Background:  Treatment of coronary bifurcation lesions using a single stenting strategy is preferable over that using a 2-stent technique. The benefit of final kissing inflation (FKI), however, has not been established. Methods and Results:  Seventy-two patients (76 lesions) with true bifurcation lesions treated with a single drug-eluting stent with FKI (n=33 lesions) or without FKI (non-FKI, n=43 lesions) were enrolled in this study. Optical coherence tomography (OCT) was performed at 6–12 months after implantation. Based on the OCT findings, the percentage of jailing struts (number of jailing struts/total number of struts at the bifurcation lesion) was ...

Previous intravascular ultrasound studies have shown that echolucent neointimal hyperplasia occasionally appears after bare-metal stent (BMS) or sirolimus-eluting stent (SES) implantation. Optical coherence tomography (OCT) studies have also demonstrated that paclitaxel-eluting stent (PES) restenosis exhibited similar images showing low signal intensity areas (LSIA) surrounding stent struts and three-layer appearance (TLA). The aim of the present study was to investigate the clinical significance of LSIA on OCT images in various types of stents. Fifty nine consecutive patients who underwent scheduled follow-up coronary angiography and OCT were enrolled. There was no significant difference in the prevalence of LSIA among the 3 stent ...

Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by chronic and mechanical obstruction of central and/or distal pulmonary arteries due to thromboembolic masses.1–4 It is one of the distinct disease entities of pulmonary hypertension (PH), with a mean pulmonary arterial pressure >25 mmHg and is classified into the central- and distal-type CTEPH.4–9 As a new therapeutic strategy, percutaneous transluminal pulmonary angioplasty (PTPA) markedly improves pulmonary hemodynamics and long-term prognosis in patients with distal-type CTEPH with no major complications.10 During this procedure, intravascular ultrasound (IVUS) is used to evaluate the presence of chronic thrombus in pulmonary ...

It is now generally recognized that acute coronary syndromes most commonly result from disruption of thin-cap fibroatheroma (TCFA), which is characterized by a large necrotic core with an overlying thin-fibrous cap measuring <65μm. Recent advances in intracoronary imaging modalities have significantly improved the ability to detect TCFA in vivo. Intravascular ultrasound (IVUS) is perhaps the most promising modality that has been used more than 15 years to evaluate atherosclerotic plaque. IVUS has revealed a lot of the clinical evidence regarding vulnerable plaque detection in live humans. Recently, by analyzing the IVUS acoustic signal before demodulation and scan conversion, IVUS ...

Optical coherence tomography-derived anatomical criteria for functionally significant coronary stenosis assessed by fractional flow reserve. The information obtained from a coronary angiogram is essential for determining the treatment strategy of ischemic heart disease. However, the coronary angiogram has some limitations because it is a form of luminology. Therefore, we use a non-invasive stress test in conjunction with angiography before percutaneous coronary intervention (PCI) to determine the significance of the stenosis. To supplement the angiogram, intracoronary imaging techniques, including intravascular ultrasound (IVUS), intracoronary angioscopy, and optical coherence tomography (OCT), have been developed.

We herein report the case of a 66-year-old patient with acute coronary syndrome who was diagnosed with immunoglobulin G4 (IgG4)-related coronary periarteritis with a perivascular pseudotumor and underwent coronary bypass graft surgery (1). The serum IgG4 concentration markedly decreased after the bypass was performed and gradually returned to the baseline level one-year after surgery (2). Despite initially achieving success, the bypass graft to the left circumflex artery (Lcx) was found to be occluded approximately one year post-operation; therefore, we chose to perform percutaneous coronary artery intervention (PCI) in the Lcx. Optical coherence tomography (OCT) images taken immediately before PCI ...

We hypothesized that the tissue components of in-stent restenosis (ISR) might differ between drug-eluting stents (DES) and bare-metal stents (BMS) and that these differences could be distinguished by qualitative and quantitative optical coherence tomography (OCT) analyses. Methods and Results:  One-hundred and twenty-two initial ISR lesions (sirolimus-eluting stents: n=28; paclitaxel-eluting stents: n=51; BMS: n=43) were evaluated with OCT. Based on their OCT appearance, the lesions were classified as homogeneous, layered or heterogeneous. The optical properties of backscatter, attenuation and signal intensity of the neointimal tissue (NIT) were quantified. To evaluate the vascular response after balloon angioplasty (BA), the ...

Optical coherence tomography (OCT) is a high resolution imaging technique that offers microscopic visualization of the coronary artery. The fast scanning speed and simple imaging procedure of new-generation frequency-domain OCT make this technology easy to use in the clinical setting. The OCT examination is useful for guidance and risk stratification of percutaneous coronary intervention (PCI). OCT-derived thin-cap fibroatheroma, which is characterized by large lipid-core and thin fibrous cap <65μm, is a predictor of peri-PCI complications, such as angiographic no-reflow, microvascular obstruction, and post-PCI cardiac troponin I elevation. Stent malapposition, tissue protrusion, and stent edge dissection are assessed in more ...

Background: Cytochrome P450 (CYP) 2C19 polymorphism is associated with reduced responsiveness to clopidogrel and poor clinical outcome after drug-eluting stent (DES) implantation, but its contribution to lesion outcome after DES implantation is unclear. Methods and Results: The study included 160 Japanese patients who received clopidogrel and underwent DES implantation with follow-up angiography. Patients were divided into 3 groups by CYP2C19 polymorphism: extensive metabolizers (EM), intermediate metabolizers (IM), and poor metabolizers (PM). The incidence of major adverse cardiac events (MACE) and target lesion revascularization (TLR) were compared among the 3 groups. Optical coherence tomography (OCT) was performed for 120 patients to ...

60-year-old man was admitted to our hospital due to acute ST-segment elevation myocardial infarction. He had a history of self-expanding stent implantation in the proximal left anterior descending artery due to stable angina pectoris 7 years earlier. Emergent coronary angiography on admission showed occlusion in the distal portion of the previously stented segment, in which observation by optical coherence tomography revealed the existence of a remarkable proliferation of lipid-laden neointimal tissues with rupture and thrombus. This suggests that very late stent thrombosis in a self-expanding stent may occur through the process of atheromatous formation

Background: For the identification of functionally significant coronary artery disease, there have not been any dedicated optical coherence tomography (OCT) studies reported previously, although OCT can clearly detect coronary vessel lumina at higher resolution than intravascular ultrasound (IVUS). Methods and Results: OCT and fractional flow reserve (FFR) measurements were performed in 62 intermediate coronary lesions in 59 patients. FFR was calculated as the ratio of distal coronary pressure divided by proximal coronary pressure during maximal hyperemia. FFR <0.75 was used as the threshold for diagnosing functionally significant stenosis. Minimal lumen area (MLA), minimal lumen diameter (MLD) and percent lumen ...

In this issue of the Journal, a clinical investigation by Ozaki et al focuses on the flushing solution used for image acquisition with frequency-domain optical coherence tomography (FD-OCT). 1 The authors present the cross-sectional area measurement as a quantitative evaluation using low-molecular dextran L (LMD-L) approximate to that of contrast media, and the non-inferiority of LMD-L to contrast media with regard to FD-OCT image quality. Although the cross-sectional and longitudinal images of OCT are analogous with those of intravascular ultrasound (IVUS), the image resolution of OCT is extremely high ( ≈10– 20 μm), which is more than 10-fold that of IVUS ...

We propose the lateral integration scheme of an MEMS tunable VCSEL and a slow light amplifier for increasing single-mode power. The modeling result predicts the maximum output power over several tens mW for a compact slow light amplifier monolithically integrated with an MEMS VCSEL. In addition, the efficient excitation of slow light in the integrated slow light amplifier is shown. A high coupling efficiency and a radiation angle from the amplifier are almost constant during wide wavelength tuning

Although an intracoronary frequency-domain optical coherence tomography (FD-OCT) system overcomes several limitations of the time-domain OCT (TD-OCT) system, the former requires injection of contrast media for image acquisition. The increased total amount of contrast media for FD-OCT image acquisition may lead to the impairment of renal function. The safety and usefulness of the non-occlusion method with low-molecular-weight dextran L (LMD-L) via a guiding catheter for TD-OCT image acquisition have been reported previously. The aim of the present study was to compare the image quality and quantitative measurements between contrast media and LMD-L for FD-OCT image acquisition in coronary stented lesions ...

Scattering centers (SC) are often observed with optical coherence tomography (OCT) in some struts of bioresorbable vascular scaffolds (BVS). These SC might be caused by crazes in the polymer during crimp-deployment (more frequent at inflection points) or by other processes, such as physiological loading or hydrolysis (eventually increasing with time). The spatial distribution and temporal evolution of SC in BVS might help to understand their meaning. Methods and Results: Three patients were randomly selected from 12 imaged with Fourier-domain OCT at both baseline and 6 months in the ABSORB cohort B study (NCT00856856). Frame-by-frame analysis of the SC distribution was ...

A prospective observational study using optical coherence tomography (OCT) of patients with myocardial infarction (MI), late following drug-eluting (DES) or bare metal stent (BMS) implantation, when the stented segment was considered culprit. Methods and Results: Seventeen patients (58.9±8.3 years; 7 DES, 10 BMS) with MI at 50 (3-180) months post-stenting. Patients with BMS sustained a MI later than patients with DES (95 (3-180) vs. 8 (3-62) months, P=0.01]; 5 (71.4%) of the DES patients demonstrated binary angiographic restenosis, in contrast to 8 (80%) with BMS (P=1.0). DES had significantly less thickness of ...

Virtual histology intravascular ultrasound (VH-IVUS) allows detailed assessment of plaque composition in the clinical setting. Optical coherence tomography (OCT) has been developed as a high-resolution imaging method, which might be a promising technique to identify thin-cap fibroatheroma (TCFA) in vivo. The purpose of the present study was to evaluate the diagnostic accuracy of VH-IVUS to identify TCFA as determined by OCT.We examined 96 target lesions in patients with stable angina pectoris by using VH-IVUS and OCT. VH-IVUS derived TCFA was defined as a focal necrotic core-rich lesion without evident overlying fibrous tissue. OCT derived TCFA was defined as a ...

Background: It has been suggested that sirolimus-eluting stents (SES) provoke a more sustained inflammatory response (IR) in neointimal hyperplasia (NIH). The purpose of this study was to compare morphological vessel characteristics, including post-stent IR in NIH, between patients with SES and bare metal stents (BMS) using optical coherence tomography (OCT). Methods and Results: Thirty-seven patients underwent OCT at their post-stent follow-up. OCT signal-intensity deviation (normalized standard-deviation; OCT-NSD) values in NIH were compared between the 2 groups. In addition, the serum concentration of high-sensitivity C-reactive protein (hs-CRP) was measured. Stent-malapposition rate (1.78% vs. 0.7%; P=0.016), uncovered stent-strut ...