Aims: In the ILUMIEN III trial, among 450 randomised patients with non-complex lesions undergoing percutaneous coronary intervention (PCI), optical coherence tomography (OCT) guidance led to greater stent expansion than angiography guidance, similar minimal stent area compared to both intravascular ultrasound (IVUS) guidance and angiography guidance, and lower rates of uncorrected dissection and malapposition than both IVUS guidance and angiography guidance. Whether these differences impact clinical outcomes is unknown. Methods and results : OCT-guided PCI, using an external elastic lamina-based protocol, was compared to operator-directed IVUS-guided or angiography-guided PCI. Target lesion failure (TLF) and major adverse cardiovascular events (MACE) at 12 months ...

Aims: This study evaluated the optical frequency domain imaging (OFDI) artifact of tangential signal dropout (TSD), which mimics the appearance of lipid-rich plaque and macrophage (Mø) infiltration. Methods and results: A total of 1,019 histological cross-sections from 23 autopsy hearts were matched with the corresponding OFDI images. Of those, 232 OFDI cross-sections that contained signal-poor regions with diffuse borders were classified as lipid-rich plaques. The angle θ was calculated between the OFDI beam that strikes the edge of the luminal surface of the low-intensity region and that which strikes the surface line of the low-intensity region. On histological evaluation, 182 ...

Aim: To determine the ability of optical frequency domain imaging (OFDI)/optical coherence tomography (OCT) imaging systems to visualize presence of cholesterol crystals (CCR) in human atherosclerotic coronary arteries. Methods and Results: We performed ex vivo imaging by OFDI/OCT of human coronary arteries. A total of 559 cross-sectional images from 45 autopsy cases were co-registered with histology and 117 histologic sections showed presence of necrotic core with cholesterol clefts (CC). We modified a previously used OFDI/OCT definition for identification of CCRs which we now define as a linear and discreet high intensity signal (bright area) within the plaque ...

Aims: We sought to evaluate procedural complications and one-year clinical outcomes for patients who underwent percutaneous coronary intervention (PCI) with orbital (OA) and rotational atherectomy (RA). Methods and results: From a total of 13,467 patients who underwent PCI in our hospital between January 2013 and June 2016, 1,149 consecutive patients were treated with atherectomy for moderately-severely calcified lesions (184 with OA, 965 with RA). Procedural complications were similarly observed in the two groups except for higher dissection and perforation rates with OA. Major adverse cardiovascular events (MACE) were defined as the composite of death, myocardial infarction or target ...

Aims: To evaluate the diagnostic performance of OCT-based optical flow ratio (OFR) in unselected patients and compare it with angiography-based quantitative flow ratio (QFR), using wire-based FFR as reference standard. Methods and results: All patients with OCT and FFR assessment prior to revascularization were analyzed. OFR and QFR were computed in blinded fashion and compared with FFR, all applying same cut-off value of ≤0.80 to define ischemia. Paired comparison between OFR and QFR was performed in 212 vessels from 181 patients. Average FFR was 0.82±0.10 and 40.1% vessels had FFR≤0.80. OFR showed significant ...

Aims: We aimed to evaluate whether optical coherence tomography (OCT)-guided rotational atherectomy (RA) improves stent expansion and clinical outcomes compared to intravascular ultrasound (IVUS)-guided RA. Methods and results: We identified 247 de-novo calcified coronary lesions that underwent RA from our database between September 2013 and December 2017. Of these, lesions with no intravascular imaging data (n=11), poor image quality (n=7), balloon angioplasty alone (n=16), and complications (2 burr entrapment, 2 perforation) were excluded. Finally, 88 and 121 lesions that underwent OCT-guided and IVUS-guided RA, respectively, were enrolled. The primary endpoint of the present study was ...

A 67-year-old female presented with an acute anterior STEMI and underwent percutaneous coronary intervention of the mid-left anterior descending (LAD) coronary artery. Following successful implantation of two drug-eluting stents with TIMI III flow, multimodality imaging using near-infrared spectroscopy with intravascular ultrasound (NIRS-IVUS) and optical coherence tomography (OCT) was performed in the LAD and right coronary artery (RCA) in the setting of an imaging study (A1 and B1).

Aims: . To develop a deep learning model for classifying frames with vs. without optical coherence tomography (OCT)-derived thin-cap fibroatheroma (TCFA). Methods and results: . Total 602 coronary lesions from 602 angina patients were randomized into training and test sets at a 4:1 ratio. A DenseNet model was developed to classify OCT frames with or without OCT-derived TCFA. Gradient-weighted class activation mapping was used to visualize the area of attention. In the training sample (35,678 frames of 480 lesions), the model with 5-fold cross-validation had an overall accuracy of 91.6±1.7%, sensitivity of 88.7±3.4 ...

Bioresorbable scaffolds (BRS) were introduced into clinical practice to overcome long-term limitations of drug-eluting stents (DES), but they were instead associated with a high rate of target lesion revascularization (TLR) and thrombosis. Whereas scaffold discontinuity was the most frequent mechanism for polymeric-BRS TLR1, there are no studies on the causes of second-generation drug-eluting absorbable metal scaffold (MgBRS) TLR (Magmaris, BIOTRONIK, Bulach, Switzerland). We sought to determine the optical coherence tomography (OCT) findings in patients who experienced a MgBRS TLR. Moreover, we performed a systematic review of the reported cases. 

ntracoronary imaging (ICI) has matured into a well-established clinical and research tool for patients with coronary artery disease (CAD). Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are now widely accepted for the assessment of lesion morphology in patients presenting with acute coronary syndromes (ACS). The large body of evidence gathered on the clinical value of these techniques cannot be summarised in a conventional clinical practice guideline format. Accordingly, a recent expert consensus document on the importance of ICI to guide coronary interventions 1 has now been followed by another expert consensus detailing the value of these techniques to unravel ...

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 ...

Aims: To use optical coherence tomography (OCT) to predict newly implanted stent expansion for treatment of in-stent restenosis (ISR). Methods and results: With OCT-guidance, 143 ISR lesions were treated with a new stent. Stent underexpansion was defined as minimum stent area (MSA) <4.5mm 2 and MSA/average of reference lumen area <70%. New stent underexpansion was found in 33 lesions (23%), had a smaller old stent MSA (4.13 [3.32-4.62] versus 5.18 [4.01-6.38] mm 2 , p=0.001), and had a higher prevalence of multiple old stent layers (51.5% versus 10.9%, p ...

ims: A novel method for computation of fractional flow reserve (FFR) from optical coherence tomography (OCT) was developed recently. This study aimed to evaluate the diagnostic accuracy of a new OCT-based FFR (OFR) computational approach, using wire-based FFR as the reference standard. Methods and results: Patients who underwent both OCT and FFR prior to intervention were analysed. The lumen of the interrogated vessel and the ostia of the side branches were automatically delineated and used to compute OFR. Bifurcation fractal laws were applied to correct the change in reference lumen size due to the step-down phenomenon. OFR was compared with ...