A 79-year-old man with a history of coronary artery bypass grafting 22 years earlier was hospitalized due to stable angina. A bare metal stent was implanted in his saphenous vein graft (SVG) 15 years ago and then, a drug-eluting stent was implanted for the in-stent restenosis 8 years ago. Coronary angiography revealed a severe instent restenosis in the SVG anastomosed to the right coronary artery (Fig. 1A). Optical coherence tomography (OCT) showed plaque fissure, cholesterol crystals, and low-intensity area without attenuation adjacent to the lipid-rich plaque (LRP), which suggested the intraplaque hemorrhage (IPH) (Fig. 1B, a, b). OCT also revealed ...

Background: Neoatherosclerosis after drug-eluting stent (DES) implantation is known to be related with increased risk of late restenosis and stent thrombosis. Neoatherosclerosis and relevant clinical outcomes between bioabsorbable polymer DES (BP-DES) and second-generation durable polymer DES (DP-DES) were evaluated by optical coherence tomography (OCT) analysis. Methods: A total of 311 patients (319 lesions) undergoing OCT analysis after DES implantation were enrolled and divided into two groups according to stent type (BP-DES [150 patients, 153 lesions] and DP-DES [161 patients, 166 lesions]). Follow-up OCT analysis was performed at least 9 months after index stent implantation. Neoatherosclerosis was defined as presence of ...

Optical coherence tomography (OCT) is a modern intravascular imaging technique that enables high - definition visualization of coronary plaque morphology and its length, as well as precise assessment of coronary artery diameter while planning a percutaneous coronary intervention (PCI). Moreover, OCT is highly effective in the evaluation of the PCI results [1] . As has been demonstrated in the multicenter CLI - OPCI registry, suboptimal stent deployment confirmed with OCT was associated with unfavorable clinical outcomes [2] . These findings contributed to the development of a multicenter, prospective, observational LightLab initiative. Its main goals are to evaluate the impact of a routine OCT clinical ...

The paper presents the most common, current indications for the use of intravascular invasive imaging diagnostic techniques, i.e. intravascular ultrasound and optical coherence tomography in Polish invasive cardiology centers. The application of the above-mentioned techniques in the diagnosis of stenosis of the left main coronary artery, optimization of stent implantation procedures, treatment of calcified lesions and other clinically important issues are discussed.

Aim of the study: To investigate in a cross-sectional study the correlations of optical coherence tomography (OCT) with clinical and magnetic resonance imaging (MRI) parameters in multiple sclerosis (MS) patients. Material and methods: OCT parameters include the peripapillary retinal nerve fibre layer (pRNFL) and ganglion cell complex (GCC). Brain magnetic resonance volumetry (T2- and T1- lesions volume, whole brain volume and grey matter volume) was evaluated using the Icobrain program. Clinical data was compared according to the history of optic neuritis (HON). Correlations were determined between OCT parameters and demographic (age, gender), clinical (disease duration, Expanded Disability Status Scale score ...

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Background: The relation between cardiac motion artefact (CMA) in optical coherence tomography (OCT) and the phases of cardiac cycle is unclear. Methods: Optical coherence tomography pullbacks containing metallic stents were co-registered with angiography and retrospectively analyzed. The beginning of three phases, namely ejection, rapid-inflow and diastasis, was identified in angiography. Rotation, shortening, elongation and repetition were qualitatively labelled as CMA artefacts. Platforms with coaxial longitudinal connectors (ML8 and Magmaris) entered a quantitative sub-study, consisting of measuring the length of their connector at the beginning of each phase. Results: A total of 261 stents (127 patients) were analyzed, including 105 stents ...

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Early healing response following stent implantation plays essential role in preventing stent thrombosis [1]. Jinnouchi et al. [2] evaluated the cut-off value of the strut neointimal thickness measured by optical coherence tomography (OCT) using histology as a gold standard. They found that the neointimal thickness of ≥40 µm in OCT is the most sensitive cut-off for identification of competent strut coverage consisting of endothelial cells with >2 layers of smooth muscle cells. Hence pathology studies have demonstrated that uncovered struts are the most powerful predictor of late and very late stent thrombosis, those findings are important in daily practice [3 ...

Advances in intravascular imaging have enabled assessment of the underlying plaque morphology in acute coronary syndromes, which allows for the initiation of individualized therapy. The atherothrombotic substrates for acute coronary syndromes consist of plaque rupture, erosion, and calcified nodule, whereas spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constitute rarer nonatherothrombotic etiologies. This review provides a brief overview of the data from clinical studies that have used intravascular optical coherence tomography to assess the culprit plaque morphology. We discuss the usefulness of intravascular imaging for effective treatment of patients presenting with acute coronary syndromes by percutaneous coronary intervention.

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Successful optical coherence tomography-guided stent ablation with rotational atherectomy for an underexpanded stent.

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In 1974 Lance Gould demonstrated that maximal coronary flow was progressively reduced by applying external constrictors in animal models [1] and physiology became the gold standard to assess the severity of coronary artery disease. Fractional flow reserve (FFR), measured with invasive intracoronary pressure measurements, proved to obtain the same goal and became the accepted method to study intermediate coronary lesions (European Society of Cardiology Class I and American College/American Heart Association Class IIa, both with Level of Evidence A). The results of the randomized FFR trials supporting this strong recommendation gained more interest in the past few months based ...

Background: This study aimed to evaluate acute injuries of the radial artery (RA) using optical coherence tomography (OCT) in patients who underwent coronary intervention via the snuffbox approach. Methods: Forty-six patients, who underwent coronary intervention and assessment of the conventional RA using OCT via the snuffbox approach, were enrolled from two university hospitals between August 2018 and August 2019. Results: The mean age of the patients was 65.1 years. In this study population, 6-French (Fr) sheaths were used. The mean diameter of the conventional RA was 2.89 ± 0.33 mm, and the mean lumen area of the conventional ...

A 59-year-old man underwent primary percutaneous coronary intervention (PCI) for thrombotic total occlusion of his distal right coronary artery. Bystander disease was limited to an ambiguous lesion in the distal left main stem (LMS) with an intraluminal filling defect suggestive of a ruptured plaque. A staged inpatient assessment of the LMS was undertaken utilizing invasive physiologic and intravascular imaging assessments as distal flow in the left coronary system was preserved and symptoms had settled with index intervention (Fig. 1A, B; Suppl. Video 1 and 2). Evaluation of the LMS lesion by instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR ...

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Both plaque macrophage infiltration [1] and calcification [2] are recently suggested characteristics of plaque vulnerability in coronary lesions. Each of these two morphologic characteristics may foster the other. [3, 4]. Thus, the aim herein, is to evaluate this interdependence using optical coherence tomography (OCT), which, due to its supreme resolution, has the ability to detect both features. A recent study defined colocalization of macrophages and calcification (ColocCaMa) as a distance < 100 µm between plaque macrophages and calcification. In this work an association was described between ColocCaMa and the more heavily calcified, but also less advanced and more vulnerable coronary lesions ...

Background: Evaluating prospectively the feasibility, accuracy and reproducibility of optical flow ratio (OFR), a novel method of computational physiology based on optical coherence tomography (OCT). Methods and results: Sixty consecutive patients (76 vessels) underwent prospectively OCT, angiography-based quantitative flow ratio (QFR) and fractional flow ratio (FFR). OFR was computed offline in a central core-lab by analysts blinded to FFR. OFR was feasible in 98.7% of the lesions and showed excellent agreement with FFR (ICCa = 0.83, r = 0.83, slope = 0.80, intercept = 0.17, kappa = 0.84). The area under curve to predict an FFR ≤ 0.80 was ...

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A 67-year-old male patient with stable angina, hypertension and hypercholesterolemia who underwent bare metal stent (BMS) implantation in the distal right coronary artery (RCA) (Azule 3 × 9 mm) and everolimus-eluting stent (EES) implantation in the first diagonal branch (D1) (Xience 2.25 × 18 mm) and in the proximal circumflex branch (LCx) (Xience 3 × 28 mm). One year subsequent to the precedure the patient was readmitted for relapse of the angina Canadian Cardiovascular Society scale II, exhibiting a positive exercise test. The coronary angiography showed a distal-edge in-stent restenosis (ISR) in the distal RCA, extending to the posterior descending artery (PDA ...

Background: Optical coherence tomography (OCT) is a high-resolution imaging modality able to provide near-histological images of vessel walls making it possible to distinguish intima and media layers of the vessel wall separately. The use of this imaging technique is increasing while data on the variability and reliability is lacking. The aim of this study was to investigate the reproducibility of frequency-domain OCT in vein grafts used for coronary revascularization. Methods: Five pullbacks were analyzed by the same analyst with a 1-month delay (intraobserver) and by two different analysts (interobserver). Five pairs of pullbacks from the same catheters and vein graft ...

Optical coherence tomography (OCT) has been waived as a breakthrough in coronary imaging. With its superb resolution in the range of 10–20 µm, OCT has proven to be a valuable technique in guiding coronary interventions [1–3]. Apart from this, among other intracoronary technical solutions, OCT certainly has the greatest potential in studying atherosclerosis in vivo, and identifying subjects with vulnerable lesions which leave patients prone to developing hard coronary events. Among the steps that enabled OCT to gain such credibility, the adoption of the non-occlusive techniques to acquire images has certainly played an instrumental role [4, 5]. Subsequently ...