1. Articles from cardiorevascmed.com

  2. 1-20 of 20
    1. Role of optical coherence tomography in managing patients with ST elevation myocardial infarction

      Role of optical coherence tomography in managing patients with ST elevation myocardial infarction

      Stenting the culprit lesion in patients presenting with acute coronary syndrome (ACS) is the standard of care. Although plaque rupture on an atheromatous lesion is the most common underlying pathology, other mechanisms can also result in ACS presentation; some of which can be managed without stenting. Here we describe a case that was managed conservatively, after evaluating plaque erosion as the underlying mechanism and lack of obstructive lesion. This case highlights the importance of intracoronary imaging to assess the underlying mechanism in patients presenting with acute coronary syndrome.

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    2. A 2-step optical coherence tomography guided therapeutic approach to acute myocardial infarction secondary to stent thrombosis

      A 2-step optical coherence tomography guided therapeutic approach to acute myocardial infarction secondary to stent thrombosis

      Myocardial infarction secondary to stent thrombosis has high mortality and recurrence rate. Emergency PCI has high risk of no-reflow. We used a 2-step approach of early recanalization with minimal mechanical intervention followed by delayed PCI 1–2 days later guided by Optical Coherence Tomography (OCT). From October 2011 to December 2013, we treated 5 patients with this approach. Time from early recanalization to the delayed definitive PCI was 1 day (median, range 1–3 days). All the OCT images were diagnostic with a clear view of the underlying structures. Summary A 2-step approach to treat stent thrombosis appears beneficial with ...

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    3. Optical coherence tomography: A pathway from research to clinical practice

      Optical coherence tomography: A pathway from research to clinical practice

      For more than half a century, coronary angiography has been the goldstandard diagnostic test for the assessment of coronary artery disease, but it does not provide information about the components of the vascular wall, atherosclerosic disease burden, or the interaction of local devices with coronary artery walls.  The development of intracoronary imaging techniques, such as optical coherence tomography (OCT), was conceived with the objective to overcome coronary angiography limitations.

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    4. Optical Coherence Tomography Plaque Characterization in a Patient with ST Segment Elevation Myocardial Infarction After Cocaine Intake

      Optical Coherence Tomography Plaque Characterization in a Patient with ST Segment Elevation Myocardial Infarction After Cocaine Intake

      A 28-year old man presented to the Emergency Department with malaise after cocaine intake. After arrival he developed retrosternal chest pain and the electrocardiogram showed ST segment elevations in V1-V2 and ST segment depressions in V5-V6. An acute coronary angiogram revealed a focal non-occlusive lesion with thrombus in the left anterior descending artery. Supplementary optical coherence tomography (OCT) detected plaque erosion with adherent thrombus to be the responsible underlying pathophysiological mechanism. The patient received an effective antithrombotic regimen. Repeat angiogram with additional OCT one month later documented thrombus resolution and complete restoration of the previously eroded coronary vascular surface area.

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    5. Time-related changes in neointimal tissue coverage of a novel Sirolimus eluting stent: Serial observations with optical coherence tomography

      Time-related changes in neointimal tissue coverage of a novel Sirolimus eluting stent: Serial observations with optical coherence tomography

      Background DES has reduced rates of restenosis compared with BMS but it has been associated with delayed healing and increase of stent thrombosis. The aim of our study was to evaluate the vascular time-related changes following implantation of a new SES coated with an amorphous silicon carbide that allows faster re-endothelisation (Orsiro-Biotronik). Methods This prospective registry enrolled STEMI-patients with multi-vessel disease, thus candidates for a two-step procedure. PCI of the culprit lesion was performed with at least one Orsiro stent that was OCT-analysed during the second-step procedure (deferred to 30,90 and 180-days). Results 16 of the 95 patients with ...

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      Mentions: Carlo Di Mario
    6. Optical coherence tomography (OCT) evaluation of intermediate coronary lesions in patients with NSTEMI - Cardiovascular Revascularization Medicine

      Optical coherence tomography (OCT) evaluation of intermediate coronary lesions in patients with NSTEMI - Cardiovascular Revascularization Medicine

      Introduction Coronary angiography is commonly performed following non-ST segment elevation myocardial infarction (NSTEMI) to assess the need for revascularization. Some of these patients have myocardial infarction (MI) with no obstructive coronary atherosclerosis (MINOCA). Patients without severe obstructive lesions are usually treated conservatively. However, coronary angiography has known limitations in the assessment of lesion severity. We report our experience of using coronary Optical Coherence Tomography (OCT) in a series of patients without severe obstructive coronary lesions. Methods 165 patients underwent coronary OCT at Vancouver General Hospital. NSTEMI was the clinical presentation in 70 patients and 26 had angiographically intermediate lesions with ...

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    7. Intra- and Interobserver Reliability and Intra-Catheter Reproducibility Using Frequency Domain Optical Coherence Tomography for the Evaluation of Morphometric Stent Parameters and Qualitative Assessment of Stent Strut Coverage

      Intra- and Interobserver Reliability and Intra-Catheter Reproducibility Using Frequency Domain Optical Coherence Tomography for the Evaluation of Morphometric Stent Parameters and Qualitative Assessment of Stent Strut Coverage

      Purpose Frequency-domain optical coherence tomography (FD-OCT) is a high-resolution imaging tool (~10-15 μm), which enables near-histological in-vivo images of the coronary vessel wall. The use of the technique is increasing, both for research- and clinical purposes. This study sought to investigate the intra- and interobserver reliability, as well as the intra-catheter reproducibility of quantitative FD-OCT-assessment of morphometric stent parameters and qualitative FD-OCT-evaluation of strut coverage in 10 randomly selected 6-month follow-up Nobori® biolimus-eluting stents (N-BES). Methods Ten N-BESs (213 cross sectional areas (CSA) and 1,897 struts) imaged with OCT 6-month post-implantation were randomly selected and analyzed by 2 experienced ...

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    8. Optical Coherence Tomography Assessment and Quantification of Intracoronary Thrombus: Status and Perspectives

      Optical Coherence Tomography Assessment and Quantification of Intracoronary Thrombus: Status and Perspectives

      Coronary angiography is the “golden standard” imaging technique in interventional cardiology and it is still widely used to guide interventions. A major drawback of this technique, however, is that it is inaccurate in the evaluation and quantification of intracoronary thrombus burden, a critical prognosticator and predictor of intraprocedural complications in acute coronary syndromes. The introduction of optical coherence tomography (OCT) holds the promise of overcoming this important limitation, as near-infrared light is uniquely sensitive to hemoglobin, the pigment of red blood cells trapped in the thrombus. This narrative review will focus on the use of OCT for the assessment, evaluation ...

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      Mentions: Francesco Prati
    9. Association of Morphologic Characteristics on Optical Coherence Tomography and Angiographic Progression Patterns of Late Restenosis After Drug-Eluting Stent Implantation

      Association of Morphologic Characteristics on Optical Coherence Tomography and Angiographic Progression Patterns of Late Restenosis After Drug-Eluting Stent Implantation

      Objectives To gain insight into the pathophysiology of late drug-eluting stent (DES) restenosis. Background Restenosis of DES has a different time course from that of bare metal stents. Methods Patients who underwent follow-up coronary angiography (CAG) twice (six to nine months and 18 to 24 months) after DES implantation were examined using optical coherence tomography (OCT). All lesions with target lesion revascularization at first follow-up were excluded. Late catch-up was defined as lesions that progressed from less than 50% diameter stenosis (DS) at the first CAG to more than 50% DS at the second CAG. Lesions with the late catch-up ...

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    10. Dual role of circulating endothelial progenitor cells in stent struts endothelialisation and neointimal regrowth: a substudy of the IN-PACT Coro trial

      Dual role of circulating endothelial progenitor cells in stent struts endothelialisation and neointimal regrowth: a substudy of the IN-PACT Coro trial

      Background Endothelialisation is a crucial event after percutaneous coronary intervention (PCI). Endothelial progenitor cells (EPC) are bone marrow derived elements with reparative properties. We aimed to assess the relationship between circulating EPC levels and stent neointimal hyperplasia (NIH) using frequency domain optical coherence tomography (FD-OCT). Methods Patients undergoing elective PCI to native vessels and randomized to bare metal stent (BMS) alone versus BMS plus drug coated balloon (DCB) were included. At six months, angiographic follow-up and FD-OCT were performed to measure percentage neointimal hyperplasia volume obstruction (%NIHV), and percentage of uncovered stent struts (%US). Venous blood samples were obtained before ...

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      Mentions: Francesco Prati
    11. Optimal visualization of five different stent layers during and after percutaneous coronary intervention for recurrent in-stent restenosis using optical coherence tomography (OCT)

      Optimal visualization of five different stent layers during and after percutaneous coronary intervention for recurrent in-stent restenosis using optical coherence tomography (OCT)

      Optical coherence tomography (OCT) has gained increasing popularity in the recent years. In this case, we documented optimal visualization of four stent layers that were seen during percutaneous coronary intervention for recurrent in-stent restenosis. OCT was clearly able to penetrate all of the neointimal tissue layers extending through to the last stent, which was near the adventitia. Our case demonstrates the excellent utility of OCT for detail assessment of a lesion with multiple stents. To our knowledge, this case is the first case report that could demonstrate excellent visualization of 5 different stent layers using OCT, extending through the deepest ...

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    12. Evaluation of acute radial artery injury following transradial percutaneous coronary intervention by optical coherence tomography

      Evaluation of acute radial artery injury following transradial percutaneous coronary intervention by optical coherence tomography

      Recent evidence has shown a reduced bleeding risk and resultant decreased morbidity and mortality when the transradial approach is utilized over the transfemoral approach for percutaneous coronary intervention (PCI). However, transradial catheterization may introduce acute and/or chronic injury to the radial artery limiting its use for future procedures and as a bypass conduit. Our goal was to utilize optical coherence tomography (OCT) to evaluate the incidence of acute radial artery injury in patients following transradial PCI.

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    13. Paclitaxel-coated balloon study: quantitative coronary angiography and optical coherence tomography evaluation in a swine in-stent stenosis model

      Paclitaxel-coated balloon study: quantitative coronary angiography and optical coherence tomography evaluation in a swine in-stent stenosis model
      Drug-coated balloons (DCBs) have shown efficacy for treatment of coronary artery disease. In the PEPCAD II ISR trial, paclitaxel-coated balloon (PCB) reduced in-stent restenosis (ISR) compared with paclitaxel-eluting stent (PES). Here we evaluated the efficacy of PCB in a porcine ISR model.
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    14. Evaluation of sirolimus-eluting stents and Titan2 bio-active stents performance by optical coherence tomography: a window on the importance of nitric oxide for strut coverage

      Evaluation of sirolimus-eluting stents and Titan2 bio-active stents performance by optical coherence tomography: a window on the importance of nitric oxide for strut coverage
      Lack of stent strut coverage has emerged as a main factor affecting stent performance in terms of restenosis and thrombosis propensity. Two groups of patients were retrospectively collected from our database. Group 1: 18 patients (14 males, 4 females, mean age 68±15 years) with a single sirolimus-eluting stent on mid-LAD (follow-up 15±8 months), and Group 2: 15 patients (10 males, 5 females, mean age 69.8±15.4 years) with a single Titan2 stent (nitric oxide stratified) on mid-LAD. All these patients underwent new coronary angiography and optical coherence tomography (OCT).
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    15. Preliminary observations using optical coherence tomography to assess neointimal coverage of a metal stent in a porcine model

      Background Concerns surrounding late stent thrombosis have prompted the development of novel imaging techniques to assess neointimal coverage. Recent clinical studies have evaluated optical coherence tomography (OCT) to evaluate neointimal coverage, but pathologic correlation in an animal model is lacking. We assessed the hypothesis that OCT could accurately assess early neointimal coverage in a porcine model. Methods OCT imaging of bare metal stents in each coronary artery was performed at implantation (n=6), Day 4 (n=3), and Day 20 (n=3), and images were evaluated at three cross-sections per stented segment. Neointimal strut coverage was categorized by OCT as ...
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      Mentions: Duke University
    16. Rapid Evaluation of Vessel hEaling After angiopLasty (reveal) study: an optical coherence tomography comparative study versus bare and drug-eluting stent at 7 and 30 days

      The aim of the present randomized study was to address vessel healing at 7 and 30 days after Polyzene-F stent deployment by using optical coherence tomography (OCT) and performing a comparison with two distinct groups of drug-eluting stents [DES: sirolimus eluting stent (SES) and paclitaxel eluting stent (PES), and bare metal stents (BMS)].
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    17. Morphological and biochemical imaging of coronary atherosclerotic plaques using optical coherence tomography and fluorescence lifetime imaging

      We propose that a multimodality imaging approach combining high-resolution optical coherence tomography (OCT) with fluorescence lifetime imaging microscopy (FLIM) molecular imaging will allow a more accurate diagnosis of vulnerable plaque (VP).We have obtained consecutive OCT and FLIM images of two postmortem coronary arteries. In the first artery (left), the OCT images showed a homogeneous, signal-rich, thick upper layer that suggested a homogenous fibrotic plaque. The FLIM images indicated two biochemically distinct areas: region of interest (ROI)-1 resembled the fluorescence emission of collagen, while ROI-2 resembled the fluorescence emission of elastin. In the second artery (right), the OCT images ...
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    18. Optical coherence tomography and intravascular ultrasound imaging of bioabsorbable magnesium stent degradation in porcine coronary arteries

      Abstract: Background: Absorbable metallic stents (AMS) composed of magnesium alloy were designed to complete degradation within 90–120 days. Among the potential advantages of these stents, when compared to conventional stents, are the elimination of late stent thrombosis, chronic inflammation, and artifacts during noninvasive imaging.Methods: Magnesium-based AMS were deployed in juvenile domestic pig coronary arteries. Angiography, optical coherence tomography (OCT), and intravascular ultrasound (IVUS) were performed before and after implant and then at 28 days and 3 months following stenting. The animals were sacrificed at 28 days or 3 months following stent implantation. Stented vessels were harvested and analyzed ...

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