Both intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can provide critical information that facilitates pre-interventional lesion assessment and post-interventional stent assessment and both have the potential to influence treatment strategy. Meta-analyses of randomized trials and observational studies comparing IVUS-guided percutaneous coronary intervention (PCI) with angiography-guided PCI revealed that IVUS-guided procedures reduce the incidence of target vessel revascularization, stent thrombosis, and myocardial infarction. Several IVUS criteria have been proposed to optimize stent implantation. Whether these criteria can be directly used to facilitate OCT-guided stent implantation needs to be clarified. Recent studies revealed several IVUS- and OCT-derived predictors of adverse events ...

Coronary optical coherence tomography (OCT) has the potential to identify in-stent neoatherosclerosis, which is a possible risk factor for late acute coronary events after drug-eluting stent implantation. The purpose of this study was to investigate differences between mid-term and late in-stent restenosis after stent implantation by quantitative and semiautomated tissue property analysis using OCT. In total, 1063 OCT image frames of 16 lesions in 15 patients were analyzed. This included 346 frames of 6 lesions in late in-stent restenosis, which was defined as restenosis that was not detected at 6 to 12 months but ≥ 12 months after follow-up coronary angiography ...

Background: The aim of the present study was to evaluate the feasibility of optical coherence tomography (OCT) for measurement of vessel area in coronary arteries with lipid-rich plaque as compared with intravascular ultrasound (IVUS). Methods and Results: We investigated 80 coronary artery segments with lipid-rich plaque on OCT and non-attenuated plaque on IVUS. According to the lipid arc on OCT, the plaques were classified into 4 groups: group 1, lipid arc ≤90°; group 2, 90°<lipid arc≤180°; group 3, 180°<lipid arc≤270°; group 4, lipid arc >270°. Vessel circular arcs that could not be identified due to OCT ...

Images in cardiovascular medicine

Background: Recently, coronary computed tomography angiography (CTA) findings of positive vessel remodeling (PR) and low-attenuation plaque (LAP) have been reported to be associated with the development of acute coronary syndromes (ACS). The aim of this study was to examine the CTA detected vulnerable plaque characteristics by using intracoronary optical coherence tomography (OCT). Method and Result: A total of 16 patients with 16 lesions underwent PCI by using intracoronary OCT, after coronary CTA examination, were enrolled in this study. The CTA detected vulnerable plaque (CT-VP) was defined as LAP (<30 hounsfield unit (HU)) with PR of at least 110%. The lesions ...

Editorial. Although drug-eluting stents (DES) have dramatically decreased restenosis and target lesion revascularization rates, very late stent thrombosis has emerged as a new problem related to first-generation DES. Abnormal inflammatory vessel response to the polymer has been considered responsible for the development of stent thrombosis.1 Pathological examinations have revealed that in-stent neointima after implantation of a first-generation DES may contain inflammatory cells and fibrin. Recently, optical coherence tomography (OCT) has become widely available as a high resolution intracoronary imaging modality for detecting coronary plaque, providing the detailed morphological features related to unfavorable

Editorial. Drug-eluting stents (DES) have significantly reduced the incidence of restenosis and the need of repeat revascularization after percutaneous coronary intervention (PCI).1 Each DES has 3 components, comprising stent strut, polymer and drug. Drugs can be coated on the stent strut and released slowly to suppress cell proliferation over a long duration by virtue of the polymer. However, it is now known that remaining polymer can delay the vascular healing process such as endothelialization by inflammation and localized hypersensitivity, a process that may induce very-late stent thrombosis. 2,3 Therefore, accurate evaluation of the neointimal coverage of DES is ...

Effects of a fluoride-releasing varnish containing surface reaction-type prereacted glass ionomer (S-PRG) filler on dentin demineralization were examined using optical coherence tomography. Bovine incisors that were sliced and treated with undersaturated 0.1 M lactic acid buffer solution (DE group). A thin film of varnish-containing S-PRG filler was applied before demineralization (PRG group). Control was maintained in artificial saliva. Using optical coherence tomography of selected locations on the dentin surface, peak intensity (dB) and width (μm) at 1/e 2 were obtained and integrated values calculated. Although alterations in integrated values were different in each group, there was a slight ...

Background: This study directly compared optical coherence tomography (OCT) and histopathology for the assessment of vascular response to first- and second-generation drug-eluting stents. Methods and Results: Sirolimus-, everolimus-, and biolimus-eluting stents (SES, EES, and BES, respectively) were randomly implanted into the coronary arteries of 12 porcine. OCT was conducted after implantation: at 1, 3, and 6 months; histopathology was assessed at 3 and 6 months. At 1-month OCT, EES had the highest neointimal area (NA) and lowest neointimal unevenness score (NUS). At 6 months, NA and NUS were equivalent among the stent types. ∆NA from 1 to 6 months was ...

Objective Very late stent thrombosis (VLST) remains an unresolved problem, and recent reports have indicated that VLST onset can occur in patients treated with both drug-eluting stents (DES) and bare metal stents (BMS). We evaluated the causes of VLST using optical coherence tomography (OCT). Methods OCT was performed in 22 patients (12 DES-treated patients, 10 BMS-treated patients). Because two instances of VLST occurred simultaneously in one case in the DES group, the DES group comprised 13 lesions, while the BMS group comprised 10 lesions. All struts were counted in each frame, and the proportion of uncovered or malapposed struts was ...

Aim : Previous clinical trials have demonstrated the effectiveness of eicosapentaenoic acid (EPA) in preventing cardiovascular events. The aim of the present study was to investigate the effects of EPA treatment on the accumulation of coronary atherosclerotic plaque using optical coherence tomography (OCT). Methods : A total of 46 acute coronary syndrome (ACS) patients without dyslipidemia were divided into two groups: those who received 1,800 mg/day of EPA ( n =15) or the control group ( n =31). Serial OCT examinations were performed at baseline and after eight months of follow-up. The target for the OCT analysis was non-culprit plaque with a ...

Background: The aim of the present study was to compare vascular healing response between everolimus-eluting stent (EES) and biolimus-eluting stent (BES) using optical coherence tomography (OCT). Methods and Results: In the NOBORI Biolimus-Eluting Versus XIENCE V/PROMUS Everolimus-Eluting Stent Trial (NEXT), a formal OCT substudy investigated 91 patients (55 EES-treated lesions in 48 patients and 51 BES-treated lesions in 43 patients) with 8–12 months follow-up imaging at 18 centers. A total of 980 frames with 8,996 struts in EES and 907 frames with 8,745 struts in BES were analyzed. Mean neointima thickness in EES and BES was ...

Optical coherence tomography (OCT) is a catheter-based imaging system that uses near-infrared light to produce cross-sectional images of the coronary arteries. With its extraordinarily high resolution (10-20 μ m), OCT allows clinicians to observe various morphological features of coronary atherosclerosis in vivo . For example, intimal thickening presents as homogeneous, signal-rich regions on OCT, while fibroatheroma with a lipid-rich necrotic core is characterized by the presence of signal-poor regions with a diffuse border. Furthermore, plaque rupture is detected in 50〜70% of culprit lesions of acute coronary syndrome (ACS), and plaque erosion develops over areas of intimal thickening and/or thick-cap fibroatheroma ...

Optical coherence tomography (OCT) is an interferometer- based imaging modality with a high resolution and its usefulness has recently attracted much attention in cardiovascular medicine.1–3 We have recently shown that OCT is useful in the management of pulmonary hypertension, not only for diagnosis but also for evaluation of treatment.4 Here, we show that OCT is also useful to document regression of pulmonary arterial remodeling in response to medical treatment. A 35-year-old woman with an 18-year history of Sjögren syndrome treated with oral prednisolone had a 4-year history of shortness of breath on exertion. On her first ...

Drug-eluting stents (DES) inhibit neointimal proliferation and reduce the rates of subsequent target lesion revascularization as compared with bare-metal stents in randomized clinical trials.1,2 However, too much inhibition of neointimal hyperplasia might cause delayed vascular healing with incomplete endothelialization, which has been associated with an increase risk of stent thrombosis.3,4 Therefore, accurate assessment of the neointimal coverage in DES may be critical in prognosticating their safety. Optical coherence tomography (OCT) uses near-infrared light and generate crosssectional images by measuring the echo time delay and intensity of light that is reflected or back-scattered from the tissue. The ...

Frequency domain optical coherence tomography (FD-OCT) provides cross-sectional images of coronary arteries and deployed stents with micron resolution and measures lumen dimensions with excellent reproducibility. FD-OCT combined with a blood flow resistances model can overcome many limitations of conventional measures of stenosis severity based on quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). The aim of this feasibility study was to investigate the relationship between pressure derived fractional flow reserve (FFR) and FD-OCT derived FFR, a new method for quantitative measure of stenosis severity that estimates the blood flow resistance and microvascular resistance of the vessel segments imaged by FD-OCT ...

Although survival after heart transplantation (HTx) has improved in recent years, cardiac allograft vasculopathy (CAV) is still the leading cause of remote morbidity and mortality in HTx recipients, partly because of difficulty with its diagnosis. In general, routine surveillance for CAV is advocated with coronary angiography accompanied by intravascular ultrasound (IVUS) if necessary. However, these modalities have limitations with respect to low spatial resolution, and sufficient qualitative/quantitative assessment of coronary intima has not been accomplished. Recently, optical coherence tomography (OCT) has emerged as a novel intracoronary imaging technique using an optical analogue of ultrasound with a spatial resolution of ...

The purpose of this study was to determine the effect of PRG filler extraction solution on the demineralization of enamel using optical coherence tomography (OCT). Bovine enamel was treated with lactic acid buffer solution and then placed in artificial saliva (De group). In the second group, specimens were stored in PRG filler extraction solution followed by immersion in lactic acid buffer solution (PRG group). In the control group, specimens were simply stored in artificial saliva. From the OCT image, the peak intensity (dB) and width at (1/e 2 ) were obtained, and the integrated value was calculated. The data were ...

We report a patient’s case of slow progressive in-stent restenosis 10 years after bare-metal stent implantation to his carotid artery. We treated the patient with an additional stent placement under a distal filter protection device. Optical coherence tomographic assessment and plaque histology during the carotid artery stenting (CAS) revealed atheromatous change at in-stent neointima, which contained lipid-rich plaque and calcification deposits. These findings suggest that in-stent neoatherosclerosis may play an important role in the pathogenesis of very late stent restenosis after CAS.

The objective of this study was to determine the efficacy of Swept Source Optical Coherence Tomography (SS-OCT) imaging in assessing a novel fissure caries model. Samples were imaged by both near infrared based SS-OCT and high resolution x-ray tomography imaging to non-destructively quantify artificial lesions. The mean relative reflectivities of the demineralized fissures were at least 6 times higher than the corresponding sound fissures ( p <0.02). Importantly, this study demonstrated that SS-OCT reflectivity images can be used to predict the depth of fissure demineralization. Despite correctly evaluating the depth, this work showed that the lesion width calculated from SS-OCT ...

Although the early failure of drug-eluting stents (DES) is mainly associated with procedural factors, the mechanism for late DES failure has not been fully clarified...

Background:  Although both optical coherence tomography (OCT) and angioscopy are robust tools for detecting intrastent thrombi and neoatherosclerosis in vivo, whether OCT findings are comparable with angioscopy findings remains unclear. Methods and Results:  22 patients presenting with de novo lesions underwent 26 sirolimus-eluting stent (SES) implantations, with follow-up OCT and angioscopy at 10 months post-implantation for segmental assessment of the proximal, mid-, and distal SES segments (66 segments). The mean signal intensity index (signal intensity of the neointima/signal intensity of fibrous intimal hyperplasia) was quantified for angioscopically detected in-stent yellow and white segments. The detection rate for red thrombi ...

We report the case of a 69-year-old male whose left circumflex coronary artery was perforated immediately after implantation of an Endeavor zotarolimus-eluting stent (E-ZES). Despite successful hemostasis by long balloon inflation, a coronary pseudoaneurysm remained at the E-ZES-implanted segment. Coronary angiography performed one year after the coronary perforation showed the pseudoaneurysm had disappeared. Simultaneous optical coherence tomography and coronary angioscopy revealed that stent struts of the E-ZES were fully covered with thick neointima. This is the first case report of a relatively rapid healing process for an E-ZES-related coronary pseudoaneurysm.

Since its invention in the late 1990s, intravascular optical coherence tomography (OCT) has been rapidly adopted in clinical research and, more recently, in clinical practice. Given its unprecedented resolution and high image contrast, OCT has been used to visualize plaque characteristics and to evaluate the vascular response to percutaneous coronary intervention. In particular, OCT is becoming the standard modality to evaluate in vivo plaque vulnerability, including the presence of lipid content, thin fibrous cap, or macrophage accumulation. Furthermore, OCT findings after stent implantation, such as strut apposition, neointimal hyperplasia, strut coverage, and neoatherosclerosis, are used as surrogate markers of the ...