1. Articles from imaging.onlinejacc.org

  2. 1-24 of 45 1 2 »
    1. IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal

      IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal

      Procedural guidance with intravascular ultrasound (IVUS) imaging improves the clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) by: 1) informing the necessity for lesion preparation; 2) directing appropriate stent sizing to maximize the final stent area and minimize geographic miss; 3) selecting the optimal stent length to cover residual disease adjacent to the lesion, thus minimizing geographic miss; 4) guiding optimal stent expansion; 5) identifying acute complications (edge dissection, stent malapposition, tissue protrusion); and 6) clarifying the mechanism of late stent failure (stent thrombosis, neointimal hyperplasia, stent underexpansion or fracture, or neoatherosclerosis). Optical coherence tomography (OCT) provides similar information ...

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    2. Recanalization of Organized Thrombi Demonstrated by Coronary CT Angiography Compared With OCT

      Recanalization of Organized Thrombi Demonstrated by Coronary CT Angiography Compared With OCT

      Recanalization of organized thrombi (ROT) is a rarely recognized disease histologically characterized by older coronary thrombi forming small lumens or endothelium-lined neovascular channels within thrombus. Optical coherence tomography (OCT) is the method of choice for diagnosis and shows signal-rich, high backscattered septa dividing the lumen into multiple small channels that communicate with each other (1) . Computed tomography angiography (CTA) in the longitudinal and cross-sectional planes may demonstrate the ROT by showing multiple small contrast-filled spaces divided by low-attenuation septa in agreement with the OCT findings (Figures Figure 1 and Figure 2 ). Given its rarity, CTA findings of ROT have not ...

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    3. Heartbeat OCT and Motion-Free 3D In Vivo Coronary Artery Microscopy

      Heartbeat OCT and Motion-Free 3D In Vivo Coronary Artery Microscopy

      Intravascular optical coherence tomography (IV-OCT) has gained widespread use over the past few years, offering highly detailed images of coronary artery pathologies and interventions (1) . In contrast to the cross-sectional view, longitudinal sections and 3-dimensional (3D) renderings are affected by cardiac motion artifacts and undersampling, complicating interpretation and measurements (2) . We developed Heartbeat OCT, a new OCT method that achieves up to 4,000 frames/s imaging speed for isotropically sampled volume datasets acquired within the diastolic phase of 1 cardiac cycle to restore 3D IV-OCT image fidelity. In this research letter, we present the first in vivo data acquired ...

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    4. High Platelet Reactivity and Intrastent Thrombi Assessed by OCT After DES

      High Platelet Reactivity and Intrastent Thrombi Assessed by OCT After DES

      High platelet reactivity (HPR) on clopidogrel may be related to stent thrombosis after drug-eluting stent (DES) implantation (1) . To investigate the relationship between HPR and intrastent thrombi following DES implantation, 202 lesions treated with DES from 109 patients were studied. Coronary angiography and optical coherence tomography (OCT) examination were performed as parts of routine follow-up examination at our institution except for the presence of renal dysfunction or congestive heart failure. OCT imaging and platelet function test were performed at 6 to 9 months (median 202 days). Dual antiplatelet therapy with aspirin and clopidogrel was started before stent implantation and continued ...

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    5. Are Microcalcification and Hemosiderin Really Limitations of OCT in Detection of TCFA?

      Are Microcalcification and Hemosiderin Really Limitations of OCT in Detection of TCFA?

      With great interest, we read the recent work by Fujii et al. (1) published in iJACC reporting the diagnostic accuracy of optical coherence tomography (OCT) and grayscale intravascular ultrasound for the detection of coronary thin cap fibroatheroma (TCFA) with histologic validation in human autopsy hearts. In this publication, Fujii et al. (1) documented a limited capability of OCT and intravascular ultrasound for TCFA identification when each imaging device was solely utilized. The authors attributed the low accuracy of OCT in TCFA detection to 4 reasons: presence of foam cell macrophage, microcalcification, hemosiderin accumulation, and organizing thrombus inclusive of fibrin. However ...

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    6. Fusiform Appearance of Myocardial Bridging Detected by OCT

      Fusiform Appearance of Myocardial Bridging Detected by OCT

      Myocardial bridging (MB) is characterized by epicardial coronary artery tunneling through the myocardium, with angiographic “milking” and an intravascular ultrasound (IVUS) “half-moon” echolucent (1) . Optical coherence tomography (OCT), a light-based technique, can provide unprecedented in vivo imaging of coronary vessel wall structure, especially of intima and plaque composition, with a high resolution of 10 μm. So far, there are no data on visualization of MB using OCT.

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      Mentions: Gary S. Mintz
    7. OCT Images of Longitudinal Deformation Following BVS Implantation in the Right Coronary Ostium

      OCT Images of Longitudinal Deformation Following BVS Implantation in the Right Coronary Ostium

      A 62-year-old man presenting with stable angina underwent coronary angiography demonstrating critical diffuse disease of the right coronary artery. Four sequential Absorb bioresorbable scaffolds (BRS) (Abbott Vascular, Santa Clara, California) were implanted from distal to proximal lesions in the right coronary artery following pre-dilation. This was followed by post-dilation with a 3.5-mm noncompliant balloon (20 atm) proximally and a 3.0-mm noncompliant balloon (18 atm) distally. Although angiography following post-dilation demonstrated an acceptable result, optical coherence tomography (Ilumien Optis, St. Jude Medical, St. Paul, Minnesota) clearly revealed longitudinal deformation and strut disruption of the BRS at the ostium of ...

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      Mentions: St. Jude Medical
    8. How to Detect and Treat Coronary Fibroatheromas The Synergy Between IVUS and NIRS

      How to Detect and Treat Coronary Fibroatheromas The Synergy Between IVUS and NIRS

      Coronary fibroatheromas can cause a wide spectrum of adverse events, such as sudden death, acute coronary syndromes, and procedural complications during percutaneous coronary interventions (PCI) ( 2 ). Accurate fibroatheroma detection could significantly enhance our ability to treat these lesions and prevent complications.

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    9. Two-Year Follow-Up OCT Images of 2 Bifurcation Lesions Treated With Bioresorbable Vascular Scaffolds

      Two-Year Follow-Up OCT Images of 2 Bifurcation Lesions Treated With Bioresorbable Vascular Scaffolds

      Letter to the editor. Diagnostic angiogram of a 66-year-old man presenting with stable angina revealed significant lesions in the left main coronary artery (LMCA) trifurcation and the left anterior descending artery (LAD) diagonal bifurcation (Figure 1 ). In the latter, after deployment of a 2.5 × 16.0 mm Promus element (Boston Scientific, Natick, Massachusetts) with mini-crush technique in the diagonal with initial kissing balloon inflation (KBI), a 3.0 × 18.0 mm ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) was implanted in the proximal LAD without final KBI. In the LMCA trifurcation lesion, a 3.5 × 18 ...

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    10. Multiple Simultaneous Plaque Erosion in 3 Coronary Arteries

      Multiple Simultaneous Plaque Erosion in 3 Coronary Arteries

      We performed optical coherence tomography (OCT) imaging with matched histology in a 34-year-old man with history of smoking and untreated hyperlipidemia who had suffered from epigastric pain and was found dead at home. Multiple plaque erosions in 3 major coronary arteries were discovered (Figure 1 )

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    11. Integrated IVUS-OCT for Real-Time Imaging of Coronary Atherosclerosis

      Integrated IVUS-OCT for Real-Time Imaging of Coronary Atherosclerosis

      Accurate assessment of atherosclerotic plaque characteristics and the subsequent tailoring of optimal therapy holds great promise for preventing acute coronary syndromes (ACS) and life-threatening sequelae 1 . Combined use of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) was proposed as a potential method for accurate assessment of plaque characteristics and vulnerability ( 2 , ). However, significant challenges remain in trying to adapt an integrated OCT-IVUS system for clinical applications. We report here a fully integrated intracoronary OCT-IVUS imaging technique to visualize atherosclerotic plaque in living animals and human coronary arteries from cadavers with high resolution and deep penetration capability simultaneously.

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    12. Carotid Artery OCT in Cerebral Infarction

      Carotid Artery OCT in Cerebral Infarction

      In a recent issue of iJACC , Prati et al. 1 suggested that plaque characterization by newer imaging modalities such as intracoronary optical coherence tomography (OCT) may help optimize management strategies in acute coronary events. Although OCT imaging has been extensively performed for the characterization of culprit plaques in acute coronary events ( 2 ), the intravascular imaging data defining plaque composition in the acute cerebral events is rather sparse 3 . We present anecdotal examples of internal carotid artery (ICA) OCT images of plaque morphology in the patients afflicted by acute cerebral infarction. An 83-year-old man presented with sudden hemiplegia while praying in ...

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      Mentions: St. Jude Medical
    13. OCT Versus IVUS: Accuracy Versus Clinical Utility

      OCT Versus IVUS: Accuracy Versus Clinical Utility

      The technology of optical coherence tomography (OCT) has evolved from time-domain to frequency-domain imaging. Time-domain OCT is most often performed using proximal balloon occlusion; as such, dimensions are smaller than measured using intravascular ultrasound (IVUS), presumably due to diminished perfusion pressure. Conversely, frequency-domain OCT does not require proximal balloon occlusion, theoretically resulting in more accurate measurements. With this background, Kubo et al. ( 1 ) in this issue of iJACC , conducted a multicenter study to compare pre-intervention quantitative analysis and post-intervention qualitative analysis among frequency-domain OCT, IVUS, and quantitative coronary angiography (QCA). The mean minimum lumen diameter measured by QCA was smaller ...

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    14. Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection

      Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection

      Spontaneous coronary artery dissection (SCD) is a rare clinical entity ( 1 and 2 ). Clinical diagnosis is challenging and classically relies on the angiographic demonstration of an intimomedial “flap” leading to a double lumen appearance ( 1 and 2 ). Angiography, however, is unable to visualize the coronary wall. New intracoronary diagnostic tools provide comprehensive, tomographic, high-resolution insights on vessel wall pathology, allowing a precise diagnosis of SCD ( 3 and 4 ). A 58-year-old woman presented with a non–ST-segment elevation inferior myocardial infarction. Angiography ( Fig. 1 A) revealed a normal right coronary artery with just minor lumen irregularities. Intravascular ultrasound (IVUS) ( Fig. 1 ...

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    15. OCT-Verified Peri-Strut Low-Intensity Areas and the Extent of Neointimal Formation After 3 Years Following Stent Implantation

      OCT-Verified Peri-Strut Low-Intensity Areas and the Extent of Neointimal Formation After 3 Years Following Stent Implantation

      Drug eluting stents (DES) have decreased substantially the neointimal formation after percutaneous coronary intervention (PCI). However, DES are not free from neointimal hyperplasia (NIH) and stent thrombosis, which are related to the delayed arterial healing following DES implantation. The recently introduced optical coherence tomography (OCT) enables a detailed investigation of vessel healing. The presence of peri-strut low intensity (PLI) has been described as a potential marker of abnormal neointimal healing (( 1 ), 2 ). We investigated the late healing characteristics of stents implanted over 3 years, specifically the potential impact of PLI on NIH and restenosis.

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    16. Spontaneous Multivessel Coronary Intramural Hematoma: An Insight With OCT

      Spontaneous Multivessel Coronary Intramural Hematoma: An Insight With OCT

      Spontaneous coronary arterial intramural hematoma is a rarely diagnosed cause of acute myocardial infarction. The underlying pathophysiology is poorly understood. A historical series of intramedial dissecting hematomas, published in 1965 ( 1 ), postulated that rupture of the vasa vasorum or cystic medial necrosis, as described in the aorta by Erdheim ( 2 ), could be the precipitant. The appearance of angiographic luminal obstruction, without intravascular imaging to investigate its etiology, is likely to have contributed to an under-reporting of this phenomenon. A small number of case reports document intramural hematoma by intravascular ultrasound; however, the limited resolution of intravascular ultrasound may preclude accurate ...

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    17. Reproducibility of In Vivo Measurements for Fibrous Cap Thickness and Lipid Arc by OCT

      Reproducibility of In Vivo Measurements for Fibrous Cap Thickness and Lipid Arc by OCT

      Thin fibrous cap and lipid pool are thought to be major determinants of plaque instability. However, current imaging modalities such as angiography, intravascular ultrasound, and angioscopy do not have sufficient resolution to accurately measure them. It is widely accepted that optical coherence tomography (OCT) is the in vivo “gold standard” imaging modality for the measurement of fibrous cap thickness. However, its reproducibility has never been systematically studied. Therefore, we attempted a systematic investigation of interobserver agreement and intraobserver reproducibility of fibrous cap thickness and lipid arc measurements. Fifty frames and 25 pullback runs of OCT were randomly selected for frame ...

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    18. Impact of Statin Therapy on Plaque Characteristics as Assessed by Serial OCT, Grayscale and Integrated Backscatter–IVUS

      Impact of Statin Therapy on Plaque Characteristics as Assessed by Serial OCT, Grayscale and Integrated Backscatter–IVUS

      Objectives: The purpose of this study was to evaluate the effect of statin treatment on coronary plaque composition and morphology by optical coherence tomography (OCT), grayscale and integrated backscatter (IB) intravascular ultrasound (IVUS) imaging. Background: Although previous studies have demonstrated that statins substantially improve cardiac mortality, their precise effect on the lipid content and fibrous cap thickness of atherosclerotic coronary lesions is less clear. While IVUS lacks the spatial resolution to accurately assess fibrous cap thickness, OCT lacks the penetration of IVUS. We used a combination of OCT, grayscale and IB-IVUS to comprehensively assess the impact of pitavastatin on plaque ...

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    19. Ex Vivo Assessment of Vascular Response to Coronary Stents by Optical Frequency Domain Imaging

      Ex Vivo Assessment of Vascular Response to Coronary Stents by Optical Frequency Domain Imaging

      Objectives This study sought to examine the capability of optical frequency domain imaging (OFDI) to characterize various morphological and histological responses to stents implanted in human coronary arteries. Background A precise assessment of vascular responses to stents may help stratify the risk of future adverse events in patients who have been treated with coronary stents. Methods Fourteen human stented coronary segments with implant duration ≥1 month from 10 hearts acquired at autopsy were interrogated ex vivo by OFDI and intravascular ultrasound (IVUS). Comparison with histology was assessed in 134 pairs of images where the endpoints were to investigate: 1) accuracy ...

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    20. IVUS and OCT: Either or Survivor...

      IVUS and OCT: Either or Survivor...

      Since its introduction over 20 years ago, intravascular ultrasound (IVUS) has become the dominant imaging technology, helping us to better understand vessel biology and guiding interventional procedures, and providing information on atherosclerosis progression or regression in clinical trials. During this time period, IVUS has survived many other intracoronary techniques that have fallen by the wayside. Recently, optical coherence tomography (OCT), a far higher resolution optical imaging technique, was approved for clinical use by the U.S. Food and Drug Administration. Suter et al. (1), in a State-of-the-Art review article in this issue of iJACC, have highlighted the relative merits of ...

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    21. Correlation of Angiographic Late Loss With Neointimal Proliferation in Stents Evaluated by OCT and Histology in Porcine Coronary Arteries

      Correlation of Angiographic Late Loss With Neointimal Proliferation in Stents Evaluated by OCT and Histology in Porcine Coronary Arteries
      Objectives We aimed to evaluate the correlation of angiographic late loss (LL) with the degree of in-stent neointimal proliferation assessed by optical coherence tomography (OCT) and histology. Background Angiographic LL is the most common endpoint used in clinical trials for the evaluation of the efficacy of drug-eluting stents (DES). However, there are few data in regards to the accuracy of angiographic LL in the evaluation of DES displaying lower degrees of neointimal proliferation. Methods A total of 49 stents (36 DES and 13 bare-metal stents) were deployed in coronary arteries of 23 domestic swine and followed up for 28 or ...
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    1-24 of 45 1 2 »
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