Objectives This study sought to investigate the potential of the noninvasive albumin-binding probe gadofosveset-enhanced cardiac magnetic resonance (GE-CMR) for detection of coronary plaques that can cause acute coronary syndromes (ACS). Background ACS are frequently caused by rupture or erosion of coronary plaques that initially do not cause hemodynamically significant stenosis and are therefore not detected by invasive x-ray coronary angiography (XCA). Methods A total of 25 patients with ACS or symptoms of stable coronary artery disease underwent GE-CMR, clinically indicated XCA, and optical coherence tomography (OCT) within 24 h. GE-CMR was performed approximately 24 h following a 1-time application of ...

Letter to the Editor: Acute coronary thrombosis with plaque erosion is responsible for about one-third of patients with acute coronary syndromes...

Optical coherence tomography (OCT) allows resolution of tissue infrastructural interfaces ranging from depths of 2 to 5 um. Inasmuch as contrast in standard OCT is primarily due to...

Letter to the Editor

Objectives This study sought to assess the presence and morphological features of coronary plaques on optical coherence tomography (OCT) as the causes of myocardial infarction with nonobstructive coronary arteries (MINOCA). Background Although coronary atherosclerosis has been postulated as a potential mechanism of MINOCA, the interaction between disrupted coronary plaques and myocardial injury remains unknown. Methods In a prospective study, consecutive patients with MI but without significant coronary stenosis (≥50%) at angiography underwent OCT and cardiac magnetic resonance (CMR) with late gadolinium-enhancement (LGE). The infarct-related artery (IRA) was identified by localization of ischemic-type LGE. Results Thirty-eight MINOCA patients (mean age 62 ...

Download figure Open in new tab Download powerpoint Abstract Objectives This study sought to describe the initial findings from the International Pediatric Optical Coherence Tomography (OCT) registry in pediatric heart transplant recipients. Background Cardiac allograft vasculopathy (CAV) is a common cause of late graft failure and mortality in pediatric heart transplant recipients. Early diagnosis may improve outcomes. OCT is a high-resolution intravascular imaging technique that has the potential to identify CAV earlier than angiography. Methods OCT and angiography of the coronary arteries were performed in pediatric heart transplant recipients at participating centers. Demographics, clinical data, medications, episodes of rejection, and ...

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 ...

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 ...

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 ...

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 ...

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 ...

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.

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 ...

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.

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 ...

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 )

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.

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 ...

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 ...

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 ...

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.

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 ...

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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