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    1. 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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    2. 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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    3. 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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    4. 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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    5. 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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    6. 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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    7. A new novolimus-eluting bioresorbable scaffold for large coronary arteries: an OCT study of acute mechanical performance

      A new novolimus-eluting bioresorbable scaffold for large coronary arteries: an OCT study of acute mechanical performance

      Aims To evaluate the acute performance of a novolimus-eluting bioresorbable scaffold (BRS) with a nominal diameter of 4.0 mm (DESolve® XL) using optical coherence tomography (OCT) in terms of appropriate scaffold deployment. Methods and results Ten patients (55.6% male, mean age 60.0 y) undergoing OCT-guided scaffold implantation were enrolled consecutively in this retrospective study. Using data from the final pullback, the following indexes were calculated: mean and minimum area, residual area stenosis, incomplete strut apposition, tissue prolapse, eccentricity and symmetry indexes, strut fracture, and edge dissection. The clinical indication for the procedure was acute coronary syndrome in ...

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    8. Everolimus-Eluting Bioresorbable Vascular Scaffolds implanted in Coronary Bifurcation Lesions

      Everolimus-Eluting Bioresorbable Vascular Scaffolds implanted in Coronary Bifurcation Lesions

      Background Limited data are available on bioresorbable vascular scaffolds (BVS) performance in bifurcations lesions and on the impact of BVS wider struts on side-branch impairment. Methods Patients with at least one coronary bifurcation lesion involving a side-branch ≥2 mm in diameter and treated with at least one BVS were examined. Procedural and angiographic data were collected and a dedicated methodology for off-line quantitative coronary angiography (QCA) in bifurcation was applied (eleven-segment model), to assess side-branch impairment occurring any time during the procedure. Two- and three-dimensional QCA was used. Optical coherence tomography (OCT) analysis was performed in a subgroup of patients ...

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    9. In-stent accordion phenomenon

      In-stent accordion phenomenon

      A 60-year-old female underwent successful stenting of the proximal to distal right coronary artery (RCA). Follow-up angiography was performed 16 months after the index procedure. It revealed moderate in-stent restenosis in the mid-RCA (Fig. 1A). Optical coherence tomography (OCT) was performed to evaluate it. After insertion of the guidewire (SION blue, Asahi Intecc, Nagoya, Japan) into the distal RCA, a short-segment stenosis appeared in the proximal RCA where zotarolimus-eluting stents (Resolute integrity, Medtronic, Minneapolis, MN) were implanted (Fig.

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    10. Prevalence of parameters of suboptimal scaffold deployment following angiographic guided bioresorbable vascular scaffold implantation in real world practice - an optical coherence tomography analysis

      Prevalence of parameters of suboptimal scaffold deployment following angiographic guided bioresorbable vascular scaffold implantation in real world practice - an optical coherence tomography analysis

      Aim To assess the prevalence of suboptimal bioresorbable vascular scaffold (BVS, Abbott Vascular, Santa Clara, California) deployment in real world practice with intracoronary optical coherence tomography (OCT) imaging. Methods Consecutive patients who underwent percutaneous coronary intervention using BVS and the final optimization assessed with OCT imaging in two tertiary care centers between December 2012 and February 2015 were evaluated for parameters of suboptimal scaffold deployment by OCT. Results Overall, 36 scaffolds were implanted in 27 patients during this period. Mean age of the population was 54.7 ± 8.2 years and 19 (70.4%) were type B2/C lesions. The ...

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    11. Evaluation of the characterization of thrombi in vitro by optical coherence tomography

      Evaluation of the characterization of thrombi in vitro by optical coherence tomography

      Aim The purpose of this study was to provide a new assessable method of the optical coherence tomography (OCT) in characterization of thrombi with different concentrations of red blood cell (RBC). Methods and results A series of thrombus models were constructed by using human blood in vitro. The thrombi were made by using human blood with different concentration of RBC (from 1% to 35%). Then tip of an FD-OCT catheter was put on the top of the thrombus to scan. After OCT being performed, all the acquired images were processed by a newly developed software to analyze the RBC levels ...

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    12. Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients

      Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients

      Objectives To determine security and benefits of high pressure postdilatation (HPP) of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) of complex lesions whatever its indication is. Background Acute scaffold disruption has been proposed as the main limitation of BVS when they are overexpanded. However, clinical implications of this disarray are not yet clear and more evidence is needed. Methods A total of 25 BVS were deployed during PCI of 14 complex lesions after mandatory predilatation. In all cases HPP was performed with NC balloon in a 1:1 relation to the artery. After that, optical coherence tomography (OCT ...

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    13. Optical coherence tomography assessment of in-stent restenosis after percutaneous coronary intervention with two-stent technique in unprotected left main

      Optical coherence tomography assessment of in-stent restenosis after percutaneous coronary intervention with two-stent technique in unprotected left main

      Background Optical coherence tomography (OCT) has contributed to a better understanding of in-stent restenosis (ISR); however, studies evaluating ISR pattern after two-stent technique in unprotected left main (ULM) are lacking. We aim to evaluate the ISR pattern of proximal LAD and LCX after two-stent technique in ULM. Methods We performed OCT in 26 patients with isolated or combined ISR (identified by angiography as >50%) after two stent implantation in the proximal LCX and LAD. Finally, 13 LAD and 22 LCX ISR lesions underwent OCT assessments. OCT analyses were undertaken in the proximal segments of the LAD and LCX. In addition ...

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    14. Bioresorbable vascular scaffold implantation and scaffold edge dissection, to treat or not to treat? The dilemma clarified by optical coherence tomography

      Bioresorbable vascular scaffold implantation and scaffold edge dissection, to treat or not to treat? The dilemma clarified by optical coherence tomography

      In the last years, the use of bioresorbable vascular scaffold (BVS) has increased considerably in all setting of patients but acute and long term follow up complications after revascularization as iatrogenic coronary dissection(CD) are not established, nor the best treatment and resolution of them.

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    15. A glimpse into first generation drug-eluting and bare metal stents ten years later with optical coherence tomography analysis

      A glimpse into first generation drug-eluting and bare metal stents ten years later with optical coherence tomography analysis

      Currently, the very long-term behavior of first-generation drug-eluting stents (DES) is not available. However, several studies have shown that the TAXUS™ paclitaxel-eluting stent (PES) (Boston Scientific, Natick, Massachusetts) is associated with a rate of 5-year stent thrombosis ranging from 3 to 7%, depending on the complexity of the lesion [1], with higher rates of very late stent thrombosis compared with second-generation DES [2].

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    16. Metabolic syndrome predicts plaque rupture in patients with acute myocardial infarction. An optical coherence study

      Metabolic syndrome predicts plaque rupture in patients with acute myocardial infarction. An optical coherence study

      The metabolic syndrome (MS) is conceptualized as a clustering of risk factors-including insulin resistance, dyslipidemia, central adiposity, and elevated blood pressure (BP)-that increase the risk for cardiovascular disease and type 2 diabetes mellitus (DM) [1]. Metabolic syndrome is known to be a low-grade systemic inflammatory condition with its origins in the perinatal period and childhood, while recent evidence suggests that markers of systemic inflammation may be included in the definition of the syndrome and play some role in its pathogenesis

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    17. Progression of calcification after implantation of a fully bioresorbable scaffold: A serial and combined IVUS-OCT follow-up of 5 years

      Progression of calcification after implantation of a fully bioresorbable scaffold: A serial and combined IVUS-OCT follow-up of 5 years

      A 72-year-old female enrolled in the ABSORB Cohort B2 trial underwent successful percutaneous coronary intervention of the proximal left anterior descending artery with a 3 × 18 mm Absorb everolimus-eluting Bioresorbable scaffold (Absorb BVS, Abbott Vascular, CA). Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) images after the procedure showed optimal scaffold expansion without any mechanical complication (Fig. 1: Post-A, C). As protocol mandated, follow-up invasive coronary imagings (angiography, OCT, IVUS) were scheduled at 1-, 3- and 5-year, respectively.

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    18. Disappearing stent but persisting problems? Optical coherence tomography assessment of intra-scaffold restenosis

      Disappearing stent but persisting problems? Optical coherence tomography assessment of intra-scaffold restenosis

      A 72-year-old male who had performed 13 months earlier a percutaneous coronary intervention (PCI) for unstable angina with 3 overlapping bioresorbable vascular scaffolds (BVSs) (Abbott Vascular, Santa Clara, California) in a long lesion of the left anterior descending (LAD), presented with new onset effort angina. Coronary angiography revealed significant focal in-scaffold restenosis of the distal LAD (Fig. 1, black arrow). Optical coherence tomography (OCT) imaging (Fig. 2) showed good expansion of the scaffolds with minimum neointima coverage (A, D), except for a focal under-expansion with severe prominent neointimal hyperplasia located in the body of the distal scaffold (B, C).

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    19. Paclitaxel-coated balloon exerts late vessel healing and enlargement: A documented phenomenon with optical coherence tomography analysis

      Paclitaxel-coated balloon exerts late vessel healing and enlargement: A documented phenomenon with optical coherence tomography analysis

      As by the most recent guidelines on myocardial revascularization underline [1], drug coated balloon (DCB) is an effective and safe treatment for in-stent restenosis (ISR). However this device represents an innovation with a high potential impact currently investigated in other lesion settings, such as the treatment of atherosclerotic native coronary vessels [2,3]

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    20. Plaque morphologies and the clinical prognosis of acute coronary syndrome caused by lesions with intact fibrous cap diagnosed by optical coherence tomography

      Plaque morphologies and the clinical prognosis of acute coronary syndrome caused by lesions with intact fibrous cap diagnosed by optical coherence tomography

      Background Pathological studies have suggested that acute coronary syndrome (ACS) may be caused by culprit lesions with intact fibrous cap (IFC), including plaque erosions. This study sought to evaluate the morphological features and clinical outcomes of patients with ACS caused by lesions with IFC. Methods A total of 318 patients with ACS who underwent optical coherence tomography (OCT) of a culprit lesion were investigated. The culprit lesions were categorized as follows: those with plaque rupture (PR group), those with an IFC (IFC group), and those with a massive thrombus precluding plaque visualization (MT group). Intravascular ultrasound (IVUS) was performed in ...

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    21. Incidence and distribution of thin-high signals detected by coronary optical coherence tomography in patients treated with paclitaxel-coated balloon angioplasty for in-stent restenosis

      Incidence and distribution of thin-high signals detected by coronary optical coherence tomography in patients treated with paclitaxel-coated balloon angioplasty for in-stent restenosis

      Paclitaxel-coated balloon (PCB) angioplasty is one of the common treatments for patients with in-stent restenosis because its safety and efficacy has already been reported [1–3]. Meanwhile, optical coherence tomography (OCT) has great spatial resolution, which allows the observation of subtle changes in the coronary artery [4,5]. In a previous report, thin-high signals after PCB angioplasty were observed using OCT [6]. However, the incidence and distribution of thin-high signals have yet to be investigated.

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