We developed robust, three-dimensional methods, as opposed to traditional A-line analysis, for estimating the optical properties of calcified, fibrotic, and lipid atherosclerotic plaques from in vivo coronary artery intravascular optical coherence tomography clinical pullbacks. We estimated attenuation μ t and backscattered intensity I 0 from small volumes of interest annotated by experts in 35 pullbacks. Some results were as follows: noise reduction filtering was desirable, parallel line (PL) methods outperformed individual line methods, root mean square error was the best goodness-of-fit, and α -trimmed PL ( α -T-PL) was the best overall method. Estimates of μ t were calcified ( 3.84 ± 0.95 mm − 1 ...
Objectives This study sought to assess in vivo sex differences in the pathophysiology of ST-segment elevation myocardial infarction (STEMI) and vascular response to primary percutaneous coronary intervention (PCI). Background There is no consensus on whether differences in the pathophysiology of STEMI and response to primary PCI between women and men reflect biological factors as opposed to differences in age. Methods In this prospective, multicenter study, 140 age-matched men and women with STEMI undergoing primary PCI with everolimus-eluting stent were investigated with intravascular optical coherence tomography, histopathology-immunohistochemistry of thrombus aspirates, and serum biomarkers. Primary endpoints were the percentages of culprit plaque ...
Percutaneous coronary intervention (PCI) in bifurcations is routinely performed, however this procedure is associated with higher rates of adverse events compared non-bifurcation PCI [1,2]. While bifurcation PCI per se leads to progressively higher rates of periprocedural myocardial infarction as its complexity increases (i.e., 1- vs. 2-stent technique) [3], side-branch (SB) stenosis (SBS) after main-branch (MB) stenting may further contribute to myocardial ischemia and necrosis; in addition, it might require additional intervention and resource utilization.
Objectives The goal of this study was to investigate carotid plaque characteristics in symptomatic versus asymptomatic patients with the use of nonocclusive optical coherence tomography (OCT). Background The identification of asymptomatic patients with carotid disease who are at risk of stroke remains a challenge. There is an increasing awareness that plaque characteristics may best risk-stratify this population. We hypothesized that OCT, a new high-resolution (∼10 μm) imaging modality, might be useful for the identification of low-risk versus high-risk carotid plaque features and help us to understand the relationship between carotid diameter stenosis and plaque morphology to ischemic stroke. Methods Fifty-three ...
A system and related methods for automatic or semi-automatic segmentation and quantification of blood vessel structure and physiology, including segmentation and quantification of lumen, guide wire, vessel wall, calcified plaques, fibrous caps, macrophages, metallic and bioresorbable stents are described, and including visualization of results. Calcified plaque segmentation can be used to estimate the distribution of superficial calcification and inform strategies stenting. Volumetric segmentation and quantification of fibrous caps can provide more comprehensive information of the mechanisms behind plaque rupture. Quantification of macrophages can aid diagnosis and prediction of unstable plaque and associated acute coronary events. Automated detection and quantification of ...
Background —Optical Coherence Tomography (OCT) is a high-resolution intravascular imaging technique used in adults. We tested the hypothesis that OCT could identify coronary abnormalities not seen by angiography in children with a history of Kawasaki Disease (KD) and pediatric heart transplant (TX) recipients. Methods and Results —KD patients and TX recipients were evaluated between December 2012 and October 2013 with angiography and OCT (Ilumien System, LightLabs, St Jude Medical, Westford, MA). Modifications were made to the adult OCT protocol to adapt this technique for children. Serial cross sectional area (CSA) measurements of the lumen, intima and media were made. Entire ...
A 55-year-old male underwent percutaneous coronary intervention (PCI) of a Medina 1,1,1 circumflex (LCx) and a first obtuse marginal (OM1) bifurcation lesion. A double kissing crush technique was performed, utilising a 2.75×12 mm everolimus-eluting stent (EES) in OM1 and a XIENCE V 4.0×15 mm EES (Abbott Vascular, Santa Clara, CA, USA) in the LCx (Online Figure 1). Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) runs were performed (Online Figure 2, Online Figure 3, Moving image 1). 3D reconstruction of the OCT further clarified the reconstruction of the bifurcation carina and paving, in particular ...
A 67-year-old man with medically refractory vertebrobasilar insufficiency and short segment occlusions of the intracranial vertebral arteries was treated with angioplasty and stent placement. Fifteen hours after the procedure the patient developed symptoms of posterior fossa ischemia and repeat angiography showed thrombus formation within the stent which was treated with thrombolytic and aggressive antiplatelet therapy. Angiography revealed lysis of the clot, but concerns regarding the mechanism of the thrombotic phenomenon prompted frequency-domain optical coherence tomography (FDOCT) assessment. FDOCT provided excellent visualization of the stent and vessel wall interactions, as well as excluding residual flow-limiting stenosis, obviating the need for further ...
Optical coherence tomography (OCT) is the current state-of-the-art intracoronary imaging modality that allows visualization of detailed morphological characteristics of both atherosclerotic plaque and stent. So far, three expert review documents have been released for standardization of OCT image analysis. In the real world, a variety of definitions are being used by different groups and by different core laboratories to analyze OCT findings because of different clinical/procedural contexts in which OCT research has been carried out. This comprehensive overview is aimed to summarize different applicable definitions used by different research groups in plaque and stent analysis using OCT. In addition ...
Hiram G. Bezerra, M.D., is with the University Hospitals Case Medical Center-Interventional Cardiovascular Center and Research & Innovation Center.