1. Articles from Heart

    heart.bmj.com

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    1. Intracoronary Imaging

      Intracoronary Imaging

      Two intracoronary imaging techniques are routinely available to complement angiography in the management of coronary artery disease, namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The former has been in clinical use for >25 years and has directly informed the fundamentals of atherosclerotic plaque composition and arterial remodelling, as well as contemporary optimal stent implantation technique. 1 , 2 The latter, introduced 10 years ago, has only been more widely adopted with the development of the frequency domain (FD)-OCT imaging, which enables complete image acquisition over a 6–10 cm segment during a 3–5 s pullback period obtaining ...

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    2. Hazy filling defect on coronary angiography: insights from optical coherence tomography

      Hazy filling defect on coronary angiography: insights from optical coherence tomography

      A middle-aged patient with previous stent to the left circumflex artery (LCx) 12 months before suffering from angina, now presented with acute-onset severe retrosternal chest pain with an ECG showing ST-elevation in the precordial leads (see online supplementary figure S1). He underwent emergency coronary angiography, which showed normal flow in all arteries and a patent LCx stent. The left anterior descending artery (LAD) contained a hazy filling defect in the mid vessel (figure 1A). Following administration of heparin, the filling defect in the mid-LAD resolved (figure 1B). The left ventriculogram showed severe systolic dysfunction involving the mid and apical segments ...

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    3. Hazy filling defect on coronary angiography: insights from optical coherence tomography

      Hazy filling defect on coronary angiography: insights from optical coherence tomography

      A middle-aged patient with previous stent to the left circumflex artery (LCx) 12 months before suffering from angina, now presented with acute-onset severe retrosternal chest pain with an ECG showing ST-elevation in the precordial leads (see online supplementary figure S1). He underwent emergency coronary angiography, which showed normal flow in all arteries and a patent LCx stent. The left anterior descending artery (LAD) contained a hazy filling defect in the mid vessel (figure 1A). Following administration of heparin, the filling defect in the mid-LAD resolved (figure 1B). The left ventriculogram showed severe systolic dysfunction involving the mid and apical segments ...

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    4. OCT Findings from the European Multi-centre Prestige Stent Thrombosis Study

      OCT Findings from the European Multi-centre Prestige Stent Thrombosis Study

      Background Coronary stent thrombosis (ST) remains the ‘Achilles Heel’ of percutaneous coronary intervention (PCI). Although relatively rare, it is associated with a high rate of acute myocardial infarction and death.A specific point of concern is the ongoing risk of very late ST, occurring more than one year after stent implantation, and the fact that this seems to occur steadily at an annual rate of 0.5% with a high risk of recurrence. The exact mechanisms are multi-factorial and poorly understood and previous studies have been hampered by small sample sizes, incomplete patient characterisation, and a lack of intracoronary imaging ...

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      Mentions: St. Jude Medical
    5. Relationship between optical coherence tomography derived intraluminal and intramural criteria and haemodynamic relevance as determined by fractional flow reserve in intermediate coronary stenoses of patients with type 2 diabetes

      Relationship between optical coherence tomography derived intraluminal and intramural criteria and haemodynamic relevance as determined by fractional flow reserve in intermediate coronary stenoses of patients with type 2 diabetes

      Background The relationship between functional relevance and optical coherence tomography (OCT)-derived measurements of coronary lesions is incompletely understood and of critical importance, particularly in cardiovascular high-risk patients with type 2 diabetes. Objective To investigate the association between functional relevance of intermediate grade coronary stenoses as assessed by fractional flow reserve (FFR) and OCT-derived lesion parameters in patients with diabetes. Methods In 46 diabetic patients with stable coronary artery disease, FFR and OCT were performed in 62 coronary lesions with intermediate severity as determined by quantitative coronary angiography. Among lesions haemodynamic relevance was defined as FFR≤0.8. Results There ...

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    6. Plaques with high lipid burden: keeping the fat out of the fire

      Plaques with high lipid burden: keeping the fat out of the fire

      Two recent papers published in Heart have evaluated the utility of advanced imaging modalities for the morphological detection and evaluation of high-risk atherosclerotic plaques. 1 , 2 While these studies employed differing methodologies (CT angiography (CTA), optical coherence tomography (OCT) and optic angioscopy), the results are broadly concordant and of major potential clinical significance. Notably, when subjected to percutaneous coronary intervention (PCI), such high-risk plaques may embolise and release a slurry of lipid-rich necrotic debris to the distal circulation, with consequent myocardial damage. In addition, it has been proposed that PCI of lipid-rich plaques (LRP) with thin fibrous caps (<65 μm ...

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    7. Almanac 2012: interventional cardiology: The national society journals present selected research that has driven recent advances in clinical cardiology

      Almanac 2012: interventional cardiology: The national society journals present selected research that has driven recent advances in clinical cardiology
      The field of interventional cardiology continues to progress quickly. The efficacy of percutaneous interventions with newer generation drug-eluting stents has advanced a lot over the last decade. This improvement in stent performance has broadened the level of indication towards more complex interventions such as left main and multi-vessel PCI. Major improvements continue in the field of medical co-therapy such as antiplatelet therapies (bivalirudin, prasugrel, ticagrelor) and this will further improve outcomes of PCI. The same is true for intravascular imaging such as ultrasound IVUS and optical coherence tomography OCT. However, interventional cardiology has become a rather broad field, also including ...
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    8. IN-STENT LIPID-RICH PLAQUE IN HIGH CHOLESTEROL DIET RABBIT VALIDATED BY INTRAVASCULAR OPTICAL COHERENCE TOMOGRAPHY AND HISTOLOGY

      IN-STENT LIPID-RICH PLAQUE IN HIGH CHOLESTEROL DIET RABBIT VALIDATED BY INTRAVASCULAR OPTICAL COHERENCE TOMOGRAPHY AND HISTOLOGY

      Objectives In-stent lipid-rich plaque had been found frequently in patients underwent stent implantation by optical coherence tomography (OCT) and intravascular ultrasound (IVUS). The paucity of a reliable animal model limits the further research of lipid-rich plaque development and treatment. The present study aims to develop an animal model of lipid-rich plaque. Methods Four New Zealand White Rabbits were fed a high cholesterol diet (HCD) until euthanasia. Eight bare metal stents were randomly implanted into iliac arteries after 1 week HCD. The rabbits underwent OCT and IVUS imaging at 8 weeks after stent implantation. Then the stents were harvested and processed ...

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    9. Almanac 2012: interventional cardiology

      Almanac 2012: interventional cardiology
      The field of interventional cardiology continues to progress quickly. The efficacy of percutaneous interventions with newer generation drug-eluting stents has advanced a lot over the last decade. This improvement in stent performance has broadened the level of indication towards more complex interventions such as left main and multi-vessel PCI. Major improvements continue in the field of medical co-therapy such as antiplatelet therapies (bivalirudin, prasugrel, ticagrelor) and this will further improve outcomes of PCI. The same is true for intravascular imaging such as ultrasound IVUS and optical coherence tomography OCT. However, interventional cardiology has become a rather broad field, also including ...
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    10. Significance of intraplaque neovascularisation for vulnerability: optical coherence tomography study

      Significance of intraplaque neovascularisation for vulnerability: optical coherence tomography study

      Objectives This study aimed to investigate the role of intraplaque neovascularisation (NV) in culprit lesions and non-culprit lesions of unstable angina pectoris (UAP) and in lesions of stable angina pectoris (SAP) using optical coherence tomography (OCT). Design This study was a retrospective study. Setting The significance of NV for culprit and non-culprit plaques remains unclear. Participants A total of 356 plaques from 92 UAP patients and 25 SAP patients who underwent OCT imaging were divided into three groups: culprit lesions in UAP (92), non-culprit lesions in UAP (203) and lesions of SAP (61). Main outcome measures NV and plaque characteristics ...

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    11. Putting the microscope on stent thrombosis

      Putting the microscope on stent thrombosis

      Intravascular ultrasound (IVUS) initially gained widespread use in interventional cardiology as a technique to prevent stent thrombosis (ST) by detecting and avoiding angiographically unapparent underexpansion, malapposition and incomplete lesion coverage. In a seminal report from the Milan group, a large series of patients receiving stents for complex lesions showed a very low incidence of thrombosis using aspirin alone1—in contrast with the more aggressive anticoagulation regimes that had been used up to that point—when IVUS guidance was used. The results were subsequently duplicated in a small multicentre study (MUSIC) which used stringent criteria of stent deployment and expansion.2 ...

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    12. Combined use of optical coherence tomography and intravascular ultrasound imaging in patients undergoing coronary interventions for stent thrombosis

      Combined use of optical coherence tomography and intravascular ultrasound imaging in patients undergoing coronary interventions for stent thrombosis

      Objective This prospective study sought to assess the diagnostic value of optical coherence tomography (OCT) compared with intravascular ultrasound (IVUS) in patients presenting with stent thrombosis (ST). Design and setting Although the role of IVUS in this setting has been described, the potential diagnostic value of OCT in patients suffering ST remains poorly defined. Catheterization Laboratory, University Hospital. Patients and interventions Fifteen consecutive patients with ST undergoing rescue coronary interventions under combined IVUS/OCT imaging guidance were analysed. Mean outcome measures Analysis and comparison of OCT and IVUS findings before and after interventions. Results Before intervention, OCT visualised the responsible ...

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    13. Very late bare metal stent thrombosis due to neoatherosclerotic plaque rupture: an optical coherence tomography finding

      Very late bare metal stent thrombosis due to neoatherosclerotic plaque rupture: an optical coherence tomography finding

      Very late stent thrombosis (VLST) is a rare but potentially catastrophic complication occurring after percutaneous coronary intervention. The mechanisms involved in VLST in bare metal stents (BMS) are poorly understood. A 50-year-old man presented with an inferior ST-elevation myocardial infarction. There was a history of percutaneous coronary intervention of the right coronary artery with a BMS 7 years ago. Emergency coronary angiography revealed acute stent thrombosis within the right coronary artery stent (figure 1) (panel A). After aspiration thrombectomy, optical coherence tomography was performed (panel I–V). The optical coherence tomography findings in this case support the growing evidence that ...

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    14. Different vessel response between chronic total occlusions and non-CTO lesion after Sirolimus-eluting stent implantation: a serial optical coherence tomography study

      Different vessel response between chronic total occlusions and non-CTO lesion after Sirolimus-eluting stent implantation: a serial optical coherence tomography study
      Objectives To investigate the neointimal coverage and malapposition of sirolimus-eluting stent in treatment of CTOs and non-CTO lesions (including lipid-rich plaque and non-lipid-rich plaque) by optical coherence tomography. Methods We enrolled 64 patients (CTO: n=29 stents/21 patients, lipid-rich plaque: n=33 stents/26 patients, and non-lipid-rich plaque: n=21 stents/17 patients) with 68 target vessels and examined lesion characteristics by using OCT at pre- and post-SES implantation and 6 months follow-up. Lipid rich plaque was defined as the plaque with lipid content in ≥2 quadrants. Non-lipid-rich plaque consists of fibrous, fibrocalcific plaque, and lipid plaque with less ...
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    15. In vivo evaluation of vulnerable atherosclerotic plaque rabbit carotid model by optical coherence tomography

      In vivo evaluation of vulnerable atherosclerotic plaque rabbit carotid model by optical coherence tomography

      Background We sought to test the feasibility of imaging vulnerable atherosclerotic plaque in vivo using optical coherence tomography (OCT) to assess the value of vulnerable atherosclerotic plaque rabbit model established with a novel way. Methods 30 Rabbits were randomly divided into two groups: Group A (n=15): Balloon injury of carotid artery followed by high cholesterol diet (HCD) for 12 weeks. Group B (n=15): In this group, a thin filter paper slip statured with 10% ferric trichloride was lay between paraffin filter paper and common carotid artery infiltrated for 3 to 5 min. We analysed OCT data including plaque ...

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    16. Detection of very early stent healing after primary angioplasty: an optical coherence tomographic observational study of chromium cobaltum and first-generation drug-eluting stents. The DETECTIVE Study

      Detection of very early stent healing after primary angioplasty: an optical coherence tomographic observational study of chromium cobaltum and first-generation drug-eluting stents. The DETECTIVE Study

      Background Lack of stent coverage appears to be associated with stent thrombosis, a problem of particular concern in patients with ST elevation myocardial infarction (STEMI). Methods The DETECTIVE European Multicenter Registry was set up to address the early modality of stent healing in the setting of STEMI. The Registry compared, with an early optical coherence tomography (OCT) evaluation performed at 3–7 days, the patterns of coverage and apposition of the first generation of drug-eluting stents (DESs) and cobalt chromium non-drug-eluting stents (CCSs) that were deployed in culprit lesions and in non-culprit segments. The Registry included only patients with a ...

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    17. Optical coherence tomography: has its time come?

      Optical coherence tomography: has its time come?
      Cardiologists using intravascular ultrasound (IVUS) towards the end of the past millennium can recall the time when enthusiasm for a method that was initially seen purely as a powerful research tool began to be substituted by the awareness that intravascular imaging had the potential to revolutionise our understanding of the mechanisms of coronary interventions. Such a revolution occurred in Milan when Antonio Colombo and his group applied ultrasound to elucidate the mechanism of stent thrombosis, at that time common despite high levels of anticoagulation. 1 Many early adopters of optical coherence tomography (OCT) have a similar perception now. A research ...
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    18. Assessing healing of drug eluting stents

      Assessing healing of drug eluting stents
      Drug eluting stents (DES) have undoubtedly been efficacious in attenuating restenosis. There is comparatively little in vivo data however, on the influence of DES and the powerful cytostatic agents they employ on arterial healing in patients. Even in the early DES trials, intravascular ultrasound (IVUS) demonstrated adverse (expansive) arterial remodelling with late acquired malapposition of stent struts, though the clinical relevance of this was overlooked until associations with late stent thrombosis (LST) were demonstrated. 1 Autopsy studies of patients dying of late DES thrombosis show a pattern of delayed arterial healing characterised by incomplete re-endothelialisation and persistence of fibrin. A ...
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    19. Endothelium-dependent coronary vasomotor response and neointimal coverage of zotarolimus-eluting stents 3 months after implantation

      Endothelium-dependent coronary vasomotor response and neointimal coverage of zotarolimus-eluting stents 3 months after implantation

      Background Zotarolimus-eluting stents (ZES) have a higher rate of neointimal coverage than the first-generation drug-eluting stents on optical coherence tomography (OCT). Objective To determine whether neointimal coverage of stent struts detected by OCT can be used as a surrogate for endothelial function after ZES implantation. Design Cross-sectional observational study. Setting Three months after ZES implantation. Patients and methods OCT was performed in 20 patients with a ZES at 3 months after stent implantation to evaluate strut coverage. Endothelium-dependent coronary vasomotion was estimated by infusing incremental doses of acetylcholine into the coronary ostium. The vascular response was measured in the 10 ...

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    20. Impact of plaque morphology on intimal hyperplasia after stenting assessed by optical coherence tomography

      Impact of plaque morphology on intimal hyperplasia after stenting assessed by optical coherence tomography
      Objective The objective of this study was to evaluate whether the plaque morphology can affect the in-stent neointimal hyperplasia. Methods 74 patients (93 stents) with OCT post-stent implantation were included in the study. Cross-sectional OCT images were analysed at 1-mm intervals (every 15 frames), and 302 cross-sectional images with lipid or calcific lesions under the stent struts were selected. The struts in these sections were divided into four groups according to the plaque conditions under the struts: group 1—struts on the normal vessel, group 2—on the fibrotic lesion, group 3—on the calcific lesion, group 4—on the ...
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    21. High frequency of peri-strut low intensity area assessed by optical coherence tomography after polymer-based sirolimus-eluting stents implantation in porcine model

      High frequency of peri-strut low intensity area assessed by optical coherence tomography after polymer-based sirolimus-eluting stents implantation in porcine model
      Objectives To assess the frequency of peri-strut low intensity area (PLIA) in polymeric and nonpolymeric drug-eluting stents by optical coherence tomography (OCT) in porcine model, to analyse the pathological changes in PLIA. Setting Previous intravascular ultrasound studies showed that black holes were more commonly seen in sirolimus-eluting stent restenosis. Similar phenomenon (peri-strut low intensity area) was also frequently detected by OCT in DES follow-up. However, it is still largely unknown what triggers this uncommon response. Design and interventions: A total of 18 stents (BMS, n=6; polymer-free PES [PF-PES], n=6 and polymer-based SES [PB-SES], n=6) were implanted in ...
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    22. Evaluate seriate progress of vulnerable plaque by optical coherence tomography on rabbit vulnerable plaque model

      Evaluate seriate progress of vulnerable plaque by optical coherence tomography on rabbit vulnerable plaque model

      Objectives Assess seriate progress of vulnerable plaque (VP) formation fusing Optical Coherence Tomography (OCT) with histopathological test to confirm what we find in the OCT imaging of vulnerable plaque on established rabbit vulnerable plaque model. Providing early characteristics of the signals displayed by VP in order to prior recognise vulnerable people, in order to give accurate and reasonable therapy. Method 23 New Zealand white rabbits were randomly divided into 4 groups after balloon injurying the intima with subsequently 1% high fat diet. Grouping: Examed at 4 time points: 6 (n=6), 8 (n=5), 10 (n=5), 12 (n=7 ...

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    23. The ability of optical coherence tomography for assessment of intermediate coronary stenosis comparison with quantitative coronary angiography

      The ability of optical coherence tomography for assessment of intermediate coronary stenosis comparison with quantitative coronary angiography
      Objective Optical coherence tomography is a new intravascular imaging method with a high resolution of approximately 10 μm. This study aims to examine quantitative optical coherence tomography (OCT) derived measurements intermediate coronary stenosis from quantitative coronary angiography (QCA). Methods 240 patients with coronary intermediate stenosis by quantitative coronary angiography (QCA) and underwent OCT assessment of the lesions artery. The results from QCA and OCT were compared using unpaired t-test. Multiple regression analysis was performed. The latter of MACE was significantly lower than that by QCA detected. Results A total of 118 stenotic coronary lesions were classified as intermediate by QCA ...
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    24. Optical coherence evaluation for everolimus-eluting stents at 8 months after implantation

      Optical coherence evaluation for everolimus-eluting stents at 8 months after implantation
      Objective The aim of this study was to evaluate detailed vessel response after everolimus-eluting stents (EES) implantation in human de novo coronary lesions by optical coherence tomography (OCT). Design, setting and patients Between November 2008 and October 2009, 25 patients (14 men, 65.5±8.6 years) with de novo native coronary artery lesions were implanted with 30 EES, and OCT was performed at 8 months post-implantation. Main Outcome Measures Neointimal thickness (NIT) on each strut, strut apposition to the vessel wall, the frequency of struts surrounded by low intensity area and the incidence of intra-stent thrombus were analysed. To ...
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    1-24 of 46 1 2 »
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