1. 1-24 of 49 1 2 »
    1. Enhanced Adventitial Vasa Vasorum Formation in Patients With Vasospastic Angina Assessment With OFDI

      Enhanced Adventitial Vasa Vasorum Formation in Patients With Vasospastic Angina Assessment With OFDI

      Coronary artery spasm plays important roles in the pathogenesis of a wide range of ischemic heart disease. Recent studies have demonstrated that coronary spasm is frequently noted in Caucasians as in Asians (1) . We previously demonstrated that vascular smooth muscle cell hypercontraction through Rho-kinase activation is the key mechanism of the spasm, for which adventitial inflammatory changes may be involved (1) . The adventitia has recently attracted much attention as a source of inflammation as it harbors nutrient blood vessels called vasa vasorum (VV). Indeed, VV plays an important role as a supply route of vascular inflammation in the progression of ...

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    2. Impact of Side Branch Modeling on Computation of Endothelial Shear Stress in Coronary Artery Disease Coronary Tree Reconstruction by Fusion of 3D Angiography and OCT

      Impact of Side Branch Modeling on Computation of Endothelial Shear Stress in Coronary Artery Disease Coronary Tree Reconstruction by Fusion of 3D Angiography and OCT

      Background Computational fluid dynamics allow virtual evaluation of coronary physiology and shear stress (SS). Most studies hitherto assumed the vessel as a single conduit without accounting for the flow through side branches. Objectives This study sought to develop a new approach to reconstruct coronary geometry that also computes outgoing flow through side branches in hemodynamic and biomechanical calculations, using fusion of optical coherence tomography (OCT) and 3-dimensional (3D) angiography. Methods Twenty-one patients enrolled in the DOCTOR (Does Optical Coherence Tomography Optimize Revascularization) fusion study underwent OCT and 3D-angiography of the target vessel (9 left anterior descending, 2 left circumflex, 10 ...

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    3. Vasa Vasorum Restructuring in Human Atherosclerotic Plaque Vulnerability

      Vasa Vasorum Restructuring in Human Atherosclerotic Plaque Vulnerability

      Background Previous studies have suggested that vasa vasorum (VV) is associated with plaque progression and vulnerability. Objectives The aim of this study was to investigate the relationship between coronary neovascularization structures and plaque characteristics. Methods We included 53 patients who underwent optical coherence tomography to observe the proximal left anterior descending coronary artery. Patients were classified into 5 groups according to lesion characteristics: normal; fibrous plaque (FP); fibroatheroma (FA); plaque rupture (PR); and fibrocalcific plaque (FC). We defined signal-poor tubuloluminal structures recognized in cross-sectional and longitudinal profiles located in adventitial layer as VV, and within plaque as intraplaque neovessels. Two ...

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    4. Cholesterol Crystals Associate With Coronary Plaque Vulnerability In Vivo

      Cholesterol Crystals Associate With Coronary Plaque Vulnerability In Vivo

      The high local concentration of cholesterol in foam cells has been reported to formulate cholesterol crystals, which trigger a local inflammatory response ( 1 ). Intracellular crystals also induce apoptosis of foam cells, leading to further attraction of macrophages and development of a lipid-rich necrotic core 2 . These effects may suggest a potential contribution of cholesterol crystals to plaque destabilization. Frequency-domain optical coherence tomography (FD-OCT) enables visualization of cholesterol crystals in vivo ( 3 ). We investigated the impact of cholesterol crystals on plaque vulnerability in stable patients with coronary artery disease.

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    5. In Search of the Vulnerable Plaque Is There Any Light at the End of the Catheter?

      In Search of the Vulnerable Plaque Is There Any Light at the End of the Catheter?

      Plaque destabilization with consequent rupture (or erosion) and superimposed thrombosis is the proximate cause of acute coronary syndromes (ACS). Although ACS treatment has advanced considerably in the past decade, the ability to detect, predict, and prevent plaque vulnerability remains elusive. Several imaging tools have been developed to characterize morphological determinants of plaque vulnerability 1 . Among these, intravascular ultrasound (IVUS) is useful for characterizing stenosis severity, plaque burden (PB), remodeling, and calcification but has low resolution and limited ability to detect plaque erosion, rupture, and thrombus. Optical coherence tomography (OCT) can characterize plaques but possesses poor penetration, thereby limiting assessment of ...

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      Mentions: Jagat Narula
    6. Effect of Atorvastatin Therapy on Fibrous Cap Thickness in Coronary Atherosclerotic Plaque as Assessed by Optical Coherence Tomography The EASY-FIT Study

      Effect of Atorvastatin Therapy on Fibrous Cap Thickness in Coronary Atherosclerotic Plaque as Assessed by Optical Coherence Tomography The EASY-FIT Study

      Background The detailed mechanism of plaque stabilization by statin therapy is not fully understood. Objectives The aim of this study was to assess the effect of lipid-lowering therapy with 20 mg/day of atorvastatin versus 5 mg/day of atorvastatin on fibrous cap thickness in coronary atherosclerotic plaques by using optical coherence tomography (OCT). Methods Seventy patients with unstable angina pectoris and untreated dyslipidemia were randomized to either 20 mg/day or 5 mg/day of atorvastatin therapy. OCT was performed to assess intermediate nonculprit lesions at baseline and 12-month follow-up. Results Serum low-density lipoprotein cholesterol level was significantly lower ...

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    7. Comparison of Circulating Dendritic Cells and Monocyte Subsets at Different Stages of Atherosclerosis: insights from optical coherence tomography

      Comparison of Circulating Dendritic Cells and Monocyte Subsets at Different Stages of Atherosclerosis: insights from optical coherence tomography

      Objectives Proinflammatory dendritic cells (DC) and monocytes are critically involved in the proceeding and destabilization of atherosclerosis. Recent studies have reported potential associations of specific patterns of circulating DCs and monocytes with the incidence of coronary artery disease (CAD) and ST-elevation myocardial infarction (STEMI); however, further information of DC and monocyte subsets on plaque morphology and vulnerability is uncertain and required. Methods Forty-seven CAD patients with borderline lesions (stenosis 50%-70%) by coronary angiography (CAG) were enrolled, while 31 subjects free of luminal diameter narrowing ≥ 50% served as controls. Likewise, 35 patients with STEMI were enrolled and confirmed with the ...

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    8. Serum Cystatin C Level Not Associated with Coronary Artery Plaque Vulnerability Analyzed by Optical Coherence Tomography

      Serum Cystatin C Level Not Associated with Coronary Artery Plaque Vulnerability Analyzed by Optical Coherence Tomography

      Objectives Cystatin C, which is an endogenous marker for renal function, is reported to be a novel marker for coronary atherosclerosis. Some studies showed that lower cystatin C levels may be associated with increased severity of CAD in clinically stable patients, whereas higher levels may indicate the presence of any vulnerable plaque. To evaluate the relationship of Serum Cystatin C level and the coronary artery plaque vulnerability assessed by OCT in patients with coronary artery disease. Methods Eighty-two patients with chest pain underwent OCT assessment after coronary angiogram, all the lesions with diameter stenosis ≥30% and <100% were analyzed. The ...

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    9. Prevalence and Characteristics of TCFA and Degree of Coronary Artery Stenosis An OCT, IVUS, and Angiographic Study

      Prevalence and Characteristics of TCFA and Degree of Coronary Artery Stenosis An OCT, IVUS, and Angiographic Study

      Background The relationship between features of vulnerable plaque and angiographic coronary stenosis is unknown. Objectives The purpose of this study was to systematically investigate the absolute number, relative prevalence, and characteristics of thin-cap fibroatheroma (TCFA) at different degrees of stenosis using optical coherence tomography (OCT), intravascular ultrasound, and coronary angiography. Methods We identified 643 plaques from 255 subjects who underwent OCT imaging in all 3 coronary arteries. They were divided into 3 groups on the basis of angiographic diameter stenosis: Group A (30% to 49%, n = 325), Group B (50% to 69%, n = 227), and Group C (>70%, n = 91 ...

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    10. Intravascular Photoacoustic Tomography of Coronary Atherosclerosis

      Intravascular Photoacoustic Tomography of Coronary Atherosclerosis

      The emergence of coronary angiography in the late 1950s enabled an imaging-based understanding of coronary artery disease and led to surgical and intravascular treatment approaches of coronary luminal stenosis. Based on the increasing familiarity with intracoronary catheter manipulation, miniature intravascular ultrasound probes subsequently were developed. The advantage of direct, intraluminal imaging was initially considered to be its capability to clarify indeterminate luminal findings (e.g., severity of left main stenosis, dissection, in-stent restenosis). However, investigators soon realized that the visualization of the wall/plaque beyond the narrowed lumen with intravascular imaging provided important insights into pathophysiologic aspects of atherosclerosis ( 1 ...

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      Mentions: Cleveland Clinic
    11. Treatment of Coronary In-Stent Restenosis With Bioabsorbable Vascular Scaffolds

      Treatment of Coronary In-Stent Restenosis With Bioabsorbable Vascular Scaffolds

      A 77-year-old woman was admitted for angina 13 years after receiving a bare-metal stent in the left anterior descending coronary artery. Angiography showed in-stent restenosis (ISR). Optical coherence tomography (OCT) revealed a well-expanded stent with focal ISR ( arrow in longitudinal display, A ) and heterogeneous tissue, including lipid pools (+) and and calcified segments (#) , suggesting neoatherosclerosis (B to D) (wire-artifact [*] ). Most underlying struts were not visible. A bioabsorbable vascular scaffold (BVS) was deployed and subsequently post-dilated at high pressures to remove a residual waist. Final OCT revealed a minimal lumen area of 8 mm 2 . The classic “ black box ” BVS appearance (without ...

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    12. Current Treatment of In-Stent Restenosis

      Current Treatment of In-Stent Restenosis

      Management of patients with in-stent restenosis (ISR) remains an important clinical problem. Although drug-eluting stents (DES) have drastically reduced the incidence of ISR, treatment of DES-ISR is particularly challenging. ISR mainly results from aggressive neointimal proliferation, but recent data also suggest that neoatherosclerosis may play an important pathophysiological role. Intracoronary imaging provides unique insights to unravel the underlying substrate of ISR and may be used to guide repeated interventions. In this paper, we systematically reviewed clinical trial data with currently available therapeutic modalities, including DES and drug-coated balloons, in patients presenting with ISR within bare-metal stents or DES.

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    13. We Should Use the OCT-Based Clinical Term “Acute Coronary Syndrome With Intact Fibrous Cap (ACS-IFC)” Rather Than the Pathology Term “Plaque Erosion”

      We Should Use the OCT-Based Clinical Term “Acute Coronary Syndrome With Intact Fibrous Cap (ACS-IFC)” Rather Than the Pathology Term “Plaque Erosion”

      We welcome the contribution of Jia et al. 1 to our understanding of the role of optical coherence tomography (OCT) in acute coronary syndromes. Their study ( 1 ) confirms that OCT can help discriminate between plaque rupture and erosion clinically 2 . However, we believe that a pathological term such as erosion may not be appropriate, and, as we proposed, the acute coronary syndromes should be clinically classified on the basis of OCT as those associated with an intact fibrous cap (IFC-ACS) and ruptured fibrous cap (RFC-ACS) ( 2 ). This is not a mere semantic difference but makes the clinical classification as the ...

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      Mentions: Yukio Ozaki
    14. Searching Between the Plaques Layers to Understand the Past and Predict the Future ∗

      Searching Between the Plaques Layers to Understand the Past and Predict the Future ∗

      The layers of the earth and the fossils hidden within the rocks reveal to the geologist the secrets of the past, sending him back for a trip millions of years long. Pathologists and nowadays cardiologists try to do the same, interrogating the vessel wall and atherosclerotic plaques, looking for the missing pieces of the complex puzzle that determine the pathophysiology of myocardial infarction and sudden death. Tian et al. 1 should be congratulated for their effort to collect new insights on the “in vivo” anatomy of coronary lesions, using a complex approach combining intravascular ultrasound and optical coherence tomography (OCT ...

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      Mentions: Francesco Prati
    15. Optical Coherence Tomographic Image of an Angiographically Borderline Lesion With a Significant Fractional Flow Reserve

      Optical Coherence Tomographic Image of an Angiographically Borderline Lesion With a Significant Fractional Flow Reserve

      A 42-year-old diabetic woman presented with left ventricular dysfunction late after an anterior wall myocardial infarction. Fluoro-deoxy glucose-positron emission tomography showed viability in the left anterior descending artery (LAD) territory. Coronary angiogram ( A , Online Video 1 ) showed a significant mid-LAD disease which was stented. Fractional flow reserve (B) done for the borderline lesions in the right coronary artery (RCA) was significant (0.53). Optical coherence tomography (C, D, E) done for the RCA lesion showed lotus root–like appearance ( 1 ) with multiple channels of varying diameters corresponding to the hazy lesion in the mid-RCA. The contrast flowing through these channels ...

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    16. Advances in the Understanding of Plaque Composition and Treatment Options - Year in Review

      Advances in the Understanding of Plaque Composition and Treatment Options - Year in Review

      Atherosclerosis research has classically followed 2 intertwining lines of investigation concerning atherosclerosis as a local process (the “high-risk plaque”) and as a systemic disease (the “high-risk patient”). Over time, the weight of attention has swung, like a pendulum, between these 2 related foci. With optimal medical therapy and attention to risk factors firmly established as fundamental aspects of management, in the past year, we have nevertheless perceived a shift in the pendulum toward renewed focus on the local plaque. We contend that this shift results from a convergence of major advances in understanding the biology of plaque progression, novel sophisticated ...

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    17. Mechanisms, Pathophysiology, and Clinical Aspects of Incomplete Stent Apposition

      Mechanisms, Pathophysiology, and Clinical Aspects of Incomplete Stent Apposition

      Incomplete stent apposition (ISA) is characterized by the lack of contact of at least 1 stent strut with the vessel wall in a segment not overlying a side branch; it is more commonly found in drug-eluting stents than bare-metal stents. The accurate diagnosis of ISA, initially only possible with intravascular ultrasound, can currently be performed with higher accuracy by optical coherence tomography, which also enables strut-level assessment due to its higher axial resolution. Different circumstances related both to the index procedure and to vascular healing might influence ISA occurrence. Although several histopathology and clinical studies linked ISA to stent thrombosis ...

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    18. New Insights on Plaque Erosion and Calcified Nodules “Seeing Is Believing”

      New Insights on Plaque Erosion and Calcified Nodules “Seeing Is Believing”

      Plaque erosion (PE) and calcified nodules (CN) have been classically described in pathological studies as causes of acute coronary syndromes (ACS) ( 1 ). However, until very recently, the diagnosis of these entities in the clinical setting has remained largely elusive ( 1 ). In this regard, the study of Jia et al. 2 , using optical coherence tomography (OCT) for the diagnosis of PE and CN, is of major clinical interest and raises several important issues. First, the investigators considered that OCT might provide a “definitive” diagnosis of PE when fibrous cap disruption is excluded and a thrombus overlying an “intact” plaque is visualized ...

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    19. Bikram Yoga and Acute Myocardial Infarction

      Bikram Yoga and Acute Myocardial Infarction

      Bikram yoga (BY) is a specific practice, with thousands of followers over the world, that consists of a series of 26 postures performed in a heated humidified studio 1 . It has been reported that exertion may be a possible trigger for plaque rupture and acute coronary syndromes (ACS) ( 2 ). We present the case of a healthy 53-year-old man without any cardiovascular risk factors who developed ACS with ST-segment elevation during a BY session. Intravenous fibrinolysis was administered with clinical success. A coronary angiogram performed the next day revealed a critical stenosis in the proximal left anterior descending artery (arrow, A ...

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    20. Coronary Thrombosis From Large, Nonprotruding, Superficial Calcified Coronary Plaques

      Coronary Thrombosis From Large, Nonprotruding, Superficial Calcified Coronary Plaques

      A 76-year-old man admitted for an acute coronary syndrome showed on angiography diffuse coronary calcification and mild lumen irregularities in the proximal left anterior descending and mid left circumflex coronary arteries. Optical coherence tomography revealed preserved coronary lumen at all segments. No features consistent with thin- or thick-cap fibroatheromas, ruptured plaques, or erosions were detected. However, a massive calcification of the left anterior descending and left circumflex coronary artery was recognized. The pattern of calcification was rather unique, involving the entire vessel circumference (ranging from 120° to 360°) and strikingly superficial, with a characteristic “concave shaped” surface apparently devoid of ...

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    21. Intravascular Ultrasound Versus Optical Coherence Tomography Guidance

      Intravascular Ultrasound Versus Optical Coherence Tomography Guidance

      IVUS Versus Angiography Guidance for DES PlacementFirst Author/Study (Ref. #), Year (Study)nStudy PopulationStudy DesignIVUS Criteria for Optimal ExpansionCriteria FulfilledMain Outcome MeasuresResultsRoy et al. (2), 20081,768De novo native coronary lesions, restenotic and SVG lesionsSingle-center registryDiscretion of the treating operator—Definite stent thrombosis and MACE at 12 monthsIVUS better (stent thrombosis and TLR)Classen et al. (3), 2011 (MATRIX)1,504 (SES)De novo native coronary and restenotic lesionsMulticenter registryDiscretion of the treating operator—30-day, 1-yr, and 2-yr rates of death/MI, MACE, and stent thrombosisIVUS betterPark et al. (4), 2009682Left main lesionsMulticenter registryDiscretion of the treating operator3-yr mortalityIVUS betterChieffo ...

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    22. Endovascular Imaging and 3-Dimensional Reconstruction of Spontaneous Coronary Artery Dissection

      Endovascular Imaging and 3-Dimensional Reconstruction of Spontaneous Coronary Artery Dissection

      A 57-year-old woman without coronary risk factors presented with non–ST-segment elevation myocardial infarction. Angiography revealed a normal anterior descending artery with lumen irregularities in the middle part (A, B, C) . Intravascular ultrasound (IVUS) (D, E, F) disclosed an intramural hematoma along the middle segment of the artery. Optical coherence tomography (OCT), resolution 15 μm, showed a proximal entry tear (G, H, arrow) , a large intramural hematoma (*) that compress the true lumen (TL) and a re-entry tear in the distal part (J) . The OCT 3-dimensional (3-D) reconstruction clearly visualize the spiral development of the dissection and the severe compression of ...

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    23. Optical Coherence Tomography Imaging of Acute Stent Thrombosis After Stentys Stent Implantation

      Optical Coherence Tomography Imaging of Acute Stent Thrombosis After Stentys Stent Implantation

      A 56-year-old man was referred to our catheterization laboratory for percutaneous coronary intervention because of stable angina caused by a stenosis of the proximal left anterior descending coronary artery ( A, Online Video 1 ). The patient was pre-treated with aspirin and clopidogrel and heparin peri-procedural as per routine. After pre-dilation, a Stentys self-expandable drug-eluting stent (Stentys S.A., Paris, France) was placed in the left main coronary artery and proximal left anterior descending coronary artery, followed by post-dilation, with a good angiographic result ( B , Online Video 2 ). Optical coherence tomography revealed an image of a freshly placed stent with uncovered stent ...

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      Mentions: St. Jude Medical
    24. Neoatherosclerosis: The Missing Link Between Very Late Stent Thrombosis and Very Late In-Stent Restenosis

      Neoatherosclerosis: The Missing Link Between Very Late Stent Thrombosis and Very Late In-Stent Restenosis

      A 55-year-old patient was admitted with a non–ST-segment elevation myocardial infarction. Eight years previously, he had received a bare-metal stent in the left circumflex coronary artery that maintained an excellent result on 6-month angiography. Angiography (A) disclosed focal in-stent restenosis together with a large thrombus (white arrow) within the stent (arrowheads). Optical coherence tomography revealed mild neointimal hyperplasia with a bright homogenous pattern at the distal stent segment (B, asterisk denotes wire artefact). Proximally, a large, protruding red thrombus (T) was clearly visualized, nicely separated from the adjacent uniform neointima (C). Neoatherosclerosis (D, E) was detected at the proximal ...

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    1-24 of 49 1 2 »
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