose of this study is to evaluate the difference of vascular responses following stent implantation in the ACS lesions between paclitaxel-eluting stent (PES) and bare-metal stent (BMS) using OCT. Method: Fifty-eight ACS patients who were treated with either PES or BMS (33PESs and 25 BMSs) underwent OCT at 3 months follow-up, and 38 of them (20PESs and 18BMSs) also had ...
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    17. Assessment of a New Biodegradable Drug Eluting Stent for the Inhibition of Neovascularisation and Neointimal Hyperplasia: An Experimental Study With Optical Coherence Tomography

      Background: Vascular endothelial growth factor (VEGF) appears to be the most important mediator of neovascularisation. We assumed that inhibition of VEGF, using local delivery of bevacizumab, a monoclonal antibody specific for VEGF, could affect neovascularization and intimal hyperplasia in hypercholesterolemic rabbits. Methods: We used 10 New Zealand white rabbits under atherogenic diet for 3 weeks. Eleven biodegradable bevacizumab-eluting stents (BES) were implanted in the distal aorta. The control group consisted of 7 New Zealand white rabbits that were treated with 7 bare metal stents covered by biodegradable polymer. All animals were treated with aspirin and clopidogrel for 4 weeks. Follow-up ...

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    18. Morphological Characteristics of the Culprit Lesion Correlate With the Angiographic Flow Grade Following Thrombolysis in Myocardial Infarction. An Optical Coherence Tomography Study

      Background: Intravenous thrombolysis fails to restore blood flow in a significant percentage of patients with ST-elevation myocardial infarction (STEMI). It remains unknown, whether certain morphological characteristics of the culprit lesion (CL) can predict the success of thrombolysis. We hypothesized that the thickness of the fibrous cap and the incidence of plaque rupture at the CL, as measured by Optical Coherence Tomography (OCT), may correlate with the outcome of thrombolysis. Methods: We prospectively enrolled 55 consecutive patients with STEMI that were treated with thrombolysis 6 hours from symptom onset. All patients underwent coronary angiography within 24 hours from thrombolysis. We estimated ...

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    19. Evaluation of the Peri-strut Low Intensity Area Following Sirolimus- and Paclitaxel-Eluting Stents Implantation: Insights From an Optical Coherence Tomography Study in Humans

      Evaluation of the Peri-strut Low Intensity Area Following Sirolimus- and Paclitaxel-Eluting Stents Implantation: Insights From an Optical Coherence Tomography Study in Humans
      Background: In previous pathological studies, paclitaxel-eluting stents (PES) showed greater fibrin deposition around stent struts, while sirolimus-eluting stent (SES) showed predominance of inflammatory cells with less fibrin deposition than PES. However, there are limited in-vivo data clarifying those qualitative differences in the process of vascular healing after 1st-generation drug-eluting stents (DES) implantation. A recent animal study has shown that peri-strut low intensity area (PLIA) seen in optical coherence tomography (OCT) imaging might represent the process of hyaluronic acid and proteoglycan replacing fibrin. Methods: A total of 60 patients who underwent 6-month follow-up OCT after SES (n=34) and PES (n ...
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    20. The Prevalence and Determinant Factors of Intracoronary Thrombus Formation After Various Types of Drug-Eluting Stents Implantation: Optical Coherence Tomography Study

      Backgrounds: Intracoronary thrombus has been commonly shown after sirolimus eluting stent (SES) implantation in optical coherence tomography (OCT) examination. But, there was no data for other drug eluting stents (DES). Therefore, we investigated the prevalence and relating factors of intracoronary thrombus after various DES implantations using OCT. Methods: Two hundred twenty six patients [244 stents: 95 SES, 62 paclitaxel eluting (PES) and 87 zotarolimus eluting stent (ZES)] underwent OCT examination at mean 11 months (3– 66 months) after stent implantation. OCT evaluation focused on the thrombus, neointimal coverage and malapposition at each strut. The baseline, angiographic and OCT findings were ...

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    21. Comparison of Subsequent Vascular Response in Diabetic Patients Following Coronary Stenting Between Sirolimus- and Paclitaxel-Eluting Stents: Optical Coherence Tomography Analysis

      Comparison of Subsequent Vascular Response in Diabetic Patients Following Coronary Stenting Between Sirolimus- and Paclitaxel-Eluting Stents: Optical Coherence Tomography Analysis
      Background: Diabetes mellitus is one of the major predictors for target lesion revascularization even in drug-eluting stent era. The aim of this study is to evaluate the differences of chronic vascular response in patients with diabetes mellitus (DM) following coronary stenting between sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) using optical coherence tomography (OCT). Methods: We examined non-restenotic 60 SESs and 60 PESs were imaged with motorized OCT pull-back system (1 mm/s) at 9-month follow-up and analyzed at interval of 1 mm. Neointimal coverage of stent struts and the incidence of stent malapposition were evaluated. Results: See table. Conclusions ...
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    22. Correlation Between Plaque Rupture and Morphological Features of Thin Cap Fibroatheroma in Acute Coronary Syndrome Assessed by Optical Coherence Tomography

      Backgrounds: Plaque rupture (PR) and secondary thrombus formation (TF) play key roles in the onset of acute coronary syndrome (ACS), and thin cap fibroatheroma (TCFA) is believed to be prone to rupture. We sought to determine the relationship between morphological features and PR in vivo by optical coherence tomography (OCT). Methods: We studied 26 lesions from 26 consecutive patients with NSTEMI/UAP who underwent percutaneous coronary intervention (PCI) for culprit lesions with OCT examination. OCT imaging was performed before any device passage in the present study, and was analyzed by two independent observers. TCFA was defined as a fibroatheromatous with ...
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    23. Spatial Distribution of Tissue Components in the Left Anterior Descending Coronary Arteries Detected by Optical Coherence Tomography Color-coded Maps

      Spatial Distribution of Tissue Components in the Left Anterior Descending Coronary Arteries Detected by Optical Coherence Tomography Color-coded Maps
      Background: It has been reported that thin-cap fibroatheroma (TCFA) clustered in the proximal sites of left ascending (LAD) and left circumflex coronary arteries. However, special distribution of each tissue component has not been elucidated well. Methods: Forty coronary atherosclerotic lesions in 15 LAD of 15 patients with stable angina were visualized by optical coherence tomography (OCT, Light Lab). Tissue characteristics and thickness of each tissue component were measured and color-coded maps were reconstructed. Results: The arc of the TCFA were negatively correlated with the distance from the branch within 5mm distal (r= –0.71, p=0.004) and proximal (r ...
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      Mentions: St. Jude Medical
    25-48 of 83 « 1 2 3 4 »
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