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    1. The year in cardiology: acute coronary syndromes: The year in cardiology 2019

      The year in cardiology: acute coronary syndromes: The year in cardiology 2019

      The mechanisms and the pathologic substrate of plaque erosion and plaque fissure are different. Indeed, plaques complicated by erosion tend to be matrix-rich, lipid-poor, and usually lack prominent macrophage collections, unlike plaques that rupture, which characteristically have thin fibrous caps, large lipid pools, and abundant foam cells. 9 In a prospective study in 211 patients with STEMI who underwent pre-intervention optical coherence tomography (OCT) examination for the culprit lesion, Tan et al . 10 found that trimethylamine N-oxide (TMAO) levels, a gut microbiota-dependent metabolite derived from dietary phosphatidylcholine and choline, were significantly and independently higher in patients with plaque fissure than ...

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    2. Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation

      Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation

      Fractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance of epicardial coronary stenosis. Despite the overall trend towards more physiology-guided revascularization, there remains a gap between guideline recommendations and the clinical adoption of functional evaluation of stenosis severity. A number of image-based approaches have been proposed to compute FFR without the use of pressure wire and induced hyperaemia. In order to better understand these emerging technologies, we sought to highlight the principles, diagnostic performance, clinical applications, practical aspects, and current challenges of computational physiology in the catheterization laboratory ...

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    3. Cracking (the code of) coronary artery calcification to win the last battle of percutaneous coronary intervention: still in the middle of a rocky road

      Cracking (the code of) coronary artery calcification to win the last battle of percutaneous coronary intervention: still in the middle of a rocky road

      This editorial refers to ‘Vascular responses to coronary calcification following implantation of newer-generation drug-eluting stents in humans: impact on healing’, by S. Torii et al ., doi: 10.1093/eurheartj/ehz850 . Vascular calcification is classified into two categories according to its location. Calcification in the medial layer is called Monckeberg’s atherosclerosis and is seen mainly in the peripheral arteries. Intimal calcification is the dominant type of calcification seen in the coronary arteries. Coronary artery calcification (CAC) pathologically begins as microcalcification (0.5–15 μm) resulting from apoptosis of foam cells and/or smooth muscle cells. 1 Microcalcification may become calcified ...

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    4. Characteristics of non-culprit plaques in acute coronary syndrome patients with layered culprit plaque

      Characteristics of non-culprit plaques in acute coronary syndrome patients with layered culprit plaque

      Aims  Layered plaques represent signs of previous plaque destabilization. A recent study showed that acute coronary syndrome (ACS) patients with layered culprit plaque have more vulnerability at the culprit lesion and systemic inflammation. We aimed to compare the characteristics of non-culprit plaques between patients with or without layered plaque at the culprit lesion. We also evaluated the characteristics of layered non-culprit plaques, irrespective of culprit plaque phenotype. Methods and results We studied ACS patients who had undergone pre-intervention optical coherence tomography (OCT) imaging. The number of non-culprit lesions was evaluated on coronary angiogram and morphological characteristics of plaques were studied ...

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    5. Optical coherence tomography allows 3D reconstruction of ablation lesions

      Optical coherence tomography allows 3D reconstruction of ablation lesions

      Radiofrequency catheter ablation (RFA) is an effective interventional treatment for atrial fibrillation. However, the immediate effect of RFA on the tissue is not directly visualized. This is a key limitation as only acute electrical measurements are taken into account and the atrial wall structure or ablation lesion form are neglected. Optical coherence tomography (OCT) is an imaging technique that uses light to capture histology-like images with a moderate penetration depth of 1–3 mm in the cardiac tissue. It is well-established to characterize plaques in patients with coronary artery disease. Therefore, it might also be used for high-precision imaging of ...

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    6. Diagnosis of malignant coronary vasospasm by 12-lead Holter electrocardiogram and optical coherence tomography

      Diagnosis of malignant coronary vasospasm by 12-lead Holter electrocardiogram and optical coherence tomography

      A 73-year-old man presented with recurrent syncopes preceded by angina. Three years earlier, the patient had a pacemaker implanted due to symptomatic sick sinus syndrome. Device interrogation showed several torsade-like ventricular tachycardias (VTs) corresponding with the symptoms. Left ventricular ejection fraction was normal. Coronary angiography revealed diffuse coronary sclerosis and a hazy 50% lesion in the mid left anterior descending artery (LAD), which was treated with a drug-eluting stent. Three days later, the patient experienced another syncope with documentation of ventricular fibrillation by the provided life-vest ( Panel A ). The pacemaker was upgraded to an implantable cardioverter-defibrillator. During subsequent workup, a ...

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    7. Refining percutaneous coronary intervention: intracoronary imaging, haemodynamics, P2Y12 antagonists, and public outcomes reporting

      Refining percutaneous coronary intervention: intracoronary imaging, haemodynamics, P2Y12 antagonists, and public outcomes reporting

      Podcast: Percutaneous coronary intervention (PCI) is a remarkable success story and a lesson to sceptics as well. Although Andreas Grüntzig’s seminal first procedure went smoothly with an amazing and longstanding result after two balloon inflations, PCI remained a risky and complication-prone procedure initially. 1 Had it not have been for its elegance and vision, PCI would have been abandoned due to the risk of acute occlusions and its high rate of restenosis. 2 However, against all odds, step by step, the procedure was improved and refined, thanks to guidewires, stents, 3 , 4 antithrombotic medication 5 , 6 , secondary prevention ...

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    8. Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study

      Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study

      Aims The CLIMA study, on the relationship between c oronary p l aque morphology of the left anter i or descending artery and twelve m onths clinic a l outcome, was designed to explore the predictive value of multiple high-risk plaque features in the same coronary lesion [minimum lumen area (MLA), fibrous cap thickness (FCT), lipid arc circumferential extension, and presence of optical coherence tomography (OCT)-defined macrophages] as detected by OCT. Composite of cardiac death and target segment myocardial infarction was the primary clinical endpoint. Methods and results From January 2013 to December 2016, 1003 patients undergoing OCT evaluation ...

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    9. Plaque burden can be assessed using intravascular optical coherence tomography and a dedicated automated processing algorithm: a comparison study with intravascular ultrasound

      Plaque burden can be assessed using intravascular optical coherence tomography and a dedicated automated processing algorithm: a comparison study with intravascular ultrasound

      Aims Plaque burden (PB) measurement using intravascular optical coherence tomography (IVOCT) is currently thought to be inferior to intravascular ultrasound (IVUS). We developed an automated IVOCT image processing algorithm to enhance the external elastic lamina (EEL) contour. Thus, we investigated the accuracies of standard IVOCT and an IVOCT enhancement algorithm for measuring PB using IVUS as the reference standard. Methods and results The EEL-enhancement algorithm combined adaptive attenuation compensation, exponentiation, angular registration, and image averaging using three sequential frames. In two different laboratories with intravascular imaging expertise, PB was quantified on 200 randomized, matched IVOCT and IVUS images by four ...

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    10. Using Optical Coherence Tomography to Make Needle Biopsies Safer

      Using Optical Coherence Tomography to Make Needle Biopsies Safer

      Stereotactic needle biopsy continues to be widely employed in the diagnosis of intracranial lesions. Despite an overall low complication rate, hemorrhage remains one the most common and potentially serious risks of the procedure. Previous series have reported a symptomatic hemorrhage rate of 3% to 6%, with a minority requiring craniotomy and hemorrhage evacuation. 1-4 Though certain factors inherent to the lesion or the patient have been known to increase hemorrhage risk, 2 , 3 up until this point there has been little that surgeons can do intraoperatively to avoid hemorrhage after a trajectory has been selected. A new report in Science ...

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    11. Refining the management of acute coronary and aortic syndromes

      Refining the management of acute coronary and aortic syndromes

      Stents have revolutionized the treatment of acute coronary syndromes (ACS) 1 . Although drug-coated devices and in particular biolimus-eluting stents with biodegradable polymer are increasingly used in this patient population, their long-term outcomes as compared with bare metal stents in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown. 2 In their article entitled ‘ Five-year clinical outcomes and intracoronary imaging findings of the COMFORTABLE AMI trial: randomized comparison of biodegradable polymer-based biolimus-eluting stents with bare-metal stents in patients with acute ST-segment elevation myocardial infarction ’, 3 Lorenz Räber and colleagues from the Bern University Hospital in Switzerland report the 5-year follow-up ...

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    12. Functional assessment of tandem coronary artery stenosis by intracoronary optical coherence tomography-derived virtual fractional flow reserve: a case series

      Functional assessment of tandem coronary artery stenosis by intracoronary optical coherence tomography-derived virtual fractional flow reserve: a case series

      Background Optical coherence tomography (OCT)-derived fractional flow reserve (FFR)—which may be calculated using fluid dynamics—demonstrated an excellent correlation with the wire-based FFR. However, the applicability of the OCT-derived FFR in the assessment of tandem lesions is currently unclear. Case summary We present two cases of tandem lesions in the mid segment of the left anterior descending (LAD) artery which could have assessed accurately by OCT-derived FFR. The first patient underwent wire-based FFR at the far distal site of LAD, showed a value of 0.66. The OCT-derived FFR was calculated, yielding a value of 0.64. In ...

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    13. Optical coherence tomography in varying aetiologies of renal artery stenosis: a case series

      Optical coherence tomography in varying aetiologies of renal artery stenosis: a case series

      Background Renal artery stenosis (RAS) is a common cause of secondary hypertension. The most common aetiology is atherosclerosis; however, other causes like fibromuscular dysplasia (FMD) and Takayasu arteritis (TA) are also frequently encountered. The lesion characteristics and its response to percutaneous intervention depend upon the aetiology of RAS. Optical coherence tomography (OCT) is an excellent imaging modality to analyse coronary lesions during percutaneous coronary interventions. The data regarding the utility of OCT in renal artery imaging is limited, consisting of a few case reports. Case summary We hereby report four cases of RAS, each of different aetiology (atherosclerotic, FMD, post-transplant ...

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      Mentions: Takashi Akasaka
    14. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Intervent

      Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Intervent

      This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful ...

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    15. Volumetric laser endomicroscopy and its application to Barrett's esophagus: results from a 1,000 patient registry

      Volumetric laser endomicroscopy and its application to Barrett's esophagus: results from a 1,000 patient registry

      Volumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE ...

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    16. Optical coherence tomography: a window to the optic nerve in clinically isolated syndrome

      Optical coherence tomography: a window to the optic nerve in clinically isolated syndrome

      In this study, we aimed to evaluate the association of asymptomatic optic nerve demyelinating lesion in patients presenting a clinically isolated syndrome with the asymptomatic retinal neuro-axonal loss previously reported at clinically isolated syndrome. We prospectively recruited 66 patients presenting a clinically isolated syndrome and 66 healthy control subjects matched according to age and gender. All patients underwent brain magnetic resonance imaging including 3D-double inversion recovery (DIR) sequence, optical coherence tomography examination and visual function evaluation, at 2.5–4.5 months after CIS. Evaluation criteria were presence and length of optic nerve DIR hypersignal, retinal layers (including ganglion cell ...

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    17. Intimal lesions detected by optical coherence tomography herald intraluminal progression of cardiac allograft vasculopathy associated with humoral rejection

      Intimal lesions detected by optical coherence tomography herald intraluminal progression of cardiac allograft vasculopathy associated with humoral rejection

      This case illustrates humoral-rejection related cardiac graft vasculopathy (CAV) in a 44-year-old heart transplant recipient. In March 2018, at 3 years post-transplant de novo anti-HLA Class II donor-specific antibodies (DSA: DQ2 + DQ7 >25 000 MFI) were detected. The coronary angiogram (CA) in 2016 had been unsuspicious ( Panels A and B ; left), whereas optical coherence tomography (OCT) had noted a pathologic intima: media thickness ratio of 2:1 ( Panel C , left). The CA in March 2018, however, showed mild Type C CAV lesions in the distal LAD and RCA ( Panels A and B ; middle). Moreover, OCT marked intimal ‘opacity’ ( Panel C ,...

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    18. Impact of procedural characteristics on coronary vessel wall healing following implantation of second-generation drug-eluting absorbable metal scaffold in patients with de novo coronary artery lesions: an optical coherence tomography analysis

      Impact of procedural characteristics on coronary vessel wall healing following implantation of second-generation drug-eluting absorbable metal scaffold in patients with de novo coronary artery lesions: an optical coherence tomography analysis

      Aims Second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) is an alternative novel device for treating coronary lesions. However, the relationship between in-scaffold dimensions after implantation of DREAMS 2G and vessel healing and luminal results at follow-up is unknown. The aim of this study is, therefore, to investigate whether the expansion index after implantation of DREAMS 2G as assessed by optical coherence tomography (OCT) impacts late luminal status and healing of the vessel wall. Methods and results This study comprises of a total 65 out of 123 patients who were enrolled in the BIOSOLVE-II trial. We assessed both qualitative and quantitative ...

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    19. ‘Full-plastic jacket’ with bioresorbable vascular scaffolds: 5-year optical coherence tomography follow-up

      ‘Full-plastic jacket’ with bioresorbable vascular scaffolds: 5-year optical coherence tomography follow-up

      A 54-year-old male patient with type 2 diabetes mellitus and dyslipidaemia was referred to our catheterization laboratory for unstable angina. Coronary angiography revealed severe diffuse and distal three-vessel coronary artery disease. The patient refused bypass surgery and was therefore scheduled for multivessel percutaneous coronary intervention. Following the PSP (pre-dilatation, vessel sizing, post-dilatation) strategy, three 3.0 × 28 mm everolimus-eluting bioresorbable scaffolds (BRS, Absorb, Abbott Vascular, USA) were implanted in the left anterior descending (LAD) artery, three 3.0 × 28 mm BRS in the right coronary artery (RCA) and one single 2.5 × 28 mm BRS was deployed in the obtuse ...

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    20. Multiple sclerosis: is it all black and white in optical coherence tomography?

      Multiple sclerosis: is it all black and white in optical coherence tomography?

      This scientific commentary refers to ‘Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis: a longitudinal study’, by Gonzalez Caldito et al. (doi: 10.1093/brain/awy245 ). ... Multiple sclerosis is an inflammatory demyelinating disease of the CNS. Histopathologically, degenerative processes have also been identified early in the disease course and independent of the demyelinating white matter disease. MRI of brain atrophy is currently the gold standard to assess neurodegeneration in vivo . However, longitudinal MRI of brain atrophy is difficult at the individual level owing to great interscan variability. Thus, alternative proxies for neurodegenerative processes that can predict future ...

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    21. Intravascular optical coherence tomography

      Intravascular optical coherence tomography

      Intravascular optical coherence tomography (IVOCT) began at MIT in the early 1990’s with the recognition that OCT could be used for clinical applications other than ophthalmology. Initial steps made there towards IVOCT feasibility included the acquisition of cadaver arterial images demonstrating the capacity of OCT to visualize depth-resolved architectural detail of plaque 5 and the development of the first mechanical scanning catheter. 6 Early histopathologic correlation studies from cadaver arteries demonstrated that IVOCT was capable of distinguishing the major fibrous, fibrocalcific, and lipid-rich plaque types and also potentially identifying inflammation as manifested by macrophage accumulations. 7, 8 Data from ...

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    22. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions

      Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions

      his Consensus Document is the first of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The first document appraises the role of intracoronary imaging to guide percutaneous coronary interventions (PCIs) in clinical practice. Current evidence regarding the impact of intracoronary imaging guidance on cardiovascular outcomes is summarized, and patients or lesions most likely to derive clinical benefit from an imaging-guided intervention are identified. The relevance of the use of IVUS or OCT prior ...

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    23. Assessing coronary plaques: non-invasive and intracoronary imaging and haemodynamic measurements

      Assessing coronary plaques: non-invasive and intracoronary imaging and haemodynamic measurements

      Atherosclerotic plaque is the hidden culprit of angina and infarction. Commonly, we assume that a coronary plaque that causes ischaemia and/or angina is clinically relevant, although we have learned that even non-obstructive plaques can cause acute coronary syndromes. 1–3 The assessment of haemodynamically relevant plaques is challenging. The so-called gold standard, i.e. coronary angiography, only provides an estimate of the significance of luminal narrowing as it provides only a two-dimensional pictures of the lumen and, unless it is analysed quantitatively, also involves a lot of subjectivity. Intracoronary imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT ...

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    24. Intraoperative Imaging Modalities and the Potential Role of Speckle Modulating Optical Coherence Tomography

      Intraoperative Imaging Modalities and the Potential Role of Speckle Modulating Optical Coherence Tomography

      Maximizing extent of resection has been correlated with improved outcomes in a variety of pediatric and adult brain tumors. 1-11 While gross total resections are often achieved without the use of intraoperative adjuncts, difficulty in distinguishing tumor from normal brain can at times prevent the complete resection of brain tumors. Intraoperative imaging tools have increasingly been embraced with the goal of improving rates of gross total resection. In this review, we will discuss several currently used intraoperative imaging modalities, including intraoperative magnetic resonance imaging (iMRI), wide-field fluorescence, high-resolution fluorescence microscopy, and optical coherence tomography (OCT). 12-17 We will also discuss ...

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    1-24 of 49 1 2 »
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