Optimal coronary stent implantation is among the few successful strategies in preventing stent failures, notably in-stent restenosis and stent thrombosis. 1 Understanding the intravascular milieu is a prerequisite for optimization of percutaneous coronary intervention (PCI). Calcified lesions limit stent expansion, the most robust predictor of target lesion revascularization, and are thus associated with worst outcomes. 2 Coronary angiography is a poor discriminator of calcium distribution and thickness. Reliance on angiography to guide PCI and define procedural success in severe coronary calcification is associated with poor outcomes. 3 Both intravascular ultrasound and optical coherence tomography (OCT) enable detailed evaluation of cross-sectional ...

Background— Durable polymers used in drug-eluting stents are considered a potential cause of hypersensitivity inflammatory response adversely affecting stent healing. Using a sequential follow-up with optical coherence tomography, we compared the differences in healing profiles of 2 drug-eluting stents with a biodegradable or durable polymer. Methods and Results— Sixty patients with multivessel disease were prospectively enrolled to receive both study stents, which were randomly assigned to 2 individual vessels, a Resolute Integrity zotarolimus-eluting stent with a durable BioLinx polymer and a BioMatrix NeoFlex Biolimus A9–eluting stent with a biodegradable polylactic acid polymer. Optical coherence tomography was performed at baseline ...

Background— Durable polymers used in drug-eluting stents are considered a potential cause of hypersensitivity inflammatory response adversely affecting stent healing. Using a sequential follow-up with optical coherence tomography, we compared the differences in healing profiles of 2 drug-eluting stents with a biodegradable or durable polymer. Methods and Results— Sixty patients with multivessel disease were prospectively enrolled to receive both study stents, which were randomly assigned to 2 individual vessels, a Resolute Integrity zotarolimus-eluting stent with a durable BioLinx polymer and a BioMatrix NeoFlex Biolimus A9–eluting stent with a biodegradable polylactic acid polymer. Optical coherence tomography was performed at baseline ...

Background— The initial EROSION study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography–Based Management in Plaque Erosion) demonstrated that patients with acute coronary syndrome caused by plaque erosion might be stabilized with aspirin and ticagrelor without stenting for ≤1 month. However, a long-term evaluation of outcomes is lacking. The aim of this study was to assess whether the initial benefit of noninterventional therapy for patients with acute coronary syndrome caused by plaque erosion is maintained for ≤1 year. Methods and Results— Among 53 patients who completed clinical follow-up, 49 underwent repeat optical coherence tomography imaging at 1 year ...

Background— To assess the vessel-healing pattern of Ultimaster drug-eluting stent using optical frequency domain imaging. Our hypothesis is that biodegradable polymer-based drug-eluting technology allows complete very early strut coverage. Methods and Results— The DISCOVERY 1TO3 study (Evaluation With OFDI of Strut Coverage of Terumo New Drug Eluting Stent With Biodegradable Polymer at 1, 2, and 3 Months) is a prospective, single-arm, multicenter study. A total of 60 patients with multivessel disease requiring staged procedure at 1 month were treated with Ultimaster. Optical frequency domain imaging was acquired at baseline, 1, 2, and 3 months. The primary end point is optical ...

Background— The long-term fate of Absorb bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, CA) struts jailing side branch ostia has not been clarified. We therefore evaluate serially (post-procedure and at 6 months, 1, 2, 3, and 5 years) the appearance and fate of jailed Absorb bioresorbable vascular scaffold struts. Methods and Results— We performed 3-dimensional optical coherence tomographic analysis of the ABSORB Cohort B trial (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions) up to 5 years using a novel, validated cut-plane analysis method. We ...

Background— Low endothelial shear stress (ESS) is associated with plaque progression and vulnerability. To date, changes in plaque phenotype over time in relation to ESS have not been studied in humans. The aim of this study was to investigate whether local ESS can predict subsequent changes to plaque phenotype using optical coherence tomography. Methods and Results— A total of 25 coronary arteries from 20 patients who underwent baseline and 6-month follow-up optical coherence tomography were included. Arteries were divided into serial 3-mm segments, and plaque characteristics were evaluated in each segment. A total of 145 segments were divided into low-ESS ...

Introduction Recanalized coronary thrombi (RCT) are rarely recognized in real-world clinical practice. Incidence and functional significance of RCT remain unclear. High-resolution imaging modalities, such as optical coherence tomography (OCT), may provide novel insight to further characterize this unique phenomenon. 1 , 2 We present a case series of RCT treated with bioresorbable vascular scaffold (BVS). Case 1 A 75-year-old man with a previous history of an inferior myocardial infarction was admitted with congestive heart failure. Inferior hypokinesia was detected on echocardiography. Coronary angiography showed a filling defect and luminal haziness in the proximal segment of the right coronary artery (Figure 1A ...

A 58-year-old woman with a previous history of hypertension, hypercholesterolemia, and cigarette smoking presented with a non–ST-segment–elevation myocardial infarction with transient (nonpersistent) anterior ST-segment–elevation suggesting ischemia on the territory of the left anterior descending coronary artery. The coronary angiogram showed no signs of atherosclerosis but depicted severely tortuous coronary arteries with a focal lumen narrowing in the mid-segment of the left anterior descending coronary artery (Figure 1A). In addition, a diffuse lesion with a double lumen was demonstrated at the mid-segment of the posterior descending coronary artery branch of the right coronary artery (Figure 1B). Moreover, the ...

A 58-year-old woman with a previous history of hypertension, hypercholesterolemia, and cigarette smoking presented with a non–ST-segment–elevation myocardial infarction with transient (nonpersistent) anterior ST-segment–elevation suggesting ischemia on the territory of the left anterior descending coronary artery. The coronary angiogram showed no signs of atherosclerosis but depicted severely tortuous coronary arteries with a focal lumen narrowing in the mid-segment of the left anterior descending coronary artery (Figure 1A). In addition, a diffuse lesion with a double lumen was demonstrated at the mid-segment of the posterior descending coronary artery branch of the right coronary artery (Figure 1B). Moreover, the ...

Background— The main causes of late (>1 month) stent thrombosis (ST) are stent uncoverage, malapposition, and neoatherosclerosis. First-generation drug-eluting stents were associated with higher rate of late ST compared with bare-metal stents (BMS), especially in patients with ST-segment–elevation myocardial infarction. Second-generation everolimus-eluting stents (EES) have shown similar rate of late ST than BMS. The aims of the study are to compare the ratio of uncovered to total struts per cross-section ≥30% and other optical coherence tomographic findings associated with ST between EES and BMS in patients with ST-segment–elevation myocardial infarction at 5 years. Methods and Results— One hundred ...

Background— Stent edge restenosis (SER) remains a potential limitation of drug-eluting stents. The aim of this study was to determine optical coherence tomography (OCT) predictors for angiographic late SER after everolimus-eluting stent implantation. Methods and Results— We retrospectively analyzed 319 patients who underwent OCT immediately after everolimus-eluting stent implantation and scheduled 9- to 12-month follow-up angiography. The binary angiographic SER rate was 10% (32/319) in the patients, 8.4% (32/382) in lesions, and 4.4% (33/744) in stent edge segments. In the stent edge segments at post stenting, OCT-derived lipidic plaque (61% versus 20%; P <0.001 ...

Sheth et al 1 compared optical coherence tomography (OCT)–guided versus angiography-guided primary percutaneous coronary intervention for ST-segment–elevation myocardial infarction among patients in the TOTAL trial (Thrombectomy Versus Percutaneous Coronary Intervention Alone). Patients (n=214) were imaged with OCT and were propensity-matched with 428 patients who had angio-guided percutaneous coronary intervention. There were clear OCT guidelines for stent optimization; however, operator compliance to follow those guidelines and whether optimal results were achieved are not reported. This makes us wonder whether the investigator’s good intentions were actually executed and were effective. Hence, it is uncertain whether the OCT group ...

Background— Previous studies reported that reduced TIMI (Thrombolysis in Myocardial Infarction) flow grade before procedure was associated with worse clinical outcomes in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention. The aim of this study was to identify specific morphological characteristics of the culprit plaque associated with poor TIMI flow grade at baseline in patients with ST-segment–elevation myocardial infarction using both optical coherence tomography and intravascular ultrasound. Methods and Results— A total of 111 ST-segment–elevation myocardial infarction patients who underwent percutaneous coronary intervention within 24 hours of symptom onset were included. Both optical coherence tomography ...

Sheth et al 1 compared optical coherence tomography (OCT)–guided versus angiography-guided primary percutaneous coronary intervention for ST-segment–elevation myocardial infarction among patients in the TOTAL trial (Thrombectomy Versus Percutaneous Coronary Intervention Alone). Patients (n=214) were imaged with OCT and were propensity-matched with 428 patients who had angio-guided percutaneous coronary intervention. There were clear OCT guidelines for stent optimization; however, operator compliance to follow those guidelines and whether optimal results were achieved are not reported. This makes us wonder whether the investigator’s good intentions were actually executed and were effective. Hence, it is uncertain whether the OCT group ...

Background— There are few clinical studies on the pathophysiological mechanisms of very late stent thrombosis (VLST). We report optical coherence tomography findings in patients with VLST and compare the findings between bare-metal stents (BMS) and drug-eluting stents (DES). Methods and Results— We conducted a registry of stent thrombosis at 4 North American centers with optical coherence tomography imaging programs SAFE registry (The Study of Late Stent Failure Evaluated by OCT). Images were acquired in 61 patients (42 DES and 19 BMS) presenting with definite VLST. The median duration from implantation to VLST presentation was 51.4 months in the DES ...

Background— Previous studies reported that reduced TIMI (Thrombolysis in Myocardial Infarction) flow grade before procedure was associated with worse clinical outcomes in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention. The aim of this study was to identify specific morphological characteristics of the culprit plaque associated with poor TIMI flow grade at baseline in patients with ST-segment–elevation myocardial infarction using both optical coherence tomography and intravascular ultrasound. Methods and Results— A total of 111 ST-segment–elevation myocardial infarction patients who underwent percutaneous coronary intervention within 24 hours of symptom onset were included. Both optical coherence tomography ...

Background— Intravascular optical coherence tomography (OCT) imaging provides limited information on the functional assessment of coronary stenosis. We evaluated a new approach to OCT image–based computation modeling, which can be used to estimate the fractional flow reserve (FFR) in patients with intermediate coronary stenosis. Methods and Results— Ninety-two patients with intermediate diameter stenosis in the left anterior descending artery underwent both FFR measurement with pressure wires and OCT examination. Using the OCT data, a computational fluid dynamics algorithm was used to calculate the computational FFR (FFR OCT ). The diagnostic performance of the FFR OCT was assessed based on the ...

Background— Current monotherapy drug-eluting stents are associated with impaired healing, neoatherosclerosis, and late stent thrombosis. The healing profile and neointimal transformation of the first dual-therapy endothelial progenitor cell–capturing sirolimus-eluting stent are unknown. Methods and Results— In this prospective, single-center study, 61 patients treated with the Combo stent had optical coherence tomography at baseline, early follow-up (4 monthly groups in a 1:2:2:1 ratio from 2 to 5 months), 9 months, and 24 months. Optical coherence tomography early strut coverage increased from 77.1% to 92.5% to 92.7% to 94.9% between 2 and 5 months ...

Background— Intravascular optical coherence tomography (IVOCT) images are recorded by detecting light backscattered within coronary arteries. We hypothesize that non–thin-capped fibroatheroma (TCFA) causes may scatter light to create the false appearance of IVOCT TCFA. Methods and Results— Ten human cadaver hearts were imaged with IVOCT (n=14 coronary arteries). IVOCT and histological TCFA images were coregistered and compared. Of 21 IVOCT TCFAs (fibrous cap <65 μm, lipid arc >1 quadrant), only 8 were true histological TCFA. Foam cell infiltration was responsible for 70% of false IVOCT TCFA and caused both thick-capped fibroatheromas to appear as TCFA, and the appearance ...

The goal of research into the in vivo detection of vulnerable plaques is to provide a clinician with a diagnostic tool that identifies vulnerable plaques prospectively to prevent acute events. This tool must have both a high positive predictive value and a high negative predictive value in the clinical setting (not just against histopathology) and cannot require specific expertise or core-laboratory analysis to determine whether a plaque should be treated pre-emptively—in other words, a yes/no, red light/green light, treat/don’t treat tool. Optical coherence tomography (OCT) has been proposed to be that tool. 1 OCT criteria ...

Introduction Straightening of tortuous coronaries by intracoronary guidewires may generate intimal wrinkles or coronary pleating and lead to the development of different abnormal angiographic findings widely known as pseudostenosis or accordion effect. 1 We report the unique findings disclosed by optical coherence tomography (OCT) in 3 patients developing coronary pleating. Patient 1 An 84-year-old woman with severe aortic stenosis was referred for coronary angiography before transcatheter aortic valve implantation. A severe stenosis in the mid segment of the right coronary artery was treated with a bare metal stent. The guidewire induced a new moderate focal lesion at the most proximal ...

Introduction Straightening of tortuous coronaries by intracoronary guidewires may generate intimal wrinkles or coronary pleating and lead to the development of different abnormal angiographic findings widely known as pseudostenosis or accordion effect. We report the unique findings disclosed by optical coherence tomography (OCT) in 3 patients developing coronary pleating. Patient 1 An 84-year-old woman with severe aortic stenosis was referred for coronary angiography before transcatheter aortic valve implantation. A severe stenosis in the mid segment of the right coronary artery was treated with a bare metal stent. The guidewire induced a new moderate focal lesion at the most proximal segment ...

BACKGROUND: Patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction are at increased risk for adverse events. It is unclear if image guidance by optical coherence tomography (OCT) can improve outcomes in these patients. We compared OCT-guided versus angiography-guided primary PCI for ST-segment-elevation myocardial infarction among patients in the Thrombectomy Versus PCI Alone (TOTAL) trial. METHODS AND RESULTS: Among 10 732 patients enrolled in the TOTAL trial, OCT was used for PCI guidance as a part of a prospective substudy in 214 patients. Using 2:1 propensity matching, we identified 428 patients in the trial who had PCI ...