A 54-year-old male with stable angina, hypertension, and dyslipidaemia, as well as a history of coronary artery bypass grafting with implantation of two saphenous vein grafts to left anterior descending artery (LAD) (Ao-LAD) and diagonal branch (Ao-D1) 23 years ago. Coronary angiography done because of recurrent angina revealed a chronic total occlusion of the right coronary artery, occlusion of Ao-LAD, and significant stenosis of Ao-D1. Quantitative coronary angiography (QCA) showed...

A 42-year-old female was referred for intermittent effort angina. She had low body mass index, no coronary risk factors and an unremarkable past medical history except for a Raynaud's phenomenon. Owing to a normal exercise stress test ( Panel A ), symptoms were initially attributed to anxiety. However, a 24h-EKG monitoring revealed diffuse ST-segment depression during …

Purpose: Adequate stent expansion and apposition are important for maintaining good clinical outcomes after coronary intervention. We determined the effect of inflation time of the stent balloon on stent expansion and apposition using optical coherence tomography. Methods: Subjects included 17 patients (18 de novo coronary artery lesions), in whom Resolute Integrity® (n=9) and Xience prime® (n=9) were deployed. The stents were inflated three times in all cases at the nominal inflation pressures (8.9±0.6 atm) by the stent delivery balloon with different inflation times of first, 15 seconds and 30 seconds. The first inflation time was ...

Aims: Aspirin has been shown to be beneficial in the primary prevention, secondary prevention, and treatment of acute coronary syndromes (ACS). However, it is less clear whether prior aspirin therapy affects lesion morphology in ACS. The aim of the present study is to investigate the association between prior aspirin use and the culprit lesion morphology examined by optical coherence tomography (OCT) in patients with the first ACS event. We further performed subgroup analysis on the basis of the presence or the absence of type 2 diabetes mellitus (DM). Methods and results: We studied 250 patients with the first ACS event ...

Objectives The purpose of this study was to assess the occurrence, predictors, and mechanisms of optical coherence tomography (OCT)-detected coronary evaginations following drug-eluting stent (DES) implantation. Background Angiographic ectasias and aneurysms in stented segments have been associated with a risk of late stent thrombosis. Using OCT, some stented segments show coronary evaginations reminiscent of ectasias. Methods Evaginations were defined as outward bulges in the luminal contour between struts. They were considered major evaginations (MEs) when extending ≥3 mm along the vessel length, with a depth ≥10% of the stent diameter. A total of 228 patients who had sirolimus (SES ...

Guidelines summarize and evaluate all evidence available, at the time of the writing process, on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are not substitutes but are complements for textbooks, and cover the ESC Core Curriculum topics. Guidelines and recommendations should help physicians to make decisions in their daily practice: however, the final decisions concerning an individual patient must be made by the ...

We have come a long way When, more than 2500 years ago, Thales of Milet (624–547 BC) claimed that nature was ruled by laws and not by gods, he changed the world. 1 Such a concept allowed for the discovery and mathematical proof of impersonal causation of what, until then, had been a mystery ruled by unpredictable gods. Indeed, ever since then the understanding of nature—today we would call it the natural sciences—has become a major activity of mankind. With this strategy, we have come a long way. Initially, it allowed us to use the position of ...

The rupture of an unstable atherosclerotic plaque precedes the majority of acute coronary syndromes, and considerable effort has been devoted to identifying patients at increased risk of future coronary ischaemic events. Atherosclerosis imaging is a potentially attractive strategy to detect vulnerable coronary plaques, with each modality having its own advantages and limitations. Different characteristics of the atherosclerotic plaque can be targeted with imaging, such as the number and severity of luminal narrowings with angiography, atheroma burden and remodelling with intravascular ultrasonography (IVUS), elastic properties with elastography, radiofrequency-determined plaque types with virtual histology, fibrous cap thickness and necrotic core with optical ...

A 66-year-old woman with long-term essential hypertension presented with poorly controlled blood pressure in spite of six antihypertensive drugs. Percutaneous renal denervation was indicated as a treatment of resistant arterial hypertension. Renal angiography showed ‘strings of beads’ appearance characteristic of fibromuscular dysplasia (FMD) in the mid-segment of the right …

A 78-year-old male was admitted to our centre because of III/IV CCS stable angina despite optimal medical treatment. Stress-induced myocardial ischaemia was demonstrated by SPECT in the inferior wall ( Panel A ), and a coronary angiography was performed. Severe coronary stenosis was observed in the first diagonal and in the circumflex. The right coronary artery (RC A )

Coronary artery disease (CAD) is primarily a structural disease characterized by the build-up of atherosclerotic plaques in the coronary arteries. With progressive impingement on coronary blood flow, a given coronary stenosis will elicit functional consequences that are described by the ‘ischaemic cascade’ and emerge progressively as inducible changes of perfusion, wall motion, and electrocardiogram, and finally manifest as chest pain ( Figure 1 ). Thus, definitions for clinically significant CAD may vary considerably based on whether rather anatomical vs. functional criteria are used ( Table 1 ).

A 78-year-old female was referred to the Andreas Gruentzig Catheterization Laboratories suffering from angina pain CCS II. Coronary angiography demonstrated a bifurcation lesion in the middle left anterior descending and the first diagonal branch ( Panel A ). Based on these findings, percutaneous coronary intervention (PCI) was performed with implantation of a

Aims Cardiac allograft vasculopathy (CAV) is a major limitation to long-term survival following cardiac transplantation. Conventional imaging modalities such as angiography and intravascular ultrasound fail to characterize CAV plaque morphology. Our aim was to characterize CAV in vivo using the high spatial resolution of intracoronary optical coherence tomography (OCT). Methods and results We prospectively enrolled 53 cardiac transplant patients to undergo OCT of the left anterior descending coronary artery (LAD) in addition to annual CAV screening by coronary angiography and intravascular ultrasound (IVUS). The proximal 30 mm of the LAD was divided into three segments of 10 mm each ( n ...

Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by unresolved thromboemboli in the pulmonary arteries (PAs). We have previously demonstrated the usefulness of optical coherence tomography

Aims Catheter-based renal nerve ablation (RNA) using radiofrequency energy is a novel treatment for drug-resistant essential hypertension. However, the local endothelial and vascular injury induced by RNA has not been characterized, although this importantly determines the long-term safety of the procedure. Optical coherence tomography (OCT) enables in vivo visualization of morphologic features with a high resolution of 10–15 µm. The objective of this study was to assess the morphological features of the endothelial and vascular injury induced by RNA using OCT. Methods and results In a prospective observational study, 32 renal arteries of patients with treatment-resistant hypertension underwent OCT ...

Although mortality rates from coronary heart disease in the western countries have declined in the last few decades, morbidity caused by this disease is increasing and a substantial number of patients still suffer acute coronary syndrome (ACS) and sudden cardiac death. Acute coronary syndrome occurs as a result of myocardial ischaemia and its manifestations include acute myocardial infarction and unstable angina. Culprit plaque morphology in these patients varies from thrombosis with or without coronary occlusion to sudden narrowing of the lumen from intraplaque haemorrhage. The coronary artery plaque morphologies primarily responsible for thrombosis are plaque rupture, and plaque erosion, with ...

Aims We aimed to compare coronary artery disease (CAD) at the time of a first acute coronary syndrome (ACS) in type II diabetic and non-diabetic patients by coronary angiography and by optical coherence tomography (OCT). Methods and results Two different patient populations with a first ACS were enrolled for the angiographic (167 patients) and the OCT (72 patients) substudy. Angiographic CAD severity was assessed by Bogaty, Gensini, and Sullivan scores, whereas collateral development towards the culprit vessel was assessed by the Rentrop score. Optical coherence tomography plaque features were evaluated at the site of the minimum lumen area (MLA) and ...

A 37-year-old male was admitted with a non-ST-elevation myocardial infarction. Coronary angiography and optical coherence tomography (OCT) revealed a 70% stenosis of the ostial left artery descending (LAD) with little thrombotic material but without obvious signs for rupture/dissection ( Panels A and B , Supplementary material online, Video S1 ). After direct stenting with a biolimus-eluting stent (BES, 3.5 × 18 mm, 10 atmospheres), OCT revealed suboptimal strut apposition with

Aims Primary percutaneous coronary intervention (PPCI) with thrombectomy (TB) seems to reduce the thrombus burden, resulting in a larger flow area as measured with optical frequency domain imaging (OFDI). Methods and results In a multi-centre study, 141 patients with ST elevation myocardial infarction <12 h from onset were randomized to either PPCI with TB using an Eliminate catheter (TB: n = 71) or without TB (non-TB: n = 70), having operators blinded for the OFDI results. The primary endpoint was minimum flow area (MinFA) post-procedure assessed by OFDI, defined as: [stent area + incomplete stent apposition (ISA) area] − (intraluminal defect + tissue prolapse area ...

Niccoli et al . assessed the severity of coronary artery disease (CAD) in the culprit vessels of diabetic type II as well as non-diabetic patients ( n = 167) at the time of their first coronary event employing standard coronary angiography and intracoronary optical coherence tomography (OCT) imaging ( n = 72). 1 To assess the severity of CAD, they applied the Bogarty, Gensini, and Sullivan scores, and to evaluate the development of collaterals they used the Rentrop score, all based on coronary angiography. Intracoronary imaging by OCT was performed to study coronary plaque morphology, more particularly to quantify the amount of lipids and calcification ...

Percutaneous catheter-based renal denervation is an emerging technique to treat severe and ‘resistant’ arterial hypertension. We report the case of a 56-year-old woman who was considered as ‘resistant’ hypertensive despite being treated with four antihypertensive drugs (including one diuretic) and was referred for percutaneous catheter-based renal denervation to our institution. The procedure was performed in accordance with the manufacturer'

Optical coherence tomography (OCT) is a novel high-resolution intravascular imaging technique allowing characterization of coronary artery plaques and evaluation of stent strut coverage. As a new application, OCT can be also used in allograft vasculopathy as demonstrated by the following images. Comparison of OCT and coronary angiography...

Although he makes no claim to be a pioneer, Prof. Patrick Serruys, who recently retired as Chief of Interventional Cardiology at the Thoraxcenter, Rotterdam, and his colleagues have taken the simple idea of the stent to new heights, and in the process produced an original paper once every few days, reports Barry Shurlock PhD Once in a while medicine gets hold of a really big idea that opens up completely new approaches to treatment. Penicillin was one of these, and arguably, percutaneous coronary intervention (PCI) was another. The 35 years since Andreas Grüntzig first opened a coronary vessel with ...