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    1. Assessing the impact of PCSK9 inhibition on coronary plaque phenotype with optical coherence tomography: rationale and design of the randomized, placebo-controlled HUYGENS study

      Assessing the impact of PCSK9 inhibition on coronary plaque phenotype with optical coherence tomography: rationale and design of the randomized, placebo-controlled HUYGENS study

      Background: Technological advances in arterial wall imaging permit the opportunity to visualize coronary atherosclerotic plaque with sufficient resolution to characterize both its burden and compositional phenotype. These modalities have been used extensively in clinical trials to evaluate the impact of lipid lowering therapies on serial changes in disease burden. While the findings have unequivocally established that these interventions have the capacity to either slow disease progression or promote plaque regression, depending on the degree of lipid lowering achieved, their impact on plaque phenotype is less certain. More recently optical coherence tomography (OCT) has been employed with a number of studies ...

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    2. How can optical coherence tomography be used to optimize percutaneous coronary intervention?

      How can optical coherence tomography be used to optimize percutaneous coronary intervention?

      Optical coherence tomography (OCT) imaging provides high resolution assessment of coronary parietal and endoluminal abnormalities. Clinical evidence and intuitive utilization make this tool relevant for use in daily practice in the catheterization laboratory. In the present review, we summarize the benefits of OCT for the optimization of percutaneous coronary intervention (PCI) in daily practice. First, we focus on the characterization of lesion type with a view to anticipating challenges during PCI. Then, we describe the utility of OCT to identify culprit lesions and ambiguous angiographic findings. Finally, we outline targets for optimization after PCI and the mechanisms underlying stent failure.

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    3. When to use intravascular ultrasound or optical coherence tomography during percutaneous coronary intervention?

      When to use intravascular ultrasound or optical coherence tomography during percutaneous coronary intervention?

      Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are intravascular imaging technologies widely used in the cardiac catheterization laboratory. The impact of these modalities for optimizing the acute and longer-term clinical impact following percutaneous coronary intervention (PCI) is supported by a wealth of clinical evidence. Intravascular imaging provides unique information for enhanced lesion preparation, optimal stent sizing, recognizing post PCI complications, and the etiology of stent failure. This review compares and contrasts the key aspects of these imaging modalities during PCI.

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      Mentions: Cleveland Clinic
    4. Optical coherence tomography: fundamentals and clinical utility

      Optical coherence tomography: fundamentals and clinical utility

      Although coronary angiography is the standard method employed to assess the severity of coronary artery disease and to guide treatment strategies, it provides only 2D image of the intravascular lesions. In contrast, intravascular imaging modalities such as optical coherence tomography (OCT) produce cross-sectional images of the coronary arteries at a far greater spatial resolution, capable of accurately determining vessel size as well as plaque morphology, eliminating many of the disadvantages inherent to angiography. This review will discuss the role of OCT in the catherization laboratory for the assessment and management of coronary disease.

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    5. The assessment of intermediate coronary lesions using intracoronary imaging

      The assessment of intermediate coronary lesions using intracoronary imaging

      Intermediate coronary artery stenosis, defined as visual angiographic stenosis severity of between 30–70%, is present in up to one quarter of patients undergoing coronary angiography. Patients with this particular lesion subset represent a distinct clinical challenge, with operators often uncertain on the need for revascularization. Although international guidelines appropriately recommend physiological pressure-based assessment of these lesions utilizing either fractional flow reserve (FFR) or quantitative flow ratio (QFR), there are specific clinical scenarios and lesion subsets where the use of such indices may not be reliable. Intravascular imaging, mainly utilizing intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represents an ...

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    6. In vivo imaging of vulnerable plaque with intravascular modalities: its advantages and limitations

      In vivo imaging of vulnerable plaque with intravascular modalities: its advantages and limitations

      In vivo imaging of plaque instability has been considered to have a great potential to predict future coronary events and evaluate the stabilization effect of novel anti-atherosclerotic medical therapies. Currently, there are several intravascular imaging modalities which enable to visualize plaque components associated with its vulnerability. These include virtual histology intravascular ultrasound (VH-IVUS), integrated backscatter IVUS (IB-IVUS), optical coherence tomography (OCT), near-infrared spectroscopy and coronary angioscopy. Recent studies have shown that these tools are applicable for risk stratification of cardiovascular events as well as drug efficacy assessment. However, several limitation exists in each modality. The current review paper will outline ...

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    7. The role of intracoronary imaging in translational research

      The role of intracoronary imaging in translational research

      Atherosclerotic cardiovascular disease is a key public health concern worldwide and leading cause of morbidity, mortality and health economic costs. Understanding atherosclerotic plaque microstructure in relation to molecular mechanisms that underpin its initiation and progression is needed to provide the best chance of combating this disease. Evolving vessel wall-based, endovascular coronary imaging modalities, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS), used in isolation or as hybrid modalities, have been advanced to allow comprehensive visualization of the pathological substrate of coronary atherosclerosis and accurately measure temporal changes in both the vessel wall and plaque characteristics. This ...

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    8. Stent accordion phenomenon visualized with optical coherence tomography

      Stent accordion phenomenon visualized with optical coherence tomography

      Percutaneous coronary intervention (PCI) was done in a 57-year-old male with chronic kidney disease who presented with non-ST segment elevation myocardial infarction. Coronary angiogram showed two vessel disease of the left anterior descending artery (LAD) and the right coronary artery (RCA). The LAD was successfully stented. After predilatation and rotablation, PCI was performed with 2 overlapping drug eluting stents (DES) Promus (Boston Scientific, Marlborough, Massachusetts, USA) 3 mm × 38 mm to the mid RCA and Resolute Onyx 3.5 mm × 34 mm (Medtronic, Minneapolis, Minnesota, USA) to the ostial proximal segment, respectively. After post dilatation using a 3.5 non-compliant ...

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    9. Should all spontaneous coronary dissections need to be diagnosed by intracoronary imaging techniques?

      Should all spontaneous coronary dissections need to be diagnosed by intracoronary imaging techniques?

      Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death. The diagnosis of SCAD is based only on angiography in most of the studies ( 1 - 3 ) and the angiographic type 1 pattern is considered pathognomonic of an SCAD. A 74-year-old man with history of smoking, hypertension and dyslipidemia was admitted at our center due to a minimum effort angina of recent onset, with neither ST changes in basal electrocardiogram nor troponin elevation. An echocardiogram showed preserved ejection fraction without regional wall motion abnormalities. His coronary angiography showed a 90% stenosis in the proximal ...

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