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

No abstract provided.

No abstract provided.

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 ...

No abstract provided.

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 ...

Background: Non-occlusive technique is universally accepted for acquisition of coronary optical coherence tomography (OCT), but the amount of contrast infused is still inconsistently calculated. Proposed herein, is an empirical formula for accurate contrast volume calculation. Methods: In an observational prospective study, contrast volume of consecutive patients undergoing OCT was either calculated with formula, or eyeballed based on manufacturer recommendations. The quality of pullback, defined as % of high quality cross-sections (CS) in the segment of interest (SOI), was analyzed by two independent operators and compared between groups, together with the amount of contrast per pullback. Results: Sixty patients (115 pullbacks, 4252 ...

No abstract provided.

No abstract provided.

Background: We hypothesise that a comprehensive optical coherence tomography (OCT)-guided implantation protocol for bioresorbable scaffolds (BRS) might improve expansion and apposition, thus translating into better clinical outcomes, particularly reducing thrombotic events. Methods: Patients considered suitable for BRS therapy in de novo coronary lesions underwent OCT. The predominant type of plaque was classified as lipidic, fibrous or calcific, undergoing tailored plaque preparation accordingly. After proper sizing, BRS was deployed and final OCT was acquired. Post-dilation was only performed if suboptimal deployment. Procedural and 12 months clinical follow-up are reported. Results: 29 patients (41 lesions) considered clinically and angiographically suitable for ...

A 49-year-old woman presented with sudden onset chest pain, at rest, evident of ST-segment elevation in the anterior leads of a 12-lead electrocardiogram. She received stent implantation with a 3.5 × 23 mm sirolimus-eluting stent at the proximal portion of left anterior descending artery (LAD) 10 years ago. Dual antiplatelet therapy, however, was discontinued 3 years ago. Urgent coronary angiography demonstrated a near total occlusion at the proximal portion of LAD, which was the same segment of the previous stent implantation (Fig. 1A). Optical coherence tomography

A 55-year-old man underwent left anterior descending (LAD) chronic total occlusion intervention (Fig. 1A, B). The occlusion was crossed antegradely and predilated (Fig. 1C). During delivery of a 3.0 × × 33-mm stent, the operator encountered significant resistance, and soon noticed stent dislodgment from the delivery system. Since the stent appeared deformed and was located in front of the circumflex and first diagonal (D1) ostia (Fig. 1D), the operator chose to crush it (Fig. 1E). A 3.5 × × 33-mm stent (Fig. 1F) was then implanted and post-dilated with a 4.5-mm non-compliant balloon. Optical coherence tomography revealed that stent crushing also ...

INTRODUCTION. The aim of the study is to evaluate intereye asymmetry of optic nerve head (ONH) parameters and the circumpapillary retinal nerve fibre layer (cpRNFL) thickness in patients with primary open angle glaucoma (POAG). MATERIA LS AND METHODS. The study included 44 patients with POAG in both eyes, 48 binocular glaucoma suspects, and 75 individuals with two healthy eyes. A mixed group of 20 patients had only one eye that met the criteria for POAG. We evaluated the differences between right and left eyes and absolute intereye asymmetry for the individual ONH parameters and cpRNFL thickness, measured by spectral domain ...

Interventional cardiologists can use 3-dimensional optical coherence tomography (3D-OCT) to intraprocedurally check a recrossed cell on a jailed side branch ostium (SBO) [1]. Although 3D-OCT on the console was useful, 3D-OCT with the current version (E.4 [Build 10457]) of Metallic Stent Optimization Software (St. Jude Medical, Minneapolis, MN, USA) a mirror image was presented. The struts of the Ultimaster (Terumo, Tokyo, Japan) had alternating 3- and 5-side parts between links. The photograph of the outside view of the Ultimaster, that was deployed on the phantom vessel and kissing balloon inflation was performed, this indicated that the 3-side part of ...

A 76-year-old female patient with chronic thrombo-embolic pulmonary hypertension (CTEPH) as a result of previous pulmonary embolism was admitted for balloon pulmonary angioplasty. Right heart catheterization showed mean pulmonary artery pressure of 61 mm Hg. Selective pulmonary angiography revealed subtotal occlusion of the A8 segmental branch of the left pulmonary

No abstract provided.

Background: Our aim was to prospectively analyze the usefulness of mother-and-child catheter approach with the GuideLiner® (GL) catheter extension system to overcome some potential limitations associated with the use of optical coherence tomography (OCT). Methods: We included consecutive patients referred to our institution for coronary angiogram in whom OCT image acquisition was obtained using GL. From February 2015 to May 2016, a total of 19 procedures (18 patients) were prospectively included. Results: In more than two thirds of the procedures, the OCT catheter was unable to cross the coronary stenosis prior to the use of GL. The right coronary artery ...

A 68-year-old male, former smoker, with dyslipidemia, and 7-year history of stable angina was admitted to our center due to symptom progression and positive treadmill test under optimal medical treatment with aspirin, beta-blockers, and highdose statins. Transradial coronary angiography evidenced a chronic total occlusion (CTO) of the proximal left anterior descending artery (LAD), severe stenosis of the proximal left circumflex artery (LCx), and a dominant right coronary artery with collateral flow to the mid and distal bed of the LAD (Rentrop 3, CC 2). Left ventricular (LV)-angiography evidenced LV normal size and function. LCx stenosis was successfully treated with ...

Background: An a priori combined therapy of a bare metal stent (BMS) post-dilated with a paclitaxel-coated balloon (PCB) was investigated with optical coherence tomography (OCT) at 2- and 6 months regarding vessel response. Previous studies have shown inconsistent results and the time course of vessel healing after such an interventional strategy is unknown. Methods: Thirty-three de novo lesions in 32 patients were electively treated. Six-month OCT analysis was available in 24 lesions. Two-month OCT f/u was obtained in 16 lesions. Sequential OCT at 2- and 6 months was available in 7 patients. A novel 3-dimensional picture of vessel segments ...