Images in intervention.

A 48-year-old man was admitted because of a non–ST-segment elevation myocardial infarction. Fifteen months previously, he had received a 3.0 × 28-mm bioresorbable vascular scaffold (BVS) (Absorb, Abbott Vascular, Santa Clara, California) in the mid-left anterior descending coronary artery for stable angina. Coronary angiography showed a focal in-scaffold restenosis (Figure 1 ). Optical coherence tomography (OCT) (Ilumien, St. Jude Medical, Saint Paul, Minnesota) revealed a heterogeneous pattern consisting of neointimal hyperplasia (Figure 1 ), mural white thrombus (Figure 1 ), and lipidic plaque with attenuation (Figure 1 ). OCT after pre-dilation with a 2.0 × 15-mm semicompliant balloon showed outer migration of scaffold ...

Optical coherence tomography (OCT) is a novel invasive imaging technique that produces high resolution intracoronary images. Its general principle of operation is similar to IVUS, however OCT uses infrared light, not ultrasound. In the last years, the need for more precise information regarding coronary artery disease to achieve optimal treatment has seen intravascular imaging becoming an area of primary importance in interventional cardiology. OCT in this area has grown and is spreading. It benefits both therapeutic and research purposes and is also proving able to fill gaps in conventional invasive coronary imaging.

Objectives : We performed systematic optical coherence tomography (OCT) analyses after BVS implantation in a “real world” setting aiming at evaluating scaffold expansion and longitudinal integrity. Background : A comprehensive elucidation of bioresorbable vascular scaffolds´ (BVS) acute performance in the “real-world” setting is lacking Methods : Acute BVS expansion compared with compliance chart information and longitudinal integrity were assessed in 29 patients (32 lesions) by OCT. In addition, bench experiments with 4 scaffolds were performed with different combinations of deployment pressures and tube stiffness. Results : Scaffold underexpansion, using compliance chart information as reference, was observed in 97% of OCT cross-sections in vivo; however ...

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 ...

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 ...

Aims: Frequency-domain optical coherence tomography (FD-OCT) provides a rapid tomographic scan of a coronary vessel, with an accurate reconstruction of its lumen profile. An FD-OCT-based metric that corresponds more closely with physiological significance of lesions may enable more precise guidance of interventional procedures. The aim of this feasibility study was to evaluate a new method for quantifying coronary lesion severity that estimates hyperaemic flow resistance of branched vessel segments imaged by FD-OCT. Methods and results: An analytical flow model was developed that relates fractional flow reserve (FFR) to the vascular resistance ratio (VRR), a measure of blood flow resistance derived ...

Aims: Angiographic guidance for percutaneous coronary intervention (PCI) has substantial limitations. The superior spatial resolution of optical coherence tomography (OCT) could translate into meaningful clinical benefits. We aimed to compare angiographic guidance alone versus angiographic plus OCT guidance for PCI. Methods and results: Patients undergoing PCI with angiographic plus OCT guidance (OCT group) were compared with matched patients undergoing PCI with angiographic only guidance (Angio group) within 30 days. The primary endpoint was the one-year rate of cardiac death or myocardial infarction (MI). A total of 670 patients were included, 335 in the OCT group and 335 in the Angio ...

Introduction This document is complementary to an Expert Review Document on Optical Coherence Tomography (OCT) for the study of coronary arteries and atherosclerosis.1 The goal of this companion manuscript is to provide a practical guide framework for the appropriate use and reporting of the novel frequency domain (FD) OCT imaging to guide interventional procedures, with a particular interest on the comparison with intravascular ultrasound (IVUS).1–4 Technique for optical coherence tomography imaging In the OCT Expert Review Document on Atherosclerosis, a comprehensive description of the physical principles for OCT imaging and time domain (TD) catheters (St Jude Medical ...