1. Renu Virmani

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    1. Mentioned In 49 Articles

    2. Malapposition: is it a major cause of stent thrombosis?

      Malapposition: is it a major cause of stent thrombosis?
      Stent thrombosis (ST) is a devastating complication associated with a high morbidity and mortality in patients who have undergone percutaneous coronary intervention (PCI) for coronary heart disease (CHD). In-hospital mortalities of patients suffering from ST have been reported to be as high as 7.9% for acute ST (AST; occurring 24 h after PCI) and subacute ST (SAST; occurring within 30 days after PCI), 3.8% for late ST (LST ...
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    3. Are Microcalcification and Hemosiderin Really Limitations of OCT in Detection of TCFA?

      Are Microcalcification and Hemosiderin Really Limitations of OCT in Detection of TCFA?
      With great interest, we read the recent work by Fujii et al. (1) published in iJACC reporting the diagnostic accuracy of optical coherence tomography (OCT) and grayscale intravascular ultrasound for the detection of coronary thin cap fibroatheroma (TCFA) with histologic validation in human autopsy hearts. In this publication, Fujii et al. (1) documented a limited capability of OCT and intravascular ultrasound for TCFA identification when each imaging device was solely ...
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    4. The Mystery of Spotty Calcification Can We Solve It by Optical Coherence Tomography?

      The Mystery of Spotty Calcification Can We Solve It by Optical Coherence Tomography?
      Spotty calcification has recently been introduced as a marker of plaque vulnerability in patients presenting with acute coronary syndrome undergoing invasive and noninvasive coronary imaging, 1 and it has been suggested to be of predictive value for percent atheroma volume with greater progression. 2 Several pathological and clinical studies applying computed tomography (CT) and intravascular ultrasound (IVUS) demonstrated that spotty calcification is more frequently observed in lesions with plaque rupture ...
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    5. Neoatherosclerosis: mirage of an ancient illness or genuine disease condition?

      Neoatherosclerosis: mirage of an ancient illness or genuine disease condition?
      In-stent neoatherosclerosis has become the darling of the interventional cardiology community and is blamed for most stent thrombosis (ST) occurring late after drug-eluting stent (DES) implantation. Neoatherosclerosis accounted for only 33% of late and very late ST at autopsy following implantation of first-generation DES. 1 However, the clinical prevalence of neoatherosclerosis and its percentage of cases presenting with late and very late ST remains unknown. In the current issue of ...
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    6. The coronary substrate determines prognosis in acute coronary syndromes: the kaleidoscope has been shaken ... again!

      The coronary substrate determines prognosis in acute coronary syndromes: the kaleidoscope has been shaken ... again!
      The identification of vulnerable or high risk coronary plaques has represented the quest for the Holy Grail in interventional cardiology for the past three decades. Plaque rupture (PR), plaque erosion (PE), and complicated calcified nodules (CNs) constitute the most common underlying substrates leading to coronary thrombosis and acute coronary syndromes (ACS). 1 3 Despite the advent of novel intracoronary imaging techniques, which are able to disclose unique morphological insights and ...
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    7. Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment

      Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment
      Despite the reduction in late thrombotic events with newer-generation drug-eluting stents (DES), late stent failure remains a concern following stent placement. In-stent neoatherosclerosis has emerged as an important contributing factor to late vascular complications including very late stent thrombosis and late in-stent restenosis. Histologically, neoatherosclerosis is characterized by accumulation of lipid-laden foamy macrophages within the neointima with or without necrotic core formation and/or calcification. The development of neoatherosclerosis may ...
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    8. Hypersensitivity Reaction in the US Food and Drug Administration-Approved Second-Generation Drug-Eluting Stents: Histopathological Assessment With Ex Vivo Optical Coherence Tomography

      Hypersensitivity Reaction in the US Food and Drug Administration-Approved Second-Generation Drug-Eluting Stents: Histopathological Assessment With Ex Vivo Optical Coherence Tomography
      ...yuki Yahagi, MD*; 3. Elena Ladich, MD; 4. Robert Kutys, MS; 5. Russell Alexander, MD; 6. David Fowler, MD; 7. Renu Virmani, MD; 8. Michael Joner, MD 1. From CVPath Institute Inc, Gaithersburg, MD (F.O., K.Y., E.L.,...
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    9. Optical coherence tomography surveillance following drug-eluting stent implantation

      Optical coherence tomography surveillance following drug-eluting stent implantation
      Drug-eluting stents are currently used in the majority of percutaneous coronary interventions. Preclinical investigations and human autopsy studies have shown that the high efficacy of drug‐eluting stents in preventing restenosis is achieved at the expense of a delay in healing. Optical coherence tomography (OCT) represents a novel intracoronary imaging tool to evaluate vascular healing response after stent implantation. Owing to its outstanding resolution in the catheter near‐field, quantitative ...
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    10. Multiple Simultaneous Plaque Erosion in 3 Coronary Arteries

      Multiple Simultaneous Plaque Erosion in 3 Coronary Arteries
      We performed optical coherence tomography (OCT) imaging with matched histology in a 34-year-old man with history of smoking and untreated hyperlipidemia who had suffered from epigastric pain and was found dead at home. Multiple plaque erosions in 3 major coronary arteries were discovered (Figure 1 )
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    11. Matching human pathology is essential for validating OCT imaging to detect high-risk plaques

      Comment "As my comments in Nature Cardiology Reviews show, I strongly disagree with many aspects of the article Otsuka et al. ..." - mebrezin
      Matching human pathology is essential for validating OCT imaging to detect high-risk plaques
      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
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    12. Mechanisms of Atherothrombosis and Vascular Response to Primary Percutaneous Coronary Intervention in Women Versus Men With Acute Myocardial Infarction : Results of the OCTAVIA (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angiop

      Mechanisms of Atherothrombosis and Vascular Response to Primary Percutaneous Coronary Intervention in Women Versus Men With Acute Myocardial Infarction : Results of the OCTAVIA (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angiop
      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 ...
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    13. Clinical classification of plaque morphology in coronary disease

      Clinical classification of plaque morphology in coronary disease
      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 ...
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    14. Expectations and limitations of contemporary intravascular imaging: lessons learned from pathology

      Expectations and limitations of contemporary intravascular imaging: lessons learned from pathology
      Acute coronary syndrome is the leading cause of death worldwide and plaque rupture is the most common underlying mechanism of coronary thrombosis. During the last 2 decades the understanding of atherosclerotic plaque progression advanced dramatically and pathology studies provided fundamental insights of underlying plaque morphology, which paved the way for invasive imaging modalities, which bring a new area of atherosclerotic plaque characterization in vivo. The development of intravascular ultrasound (IVUS ...
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    15. Computational Fluid Dynamics Simulations of Hemodynamics in Plaque Erosion

      Computational Fluid Dynamics Simulations of Hemodynamics in Plaque Erosion
      We investigated whether local hemodynamics were associated with sites of plaque erosion and hypothesized that patients with plaque erosion have locally elevated WSS magnitude in regions where erosion has occurred. We generated 3D, patient-specific models of coronary arteries from biplane angiographic images in 3 human patients with plaque erosion diagnosed by optical coherence tomography. Using computational fluid dynamics, we simulated pulsatile blood flow and calculated both wall shear stress (WSS ...
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    16. Increased Thin-Cap Neoatheroma and Periprocedural Myocardial Infarction in Drug-Eluting Stent Restenosis Multimodality Intravascular Imaging of Drug-Eluting and Bare-Metal Stents

      Increased Thin-Cap Neoatheroma and Periprocedural Myocardial Infarction in Drug-Eluting Stent Restenosis  Multimodality Intravascular Imaging of Drug-Eluting and Bare-Metal Stents
      ... MD, 6. Jason C. Kovacic, MD, PhD, 7. Gary S. Mintz, MD, 8. Fumiyuki Otsuka, MD, PhD, 9. Stephen Pan, MD, 10. Renu Virmani, MD, 11. Samin K. Sharma, MD, 12. Pedro Moreno, MD and 13. Annapoorna S. Kini, MD 1. From t...
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  2. About Renu Virmani

    Renu Virmani

    Renu Virmani, MD, is President and Medical Director at CV Path Institute, Gaithersburg, MD.

  3. Quotes

    1. It is a dangerous thing to put drug-eluting stents in patients who present with acute myocardial infarction...The fibrous cap is thin and has very few smooth muscle cells in it . . . and underneath, this necrotic core has no cells in it. So how does it heal? It needs cells to come in.... “Now you put a drug on top of that [by implanting DES]. It isn’t going to be allowed to heal. The reason [physicians] get away with this is patients are on dual antiplatelet therapy.
      In Incomplete Apposition Implicated in Stent Thrombosis
    2. I've never seen a rate as low as 5%. If it were truly 5%, I would agree it's probably not going to be a problem, clinically, but I think their methodology is probably wrong. . . . They may be seeing fibrin on top of the stent struts, and fibrin is not neointima, it's not healthy. OCT cannot look at the composition of the tissue, and therefore they are reading as 'covered' something that may be covered with a clot.
      In OCT imaging suggests low rates of uncovered/malapposed struts following DES for AMI