151
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Maehara A, Matsumura M, Ali ZA, Mintz GS, Stone GW. IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal. JACC Cardiovasc Imaging 2018; 10:1487-1503. [PMID: 29216976 DOI: 10.1016/j.jcmg.2017.09.008] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/11/2017] [Accepted: 09/28/2017] [Indexed: 12/17/2022]
Abstract
Procedural guidance with intravascular ultrasound (IVUS) imaging improves the clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) by: 1) informing the necessity for lesion preparation; 2) directing appropriate stent sizing to maximize the final stent area and minimize geographic miss; 3) selecting the optimal stent length to cover residual disease adjacent to the lesion, thus minimizing geographic miss; 4) guiding optimal stent expansion; 5) identifying acute complications (edge dissection, stent malapposition, tissue protrusion); and 6) clarifying the mechanism of late stent failure (stent thrombosis, neointimal hyperplasia, stent underexpansion or fracture, or neoatherosclerosis). Optical coherence tomography (OCT) provides similar information to IVUS (with some important differences), also potentially improving acute and long-term patient outcomes compared to angiography-guided PCI. The purpose of this review is to describe the similarities and differences between IVUS and OCT technologies, and to highlight the evidence supporting their utility to improve PCI outcomes.
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Affiliation(s)
- Akiko Maehara
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Ziad A Ali
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
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152
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Shlofmitz E, Shlofmitz RA, Galougahi KK, Rahim HM, Virmani R, Hill JM, Matsumura M, Mintz GS, Maehara A, Landmesser U, Stone GW, Ali ZA. Algorithmic Approach for Optical Coherence Tomography-Guided Stent Implantation During Percutaneous Coronary Intervention. Interv Cardiol Clin 2018; 7:329-344. [PMID: 29983145 DOI: 10.1016/j.iccl.2018.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intravascular imaging plays a key role in optimizing outcomes for percutaneous coronary intervention (PCI). Optical coherence tomography (OCT) utilizes a user-friendly interface and provides high-resolution images. OCT can be used as part of daily practice in all stages of a coronary intervention: baseline lesion assessment, stent selection, and stent optimization. Incorporating a standardized, algorithmic approach when using OCT allows for precision PCI.
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Affiliation(s)
- Evan Shlofmitz
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA; Department of Cardiology, St. Francis Hospital, 100 Port Washington Boulevard, Suite 105, Roslyn, NY 11576, USA; Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA
| | - Richard A Shlofmitz
- Department of Cardiology, St. Francis Hospital, 100 Port Washington Boulevard, Suite 105, Roslyn, NY 11576, USA
| | - Keyvan Karimi Galougahi
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Hussein M Rahim
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Renu Virmani
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Jonathan M Hill
- London Bridge Hospital, 2nd Floor, St Olaf House, London SE1 2PR, UK; Department of Cardiology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA
| | - Akiko Maehara
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA; Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin 12200, Germany
| | - Gregg W Stone
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA; Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA
| | - Ziad A Ali
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA; Department of Cardiology, St. Francis Hospital, 100 Port Washington Boulevard, Suite 105, Roslyn, NY 11576, USA; Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA.
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153
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Comparison of plaque morphology between peripheral and coronary artery disease (from the CLARITY and ADAPT-DES IVUS substudies). Coron Artery Dis 2018; 28:369-375. [PMID: 28118185 DOI: 10.1097/mca.0000000000000469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to help understand the different outcomes when treating peripheral arterial disease (PAD) versus coronary artery disease (CAD). We compared plaque morphology between PAD and CAD using intravascular ultrasound. METHODS Complete Lesion Assessment with ffR and IVUS TechnologY (CLARITY) was a prospective, multicenter trial that enrolled 50 PAD patients with a lower extremity wound fed by a tibial or a peroneal artery with diameter stenosis more than 50%. Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents (ADAPT-DES) was a prospective, multicenter, registry that enrolled 8582 CAD patients. We compared preintervention intravascular ultrasound findings in 42 PAD lesions from CLARITY versus 79 matched CAD lesions from ADAPT-DES. RESULTS Compared with CAD lesions, PAD lesions had (i) smaller mean vessel, plaque, and lumen volumes; (ii) twice the lesion length; (iii) greater maximum superficial calcium arc and plaque eccentricity (i.e. there was more concentric plaque) measured at the minimum lumen area site; (iv) calcium arc and plaque eccentricity were positively correlated to plaque burden in both PAD and CAD lesions; and (v) calcium arc and the presence of concentric plaque were greater in PAD compared with CAD independent of the degree of plaque burden. CONCLUSION Compared with CAD lesions, PAD lesions in a tibial or a peroneal artery were longer; had more concentric, diffuse, and calcified plaque; and had smaller vessel volumes.
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154
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Ali ZA, Galougahi KK. Shining light on calcified lesions, plaque stabilisation and physiologic significance: new insights from intracoronary OCT. EUROINTERVENTION 2018; 13:e2105-e2108. [PMID: 29624174 DOI: 10.4244/eijv13i18a346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ziad A Ali
- Center for Interventional Vascular Therapy, Division of Cardiology, Presbyterian Hospital and Columbia University, New York, NY, USA
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155
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Fujino A, Mintz GS, Matsumura M, Lee T, Kim SY, Hoshino M, Usui E, Yonetsu T, Haag ES, Shlofmitz RA, Kakuta T, Maehara A. A new optical coherence tomography-based calcium scoring system to predict stent underexpansion. EUROINTERVENTION 2018; 13:e2182-e2189. [DOI: 10.4244/eij-d-17-00962] [Citation(s) in RCA: 168] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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156
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Impact of Vascular Calcifications on Long Femoropopliteal Stenting Outcomes. Ann Vasc Surg 2018; 47:170-178. [DOI: 10.1016/j.avsg.2017.08.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 02/03/2023]
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157
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Optical frequency-domain imaging findings to predict good stent expansion after rotational atherectomy for severely calcified coronary lesions. Int J Cardiovasc Imaging 2018; 34:867-874. [PMID: 29318407 DOI: 10.1007/s10554-018-1300-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/05/2018] [Indexed: 01/16/2023]
Abstract
We aimed to evaluate the optical frequency-domain imaging (OFDI) findings after rotational atherectomy (RA) that predict good stent expansion for severely calcified coronary lesions. Fifty consecutive calcified lesions were subjected to RA under OFDI guidance. We performed OFDI just after RA and stenting. We measured the morphology of calcium after RA, and assessed how these factors influence stent expansion. The stent expansion index was defined as the minimum stent area divided by the average of the proximal and distal reference lumen areas. Minimum thickness of calcification in the intima after RA showed a significant negative correlation with stent expansion (r = - 0.53, P < 0.001), while calcium arc, length, and maximum thickness of calcification in the intima did not. Dissection after RA occurred in 22 lesions (44%), and the stent expansion index was significantly better in dissected lesions than in lesions without dissection (0.96 ± 0.08 vs. 0.82 ± 0.19, P = 0.002). Multiple regression analysis showed that the minimum thickness of calcification in the intima (standardized coefficient: - 0.451, P < 0.001) and dissection formation (standardized coefficient: 0.316, P = 0.011) were predictors of good stent expansion. Minimum of thickness of calcification in the intima and dissection formation were positively associated with good stent expansion after RA. In the clinical setting, achieving these two endpoints should be the aim of RA to ensure good stent expansion.
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158
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Bryniarski KL, Yamamoto E, Takumi H, Xing L, Zanchin T, Sugiyama T, Lee H, Jang IK. Differences in coronary plaque characteristics between patients with and those without peripheral arterial disease. Coron Artery Dis 2017; 28:658-663. [DOI: 10.1097/mca.0000000000000531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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159
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Lee MS, Gordin JS, Stone GW, Sharma SK, Saito S, Mahmud E, Chambers J, Généreux P, Shlofmitz R. Orbital and rotational atherectomy during percutaneous coronary intervention for coronary artery calcification. Catheter Cardiovasc Interv 2017; 92:61-67. [PMID: 29045041 DOI: 10.1002/ccd.27339] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/24/2017] [Indexed: 11/09/2022]
Abstract
Severe coronary artery calcification (CAC) increases the complexity of percutaneous coronary intervention (PCI) by inhibiting optimal stent expansion, leading to an increased risk of death, myocardial infarction, repeat revascularization, and stent thrombosis. Coronary atherectomy modifies and debulks calcified plaque to facilitate PCI. Although there is no clear consensus, and further studies are needed, the decision to perform atherectomy should be based upon the presence of fluoroscopic CAC or with the use of intravascular imaging. The management of CAC in the modern era relies on rotational and orbital atherectomy to prepare the lesion to facilitate stent delivery and optimal expansion. While the two technologies differ in equipment, technique, and mechanism of action, the available literature suggests similar efficacy and safety of the two systems, although head-to-head comparisons are limited. While rotational and orbital atherectomy have been shown to have excellent procedural success in terms of facilitating stent delivery, no system has been shown to reduce long-term major adverse cardiovascular events, although the definitive trial for orbital atherectomy has not been completed. Additional trials are needed to find the population who would derive the most benefit of atherectomy and to compare the two systems in a prospective manner.
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Affiliation(s)
- Michael S Lee
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan S Gordin
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | | | | | | | - Jeff Chambers
- Metropolitan Heart and Vascular Institute, Mercy Hospital, Roslyn, New York
| | - Philippe Généreux
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
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160
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Smoking Habits of Patients Undergoing Treatment for Intermittent Claudication in the Vascular Quality Initiative. Ann Vasc Surg 2017; 44:261-268. [DOI: 10.1016/j.avsg.2017.04.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 12/29/2022]
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161
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In Vivo Calcium Detection by Comparing Optical Coherence Tomography, Intravascular Ultrasound, and Angiography. JACC Cardiovasc Imaging 2017; 10:869-879. [DOI: 10.1016/j.jcmg.2017.05.014] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 05/23/2017] [Accepted: 05/27/2017] [Indexed: 11/17/2022]
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162
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Hoang V, Grounds J, Pham D, Virani S, Hamzeh I, Qureshi AM, Lakkis N, Alam M. The Role of Intracoronary Plaque Imaging with Intravascular Ultrasound, Optical Coherence Tomography, and Near-Infrared Spectroscopy in Patients with Coronary Artery Disease. Curr Atheroscler Rep 2017; 18:57. [PMID: 27485540 DOI: 10.1007/s11883-016-0607-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The development of multiple diagnostic intracoronary imaging modalities has increased our understanding of coronary atherosclerotic disease. These imaging modalities, intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy (NIRS), have provided a method to study plaques and introduced the concept of plaque vulnerability. They are being increasingly used for percutaneous coronary intervention (PCI) optimization and are invaluable tools in research studying the pathophysiology of acute coronary syndrome (ACS), in-stent thrombosis and in-stent restenosis. IVUS has the ability to visualize the intracoronary lumen and the vessel wall and can be used to detect early atherosclerotic disease even in the setting of positive arterial remodeling. Studies supporting the use of IVUS to optimize stent deployment and apposition have shown a significant reduction in cardiovascular events. OCT provides even higher resolution imaging and near microscopic detail of plaques, restenoses, and thromboses; thus, it can identify the etiology of ACS. Ongoing trials are evaluating the role of OCT in PCI and using OCT to study stent endothelialization and neointimal proliferation. NIRS is a modality capable of localizing and quantifying lipid core burden. It is usually combined with IVUS and is used to characterize plaque composition. The benefits of NIRS in the setting of ACS have been limited to case reports and series. The utilization of all these intracoronary imaging modalities will continue to expand as their indications for clinical use and research grow. Studies to support their use for PCI optimization resulting in improved outcomes with potential to prevent downstream events are ongoing.
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Affiliation(s)
- Vu Hoang
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA
| | - Jill Grounds
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA
| | - Don Pham
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA
| | - Salim Virani
- Department of Internal Medicine, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development and Section of Cardiology, Baylor College of Medicine, Houston, USA
| | - Ihab Hamzeh
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA
| | - Athar Mahmood Qureshi
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Childrens Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Nasser Lakkis
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA
| | - Mahboob Alam
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, One Baylor Plaza MS: BCM 620, Houston, TX, 77030, USA.
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163
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Current clinical applications of coronary optical coherence tomography. Cardiovasc Interv Ther 2017; 33:1-10. [PMID: 28710605 PMCID: PMC5754371 DOI: 10.1007/s12928-017-0483-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/04/2017] [Indexed: 01/16/2023]
Abstract
Optical coherence tomography (OCT) is an intra-coronary diagnostic technique that provides detailed imagings of blood vessels in the current cardiac catheterization laboratory. The higher resolution of OCT often provides superior delineation of each structure compared with intravascular ultrasound (IVUS), and it can reliably visualize the microstructure of normal and diseased arteries. The capabilities of OCT are well suited for the identification of calcified plaque and neointima formation after stent implantation. It has been reported that OCT-guided percutaneous coronary intervention (PCI) resulted in equivalent clinical and angiographic outcomes in comparison with IVUS-guided PCI. Recently, the three-dimensional reconstruction of OCT and a real-time point-to-point correspondence between coronary angiographic and OCT/OFDI images have been developed and provide useful information to PCI operators. The unique capabilities of OCT as an investigational tool for high-risk lesions will serve the cardiology community well, as it moves us toward a better understanding of atherosclerotic plaque. In addition, because of the development of new OCT technology, OCT has become a notable catheter-based imaging technology that can provide practical guidance for PCI in clinical settings.
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164
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Tanaka A, Ruparelia N, Kawamoto H, Latib A, Colombo A, Stankovic G, Louvard Y. How should I treat recurrent restenosis with underexpanded multilayered struts after repeated complex bifurcation stenting? EUROINTERVENTION 2017; 12:1795-1798. [PMID: 28216477 DOI: 10.4244/eij-d-15-00246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Akihito Tanaka
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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165
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Numasawa Y, Sakakura K, Yamamoto K, Yamamoto S, Taniguchi Y, Fujita H, Momomura SI. A novel side branch protection technique in coronary stent implantation: Jailed Corsair technique. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:295-298. [PMID: 28119044 DOI: 10.1016/j.carrev.2017.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/07/2017] [Accepted: 01/11/2017] [Indexed: 12/01/2022]
Abstract
Side branch occlusion, which was one of the common complications in percutaneous coronary interventions, was closely associated with cardiac death and myocardial infarction. Clinical guidelines also support the importance of preservation of physiologic blood flow in SB during PCI to bifurcation lesions. In order to avoid side branch occlusion during stent implantation, we often performed the jailed wire technique, in which a conventional guide wire was inserted to the side branch before stent implantation to the main vessel. However, the jailed wire technique could not always prevent side branch occlusion. In this case report, we described a case of 72-year-old male suffering from angina pectoris. Coronary angiography revealed the diffuse calcified stenosis in the proximal and middle of left anterior descending coronary artery, and the large diagonal branch originated from the middle of the stenosis. To prevent side branch occlusion, we performed a novel side branch protection technique by using the Corsair microcatheter (Asahi Intecc, Nagoya, Japan). In this case report, we illustrated this "Jailed Corsair technique", and discussed the advantage compared to other side branch protection techniques such as the jailed balloon technique.
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Affiliation(s)
- Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shingo Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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166
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Iannaccone M, Piazza F, Boccuzzi G, D’Ascenzo F, Latib A, Pennacchi M, Rossi ML, Ugo F, Meliga E, Kawamoto H, Moretti C, Ielasi A, Garbo R, Frangieh A, Hildick-Smith D, Templin C, Colombo A, Sardella G. ROTational AThErectomy in acute coronary syndrome: early and midterm outcomes from a multicentre registry. EUROINTERVENTION 2016; 12:1457-1464. [DOI: 10.4244/eij-d-15-00485] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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167
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Predictors of acute scaffold recoil after implantation of the everolimus-eluting bioresorbable scaffold: an optical coherence tomography assessment in native coronary arteries. Int J Cardiovasc Imaging 2016; 33:145-152. [PMID: 27761749 DOI: 10.1007/s10554-016-0997-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/03/2016] [Indexed: 01/16/2023]
Abstract
This study investigated the predictors of acute recoil after implantation of everolimus-eluting BRS based on optical coherence tomography (OCT). Thirty-nine patients (56 scaffolds) were enrolled. Acute absolute recoil by quantitative coronary angiography was defined as the difference between the mean diameter of the last inflated balloon (X) and the mean lumen diameter of BRS immediately after balloon deflation (Y). Acute percent recoil was defined as (X - Y) × 100/X. Plaque eccentricity (PE) and plaque composition (PC) were assessed by OCT. PC was classified into two different types: calcific (score = 1), fibrous and lipid (score = 0). Based on the mean acute scaffold recoil value of the present study, scaffolds were divided into two groups: the low acute recoil group (LAR, n = 34) and the high acute recoil group (HAR, n = 22). Acute percent and absolute recoil were 6.4 ± 3.0 % and 0.19 ± 0.11 mm. PE, PC score and scaffold/artery ratio were significantly higher in HAR than in LAR. In multivariate logistic regression analysis, PE > 1.49, PC score (score 1) and scaffold/artery ratio >1.07 were significant positive predictors for the occurrence of acute scaffold recoil (OR 10.7, 95 % CI 2.2-51.4, p < 0.01; OR 5.6, 95 % CI 1.9-22.0, p = 0.04; OR 12.4, 95 % CI 2.6-65.4, p < 0.01, respectively). Acute recoil of BRS is influenced by BRS sizing as well as OCT-derived plaque characteristics.
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168
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Okuno S, Iida O, Shiraki T, Fujita M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Takahara M, Uematsu M. Impact of Calcification on Clinical Outcomes After Endovascular Therapy for Superficial Femoral Artery Disease. J Endovasc Ther 2016; 23:731-7. [DOI: 10.1177/1526602816656612] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To investigate whether the severity of lesion calcification assessed by the novel peripheral artery calcification scoring system (PACSS) was associated with clinical outcomes after endovascular therapy (EVT) for superficial femoral artery (SFA) lesions. Methods: A retrospective analysis was conducted of 394 consecutive patients (mean age 72±8 years; 290 men) with intermittent claudication [223 (57%) with diabetes, 81 (21%) on hemodialysis] who underwent successful EVT for de novo SFA lesions [length 152.1±95.7 mm; 199 (50%) TransAtlantic Inter-Society Consensus II class C/D] between January 2010 and December 2013. The patients were retrospectively categorized using the PACSS classification (grades 0–4: no visible calcification of the target lesion, unilateral wall calcification <5 cm, unilateral calcification ≥5 cm, bilateral wall calcification <5 cm, and bilateral calcification ≥5 cm, respectively). The main outcome was primary patency, while the secondary outcome measures were mortality and major adverse limb events [MALE: any intervention (repeat EVT or surgical revision) or major (above ankle) amputation]. Cox proportional hazards analysis was used to explore whether the PACSS classification was an independent predictor of clinical outcomes. Results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: The distribution of PACSS grades was 0 in 54%, grade 1 in 16%, grade 2 in 12%, grade 3 in 9%, and grade 4 in 9%. The 2-year primary patency rates in these grades, respectively, were 70.0%, 66.6%, 72.1%, 55.6%, and 36.3% (p<0.001). After multivariate analysis, PACSS grade 4 (HR 2.74, 95% CI 1.56 to 4.83, p<0.001), diabetes (HR 1.52, 95% CI 1.06 to 2.20, p=0.022), lesion length (HR 1.04, 95% CI 1.01 to 1.07, p=0.006), and vessel diameter (HR 0.80, 85% CI 0.65 to 0.98, p=0.038) were associated with loss of primary patency. PACSS grade 4 was also associated with MALE and mortality (p=0.048 and 0.011, respectively). Bare metal stent use (HR 0.47, 95% CI 0.30 to 0.73, p<0.001) was positively associated with primary patency. Conclusion: PACSS grade 4 calcification was independently associated with clinical outcomes after EVT for de novo SFA lesions.
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Affiliation(s)
- Shota Okuno
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Tatsuya Shiraki
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Masashi Fujita
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaaki Uematsu
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
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169
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Yamada R, Okura H, Kume T, Fukuhara K, Koyama T, Higa T, Neishi Y, Yoshida K, Uemura S. Impact of stent platform on longitudinal stent deformation: an in vivo frequency domain optical coherence tomography study. Cardiovasc Interv Ther 2016; 32:199-205. [PMID: 27226007 DOI: 10.1007/s12928-016-0403-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/07/2016] [Indexed: 11/28/2022]
Abstract
Recently, longitudinal coronary stent deformation has been highlighted as a possible cause of drug-eluting stent failure. Although bench tests and in vivo studies have demonstrated difference in longitudinal stent strength among the stents with different platforms, its clinical impact is still unknown. Furthermore, it is unknown if modified stent platform favorably affect the incidence of stent deformation. The aim of this study was to investigate the longitudinal deformation of the everolimus-eluting stents (EES) with different stent platforms by using frequency domain optical coherence tomography (FD-OCT). Seventy-eight lesions treated with EES (Xience Prime: n = 26, Promus element: n = 29, Promus premier: n = 23) were studied. After successful stent implantation, FD-OCT was performed and stent length was measured using three-dimensional reconstruction of the images in vivo. Percent longitudinal stent shortening (%SS) was defined as the in vivo stent length divided by nominal stent length. Longitudinal stent deformation was defined as %SS > 10 %. Patients' and procedural characteristics were similar among 3 EESs. There was no difference in mean %SS between Xience Prime, Promus Element and Promus Premier (1.0 ± 5.8, 2.9 ± 6.7 and 0.8 ± 3.7 %, p = 0.322). Incidence of the longitudinal stent deformation was significantly higher in Promus Element than the other stents (0, 13.8 and 0 %, p = 0.028). Incidence of longitudinal stent deformation was different between EESs with different stent platforms. Stent material, stent design and/or stent delivery balloon may affect longitudinal stent deformation.
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Affiliation(s)
- Ryotaro Yamada
- Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
| | - Hiroyuki Okura
- Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Teruyoshi Kume
- Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Kenzo Fukuhara
- Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Terumasa Koyama
- Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Tomitaka Higa
- Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Yoji Neishi
- Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Kiyoshi Yoshida
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Shiro Uemura
- Division of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
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170
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Iannaccone M, Barbero U, D'ascenzo F, Latib A, Pennacchi M, Rossi ML, Ugo F, Meliga E, Kawamoto H, Moretti C, Ielasi A, Garbo R, Colombo A, Sardella G, Boccuzzi GG. Rotational atherectomy in very long lesions: Results for the ROTATE registry. Catheter Cardiovasc Interv 2016; 88:E164-E172. [PMID: 27083771 DOI: 10.1002/ccd.26548] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/28/2016] [Accepted: 03/11/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Rotational atherectomy (RA) is relatively contraindicated in patients with lesions ≥25 mm of length. Aim of this study was to evaluate RA safety and efficacy in this subset of patients with new technology and devices. METHODS AND RESULTS From April 2002 to August 2013, the ROTATE registry included all consecutive patients undergoing RA in 8 centres. They were divided into shorter lesion group (SLG, lesions < 25 mm) and longer lesion group (LLG, lesions ≥ 25 mm). The angiographic success (AS) was the primary end point. Procedural complications (PC), a composite end point of procedural perforation, slow flow/no flow, and in-hospital major acute cardiovascular events (MACE), were secondary end points, along with death, nonfatal MI, target lesion revascularization, and MACE during follow-up. Sensitivity analysis was performed according to generation of DES. 1186 patients were included: 51.5% in SLG and 48.4% in LLG. Mean age was 70.4 ± 9.3 years, 64.5% were male. AS and PC did not differ between the two groups (93% vs 91%, p = 0.24 and 9.8 vs 9.4%, p = 0.84). During follow-up (27.6 ± 22.9 months), MACE did not differ between the two groups (28% vs 29.1%, p = 0.95). At multivariate analysis chronic kidney disease, male gender increased risk of MACE (HR 1.94, IQR 1.29-2.0, p = 0.01, HR 0.52, IQR 0.34-0.79, p = 0.01) while second-generation DES seemed protective (HR 0.53, IQR 0.31-0.88, p = 0.02). Data were confirmed at sensitivity analysis for second-generation DES (759 pts, 63.9%). No differences were found in this subpopulation between the two groups in term of AS, PC, and long-term MACE (93.6% vs 93.5%, p = 0.28, 11.9% vs 9.4%, p = 0.32 and 25.5% vs 23.9%, p = 0.72, respectively). CONCLUSIONS Treating coronary lesions ≥ 25 mm length with RA does not impact short- and long-term outcome, in particular, in patients with second-generation DES. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mario Iannaccone
- "Citta' Della Scienza e della Salute", University of Turin, Italy
| | - Umberto Barbero
- "Citta' Della Scienza e della Salute", University of Turin, Italy
| | | | - Azeem Latib
- Italy and EMO-GVM Centro Cuore Columbus, San Raffaele Scientific Institute, Milan, Milan, Italy
| | - Mauro Pennacchi
- Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | | | - Fabrizio Ugo
- Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy
| | - Emanuele Meliga
- Interventional Cardiology Unit, a.O. Ordine Mauriziano Umberto I, Turin, Italy
| | | | - Claudio Moretti
- "Citta' Della Scienza e della Salute", University of Turin, Italy
| | - Alfonso Ielasi
- Department of Cardiology, Azienda Ospedaliera Bolognini Seriate, Italy
| | - Roberto Garbo
- Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy
| | - Antonio Colombo
- Italy and EMO-GVM Centro Cuore Columbus, San Raffaele Scientific Institute, Milan, Milan, Italy
| | - Gennaro Sardella
- Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Italy
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171
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Affiliation(s)
- Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
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172
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173
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Mintz GS. Intravascular imaging of coronary calcification and its clinical implications. JACC Cardiovasc Imaging 2016; 8:461-471. [PMID: 25882575 DOI: 10.1016/j.jcmg.2015.02.003] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/21/2015] [Accepted: 02/12/2015] [Indexed: 12/21/2022]
Abstract
Calcium impacts the natural history and treatment of coronary artery disease in many ways. Intravascular imaging studies, mostly intravascular ultrasound, but more recently studies using optical coherence tomography, have been instrumental in increasing our understanding of the relationship between calcium and coronary atherosclerosis, the predictors, the natural history of this relationship, and the impact on treatment. On one hand, stable coronary lesions are associated with more calcium than unstable lesions; and the amount of calcium may affect the success of percutaneous coronary intervention. On the other hand, calcium correlates with plaque burden; unstable lesions are associated with focal calcium deposits; and calcific nodules are one of the morphologies of vulnerable plaque. This review focuses on more than 20 years of intravascular imaging studies of the relationship between calcium and coronary atherosclerosis.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, New York.
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174
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Shimamura K, Guagliumi G. Optical Coherence Tomography for Online Guidance of Complex Coronary Interventions. Circ J 2016; 80:2063-72. [PMID: 27616595 DOI: 10.1253/circj.cj-16-0846] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Giulio Guagliumi
- Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII
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175
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Maejima N, Hibi K, Saka K, Akiyama E, Konishi M, Endo M, Iwahashi N, Tsukahara K, Kosuge M, Ebina T, Umemura S, Kimura K. Relationship Between Thickness of Calcium on Optical Coherence Tomography and Crack Formation After Balloon Dilatation in Calcified Plaque Requiring Rotational Atherectomy. Circ J 2016; 80:1413-9. [DOI: 10.1253/circj.cj-15-1059] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center
| | - Kenichiro Saka
- Division of Cardiology, Yokohama City University Medical Center
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center
| | - Mitsuaki Endo
- Division of Cardiology, Yokohama City University Medical Center
| | | | - Kengo Tsukahara
- Division of Cardiology, Yokohama City University Medical Center
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center
| | - Satoshi Umemura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
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176
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Drug-Eluting Stent Implantation on Calcified Nodule. JACC Cardiovasc Interv 2015; 8:e127-e128. [DOI: 10.1016/j.jcin.2015.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 02/26/2015] [Indexed: 11/21/2022]
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177
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Kubo T, Shimamura K, Ino Y, Yamaguchi T, Matsuo Y, Shiono Y, Taruya A, Nishiguchi T, Shimokado A, Teraguchi I, Orii M, Yamano T, Tanimoto T, Kitabata H, Hirata K, Tanaka A, Akasaka T. Superficial Calcium Fracture After PCI as Assessed by OCT. JACC Cardiovasc Imaging 2015; 8:1228-1229. [PMID: 25797130 DOI: 10.1016/j.jcmg.2014.11.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/05/2014] [Accepted: 11/05/2014] [Indexed: 11/27/2022]
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178
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Kubo T, Yamano T, Liu Y, Ino Y, Shiono Y, Orii M, Taruya A, Nishiguchi T, Shimokado A, Teraguchi I, Tanimoto T, Kitabata H, Yamaguchi T, Hirata K, Tanaka A, Akasaka T. Feasibility of Optical Coronary Tomography in Quantitative Measurement of Coronary Arteries With Lipid-Rich Plaque. Circ J 2015; 79:600-6. [DOI: 10.1253/circj.cj-14-1085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yong Liu
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Makoto Orii
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Aiko Shimokado
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Ikuko Teraguchi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | | | - Kumiko Hirata
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Atsuhi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
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179
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Neishi Y, Okura H, Kume T, Fukuhara K, Yamada R, Yoshida K. Prediction of Chronic Vessel Enlargement by a Novel Intravascular Ultrasound Finding. Circ J 2015; 79:607-12. [DOI: 10.1253/circj.cj-14-0917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoji Neishi
- Division of Cardiology, Kawasaki Medical School
| | | | | | | | | | - Kiyoshi Yoshida
- Department of Cardiology, The Sakakibara Heart Institute of Okayama
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180
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Koga S, Ikeda S, Miura M, Yoshida T, Nakata T, Koide Y, Kawano H, Maemura K. iMap-Intravascular Ultrasound Radiofrequency Signal Analysis Reflects Plaque Components of Optical Coherence Tomography-Derived Thin-Cap Fibroatheroma. Circ J 2015; 79:2231-7. [DOI: 10.1253/circj.cj-15-0393] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Seiji Koga
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Miyuki Miura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Takeo Yoshida
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Tomoo Nakata
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Yuji Koide
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
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181
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Hibi K, Kimura K, Umemura S. Clinical Utility and Significance of Intravascular Ultrasound and Optical Coherence Tomography in Guiding Percutaneous Coronary Interventions. Circ J 2014; 79:24-33. [DOI: 10.1253/circj.cj-14-1044] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Satoshi Umemura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
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