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    1. Association between asymmetric dimethylarginine and in-stent restenosis tissue characteristics assessed by optical coherence tomography

      Association between asymmetric dimethylarginine and in-stent restenosis tissue characteristics assessed by optical coherence tomography

      Background Impaired bioavailability of endothelium-derived nitric oxide (NO) and endothelial dysfunction may play a pivotal role in the pathogenesis of in-stent restenosis (ISR) after coronary stenting. We aimed to investigate the relation between asymmetric dimethylarginine (ADMA), an endogenous NO synthase inhibitor, and the ISR lesions tissue characteristics assessed by optical coherence tomography (OCT). Methods and results Forty-five patients with symptomatic ISR lesions (17 bare metal stents, 28 drug-eluting stents, medium implantation duration: 58.0 months) were evaluated by OCT for in-stent tissue characteristics and calcification. We defined neoatherosclerosis as the presence of lipid or calcified neointima in ISR lesions, and ...

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    2. Dual quantitative coronary angiography accurately quantifies intracoronary thrombotic burden in patients with acute coronary syndrome: Comparison with optical coherence tomography imaging

      Dual quantitative coronary angiography accurately quantifies intracoronary thrombotic burden in patients with acute coronary syndrome: Comparison with optical coherence tomography imaging

      Background Dual quantitative coronary angiography (QCA) has been recently tested for assessment of intracoronary thrombus volume in experimental models. The present study aimed to validate dual QCA in vivo for the assessment of thrombus burden by exploring the correlations between dual QCA-thrombus volume and optical coherence tomography (OCT)-derived indices of thrombotic burden. Methods and results Fifty-one patients with ACS and angiographic evidence of thrombus undergoing OCT of the culprit lesion before stenting were included. Dual QCA-thrombus volume was calculated as difference between edge-detection and video-densitometry area functions along the target segment. Culprit lesion was categorized using the Ambrose's ...

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    3. Angiographic features of patients with coronary plaque erosion

      Angiographic features of patients with coronary plaque erosion

      Background Although an in vivo diagnosis of coronary plaque erosion has become possible by optical coherence tomography (OCT), angiographic characteristics of erosion have not been studied. The aim of this study was to investigate the angiographic features of plaque erosion in patients with non-ST elevation acute coronary syndromes (NSTE-ACS). Methods Patients with NSTE-ACS who underwent OCT of the culprit lesion were collected at 11 institutions from 6 countries. Patients were classified as erosion or non-erosion based on OCT images. Angiographic features of both groups were compared. Results Among 494 cases with NSTE-ACS, 242 had plaque erosion and 252 had non-erosion ...

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    4. Optical coherence tomography and C-reactive protein in risk stratification of acute coronary syndromes

      Optical coherence tomography and C-reactive protein in risk stratification of acute coronary syndromes

      Background Patients with acute coronary syndrome (ACS) associated to high C-reactive protein (CRP) levels exhibit a higher risk of future acute ischemic events. Yet, the positive predictive value of CRP is too low to guide a specific treatment. Our study aims to identify a high-risk patient subset who might mostly benefit from anti-inflammatory treatment on the basis of the combination of optical coherence tomography (OCT) assessment of the culprit vessel and CRP serum levels. Methods Patients admitted for ACS and undergoing pre-interventional OCT assessment of the culprit vessel were selected from “Agostino Gemelli” Hospital OCT Registry. The primary end-point was ...

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    5. Correlation between CD4+CD28null T lymphocytes, regulatory T cells and plaque rupture: An Optical Coherence Tomography study in Acute Coronary Syndromes

      Correlation between CD4+CD28null T lymphocytes, regulatory T cells and plaque rupture: An Optical Coherence Tomography study in Acute Coronary Syndromes

      Background A sizeable proportion of patients with Acute Coronary Syndromes (ACS) shows a unique adaptive immune system profile, associated to a worse outcome, characterized by higher CD4 + CD28 null T-cells, lower regulatory T-cells (Treg) and increased CD4 + CD28 null /Treg ratio. We sought to investigate the correlation between CD4 + CD28 null T-cells, Treg, CD4 + CD28 null /Treg ratio and plaque phenotype as assessed by Optical Coherence Tomography (OCT). Methods Peripheral blood mononuclear cells (PBMC) were collected from 30 Non-ST Elevation Myocardial Infarction (NSTEMI) patients, sub-grouped according to OCT analysis of culprit lesions into two cohorts: Ruptured Fibrous Cap (NSTEMI-RFC, n ...

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      Mentions: Rocco Vergallo
    6. Relation of coronary culprit lesion morphology determined by optical coherence tomography and cardiac outcomes to preinfarction angina in patients with acute myocardial infarction

      Relation of coronary culprit lesion morphology determined by optical coherence tomography and cardiac outcomes to preinfarction angina in patients with acute myocardial infarction

      Background While preinfarction angina pectoris (pre-IA) is recognized as favorable effects on acute myocardial infarction (AMI), the detail has not been fully investigated. The aims of the current study were to clarify patient characteristics, lesion morphologies determined by optical coherence tomography (OCT), and cardiac outcomes related to pre-IA in patients with AMI. Methods Clinical data and outcomes were compared between AMI patients with pre-IA (pre-IA group, n = 507) and without pre-IA (non-pre-IA group, n = 653). Angiography and OCT findings were analyzed in patients with pre-intervention OCT and compared between groups of pre-IA ( n = 219) and non-pre-IA ( n = 269). Results ST-segment ...

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      Mentions: Masamichi Takano
    7. The clinical significance of echo-attenuated plaque in stable angina pectoris compared with acute coronary syndromes: A combined intravascular ultrasound and optical coherence tomography study

      The clinical significance of echo-attenuated plaque in stable angina pectoris compared with acute coronary syndromes: A combined intravascular ultrasound and optical coherence tomography study

      Background Echo-attenuated plaque (EA) on intravascular ultrasound (IVUS) is related to poor outcomes after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients. However, the clinical significance of EA in stable angina pectoris (SAP) patients compared with that in ACS patients remains unclear. We assessed the relationships between EA and unstable plaque characteristics in patients with ACS and SAP. Methods We investigated 609 coronary lesions in 609 patients (234 with ACS; 375 with SAP) undergoing pre-intervention IVUS and optical coherence tomography (OCT). The differences in plaque morphology and post-PCI outcomes were assessed according to the clinical status of ACS ...

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    8. In vivo tissue characterization of human atherosclerotic plaques by optical coherence tomography: A directional coronary atherectomy study with histopathologic confirmation

      In vivo tissue characterization of human atherosclerotic plaques by optical coherence tomography: A directional coronary atherectomy study with histopathologic confirmation

      Background The histopathological validation of optical coherence tomography (OCT) in visualizing atherosclerotic plaques has been reported only in ex vivo studies. We sought to evaluate the accuracy of OCT in tissue characterization in vivo . Methods and results A total of 25 patients with stable angina pectoris who underwent directional coronary atherectomy (DCA) were included in the investigation, whereby OCT was performed before and after a single debulking. The debulked region was determined on OCT and classified into fibrous tissue, lipid, calcification, thrombus, and macrophage accumulation, which were compared with histology. Changes in OCT signal intensity in the deeper intimal region ...

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    9. Plasma trimethylamine N-oxide is associated with vulnerable plaque characteristics in CAD patients as assessed by optical coherence tomography

      Plasma trimethylamine N-oxide is associated with vulnerable plaque characteristics in CAD patients as assessed by optical coherence tomography

      Background Plaque vulnerability indicates the risk of a cardiovascular event. In the present study, we sought to analyze the relationship between trimethylamine N-oxide (TMAO), a gut microbiota metabolite from dietary phosphatidylcholine, and vulnerable plaque characteristics in patients with coronary artery disease (CAD). Methods One hundred eighty non-culprit plaques from 90 patients with ACS or with stable angina were assessed by optical coherence tomography (OCT). The plasma TMAO levels were measured using rapid resolution liquid chromatography quadrupole time-of-flight mass spectrometry (RRLC-QTOF/MS). Results Patients were divided into two groups (high TMAO group and low TMAO group) according to the median plasma ...

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      Mentions: Jingbo Hou Bo Yu
    10. Randomised comparison of vascular response to biodegradable polymer sirolimus eluting and permanent polymer everolimus eluting stents: An optical coherence tomography study

      Randomised comparison of vascular response to biodegradable polymer sirolimus eluting and permanent polymer everolimus eluting stents: An optical coherence tomography study

      Background Drug-eluting stents with biodegradable polymer coatings have shown promising outcomes in randomised studies. Methods We compared neointimal healing patterns including strut coverage and assessed neointimal maturity using a novel algorithm in coronary lesions treated with sirolimus-eluting stents with biodegradable polymer coating (BP-SES) or everolimus eluting stents with permanent polymer coating (PP-EES) using optical coherence tomography after 6 months. Results A total of 39 patients were randomised to BP-SES ( n = 19) or PP-EES ( n = 20) for the treatment of coronary lesions. Of those, 29 patients (14 BP-SES and 15 PP-EES) underwent optical coherence tomography (OCT) and angiography at 6-month follow-up ...

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    11. Correlation between frequency-domain optical coherence tomography and fractional flow reserve in angiographically-intermediate coronary lesions

      Correlation between frequency-domain optical coherence tomography and fractional flow reserve in angiographically-intermediate coronary lesions

      Background The decision-making process of patients with angiographically-intermediate coronary lesions (ICL) is clinically challenging and may benefit from adjunctive invasive techniques. Fractional-flow-reserve (FFR) represents the gold standard to evaluate ICL but frequency-domain optical-coherence-tomography (OCT) is a novel, promising, high resolution coronary imaging technique, which allows physiopathologic assessment of coronary plaque. We investigated the possible relation between OCT and FFR in selected ICL patients. Methods Stable or unstable patients with ICL who underwent both FFR and OCT assessment at two large tertiary centers were retrospectively enrolled. FFR was performed according to standard methodology. OCT images were (on blind to clinical and ...

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    12. Vascular response and healing profile of everolimus-eluting bioresorbable vascular scaffolds for percutaneous treatment of chronic total coronary occlusions: A one-year optical coherence tomography analysis from the GHOST-CTO registry

      Vascular response and healing profile of everolimus-eluting bioresorbable vascular scaffolds for percutaneous treatment of chronic total coronary occlusions: A one-year optical coherence tomography analysis from the GHOST-CTO registry

      Background Bioresorbable vascular scaffolds (BVS) have been heralded with potential benefits that are especially desired in long lesions, including chronic total occlusions (CTOs). Procedural feasibility and mid-term outcomes of BVS in CTOs have been reported. However, there is still a paucity of data regarding the vascular and healing response to BVS in CTOs evaluated by optical coherence tomography (OCT). Methods This study included prospectively 21 patients who had a CTO lesion treated with a BVS. Angiography and OCT scan were recorded at either post-implantation and 1-year follow-up. Quantitative coronary angiography and OCT analyses were performed by an independent core laboratory ...

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    13. Reply to letter to the editor: “Plaque vulnerability, post-PCI tissue prolapse and neoatherosclerosis”

      Reply to letter to the editor: “Plaque vulnerability, post-PCI tissue prolapse and neoatherosclerosis”

      We appreciate the comments and suggestions from Dr. Tiberiu et al. relevant to our manuscript [1]. Optical coherence tomography (OCT) enables the qualitative and quantitative assessment of in-stent tissue, including tissue prolapse (TP) after percutaneous coronary intervention and neointimal hyperplasia (NIH) at follow-up. Neointimal atherosclerotic changes (neoatherosclerosis) are occasionally observed on OCT [2].

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    14. Plaque vulnerability, post-PCI tissue prolapse and neoatherosclerosis

      Plaque vulnerability, post-PCI tissue prolapse and neoatherosclerosis

      We read with great interest the recent article of Sygiyama et al., reporting that the extent of tissue prolapse (TP) at optical coherence tomography (OCT) examination immediately after a percutaneous coronary intervention (PCI) is directly related to the amount of in-stent neointimal hyperplasia (NIH) at 9-months follow-up on serial OCT [1]. At the same time, the authors demonstrate that coronary plaques presenting OCT features of vulnerability had larger TP compared to stable plaques [1].

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    15. OCT guidance during stent implantation in primary Pci: A randomized multicenter study with nine months of optical coherence tomography follow-up

      OCT guidance during stent implantation in primary Pci: A randomized multicenter study with nine months of optical coherence tomography follow-up

      Aims To assess the possible merits of optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI). Methods and results 201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n = 96) or to pPCI with OCT guidance (OCT-guided group, n = 105) and also either to biolimus A9 or to everolimus-eluting stent implantation. All patients were scheduled for nine months of follow-up angiography and OCT study. OCT guidance led to post-pPCI optimization in 29% of cases (59% malapposition and 41% dissections). No complications were found related to the ...

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    16. Absence of adventitial vasa vasorum formation at the coronary segment with myocardial bridge - An optical coherence tomography study

      Absence of adventitial vasa vasorum formation at the coronary segment with myocardial bridge - An optical coherence tomography study

      Background Myocardial bridge (MB) is a myocardial bundle through which coronary segment tunnels and could compress coronary arteries causing myocardial ischemia. However, the characteristic structural findings of MB remain to be fully elucidated. Recently, we demonstrated that optical coherence tomography (OCT) enables us to visualize adventitial vasa vasorum (VV) formation in humans. In this study, we examined adventitial VV formation at the coronary segment with MB in humans using OCT. Methods We examined 15 consecutive patients with suspected angina pectoris and MB in the left anterior descending (LAD) coronary arteries but no angiographic coronary stenosis. MB was detected on coronary ...

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    17. Feasibility and usefulness of three-dimensional optical coherence tomography guidance for optimal side branch treatment in coronary bifurcation stenting

      Feasibility and usefulness of three-dimensional optical coherence tomography guidance for optimal side branch treatment in coronary bifurcation stenting

      Background For the treatment of coronary bifurcation lesions, optimal guidewire (GW) recrossing after main vessel stenting is important for good stent apposition at the side branch (SB) orifice in kissing balloon inflation (KBI). Methods We analyzed 150 bifurcation lesions treated with single stenting following KBI in the three-dimensional optical coherence tomography (3D-OCT) bifurcation registry study (2015–16) and a single center experience (2012–16). OCT examination was performed after GW recrossing to the SB and after KBI. Patients were divided into two-dimensional (2D, n = 78) and 3D groups ( n = 72) according to 2D- or 3D-OCT guidance. GW recrossing position, jailing ...

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    18. Optical coherence tomography guidance for the management of angiographically intermediate left main bifurcation lesions: Early clinical experience

      Optical coherence tomography guidance for the management of angiographically intermediate left main bifurcation lesions: Early clinical experience

      Background Left main (LM) atherosclerotic lesions affect clinical outcomes. Frequency domain-optical coherence tomography (FD-OCT) allows detailed characterization of non-ostial coronary atherosclerotic lesions. The clinical impact of FD-OCT assessment of LM bifurcation disease on the revascularization decision is unknown. Methods Patients who underwent FD-OCT assessment to guide management of angiographically intermediate distal LM stenosis were retrospectively selected. The FD-OCT LM criteria for percutaneous or surgical revascularization were: - LM area stenosis (AS) ≥75% - LM AS >50% < 75% with minimum lumen area < 4 mm 2 or plaque ulceration critical FD-OCT ostial stenosis on the left anterior descending or circumflex arteries. Clinical follow-up was ...

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    19. Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes: A propensity matched analysis

      Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes: A propensity matched analysis

      Aim To compare in patients with ACS (Acute Coronary Syndromes) a PCI (Percutaneous Coronary Intervention) approach based on FFR (Fractional Flow Reserve) vs. one based on OCT (Optical Coherence Tomography). Methods and Results Consecutive patients admitted for ACS and treated with a PCI approach based on OCT or on FFR (recruited in two different studies) were compared and matched with propensity score analysis. Target Lesion revascularization (TLR) was the primary end point, while major adverse cardiovascular events [MACEs defined as the composite of death from cardiac causes, non- fatal MI, clinically driven target vessel revascularization (TVR), or re-hospitalization due to ...

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    20. Impact of strut thickness on acute mechanical performance: a comparison study using optical coherence tomography between DESolve 150 and DESolve 100

      Impact of strut thickness on acute mechanical performance: a comparison study using optical coherence tomography between DESolve 150 and DESolve 100

      Objective To evaluate the acute performance of a novolimus-eluting bioresorbable scaffold (BRS) with different strut thickness (DESolve system 150 and 100) using optical coherence tomography (OCT) in terms of appropriate scaffold deployment. Background Outcome after BRS implantation seen in registries and meta-analyses continue to show a higher rate of scaffold thrombosis than those reported with DES. Thus, second scaffold generations with lower strut thickness might have potential advantages in terms of flow disturbance. However, whether mechanical properties are comparable has to be evaluated. Methods and results Fifty-seven patients undergoing OCT-guided scaffold implantation were enrolled consecutively in this retrospective study. The ...

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    21. The Signal Intensity of Coronary Culprit Lesions on T1-Weighted Magnetic Resonance Imaging is Directly Correlated with the Accumulation of Vulnerable Morphologies

      The Signal Intensity of Coronary Culprit Lesions on T1-Weighted Magnetic Resonance Imaging is Directly Correlated with the Accumulation of Vulnerable Morphologies

      Since the introduction of noncontrast T1-weighted imaging (T1WI) in magnetic resonance (MR) for plaque imaging, some investigators have shown that coronary artery high-intensity signals (HISs) on T1WI are associated with vulnerable plaque morphology on intravascular imagings, such as intravascular ultrasound or optical coherence tomography (OCT) [1,2] and an increased risk of future cardiac events [3]. Previous studies proposed the calculation of the ratio defined as the highest signal intensity of the coronary plaque divided by the signal intensity of the left ventricular muscle near the coronary plaque (PMR), and used different PMR cutoff values to detect HIS [1–3].

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    22. Twenty-four months follow-up of a “biodegradable” model for coronary artery bifurcations management. Insights from optical coherence tomography of a new interventional strategy

      Twenty-four months follow-up of a “biodegradable” model for coronary artery bifurcations management. Insights from optical coherence tomography of a new interventional strategy

      A 53-year-old smoker, hypertensive male was admitted at our Department for an acute coronary syndrome. Echocardiography showed an anteroseptal ipokinesia of the left ventricular wall with mild reduction of the ejection fraction (48%). Coronarography showed a complex Medina-type 1,1,1 bifurcation lesion with subocclusion of the left anterior descending artery (LAD) involving the first-diagonal branch (DIA1) (Fig. 1A, B). After predilatation with a 2.0 mm balloon on DIA1 and a 3.0 mm on mid-LAD, we implanted a 3.5/18 mm bioresorbable vascular scaffold (BVS-Absorb, Abbott, US) on the LAD.

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    23. Angiographically intermediate left main bifurcation disease assessment by frequency domain optical coherence tomography (FD-OCT)

      Angiographically intermediate left main bifurcation disease assessment by frequency domain optical coherence tomography (FD-OCT)

      High-risk atherosclerotic plaques as thin cap fibroatheroma (TCFA) are frequently located in coronary regions with low shear stress [1,2], as coronary bifurcation and in particular left main (LM) bifurcation [3]. Previous invasive imaging studies on LM plaque characterization by intravascular ultrasound (IVUS) reported that LM carina is usually spared and that the disease is generally extended from LM into the distal branches [4]. Frequency domain-optical coherence tomography (FD-OCT) is a high resolution imaging modality that allows high-quality visualization of inner vessel wall structure and accurate measurement of vascular microstructures such as the fibrous cap [5].

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