1. 49-70 of 70 « 1 2 3
    1. Spontaneous Coronary Artery Dissection in Patients With Fibromuscular Dysplasia: A Case Series

      Spontaneous Coronary Artery Dissection in Patients With Fibromuscular Dysplasia: A Case Series

      Young women with acute coronary syndrome (ACS) frequently have nonatherosclerotic coronary artery disease (NACAD) and may be misdiagnosed. Coronary fibromuscular dysplasia (CFMD) commonly is overlooked, as the angiographic appearance is often subtle. Our group previously described CFMD as a diffuse obliterative disease starting abruptly at the mid-distal vessel, involving long segments.1 Spontaneous coronary dissection (SCAD) is another common form of NACAD and may be superimposed on CFMD, causing ACS. We report the first case series of SCAD and concomitant fibromuscular dysplasia (FMD).

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    2. Calcified In-Stent Restenosis: A Rare Cause of Dilation Failure Requiring Rotational Atherectomy

      Calcified In-Stent Restenosis: A Rare Cause of Dilation Failure Requiring Rotational Atherectomy

      The acute results of repeated interventions for patients with in-stent restenosis (ISR) are largely satisfactory, although some patients may still have recurrences. 1 , 2 In this anatomic scenario, lack of initial angiographic success is exceedingly rare. 1 , 2 We report a patient with “undilatable” ISR that eventually required rotational atherectomy to achieve procedural success. Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) unraveled the presence of severely calcified intrastent tissue, leading to “resistant” ISR. A 77-year-old man on hemodialysis was investigated for unstable angina. Coronary angiography revealed ISR of a bare metal stent that had been implanted in the right ...

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    3. Near Infrared Spectroscopy: Another Toy or Indispensible Diagnostic Tool?

      Near Infrared Spectroscopy: Another Toy or Indispensible Diagnostic Tool?

      The pursuit to identify vulnerable plaque has been relentless, as it is responsible for major healthcare problems, such as sudden cardiac death and acute coronary syndromes, including acute myocardial infarction (AMI). Per definition, vulnerable plaque is plaque that is prone to rupture but has not yet ruptured. 1 The features associated with vulnerable plaque include a large lipid core, thin fibrous cap overlying the lipid core, increased macrophage activity, positive remodeling, and increased vasa vasorum. 2 Among these 5 components, the 2 most important ones are probably the large lipid core and thin fibrous cap. Article see p 55 Since ...

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    4. Vascular Tissue Reaction to Acute Malapposition in Human Coronary Arteries: Sequential Assessment With Optical Coherence Tomography

      Vascular Tissue Reaction to Acute Malapposition in Human Coronary Arteries: Sequential Assessment With Optical Coherence Tomography

      Background—The vascular tissue reaction to acute incomplete stent apposition (ISA) is not well known. The aim of this study was to characterize the vascular response to acute ISA in vivo and to look for predictors of incomplete healing. Methods and Results—Optical coherence tomography studies of 66 stents of different designs, implanted in 43 patients enrolled in 3 randomized trials, were analyzed sequentially after implantation and at 6 to 13 months. Seventy-eight segments with acute ISA were identified in 36 of the patients and matched with the follow-up study by use of fiduciary landmarks. The morphological pattern of healing ...

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    5. Predictors of Periprocedural (Type IVa) Myocardial Infarction, as Assessed by Frequency-Domain Optical Coherence Tomography

      Predictors of Periprocedural (Type IVa) Myocardial Infarction, as Assessed by Frequency-Domain Optical Coherence Tomography

      Background—Frequency-domain optical coherence tomography (FD-OCT) is easily able to define both pre- and post-stenting features of the atherosclerotic plaque that can potentially be related to periprocedural complications. We sought to examine which FD-OCT-defined characteristics, assessed both before and after stent deployment, predicted periprocedural (type IVa) myocardial infarction (MI). Methods and Results—FD-OCT was performed before and after coronary stenting in 50 patients undergoing percutaneous coronary intervention (PCI) for either non-ST segment elevation MI (NSTEMI) or stable angina. All patients underwent single-vessel stenting, and only drug-eluting stents were implanted. Troponin T was analyzed on admission, before PCI, and at 12 ...

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      Mentions: Rocco Vergallo
    6. Serial Assessment of Coronary Artery Response to Paclitaxel-Eluting Stents Using Optical Coherence Tomography

      Serial Assessment of Coronary Artery Response to Paclitaxel-Eluting Stents Using Optical Coherence Tomography

      Background—The paucity of longitudinal, serial high-resolution imaging studies has limited our understanding of in vivo arterial response to drug-eluting stents. We sought to investigate the human coronary response to paclitaxel-eluting stent implantation, using serial optical coherence tomography assessments. Methods and Results—Thirty patients with at least 2 significant coronary lesions in different vessels were treated with a paclitaxel-eluting stent. The most severe stenosis (lesion A) was treated at the initial procedure, and the second target vessel (lesion B) was stented 3 months later. Optical coherence tomography was performed at baseline, 3-, and 9-month follow-up for lesions A and baseline ...

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    7. Natural History of a Thin-Cap Fibroatheroma: Serial Observations by Optical Coherence Tomography

      Natural History of a Thin-Cap Fibroatheroma: Serial Observations by Optical Coherence Tomography
      Disruption of thin-cap fibroatheromas (TCFAs) is an initial cause of fatal acute coronary syndrome according to fragmentary investigations of pathology.1 Postcardiac event observations using recent intracoronary imaging devices support that TCFAs are equivalent to vulnerable plaques.2,3 However, to our knowledge, no serial documentation of plaque disruption has yet been performed in living patients. A 69-year-old man with stable angina underwent successful drug-eluting stent implantation in the left anterior descending coronary artery. He was receiving medical therapies for hypertension and dyslipidemia. His fasting serum total cholesterol, triglycerides, and high-density lipoprotein cholesterol were 230 mg/dL, 649 mg/dL ...
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    8. Bioresorbable Polymeric Vascular Scaffolds: A Cautionary Tale

      Bioresorbable Polymeric Vascular Scaffolds: A Cautionary Tale
      The everolimus-eluting bioresorbable vascular scaffold (BVS, Abbott Vascular, Santa Clara, CA) is an exciting advance in percutaneous coronary intervention (PCI), providing a temporary coronary scaffold for at least 3 months and being resorbed by about 2 years. 1–3 Along with patient preference, potential advantages over metallic stents include restored vasomotion, reduced late thrombosis, and unimpaired imaging with computed tomography and magnetic resonance. However, advances in interventional devices may bring new challenges in the early days of the technology. A 78-year-old man with recent-onset angina was enrolled in the ABSORB Trial Cohort B Group 1.3 An obtuse marginal coronary ...
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    9. A Rare Cause of Late Drug-Eluting Stent Thrombosis Unraveled by Optical Coherence Tomography

      A Rare Cause of Late Drug-Eluting Stent Thrombosis Unraveled by Optical Coherence Tomography

      Drug-eluting stent (DES) thrombosis remains a rare but feared complication in patients undergoing coronary interventions. Mechanical factors (stent underexpansion, malapposition, inflow-outflow disease, residual dissections) have been suggested to play a potential role in this setting. 1,2 These predisposing problems can be readily identified with the use of intravascular ultrasound or optical coherence tomography (OCT). 1–4 Furthermore, lack of complete endothelialization appears to be implicated in cases with very late DES thrombosis, in which OCT might allow a more precise diagnosis. 3,4 We present a patient with very late DES thrombosis in whom OCT unraveled a unique, previously ...

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    10. Impact of Coronary Plaque Morphology Assessed by Optical Coherence Tomography on Cardiac Troponin Elevation in Patients With Elective Stent Implantation

      Impact of Coronary Plaque Morphology Assessed by Optical Coherence Tomography on Cardiac Troponin Elevation in Patients With Elective Stent Implantation
      Background—Mild elevations of cardiac troponin frequently occur after percutaneous coronary intervention (PCI), and patients with elevated post-PCI biomarkers have a worse prognosis. We used optical coherence tomography (OCT) to study the relationship between pre-PCI plaque morphology and post-PCI cardiac troponin I elevations. Methods and Results—One hundred thirty-one patients with normal pre-PCI cardiac troponin I levels underwent OCT before nonemergency stent implantation. Clinical and OCT findings were compared between patients with (n=31, 23.7%) and without (n=100, 76.3%) post-PCI cardiac troponin I of >3×upper reference limit (post-PCI myocardial infarction [MI]). After PCI, long-term follow-up data ...
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    11. Difference of Tissue Characteristics Between Early and Very Late Restenosis Lesions After Bare-Metal Stent Implantation: An Optical Coherence Tomography Study

      Difference of Tissue Characteristics Between Early and Very Late Restenosis Lesions After Bare-Metal Stent Implantation: An Optical Coherence Tomography Study
      Background—Although in-stent restenosis (ISR) after bare-metal stent (BMS) implantation peaks in the early phase, very late (VL) ISR occasionally is observed beyond a few years after BMS implantation. To date, this mechanism has not been fully clarified. Methods and Results—We compared the morphological characteristics of VL-ISR (>5 years, without restenosis within the first year) (n=43) to those of early (E) ISR (within the first year) (n=39) using optical coherence tomography (OCT). Qualitative restenotic tissue analysis included assessment of tissue structure (homogeneous or heterogeneous), presence of microvessels, disrupted intima with cavity, and intraluminal material and was performed ...
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    12. Spontaneous Coronary Artery Dissection: Utility of Intravascular Ultrasound and Optical Coherence Tomography During Percutaneous Coronary Intervention [Images and Case Reports in Interventional Cardiology]

      Spontaneous Coronary Artery Dissection: Utility of Intravascular Ultrasound and Optical Coherence Tomography During Percutaneous Coronary Intervention [Images and Case Reports in Interventional Cardiology]

      Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndromes but is represented disproportionately in young female patients. No specific guidelines exist concerning the appropriate treatment (medical therapy, intracoronary stents, coronary bypass surgery) or the optimal type of stents in otherwise atheroma-free vessels. The role of intracoronary imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) has yet to be fully established. A 39-year-old woman with no traditional risk factors for coronary artery disease presented with an anterior ST-segment elevation myocardial infarct after undergoing rigorous aerobic exercises. The patient was gravida 3 para 3, not known ...

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    13. Late Vascular Responses From 2 to 4 Years After Implantation of Sirolimus-Eluting Stents: Serial Observations by Intracoronary Optical Coherence Tomography

      Late Vascular Responses From 2 to 4 Years After Implantation of Sirolimus-Eluting Stents: Serial Observations by Intracoronary Optical Coherence Tomography
      Background—Late vascular responses after implantation of drug-eluting stents may play a key role in steadily increasing occurrence of very late stent thrombosis have not yet been fully investigated in human beings. Methods and Results—Serial optical coherence tomography observations at 2 and 4 years were collected for 17 patients treated with 21 sirolimus-eluting stents. Corresponding 376 cross sections within single-stent segments at intervals of 1 mm were selected for analyses, and neointimal thickness on each strut was measured. Extrastent lumen (ESL) was defined as an external lumen of the stent. Area and angle of ESL were measured. A total ...
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    14. Relationship Between Arterial and Fibrous Cap Remodeling: A Serial Three-Vessel Intravascular Ultrasound and Optical Coherence Tomography Study

      Relationship Between Arterial and Fibrous Cap Remodeling: A Serial Three-Vessel Intravascular Ultrasound and Optical Coherence Tomography Study
      Background—Positive arterial remodeling and thin fibrous cap are characteristics of rupture-prone or vulnerable plaque. The natural course of the fibrous cap thickness and the relationship between serial arterial remodeling and changes in fibrous cap thickness are unknown. Therefore, the purpose of this study was to evaluate the relationship between changes in fibrous cap thickness and arterial remodeling by using optical coherence tomography (OCT) and intravascular ultrasound (IVUS) during 6-month follow-up. Methods and Results—Both IVUS and OCT examinations were performed on 108 vessels from 36 patients with ischemic heart disease who underwent percutaneous coronary intervention. Fifty-eight fibroatheromas were selected ...
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    15. New Drug-Eluting Stents: An Overview on Biodegradable and Polymer-Free Next-Generation Stent Systems

      New Drug-Eluting Stents: An Overview on Biodegradable and Polymer-Free Next-Generation Stent Systems
      Drug-eluting stents (DES)were primarily conceived to reduce in-stent neointimal formation and therefore minimize the occurrence of restenosis, the major drawback of percutaneous coronary interventions with bare-metal stents (BMS). The development of DES has been pioneered through a combination of the increased understanding of the biology of restenosis, the selection of drugs that target 1 or more pathways in the restenotic process, controlled-release drug delivery strategies, and the use of the stent as a delivery platform. Although first-generation DES Cypher (sirolimus-eluting stent; Cordis Corporation, Johnson & Johnson, Warren, NJ) and Taxus (paclitaxel-eluting stent; Boston Scientific Corporation, Natick, Mass) have effectively achieved their main goal, reducing restenosis across virtually ...
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    16. Strut Coverage and Vessel Wall Response to a New-Generation Paclitaxel-Eluting Stent With an Ultrathin Biodegradable Abluminal Polymer: Optical Coherence Tomography Drug-Eluting Stent Investigation (OCTDESI)

      Strut Coverage and Vessel Wall Response to a New-Generation Paclitaxel-Eluting Stent With an Ultrathin Biodegradable Abluminal Polymer: Optical Coherence Tomography Drug-Eluting Stent Investigation (OCTDESI)
      Background—Polymer-coated drug-eluting stents are effective in preventing restenosis but have been associated with delayed healing and incomplete strut coverage. It is unknown whether paclitaxel-eluting stents (PES) with minimal biodegradable abluminal coating enhances strut coverage while preventing neointimal hyperplasia. Using optical coherence tomography (OCT) as a primary imaging modality, we assessed the proportion of uncovered struts at 6-month follow-up in PES coated with durable versus ultrathin (<1 µ m) biodegradable abluminal polymers. Methods and Results—In this pilot trial, 60 patients with de novo lesions (25 mm) in native coronary vessels were randomly assigned to receive either TAXUS Liberté PES ...
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    17. Development of a Novel Prohealing Stent Designed to Deliver Sirolimus From a Biodegradable Abluminal Matrix

      Development of a Novel Prohealing Stent Designed to Deliver Sirolimus From a Biodegradable Abluminal Matrix
      Background— We aimed to demonstrate that, by separating endothelial progenitor cell capture from sirolimus delivery through the application of drug to the abluminal surface of the stent, the degree of endothelialization can be enhanced. Methods and Results— Stainless steel R Stents, with biodegradable SynBiosys polymer coating with sirolimus abluminally applied and surface modified with anti-CD34 antibody were prepared at 2 dosages (low-dose sirolimus [LD-Combo, 2.5 µg sirolimus/mm] and full-dose sirolimus [Combo, 5 µg sirolimus/mm). These Combo stents and the Cypher stent (10 µg sirolimus/mm) were deployed in 98 normal porcine arteries and harvested for pharmacokinetic analysis ...
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    18. A Case of Lipid Core Plaque Progression and Rupture at the Edge of a Coronary Stent: Elucidating the Mechanisms of Drug-Eluting Stent Failure

      A Case of Lipid Core Plaque Progression and Rupture at the Edge of a Coronary Stent: Elucidating the Mechanisms of Drug-Eluting Stent Failure
      Understanding the mechanisms of coronary drug-eluting stent (DES) failure remains relevant in light of concerns brought on by clinical reports of life-threatening late and very late stent thrombosis and by autopsy studies showing delayed and incomplete healing inside the stents, which may be related to underlying necrotic lipid core.1 Frequency-domain optical coherence tomography, also known as optical frequency-domain imaging (OFDI), is a new intracoronary imaging technology that enables 3-dimensional visualization of coronary structure in vivo at a resolution (6 µm) sufficient to identify many microscopic features of the coronary wall and stents.2 Here, we present a case of ...
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    19. The High-Risk Thin-Cap Fibroatheroma - A New Kid on the Block

      Despite continuous improvements in the catheter-based treatment of coronary artery disease (CAD), our field continues to struggle with the concept that percutaneous intervention may not prevent myocardial infarction or death in the stable patient. The main reason behind this controversial but rather accepted statement is that life-threatening coronary events arise most frequently from lesions that escape proper diagnosis and treatment. As a result, our efforts in clinical practice are almost totally consumed by the treatment of lesions that have limited impact on the natural history of atherothrombosis and CAD. Thus, it is imperative to reflect on this paradox, and do ...
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    20. Advances in Intravascular Imaging

      This review updates the role of various intravascular imaging techniques (1) in the detection of vulnerable plaque and (2) during percutaneous coronary intervention (PCI), especially drug-eluting stent (DES) implantation and follow-up—including intravascular ultrasound (IVUS), virtual histology (VH-IVUS) and integrated backscatter (IB-IVUS), optical coherent tomography (OCT), near-infrared (NIR) spectroscopy, angioscopy, and MRI. IVUS, IB-IVUS, and VH-IVUS The current intracoronary ultrasound imaging frequency range of 20 to 45 MHz provides 70 to 200 µm axial resolution with >5 mm penetration.1,2 Grayscale IVUS allows robust quantitative measurements including lumen, vessel, and plaque area; qualitative assessment of lesions preintervention; and quantitative ...
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    21. Intimal Dissection Causing Late Thrombosis of a Covered Stent: Optical Coherence Tomography Appearances

      Late thrombosis is a rare but a potentially catastrophic complication of coronary stenting procedures.1 It is recognized to occur in both bare metal and drug-eluting stents2 and seems to occur at a low incidence (0.6% per year) for at least 3 years postprocedure.3 Intravascular imaging with optical coherence tomography (OCT) can provide high-resolution images (10 to 20 µm) of the coronary vessel wall and is being increasingly used to provide insight into the risks and mechanisms of late stent thrombosis (ST).4 Covered stents are occasionally used in situations where percutaneous intervention has caused coronary perforation or ...
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    22. "Intracoronary Whirling Current Phenomenon" and Thrombus Formation After Sirolimus-Eluting Stent Implantation Visualized by Optical Coherence Tomography

      We present a case of imaged "intracoronary whirling current phenomenon." A 60-year-old Japanese man was treated with 2 sirolimus-eluting stents (SES; 3.0x18 and 3.5x33 mm) in the right coronary artery (RCA) for chronic total occlusion in October 2007. After percutaneous coronary intervention, he was taking 200 mg of aspirin and 200 mg of ticlopidine. However, he had recurrent transient ischemic chest pain beginning at 7 months. A second coronary angiography at 8 months after SES implantation showed reocclusion at a site just proximal to the SES. A repeat percutaneous coronary intervention was performed for RCA chronic total occlusion ...

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    49-70 of 70 « 1 2 3
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