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    1. Radiotherapy-induced vascular damage in mammary arterial graft: correlations between optical coherence tomography and pathology

      Radiotherapy-induced vascular damage in mammary arterial graft: correlations between optical coherence tomography and pathology

      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.

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    2. The coronary substrate determines prognosis in acute coronary syndromes: the kaleidoscope has been shaken ... again!

      The coronary substrate determines prognosis in acute coronary syndromes: the kaleidoscope has been shaken ... again!

      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 ...

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    3. The association between in-stent neoatherosclerosis and native coronary artery disease progression: a long-term angiographic and optical coherence tomography cohort study

      The association between in-stent neoatherosclerosis and native coronary artery disease progression: a long-term angiographic and optical coherence tomography cohort study

      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 ...

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    4. Optical coherence tomography follow-up after bioresorbable in metallic and metallic in bioresorbable stenting: tackling in-stent restenosis in the era of bioresorbable vascular scaffolds

      Optical coherence tomography follow-up after bioresorbable in metallic and metallic in bioresorbable stenting: tackling in-stent restenosis in the era of bioresorbable vascular scaffolds

      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

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    5. Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment

      Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment

      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 ...

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    6. Culprit lesion thrombus burden after manual thrombectomy or percutaneous coronary intervention-alone in ST-segment elevation myocardial infarction: the optical coherence tomography sub-study of the TOTAL (ThrOmbecTomy versus PCI ALone) tria

      Culprit lesion thrombus burden after manual thrombectomy or percutaneous coronary intervention-alone in ST-segment elevation myocardial infarction: the optical coherence tomography sub-study of the TOTAL (ThrOmbecTomy versus PCI ALone) tria

      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 ...

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    7. Very late thrombosis observed on optical coherence tomography 22 months after the implantation of a polymer-based bioresorbable vascular scaffold

      Very late thrombosis observed on optical coherence tomography 22 months after the implantation of a polymer-based bioresorbable vascular scaffold

      A 47-year-old man was referred to our catheterization laboratory with an acute coronary syndrome. The patient received a bioresorbable vascular scaffold (BVS, Absorb) in the right coronary artery (RCA) ( Panel A ). The procedure was guided with intravascular ultrasound. Coronary angiography was performed at 22 months due to atypical symptoms and revealed haziness in the RCA ( Panel B ). Optical coherence tomography (OCT) showed homogeneous neointimal proliferation in the previously treated coronary …

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    8. Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome

      Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome

      Aims Patients presenting with acute coronary syndrome (ACS) may have different plaque morphologies at the culprit lesion. In particular, plaque rupture (PR) has been shown as the more frequent culprit plaque morphology in ACS. However, its prognostic value is still unknown. In this study, we evaluated the prognostic value of PR, compared with intact fibrous cap (IFC), in patients with ACS. Methods and results We enrolled consecutive patients admitted to our Coronary Care Unit for ACS and undergoing coronary angiography followed by interpretable optical coherence tomography (OCT) imaging. Culprit lesion was classified as PR and IFC by OCT criteria. Prognosis ...

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      Mentions: Francesco Prati
    9. A bi-directional assessment of spontaneous coronary artery dissection by three-dimensional flythrough rending of optical coherence tomography images

      A bi-directional assessment of spontaneous coronary artery dissection by three-dimensional flythrough rending of optical coherence tomography images

      A 71-year-old woman was admitted to our hospital due to unstable chest pain. Coronary angiography demonstrated a complex eccentric lesion with 80% narrowing of the right coronary arterial lumen ( Panel A ). Intravascular optical coherence tomography (IV-OCT) revealed typical characteristics of spontaneous coronary artery...

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    10. Optical coherence tomography imaging of everolimus-eluting bioresorbable vascular scaffold implanted into coronary vein graft at 3-month follow-up

      Optical coherence tomography imaging of everolimus-eluting bioresorbable vascular scaffold implanted into coronary vein graft at 3-month follow-up

      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...

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    11. Coronary artery disease in systemic sclerosis not clinically apparent: findings from optical coherence tomography

      Coronary artery disease in systemic sclerosis not clinically apparent: findings from optical coherence tomography

      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 …

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    12. Better Inflation time of stent balloon on stent expansion and apposition: an optical coherence tomography study

      Better Inflation time of stent balloon on stent expansion and apposition: an optical coherence tomography study

      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 ...

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    13. Association between prior aspirin use and optical coherence tomography findings in type II diabetes mellitus patients presenting with first acute coronary events

      Association between prior aspirin use and optical coherence tomography findings in type II diabetes mellitus patients presenting with first acute coronary events

      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 ...

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      Mentions: Yoshito Iesaka
    14. Coronary evaginations are associated with positive vessel remodelling and are nearly absent following implantation of newer-generation drug-eluting stents: an optical coherence tomography and intravascular ultrasound study

      Coronary evaginations are associated with positive vessel remodelling and are nearly absent following implantation of newer-generation drug-eluting stents: an optical coherence tomography and intravascular ultrasound study

      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 ...

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    15. 2013 ESC guidelines on the management of stable coronary artery disease

      2013 ESC guidelines on the management of stable coronary artery disease

      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 ...

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    16. The bumpy road to evidence: why many research findings are lost in translation

      The bumpy road to evidence: why many research findings are lost in translation

      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 ...

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    17. Near-infrared spectroscopy for cardiovascular risk assessment? Not ready for prime time

      Near-infrared spectroscopy for cardiovascular risk assessment? Not ready for prime time

      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 ...

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    18. Renal artery fibromuscular dysplasia: in vivo optical coherence tomography insights

      Renal artery fibromuscular dysplasia: in vivo optical coherence tomography insights

      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 …

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    19. Pathological insights of a woven coronary artery with optical coherence tomography

      Pathological insights of a woven coronary artery with optical coherence tomography

      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 )

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    20. View point: what should the future design of clinical imaging studies be?

      View point: what should the future design of clinical imaging studies be?

      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 ).

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    21. Geometrically correct three-dimensional optical coherence tomography: first self-expanding bifurcation stent evaluation

      Geometrically correct three-dimensional optical coherence tomography: first self-expanding bifurcation stent evaluation

      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

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    22. Coronary atherosclerosis with vulnerable plaque and complicated lesions in transplant recipients: new insight into cardiac allograft vasculopathy by optical coherence tomography

      Coronary atherosclerosis with vulnerable plaque and complicated lesions in transplant recipients: new insight into cardiac allograft vasculopathy by optical coherence tomography

      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 ...

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    1-24 of 63 1 2 3 »
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