Background: We investigated whether optical coherence tomography (OCT) guidance would reduce nonoptimal bioresorbable vascular scaffold (BVS) deployment. Methods: This was a randomized controlled trial. Patients who required percutaneous coronary intervention for ischemic heart disease were recruited from 2 centers in Korea. The enrolled patients were randomly assigned to receive either OCT-guided BVS (Absorb; Abbott Vascular) implantation or angiography-guided BVS implantation using an optimized technique. The primary outcome was nonoptimal deployment, which was a composite outcome of the following parameters assessed by OCT: a minimal scaffold area <5 mm 2 , residual area stenosis >20%, incomplete apposition of the scaffold struts >5 ...

Background: The pathomechanisms underlying restenosis of the bioabsorbable sirolimus-eluting metallic scaffold (Magmaris) remain unknown. Using serial optical coherence tomography, we investigated causes of restenosis, including the contribution of late scaffold recoil versus neointimal hyperplasia. Methods: Patients enrolled in BIOSOLVE-II undergoing serial angiography and optical coherence tomography (post-intervention and follow-up: 6 months and/or 1 year) were analyzed. Patients were divided into 2 groups according to angiographic in-scaffold late lumen loss (LLL) <0.5 or ≥0.5 mm. End points were late absolute scaffold recoil and neointimal hyperplasia area as assessed by optical coherence tomography. Results: Serial data were available for ...

Stent implantation for the treatment of coronary artery disease can cause unintended tearing at of vessel wall adjacent to the stent struts resulting in a stent edge dissection (SED)...

Although coronary angiography remains necessary for percutaneous coronary intervention, it provides limited information about lesion morphology, functional significance, and percutaneous coronary intervention results-limitations that are addressed by intravascular imaging and invasive physiology with demonstrated improve procedural and clinical outcomes.

Background: We investigated whether optical coherence tomography (OCT) guidance would reduce nonoptimal bioresorbable vascular scaffold (BVS) deployment. Methods: This was a randomized controlled trial. Patients who required percutaneous coronary intervention for ischemic heart disease were recruited from 2 centers in Korea. The enrolled patients were randomly assigned to receive either OCT-guided BVS (Absorb; Abbott Vascular) implantation or angiography-guided BVS implantation using an optimized technique. The primary outcome was nonoptimal deployment, which was a composite outcome of the following parameters assessed by OCT: a minimal scaffold area <5 mm 2 , residual area stenosis >20%, incomplete apposition of the scaffold struts >5 ...

It is a widely believed paradigm that intimal angiogenesis in coronary atherosclerosis contributes to plaque instability through both hemorrhagic plaque expansion and cholesterol deposition. 1 However, this article supports an alternative concept in which angiogenesis is actually essential for plaque stabilization and healing. 2 , 3 The prevailing paradigm has its origins primarily in histopathology work from the 1980s by Barger’s group reported by Kamat et al. 4 We argue that misinterpretation of their results has skewed the understanding of vulnerable plaque for >35 years. This misconception still endures in recent plaque angiogenesis reviews, affecting understanding of acute coronary syndromes ...

Background-—Fractional flow reserve (FFR) and optical coherence tomography (OCT) may help both in assessment and in percutaneous coronary intervention optimization of angiographically intermediate coronary lesions. We designed a prospective trial comparing the clinical and economic outcomes associated with FFR or OCT in angiographically intermediate coronary lesions. Methods and Results-—Three hundred fifty patients with angiographically intermediate coronary lesions (n=446) were randomized to FFR or OCT guidance. In the FFR arm, percutaneous coronary intervention was performed if FFR was ≤0.80 aiming for a postprocedure FFR >0.90. In the OCT arm, percutaneous coronary intervention was performed if percentage ...

Background The relationship between late stent malapposition (LSM) and adverse cardiovascular events is controversial. Studies are needed to evaluate long‐term (>5 years) clinical outcomes of LSM detected by optical coherence tomography (OCT) after drug‐eluting stent implantation. Methods and Results We investigated long‐term clinical outcomes of OCT‐detected LSM in 351 patients who received drug‐eluting stents and were examined by both poststent and follow‐up OCT (175±60 days after drug‐eluting stent implantation) from January 2009 to December 2011. LSM was observed in 99 patients (28%). We evaluated the cumulative rate of composite events (cardiovascular death ...

Stent malposition, recognized as an entity with the advent of intravascular imaging, refers to the lack of full contact between stent struts and the vessel wall after percutaneous coronary intervention ( Figure ). Malapposition may be present immediately after placement of stents (acute stent malapposition), or it may develop later (late stent malapposition), which can, in turn, be categorized as late persistent malapposition (ongoing since the time of implantation) or late acquired malapposition (developing de novo during follow‐up). 1

Background: Using optical coherence tomography, we evaluated early follow-up findings of significant stent malapposition (SSM) in patients treated with second-generation drug-eluting stent. Methods and Results: From the DETECT-OCT randomized trial (Determination of the Duration of the Dual Antiplatelet Therapy by the Degree of the Coverage of the Struts on Optical Coherence Tomography From the Randomized Comparison Between Everolimus- Versus Biolimus-Eluting Stent), a total of 386 patients (390 lesions) who underwent both postintervention and 3-month follow-up optical coherence tomography examinations were included for the present analysis. SSM was defined as a stent that had a strut with a maximal wall-to-strut distance ...

Optical coherence tomography (OCT) is a high-resolution imaging modality that uses backscattered light to produce cross-section images of biological tissue with micrometer resolution...

Left main coronary artery disease (LMCAD) portends higher prognostic risk as a result of the large myocardial territory at risk, ranging from 75% to 100%, depending on the dominance of the left coronary circulation. Diagnosis and management of significant LMCAD continues to be a source of clinical apprehension and uncertainty. LMCAD is not uncommonly found in stable patients undergoing coronary angiography and is often associated with concomitant coronary artery disease (CAD). Current clinical practice guidelines from both the American College of Cardiology/ American Heart Association and the European Society of Cardiology recommend revascularization for all patients with ≥50% stenosis of ...