Background Fractional flow reserve (FFR) and optical coherence tomography (OCT) may help both in assessment of angiographically-intermediate coronary lesions (AICL) and in percutaneous coronary interventions (PCI) optimization. Objectives: To compare OCT-guidance and FFR-guidance in patients with AICL in a single-center, prospective, 1:1 randomized trial (acronym: FORZA, NCT01824030 ). Methods Patients with AICL were randomized to FFR or OCT. In the FFR arm, PCI was performed if FFR was ≤0.80. In the OCT arm, PCI was performed if area stenosis was ≥75% or 50%-75% with minimal lumen area <2.5 mm 2 or plaque rupture. Angina (evaluated by Seattle ...

Download figure Open in new tab Download powerpoint Abstract Objectives This study sought to compare conventional methodology (CM) with a newly described optical coherence tomography (OCT)-derived volumetric stent expansion analysis in terms of fractional flow reserve (FFR)-derived physiology and device-oriented composite endpoints (DoCE). Background The analysis of coronary stent expansion with intracoronary imaging has used CM that relies on the analysis of selected single cross-sections for several decades. The introduction of OCT with its ability to perform semiautomated volumetric analysis opens opportunities to redefine optimal stent expansion. Methods A total of 291 lesions treated with post-stent OCT and ...

Objectives The authors sought to explore the comparative clinical efficacy of different imaging modalities for guiding percutaneous coronary interventions (PCI). Background Coronary angiography (CA) is the standard imaging modality for intraprocedural guidance of PCI. Intracoronary imaging techniques, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), can overcome some limitations of CA. Methods Comprehensive hierarchical Bayesian network meta-analysis of randomized clinical trials and adjusted observational studies comparing clinical outcomes of PCI with stent implantation guided by CA, IVUS, or OCT. Results A total of 31 studies encompassing 17,882 patients were included. Compared with CA guidance, the risks of all-cause ...

Objectives The aim of this study was to identify histological features that correlate with terms commonly used to describe optical coherence tomographic (OCT) and optical frequency-domain imaging (OFDI) images of stented vessels, by means of a histopathological validation study using stented human coronary arteries. Background OCT imaging and OFDI are used to evaluate vascular responses to stent implantation. Descriptive terms such as “peristrut low attenuation” and “heterogeneous” have been used to describe neointimal characteristics that may have clinical relevance. However, only limited histopathological correlations are available. Methods Using the CVPath stent registry, 19 cases were identified in whom implantation duration ...

Coronary calcification presents multiple technical challenges in percutaneous coronary intervention (PCI) and is associated with suboptimal procedural results and an increase in subsequent adverse clinical events (1) . Currently, there is no standardized evidence-based strategy for PCI of calcified coronary lesions. Decisions for the use of adjunctive atheroablation—shown to increase the acute procedural success rates (2) —are based on visual estimation of calcification severity on angiography (with its inherent limitations [3] ) or when delivery of devices is impeded by calcified deposits in the vessel wall. Although the so-called “rota-regret” remains common following suboptimal acute procedural results in calcified plaques not ...

Objectives The aim of this study was to evaluate if residual thrombus burden after aspiration thrombectomy affects the outcomes of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI). Background Recent studies failed to show clinical benefit of aspiration thrombectomy in STEMI patients. This might be due to insufficient removal of thrombus at the culprit lesion. Methods A total of 109 STEMI patients who underwent aspiration thrombectomy followed by stenting within 24 h from symptom onset were included. Optical coherence tomography was performed after thrombectomy to measure residual thrombus burden. Patients were divided into tertiles based on ...

Objectives The aim of the present study was to investigate the relationship between the integration process and luminal enlargement with the support of light intensity (LI) analysis on optical coherence tomography (OCT), echogenicity analysis on intravascular ultrasound, and histology up to 4 years in a porcine model. Background In pre-clinical and clinical studies, late luminal enlargement has been demonstrated at long-term follow-up after everolimus-eluting poly-l-lactic acid coronary scaffold implantation. However, the time relationship and the mechanistic association with the integration process are still unclear. Methods Seventy-three nonatherosclerotic swine that received 112 Absorb scaffolds were evaluated in vivo by OCT, intravascular ...

Side branch (SB) occlusion remains a major complication of bifurcation lesion treatment. Although plaque and carina shift are suggested as mechanisms of SB occlusion (1) , little is known about underlying plaque morphology and composition of the main vessel (MV) and its potential impact on SB occlusion after MV stenting. Optical coherence tomography (OCT) allows precise evaluation of plaque characteristics, and dedicated bifurcation 3-dimensional (3D) quantitative coronary angiography (QCA) software permits highly accurate lesion assessment (2) . The primary aim of this study was to identify the predictors of SB occlusion after MV stenting by OCT and dedicated bifurcation 3D-QCA.

A 32-year-old woman with chest pain and anterior ST-segment elevation myocardial infarction was referred to our institution for primary percutaneous coronary intervention. Coronary angiography showed severe left main stem (LMS) and left anterior descending coronary artery (LAD) stenosis ( Figures 1A and 1B ). Intravascular ultrasound (IVUS) revealed spontaneous coronary artery dissection (SCAD) with extensive intramural hematoma (IMH) ( Figures 1C and 1D ). Four minimally overlapped Absorb bioresorbable scaffolds (BRS) (Abbott Vascular, Abbott Park, Illinois) were implanted from the distal LAD to the LMS (3.0 × 28 mm; 3.5 × 28 mm; 3.5 × 12 mm, and 3.5 × 28 mm) and post-dilated ...

A 58-year-old diabetic man underwent implantation of 3 overlapping Absorb bioresorbable vascular scaffolds (BVS) (2.5/28, 2.5/28, and 3.0/28 mm) (Abbott Vascular, Santa Clara, California) in a heavily calcified left anterior descending artery stenosis. Optical coherence tomography (OCT) revealed multiple fractures of the 3.0/28 BVS, leading to in-scaffold implantation of a zotarolimus-eluting stent (ZES) ( Figures 1A and 1B ). The 4-month angiography showed a severe edge in ZES restenosis treated with another stent. The OCT revealed an unexpected disappearance of BVS struts ( Figure 1C ) in the ZES segment and a nonocclusive cluster of polymeric ...

A 47-year-old male smoker presented with an inferior ST-segment myocardial infarction (STEMI) 4 h after taking cocaine. Emergency coronary angiography demonstrated a large-caliber proximally occluded right coronary artery ( Figure 1A ) and similarly large smooth left coronary arteries. Aspiration thrombectomy was performed, directly via the guide catheter, and large volumes of red thrombus were removed ( Figure 1B ). Flow was restored, revealing a tight proximal stenosis ( Figure 1C ) that, after administration of copious intracoronary nitrates, completely resolved, suggesting cocaine-induced vasospasm ( Figure 1D ).

A 72-year-old man had undergone angioplasty of the left main stem (LMS) with an implantation of a first-generation drug-eluting stent (DES) (3.5 × 18-mm Cypher stent, Cordis, Johnson & Johnson, Bridgewater, New Jersey) ( Figure 1A ). Post-procedural intravascular ultrasound (IVUS) had shown a well-expanded stent ( Figures 1A′ and 1Aa–c ). Four years later, both angiography and IVUS exhibited no significant in-stent restenosis (ISR) or stent recoil ( Figures 1B, 1B′, and 1Ba′–c′ ). At 7 years, he presented with acute coronary syndrome (ACS) while still on long-term dual antiplatelet therapy. A subsequently obtained coronary angiogram exhibited severe ISR at the midshaft of LMS ...

Given the marked increase in the number of patients with atrial fibrillation (AF) (1) , more than 80% of acute limb ischemia (ALI) cases are now due to cardiac embolism associated with AF (2) . Fogarty thrombectomy is the gold standard treatment of ALI. An 87-year-old man with a chronic AF who underwent Fogarty thrombectomy for ALI due to cardiac embolism in his right leg 1 year earlier was hospitalized in our department for the treatment of right calf claudication ( Figures 1A and 1B ). His ankle-brachial index (ABI) was 0.69 on the right. Enhanced computed tomography (CT) revealed a severe focal ...

A 68-year-old man was treated in our catheterization laboratory for ST-segment elevation myocardial infarction. He had undergone 3.5 × 18-mm bioresorbable vascular scaffold (BVS) implantation in the proximal left anterior descending coronary artery for stable angina in another institution 2 days before. At presentation, angiography showed a filling defect located >5 mm distally to the scaffolded segment ( Figure 1A ). An attempt at thrombus aspiration was performed, without retrieving any aspiration material, and the angiographic image remained unchanged ( Figure 1B ). Optical coherence tomography (OCT) was performed and revealed the absence of intraluminal thrombus, but the presence of an occlusive intramural hematoma ...

A 79-year-old man underwent stent implantation into a severely calcified proximal left anterior descending coronary lesion ( Figure 1 ) in December 2012 followed by restenting in March 2014 to treat in-stent restenosis ( Figure 2 ), both without full balloon expansion. Optical coherence tomography (OCT) documented thick, peri-stent napkin-ring calcium. He was admitted for recurrent unstable angina in April 2014. After initial treatment with excimer laser coronary angioplasty (ELCA; 1.4 mm, Spectranetics Corporation, Colorado Springs, Colorado) using saline injection, fluence of 60 mJ/mm 2 , and frequency of 80 Hz, a balloon was fully expanded. OCT showed fracturing of peri-stent calcium and ...

We read with interest the paper by Ohno et al. ( (1) ) and found that their conclusions merit a few comments. Longitudinal nonuniform expansion patterns by the ABSORB bioresorbable scaffold (BVS) (Abbott Vascular, Irvine, California) may be of clinical importance, but the use of optical coherence tomography (OCT) to identify such patterns requires methods that take catheter motion artifacts into account. The variation in length measurements by OCT compared with nominal length has been reported in ABSORB BVS–treated patients with differences of as much as 5.2 mm ( (2) ) and as much as 10 mm in metal stent–treated patients ...

A 72-old-year-man was admitted for an inferior ST-segment elevation acute myocardial infarction. Seven years earlier, a 2.75 × 15-mm bare-metal stent (BMS) was successfully implanted in the posterolateral branch of the right coronary artery (RCA) at another institution. Emergent coronary angiography showed a thrombotic occlusion at the mid-segment of the RCA (Figure 1 ). After multiple unsuccessful attempts to cross the occlusion, eventually a hydrophilic guidewire was advanced across the occluded segment. Thromboaspiration was unsuccessful despite the use of 2 different aspiration devices that were unable to cross the lesion. Optical coherence tomography (OCT) was performed to clarify the underlying substrate ...

More than 1 million percutaneous coronary interventions (PCIs) are performed per year in the United States. Although technological advances have significantly improved outcomes following PCI, 5% to 44% of PCI patients still experience periprocedural myocardial infarction (PMI). PMI can be either macro-sized (coronary dissection or occlusion of a side branch) or microvascular such as distal embolization and/or microvascular plugging. PMIs have recently been defined as Type 4a: cardiac troponin (cTn) levels >5× elevation above the 99th percentile upper reference limit (URL), but only if the baseline cTn levels were normal (≤99th percentile URL) 1 . In addition to the elevated ...

A 59-year-old man with prior coronary artery bypass surgery underwent cardiac catheterization for worsening angina. Angiogram showed severe native coronary artery disease with 2 patent vein grafts. However, a left internal mammary artery graft to the left anterior descending artery was found to have a long lesion (Figure 1 ). Spasm was excluded by intra-arterial nitroglycerin administration. After discussing the options, optical coherence tomography (OCT)–guided percutaneous intervention was pursued.

An 83-year-old woman was referred to our hospital due to diverticular bleeding of the colon. She had a history of everolimus-eluting stent implantation in the left anterior descending artery (31 months before) and the right coronary artery (20 and 31 months before) because of stable angina. She was prescribed aspirin 100 mg/day and clopidogrel 75 mg/day, followed by single antiplatelet therapy by aspirin during the last 8 months. Aspirin was discontinued for the endoscopic therapy at her admission. Complete blood count showed hemoglobin of 17.5 g/dl and hematocrit of 55.2%, from which polycythemia vera (PV ...

A 48-year-old woman with history of multiple percutaneous coronary interventions and bypass grafting on the left anterior descending coronary artery presented with unstable angina. Coronary angiography showed a patent left internal mammary artery and de novo critical stenoses of the mid-shaft left main and the unprotected left circumflex coronary artery (LCX). Both lesions were treated with 2 nonoverlapping bioresorbable vascular scaffolds (BVS) (Absorb, Abbott Vascular, Santa Clara, California) 3.5 × 12 mm at 16 atm and 3.0 × 18 mm at 12 atm, respectively. Optical coherence tomography (OCT) confirmed good expansion and apposition of the BVS (Figure 1 ). A short ...

A 51-year-old woman was urgently admitted because of chest pain. Emergent coronary angiography revealed diffuse stenosis from the proximal to distal portion of the right coronary artery (RCA) with Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 (Figure 1 ). No stenosis was seen in the left coronary artery. Intravascular ultrasound (IVUS) images revealed an intracoronary hematoma from the posterior descending artery (PDA) to the ostium of the RCA, but could not demonstrate the entry point of the hematoma (Figure 1 ). Optical frequency domain imaging (OFDI; Terumo, Tokyo, Japan) images clearly demonstrated, not only intracoronary hematoma from the PDA to the ...

A 75-year-old man with stable angina underwent coronary angiography demonstrating significant stenosis at the bifurcation of the left anterior descending coronary artery (LAD) with a diagonal branch (Figure 1 ). Following pre-dilation, a 3.5 × 28-mm bioresorbable vascular scaffold (BVS) (Absorb, Abbott Vascular, Santa Clara, California) was implanted in the LAD. This was followed by post-dilation with a 3.5-mm noncompliant balloon and subsequent “T kissing” inflation. Because of an extensive dissection in the proximal segment of the diagonal (Figure 1 ), a 2.5 × 28-mm everolimus-eluting stent (EES) was implanted using the T-stenting with small protrusion (TAP) technique followed by “T ...

In case 1, a 60-year-old man underwent a 4.0-mm × 12-mm bare-metal stent (BMS) implantation in the proximal left anterior descending coronary artery. Six months after BMS implantation, a coronary angiogram demonstrated in-stent restenosis (ISR) at the proximal portion of the stent (Figure 1 ). Frequency-domain optical coherence tomography (FD-OCT) revealed homogeneous neointima (Figure 1 ) and coronary angioscopy (CAS) revealed white neointimal coverage at the ISR site (Figure 1 ). The lesion was dilated using a 3.5 × 13-mm conventional balloon catheter at 16 atm. After balloon angioplasty, Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was achieved, and intracoronary electrocardiography did ...