Aims Patients presenting with acute coronary syndrome (ACS) may have different plaque morphologies at the culprit lesion. In particular, plaque rupture (PR) has been shown as the more frequent culprit plaque morphology in ACS. However, its prognostic value is still unknown. In this study, we evaluated the prognostic value of PR, compared with intact fibrous cap (IFC), in patients with ACS. Methods and results We enrolled consecutive patients admitted to our Coronary Care Unit for ACS and undergoing coronary angiography followed by interpretable optical coherence tomography (OCT) imaging. Culprit lesion was classified as PR and IFC by OCT criteria. Prognosis ...

Incomplete struts coverage is a predictor of late stent thrombosis after drug eluting stent (DES) implantation in atherosclerotic lesions. The process of struts coverage in DES implanted for bare-metal stent (BMS) restenosis has never been described. Thirty-two patients with stable coronary artery disease were consecutively selected, 11 with BMS restenosis (group A) and 21 with de-novo atherosclerotic lesions (group B). All patients underwent everolimus eluting stent implantation; coronary angiography and optical coherence tomography (OCT) were performed at 6-month follow-up. Percentage difference in struts coverage between the two groups was the primary end-point. A total of 85773 struts (17891 in group ...

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 ...

Aims Vulnerable plaques are characterized by a high macrophage content. We investigated the optical coherence tomography (OCT) capability of identifying coronary plaque macrophage presence using tissue property indexes. Methods and results Fifteen epicardial coronary arteries were imaged by OCT and subsequently analysed by histology. Correlating OCT–histological sections were identified and regions of interest (ROIs) were selected on both atherosclerotic plaques and normal appearing vessel tracts. OCT-derived tissue property indexes named normalized standard deviation (NSD), signal attenuation, and granulometry index were applied on ROIs to identify inflamed ROIs defined as a macrophage percentage >10 by histology. Forty-three paired samples (OCT ...

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 ...

We thank Mark Brezinski for his Correspondence ( Capabilities, limitations, and misconceptions of using OCT to assess vulnerable plaques . Nat. Rev. Cardiol. doi:10.1038/nrcardio.2014.62-c1 ) 1 on our Review ( Clinical classification of plaque morphology in coronary disease . Nat. Rev. Cardiol. 11 , 379 – 389 ; 2014 ), 2 and for his comments and clarifications. We agree that the phenomenon

Aims: To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe. Methods and results: We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB. Among 852 ACS patients who had undergone invasive coronary angiography, 101 (11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI 3 flow without stenting. All of these patients then had repeat angiography with OCT (days 0-2 [Group 1 ...

Aims: Thrombus aspiration is useful in improving myocardial reperfusion in comparison to conventional percutaneous coronary intervention in patients with acute myocardial infarction. Nonetheless, assessment of thrombus aspiration efficacy is lacking. Aim of this study was to quantify by frequency domain optical coherence tomography (OCT) the amount of thrombus removal in patients with acute coronary syndromes undergoing manual thrombus aspiration, correlating it with the actual size of the retrieved material. Methods: Twenty-five consecutive patients with acute coronary syndrome were enrolled. OCT assessment of thrombotic lesions was performed before and after thrombus aspiration and repeated after stent deployment. OCT thrombus assessment was ...

The optical coherence tomography (OCT) evaluation of the stent anatomy requires the inspection of sequential cross section (CS). However stent coils cannot be appreciated in the conventional format as the OCT CS simply display stent struts, that are poorly representative of the stent architecture. The aim of the present study was to validate a new software ( Carpet View ), which unfolds the stented segment, reconstructing it as an open structure and displaying the stent meshwork. 21 patients were studied with frequency domain OCT after the deployment of different stents: seven bio-absorbable scaffolds (Dream), seven bare metal stent (Vision/Multilink8), seven drug ...

In published post-mortem pathological studies, more than two-thirds of acute coronary events are associated with the rupture of lipid-rich, voluminous, and outwardly remodelled plaques covered by attenuated and inflamed fibrous caps in the proximal part of coronary arteries. Superficial erosion of the plaques is responsible for most of the remaining events; the eroded plaques usually do not demonstrate much lipid burden, do not have thin fibrous caps, are not positively remodelled, and are not critically occlusive. Both noninvasive and invasive imaging studies have been performed to clinically define the plaque characteristics in acute coronary syndromes in an attempt to identify ...

Optical coherence tomography (OCT) is a light-based intracoronary imaging modality that provides high-resolution cross-sectional images of the luminal and plaque morphology. Currently, the segmentation of OCT images and identification of the composition of plaque are mainly performed manually by expert observers. However, this process is laborious and time consuming and its accuracy relies on the expertise of the observer. To address these limitations, we present a methodology that is able to process the OCT data in a fully automated fashion. The proposed methodology is able to detect the lumen borders in the OCT frames, identify the plaque region, and detect ...

Aims: Subacute, late, and very late stent thrombosis (ST) may occur after stent implantation, but they are characterised by different underlying pathophysiological mechanisms. We sought to appraise differences between subacute and late/very late ST at the thrombus site by optical coherence tomography (OCT). The Mechanism Of Stent Thrombosis (MOST) study was a prospective multicentre non-randomised registry which enrolled six subacute ST and six controls (subacute ST study), and 17 late/very late ST and 17 controls (late/very late ST study). Methods and results: Patients with subacute ST had a minimum stent area at the thrombus site of 2 ...