Cumulative evidence from histology-based studies demonstrate that the currently available intravascular imaging techniques have fundamental limitations that do not allow complete and detailed evaluation of plaque morphology and pathobiology, limiting the ability to accurately identify high-risk plaques. To overcome these drawbacks, new efforts are developing for data fusion methodologies and the design of hybrid, dual-probe catheters to enable accurate assessment of plaque characteristics, and reliable identification of high-risk lesions. Today several dual-probe catheters have been introduced including combined near infrared spectroscopy-intravascular ultrasound (NIRS-IVUS), that is already commercially available, IVUS-optical coherence tomography (OCT), the OCT-NIRS, the OCT-near infrared fluorescence (NIRF) molecular ...

Stent thrombosis (ST) is a devastating complication associated with a high morbidity and mortality in patients who have undergone percutaneous coronary intervention (PCI) for coronary heart disease (CHD). In-hospital mortalities of patients suffering from ST have been reported to be as high as 7.9% for acute ST (AST; occurring <24 h after PCI) and subacute ST (SAST; occurring within 30 days after PCI), 3.8% for late ST (LST; occurring within the first year after PCI), and 3.6% for very late ST (VLST; occurring 1 year after PCI). 1 Recently, longer duration (30 months) of dual antiplatelet therapy ...

This review discusses the possibilities offered by new modalities of non-invasive and invasive coronary imaging in an effort to optimize risk stratification for coronary artery disease, and identify subgroups at high risk that may benefit from an aggressive, personalized approach, with access to a growing number of novel drugs and interventions. Special emphasis is placed on the progress of novel invasive imaging techniques such as near infrared spectroscopy and optical coherence tomography that can reliably identify thin-capped fibroatheromas. Multiple trials are exploring the feasibility of these techniques to guide modulation of risk factor control and treatment of non-flow limiting lesions ...

Coronary plaque rupture is the most common cause of vessel thrombosis and acute coronary syndrome. The accurate early detection of plaques prone to rupture may allow prospective, preventative treatment; however, current diagnostic methods remain inadequate to detect these lesions. Established imaging features indicating vulnerability do not confer adequate specificity for symptomatic rupture. Similarly, even though experimental and computational studies have underscored the importance of endothelial shear stress in progressive atherosclerosis, the ability of shear stress to predict plaque progression remains incremental. This review examines recent advances in image-based computational modelling that have elucidated possible mechanisms of plaque progression and rupture ...

Intravascular imaging has incrementally gained in clinical relevance in recent years. First triggered by the introduction of intravascular ultrasound >25 years ago, 1 interest has recently been augmented by the widespread implementation of optical coherence tomography (OCT) in cardiac catheterization laboratories. OCT, because of its outstanding spatial resolution in the range of 10–20 μm relative to comparative invasive and non-invasive imaging modalities, has been charged with great expectations regarding its potential to advance our capabilities in detecting and characterizing vascular pathologies. In particular for patients undergoing stent implantation, OCT has been put forward as a promising tool to assess ...

Aims Inflammation plays essential role in development of plaque disruption and coronary stent-associated complications. This study aimed to examine whether intracoronary dual-modal optical coherence tomography (OCT)-near-infrared fluorescence (NIRF) structural–molecular imaging with indocyanine green (ICG) can estimate inflammation in swine coronary artery. Methods and results After administration of clinically approved NIRF-enhancing ICG (2.0 mg/kg) or saline, rapid coronary imaging (20 mm/s pullback speed) using a fully integrated OCT-NIRF catheter was safely performed in 12 atheromatous Yucatan minipigs and in 7 drug-eluting stent (DES)-implanted Yorkshire pigs. Stronger NIRF activity was identified in OCT-proven high-risk plaque compared ...

Aims Angiography has limited value for identifying the causes of stent thrombosis (ST). We studied a large cohort of patients by optical coherence tomography (OCT) to explore ST characteristics and mechanisms. Methods and results A prospective multicentre registry was screened for patients with confirmed ST. Optical coherence tomography was performed after initial intervention to the culprit lesion (in 69% of cases in a deferred procedure). Stent thrombosis was classified as acute (AST), sub-acute (SAST), late (LST), and very late (VLST). Optical coherence tomography records were analysed in a central core lab. The analysis included 120 subjects aged 61.7 [51 ...

A 67-year-old man with advanced chronic kidney disease (CKD) (creatinine = 4.5 mg/dL, eGFR = 13 mL/min/1.73 m 2 ) not requiring haemodialysis presented with progressive angina. Diagnostic angiography with ultra-low radio-contrast volume (12 mL, contrast volume/eGFR ratio <1) revealed significant stenosis in the left anterior descending (LAD) artery ( Panel A ). The lesion was haemodynamically significant (fractional flow reserve: 0.77). Post-angiography, the …

Aims Fibrin deposition and absent endothelium characterize unhealed stents that are at heightened risk of stent thrombosis. Optical coherence tomography (OCT) is increasingly used for assessing stent tissue coverage as a measure of healed stents, but cannot precisely identify whether overlying tissue represents physiological neointima. Here we assessed and compared fibrin deposition and persistence on bare metal stent (BMS) and drug-eluting stent (DES) using near-infrared fluorescence (NIRF) molecular imaging in vivo, in combination with simultaneous OCT stent coverage. Methods and results Rabbits underwent implantation of one BMS and one DES without overlap in the infrarenal aorta ( N = 20 3.5 ...

This editorial refers to ‘Coronary evaginations and peri-scaffold aneurysms following implantation of bioresorbable scaffolds: incidence, outcome, and optical coherence tomography analysis of possible mechanisms’, by T. Gori et al ., on page doi:10.1093/eurheartj/ehv581. Stent thrombosis (ST) remains a major concern due to high morbidity and mortality in both the short and long term. 1 Although the rates of this complication have been reduced with newer generation drug-eluting stents (DES), the risk of ST continues to persist for all DES and was recently also reported in bioresorbable vascular scaffolds (BVS). 2 – 4 Among the suggested causes of ST ...

Aims Endothelial dysfunction is an early step in the development of atherosclerosis. Increased formation of superoxide anions by NADPH oxidase Nox1, 2, and 5 reduces nitric oxide availability and can promote endothelial dysfunction. In contrast, recent evidence supports a vasoprotective role of H 2 O 2 produced by main endothelial isoform Nox4. Therefore, we analysed the impact of genetic deletion of Nox4 on endothelial dysfunction and atherosclerosis in the low-density lipoprotein receptor (Ldlr) knockout model. Methods and results Ex vivo analysis of endothelial function by Mulvany myograph showed impaired endothelial function in thoracic aorta of Nox4 −/− /Ldlr −/− mice. Further progression ...

Background Peri-stent coronary evaginations may disturb flow and have been proposed as possible risk factor for late stent thrombosis. We describe incidence, predictors, and possible mechanisms of coronary evaginations 12 months after implantation of bioresorbable vascular scaffolds (BVS). Methods and results One hundred and two BVS implanted in 90 patients (age 63 ± 13 years, 71 males, 14 diabetics) were analysed with angiography and optical coherence tomography (OCT) 12 months after implantation. Evaginations were identified as any hollow in the luminal vessel contour between well-apposed struts and were classified as major when extending ≥3 mm with a depth ≥10% of the ...

Early identification of vulnerable, rupture-prone atherosclerotic plaques with the optimal goal of cardiovascular event prevention is a field of vigorous research. Despite the advances in imaging modalities and the in vivo identification of many characteristics of vulnerability, few of these plaques actually rupture and even fewer lead to clinical events, questioning the predictive value of the above techniques in clinical practice. Factors causing the higher local vulnerability of the culprit plaque within a prothrombotic environment of widespread inflammation are generally unknown. Newly recognized local features, including microcalcifications and biomechanical factors, seem to contribute. In this review article, we target on ...

The field of intracoronary imaging emerged to overcome the drawbacks of coronary angiography. The visual evaluation of lesion severity of coronary stenosis by angiography remains insufficient for accurate diagnosis of the vessel indices and its estimate of functional significance. 1 Intracoronary imaging was introduced to optimize the outcome of percutaneous coronary intervention (PCI), aiming to reduce short- and long-term cardiovascular events. Intracoronary imaging systems, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), offer an inside look into the artery, which enables precision in evaluation of the vessel dimension, plaque composition, and degree of narrowing, and allows optimization of ...

In-stent neoatherosclerosis has become the darling of the interventional cardiology community and is blamed for most stent thrombosis (ST) occurring late after drug-eluting stent (DES) implantation. Neoatherosclerosis accounted for only 33% of late and very late ST at autopsy following implantation of first-generation DES. 1 However, the clinical prevalence of neoatherosclerosis and its percentage of cases presenting with late and very late ST remains unknown. In the current issue of the journal, Taniwaki et al . propose a significant and biologically relevant association between the presence of in-stent neoatherosclerosis and the progression of native atherosclerosis in a cohort of 88 patients ...

We report on a 67-year-old male, who underwent urgent coronary angiography (CA) because of prolonged chest pain and anterior ST elevation. Right coronary artery (RCA) and left anterior descending (LAD) appeared with diffuse …

Aims ILUMIEN I is the largest prospective, non-randomized, observational study of percutaneous coronary intervention (PCI) procedural practice in patients undergoing intra-procedural pre- and post-PCI fractional flow reserve (FFR) and optical coherence tomography (OCT). We report on the impact of OCT on physician decision-making and the association with post-PCI FFR values and early clinical events. Methods and results Optical coherence tomography and documentary FFR were performed pre- and post-PCI in 418 patients (with 467 stenoses) with stable or unstable angina or NSTEMI. Based on pre-PCI OCT, the procedure was altered in 55% of patients (57% of all stenoses) by selecting different ...

A 53-year-old man with a previous history of mediastinal radiotherapy was referred to our institution for coronary artery bypass graft and aortic valve replacement. Per-operative surgical analysis revealed poor flow within left and right internal mammary arteries (LIMA and RIMA), making their use as peducunlated conduits unsuitable. The proximal end arteries were removed and both vessels were harvested as free grafts.

The identification of ‘vulnerable’ or ‘high risk’ coronary plaques has represented the quest for the Holy Grail in interventional cardiology for the past three decades. Plaque rupture (PR), plaque erosion (PE), and complicated calcified nodules (CNs) constitute the most common underlying substrates leading to coronary thrombosis and acute coronary syndromes (ACS). 1 – 3 Despite the advent of novel intracoronary imaging techniques, which are able to disclose unique morphological insights and plaque features similar to those found in plaques already complicated with coronary thrombosis, their value in predicting future clinical events remains limited. 4 – 7 Optical coherence tomography (OCT) is an ...

bstract AIMS: The purpose of the present study was to investigate the relationship between in-stent neoatherosclerosis (NA) and native atherosclerosis progression of untreated coronary segments. METHODS AND RESULTS: In-stent NA was assessed by optical coherence tomography (OCT) among patients included in the SIRTAX-LATE OCT study 5 years after drug-eluting stent (DES) (sirolimus-eluting and paclitaxel-eluting stents) implantation. Neoatherosclerosis was defined as the presence of fibroatheroma or fibrocalcific plaque within the neointima of stented segments with a longitudinal extension >1.0 mm. Atherosclerosis progression in untreated native coronary segments was evaluated by serial quantitative coronary angiography (QCA). The change in minimal lumen ...

A 63-year-old woman with stable angina underwent percutaneous coronary intervention of the left circumflex coronary artery (LCX) and the first obtuse marginal branch (OM1) with biolimus-eluting stents (BES) with the V-stenting technique ( Panels A and A ′). Seven months later due to recurrent angina repeat coronary angiography was performed

Despite the reduction in late thrombotic events with newer-generation drug-eluting stents (DES), late stent failure remains a concern following stent placement. In-stent neoatherosclerosis has emerged as an important contributing factor to late vascular complications including very late stent thrombosis and late in-stent restenosis. Histologically, neoatherosclerosis is characterized by accumulation of lipid-laden foamy macrophages within the neointima with or without necrotic core formation and/or calcification. The development of neoatherosclerosis may occur in months to years following stent placement, whereas atherosclerosis in native coronary arteries develops over decades. Pathologic and clinical imaging studies have demonstrated that neoatherosclerosis occurs more frequently and ...

Aims Manual thrombectomy has been proposed as a strategy to reduce thrombus burden during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). However, the effectiveness of manual thrombectomy in reducing thrombus burden is uncertain. In this substudy of the TOTAL (ThrOmbecTomy versus PCI ALone) trial, we compared the thrombus burden at the culprit lesion using optical coherence tomography (OCT) in patients treated with thrombectomy vs. PCI-alone. Methods and results The TOTAL trial ( N = 10 732) was an international, multicentre, randomized trial of thrombectomy (using the Export catheter, Medtronic Cardiovascular, Santa Rosa, CA, USA) in STEMI ...