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Mattesini A, Demola P, Shlofmitz R, Shlofmitz E, Waksman R, Jaffer FA, Di Mario C. Optical Coherence Tomography, Near‐Infrared Spectroscopy, and Near‐Infrared Fluorescence Molecular Imaging. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Impact of stent edge dissection detected by optical coherence tomography after current-generation drug-eluting stent implantation. PLoS One 2021; 16:e0259693. [PMID: 34735528 PMCID: PMC8568188 DOI: 10.1371/journal.pone.0259693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Stent edge dissection (SED) is a well-known predictor of worse clinical outcomes. However, impact of SED after current-generation drug-eluting stent (DES) implantation remains unknown since there was no study using only current-generation DES to assess impact of SED. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation. Methods This study enrolled 175 patients receiving OCT after current-generation DES implantation. The SED group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR). Results Of 175 patients, SED detected by OCT was observed in 32 patients, while 143 patients did not show SED. In the crude population, the SED group showed a significantly higher incidence of CD-TLR, definite stent thrombosis, TV-MI and cardiac death relative to the non-SED group. After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of MACE compared with the non-SED group (hazard ratio 3.43, 95% confidence interval 1.09–10.81, p = 0.035). Fibrocalcific or lipidic plaques, greater lumen eccentricity, and stent-oversizing were the predictors of SED. Conclusions SED detected by OCT after the current-generation DES implantation led to unfavorable outcomes. Aggressive post-dilatation around the stent edge might worse clinical outcomes due to SED, although achievement of optimal stent expansion is strongly encouraged to improve clinical outcomes.
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Sibbald M, Pinilla-Echeverri N, Alameer M, Chavarria J, Dutra G, Sheth T. Using Optical Coherence Tomography to Identify Lipid and Its Impact on Interventions and Clinical Events - A Scoping Review. Circ J 2021; 85:2053-2062. [PMID: 34305071 DOI: 10.1253/circj.cj-21-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Optical coherence tomographic (OCT) imaging has enabled identification of lipid, with increasing interest in how it may affect coronary interventions and clinical outcomes. This review summarizes the available evidence around OCT identification of lipid and its effect on interventions, clinical events, and the natural history of coronary disease.Methods and Results:We conducted a scoping review using the Medline, HealthStar, and Embase databases for articles published between 1996 and 2021. We screened 1,194 articles and identified 51 for inclusion in this study, summarizing the key findings. The literature supports a common OCT definition of lipid as low-signal regions with diffuse borders, validated against histology and other imaging modalities with acceptable intra- and inter-rater reliability. There is evidence that OCT-identified lipid at the site of stent implantation increases the risk of edge dissection, incomplete stent apposition, in-stent tissue protrusion, decreased coronary flow after stenting, side branch occlusion, and post-procedural cardiac biomarker increases. In mostly retrospective studies, lipid indices measured at non-stented sites are associated with plaque progression and the development of recurrent ischemic events. CONCLUSIONS There is extensive literature supporting the ability of OCT to identify lipid and demonstrating a substantial impact of lipid on percutaneous coronary intervention outcomes. Future work to prospectively evaluate the effect of the characteristics of lipid-rich plaques on long-term clinical outcomes is needed.
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Affiliation(s)
| | | | | | | | | | - Tej Sheth
- Department of Medicine, McMaster University.,Population Health Research Institute, McMaster University
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Shlofmitz E, Ali ZA, Maehara A, Mintz GS, Shlofmitz R, Jeremias A. Intravascular Imaging-Guided Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2020; 13:e008686. [DOI: 10.1161/circinterventions.120.008686] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite consistent clinical data supporting the use of intravascular imaging with percutaneous coronary intervention, utilization remains low. A practical and standardized approach to incorporating intravascular imaging with percutaneous coronary intervention may overcome the barriers to utilization. This review focuses on basic image interpretation with intravascular ultrasound and optical coherence tomography and proposes an algorithmic approach to stent sizing and optimization. Incorporation of this strategic method for percutaneous coronary intervention may aid in the greater adoption of intravascular imaging for percutaneous coronary intervention.
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Affiliation(s)
- Evan Shlofmitz
- St. Francis Hospital, The Heart Center, Roslyn, NY (E.S., Z.A.A., R.S., A.J.)
| | - Ziad A. Ali
- St. Francis Hospital, The Heart Center, Roslyn, NY (E.S., Z.A.A., R.S., A.J.)
- Columbia University Medical Center, New York, NY (Z.A.A., A.M.)
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
| | - Akiko Maehara
- Columbia University Medical Center, New York, NY (Z.A.A., A.M.)
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
| | - Gary S. Mintz
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
| | - Richard Shlofmitz
- St. Francis Hospital, The Heart Center, Roslyn, NY (E.S., Z.A.A., R.S., A.J.)
| | - Allen Jeremias
- Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., G.S.M., A.J.)
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Cho JY, Kook H, Yu CW. Clinical impact of angiographically insignificant suboptimal poststent findings detected by optical coherence tomography after drug-eluting stent implantation. PLoS One 2020; 15:e0240860. [PMID: 33075066 PMCID: PMC7571690 DOI: 10.1371/journal.pone.0240860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022] Open
Abstract
Background Although optical coherence tomography (OCT)-detected suboptimal findings (SF-OCT) such as malapposition, edge dissection, tissue protrusion, thrombus and small minimal stent area (MSA) are frequently observed after the implantation of drug-eluting stents (DES), their clinical implications are controversial. Hypothesis Clinical outcomes may differ between patients with SF-OCTs and without SF-OCTs after DES implantation. Methods A total of 576 patients undergoing OCT analysis after DES implantation were divided into SF-OCT group (n = 379, 379 lesions) and No SF-OCT group (n = 197, 197 lesions). The study population had no significant abnormal finding in final angiography. Quantification was performed for each SF-OCT. The incidences of major adverse cardiovascular events (MACE: all-cause death, non-fatal myocardial infarction, target vessel revascularization, and stent thrombosis) were compared between the two groups. A median follow-up duration was 21.5 months. Results Among 379 patients with SF-OCT, 32.4% had multiple SF-OCTs. Malapposition (32.1%, IQR of maximal depth 315–580 μm) was the most frequent, followed by small MSA (31.6%), edge dissection (12.5%, IQR of maximal flap of opening 0.27–0.52 mm), thrombus (7.6%, IQR of diameter 1.31–1.97mm) and tissue protrusion (6.8%, IQR of diameter 1.05–1.67 mm). The SF-OCT group showed smaller stent diameter and longer stent length, and lower in-stent lumen expansion rate. The incidence of MACE did not differ between the two groups (3.0% for No SF-OCT vs. 5.0% for SF-OCT; HR 1.601; 95% CI 0.639 to 4.011; P = 0.310). Conclusions The presence of angiographically insignificant SF-OCTs were not associated with clinical outcomes in this study.
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Affiliation(s)
- Jae Young Cho
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Hyungdon Kook
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
- * E-mail:
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Takagi K, Nagoshi R, Kim BK, Kim W, Kinoshita Y, Shite J, Hikichi Y, Song YB, Nam CW, Koo BK, Kim SJ, Murasato Y. Efficacy of coronary imaging on bifurcation intervention. Cardiovasc Interv Ther 2020; 36:54-66. [PMID: 32894433 PMCID: PMC7829226 DOI: 10.1007/s12928-020-00701-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/14/2023]
Abstract
During the coronary bifurcation intervention procedure, imaging including intravascular ultrasound and optical coherence tomography is essential to provide precise anatomy of the lesion and morphological information. This consensus document between the Korean Bifurcation Club and the Japanese Bifurcation Club summarizes practical guidelines and current evidences on lesion assessment, device selection, procedural guidance, and the optimization of bifurcation intervention by the imaging.
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Affiliation(s)
- Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Byeong-Keuk Kim
- Department of Cardiology, Yonsei Severance Hospital, Seoul, South Korea
| | - Woong Kim
- Department of Cardiology, Yeungnam Medical Center, Daegu, South Korea
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | | | - Young Bin Song
- Department of Cardiology, Samsung Medical Center, Seoul, South Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Soo-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Center, National Hospital Organization, Kyushu Medical Center, 1-8-1, Jigyohama, Chuo, Fukuoka, 810-8563, Japan.
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Stent strut thickness and acute vessel injury during percutaneous coronary interventions: an optical coherence tomography randomized clinical trial. Coron Artery Dis 2020; 32:382-390. [PMID: 32826450 DOI: 10.1097/mca.0000000000000943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Compare the degree of acute vascular injury caused by a polymer-free, thin-strut drug-eluting stent (DES) to that caused by a bioresorbable polymer, thick-strut DES using optical coherence tomography (OCT). METHODS AND RESULTS Fifty patients requiring nonurgent PCI were randomized to receive either a thin or a thick-strut DES. OCT was performed before and after stent implantation. OCT-based injury score (IS) after implantation was numerically higher within thick-strut stents 0.32 vs. 0.23, but the difference was NS (P = 0.61). Edge dissections were present in 36% of the patients without differences between groups. Tissue prolapse (TP) area was larger with thin-strut stents (2.26 vs. 1.83 mm2, P = 0.04). Stent expansion and symmetry index were similar between the two platforms (85% vs. 94%, P = 0.08; and 0.82 vs. 0.80, P = 0.25). No differences were observed in total malapposition area (1.85 mm2 in thin-strut stents vs. 1.47 mm2, P = 0.48). Regarding the influence of plaque-type, IS tended to be higher (non-significant) with thick strut DES in fibrocalcific plaques. Stent malapposition area was smaller in fibrous plaques, especially with thin strut stents (P = 0.03). CONCLUSION There was no difference in the extent of OCT-based vessel injury associated with thin and thick-strut DES platforms. TP was larger with the thin strut DES, potentially reflecting a deeper stent embedment in the vessel wall.
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Fully automated plaque characterization in intravascular OCT images using hybrid convolutional and lumen morphology features. Sci Rep 2020; 10:2596. [PMID: 32054895 PMCID: PMC7018759 DOI: 10.1038/s41598-020-59315-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/17/2020] [Indexed: 11/28/2022] Open
Abstract
For intravascular OCT (IVOCT) images, we developed an automated atherosclerotic plaque characterization method that used a hybrid learning approach, which combined deep-learning convolutional and hand-crafted, lumen morphological features. Processing was done on innate A-line units with labels fibrolipidic (fibrous tissue followed by lipidous tissue), fibrocalcific (fibrous tissue followed by calcification), or other. We trained/tested on an expansive data set (6,556 images), and performed an active learning, relabeling step to improve noisy ground truth labels. Conditional random field was an important post-processing step to reduce classification errors. Sensitivities/specificities were 84.8%/97.8% and 91.4%/95.7% for fibrolipidic and fibrocalcific plaques, respectively. Over lesions, en face classification maps showed automated results that agreed favorably to manually labeled counterparts. Adding lumen morphological features gave statistically significant improvement (p < 0.05), as compared to classification with convolutional features alone. Automated assessments of clinically relevant plaque attributes (arc angle and length), compared favorably to those from manual labels. Our hybrid approach gave statistically improved results as compared to previous A-line classification methods using deep learning or hand-crafted features alone. This plaque characterization approach is fully automated, robust, and promising for live-time treatment planning and research applications.
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Huang J, Belmadani K, Chatot M, Ecarnot F, Chopard R, Wang M, Cai X, Schiele F, Meneveau N. Clinical significance of optical coherence tomography-guided angioplasty on treatment selection. Exp Ther Med 2018; 16:483-492. [PMID: 30116307 PMCID: PMC6090244 DOI: 10.3892/etm.2018.6237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 09/29/2017] [Indexed: 01/26/2023] Open
Abstract
The present study aimed to observe whether optical coherence tomography (OCT)-guided angioplasty is able to provide useful clinical information beyond that obtained by angiography as well as provide recommendations for physicians that may improve treatment selection. This prospective study included 83 patients with coronary artery disease (>18 years) undergoing coronary angiography (CAG) for ST-elevation myocardial infarction (n=13), non-ST-elevation myocardial infarction (n=19), stable angina (n=22), unstable angina (n=10), silent ischemia (n=11), or elective percutaneous coronary intervention (n=8). Following the initial CAG (CAG-pre), the patients underwent OCT before angioplasty (OCT-pre, 24 patients), after angioplasty (OCT-post, 22 patients), or both (37 patients). The thrombus burden, calcification and plaque dissection or rupture were compared between the OCT-pre and CAG-pre recordings. Following angioplasty, stent malapposition, suboptimal stent deployment, suboptimal stent lesion coverage, and edge dissection were compared between OCT-post and CAG-post alone. Among the 83 patients, 45.7% had single-vessel and 54.3% had multiple-vessel disease. OCT pre- and post-angioplasty revealed significantly more information on the procedure than CAG alone. This clinical information changed the clinical strategies in 41/83 (49.4%) patients, including 58 modifications of therapeutic strategy (69.9%, 58/83): Thrombus aspiration in 2 cases (2.4%), administration of glycoprotein IIb/IIIa inhibitors in 8 cases (9.6%), additional balloon inflation in 23 cases (27.7%), additional stent implantation in 17 cases (20.5%), avoiding stent implantation in 4 cases (4.8%), collateral intervention in 2 cases (2.4%), and guidewire reposition in 2 cases (2.4%). In conclusion, OCT-pre and OCT-post provided additional clinical information beyond that obtained by angiography alone, which resulted in modification of the treatment strategies in half of the included patients.
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Affiliation(s)
- Jianfeng Huang
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon 25030, France.,Department of Cardiology, Yueqing Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325600, P.R. China
| | - Kamal Belmadani
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon 25030, France
| | - Marion Chatot
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon 25030, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon 25030, France
| | - Romain Chopard
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon 25030, France
| | - Manhong Wang
- Department of Cardiology, Yueqing Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325600, P.R. China
| | - Xu Cai
- Department of Cardiology, Ningbo University Hospital, Ningbo, Zhejiang 315000, P.R. China
| | - Francois Schiele
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon 25030, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon 25030, France
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10
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Song HG, Kang SJ, Mintz GS. Value of intravascular ultrasound in guiding coronary interventions. Echocardiography 2018; 35:520-533. [DOI: 10.1111/echo.13837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Hae Geun Song
- Department of Cardiology; DeltaHealth Hospital; Shanghai China
| | - Soo-Jin Kang
- Department of Cardiology; Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
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Lu H, Kalkman DN, Grundeken MJ, Tijssen JGP, Wykrzykowska JJ, de Winter RJ, Koch KT. Does the novel delivery system for the STENTYS self-apposing coronary stent increase the risk of stent edge dissections? Optical coherence tomography post stent findings. Expert Rev Med Devices 2017; 15:157-165. [PMID: 29284310 DOI: 10.1080/17434440.2018.1421942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND With optical coherence tomography (OCT), details of arterial injuries during percutaneous coronary intervention can be assessed accurately. There might be an increased risk of stent edge dissections with the novel delivery system for the STENTYS stent. We evaluated the prevalence of stent edge dissections using the novel Xposition delivery device as compared with the conventional delivery device. METHODS A total of 38 patients who were treated with the self-apposing STENTYS stent and with OCT assessment at our center were retrospectively analysed. Twenty patients were treated using the Xposition- and 18 using the conventional delivery device. OCT was performed according to study protocol. Frames with poor quality were excluded. RESULTS A total of 12(18%) dissections were detected, 7(20%) in the Xposition delivery device group, and 5(15%) in the conventional group (p = 1). Using the Xposition delivery device 4(33%) dissections were found proximally, using the conventional delivery device 3(25%) (p = ns). Mean longitudinal dissection length was 2.07 ± 1.80mm, 8(67%) appeared as flaps, 4(33%) as cavities. Morphometric parameters were comparable in both groups. CONCLUSIONS Detailed OCT assessment of stent edge dissections was possible, which revealed no large differences using the Xposition delivery device as compared with conventional delivery device, however large studies are warranted.
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Affiliation(s)
- Huangling Lu
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Deborah N Kalkman
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Maik J Grundeken
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Jan G P Tijssen
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | | | - Robbert J de Winter
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Karel T Koch
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
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Bryniarski KL, Walters DL, Kim CJ, Soeda T, Higuma T, Yamamoto E, Xing L, Sugiyama T, Zanchin T, Bryniarski L, Dudek D, Lee H, Jang IK. SYNTAX Score and Pre- and Poststent Optical Coherence Tomography Findings in the Left Anterior Descending Coronary Artery in Patients With Stable Angina Pectoris. Am J Cardiol 2017; 120:898-903. [PMID: 28750824 DOI: 10.1016/j.amjcard.2017.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/23/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Abstract
SYNTAX score (SS) has been reported to be an independent predictor of future cardiac events including target lesion revascularization. The aim of this study was to assess the relation between SS and plaque characteristics and poststent vascular response using optical coherence tomography in coronary artery tree and left anterior descending artery (LAD) in patients with stable angina. A total of 179 lesions among 165 patients, including 100 lesions in LAD, were analyzed. Patients were stratified into tertiles. In pre-percutaneous coronary intervention analysis of whole coronary tree and LAD, lesions of the third tertile had the highest prevalence of lipid-rich plaque. Compared with the first tertile, the third tertile had greater lipid index, thinner fibrous cap, and higher prevalence of thin-cap fibroatheroma. In poststent optical coherence tomography, the incidence of stent edge dissection and irregular protrusion was higher in the third tertile compared with the first tertile in coronary tree analysis. In LAD analysis, the prevalence of irregular protrusion was the highest in the third tertile. In conclusion, high SS may reflect higher plaque vulnerability. Stent edge dissection and irregular protrusion were more frequent in patients with higher SS, indicating poor vascular response to stenting. Our results may explain higher cardiac event rate and target lesion revascularization in patients with higher SS.
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Song HG, Kang SJ. Current Clinical Applications of Intravascular Ultrasound in Coronary Artery Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Tenekecioglu E, Albuquerque FN, Sotomi Y, Zeng Y, Suwannasom P, Tateishi H, Cavalcante R, Ishibashi Y, Nakatani S, Abdelghani M, Dijkstra J, Bourantas C, Collet C, Karanasos A, Radu M, Wang A, Muramatsu T, Landmesser U, Okamura T, Regar E, Räber L, Guagliumi G, Pyo RT, Onuma Y, Serruys PW. Intracoronary optical coherence tomography: Clinical and research applications and intravascular imaging software overview. Catheter Cardiovasc Interv 2017; 89:679-689. [DOI: 10.1002/ccd.26920] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/19/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Erhan Tenekecioglu
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Felipe N. Albuquerque
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine; Atlanta United States
| | - Yohei Sotomi
- Academic Medical Center-University of Amsterdam; Amsterdam The Netherlands
| | - Yaping Zeng
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Pannipa Suwannasom
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
- Academic Medical Center-University of Amsterdam; Amsterdam The Netherlands
| | - Hiroki Tateishi
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Rafael Cavalcante
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Yuki Ishibashi
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Shimpei Nakatani
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | | | - Jouke Dijkstra
- Leiden University Medical Center; Leiden The Netherlands
| | | | - Carlos Collet
- Academic Medical Center-University of Amsterdam; Amsterdam The Netherlands
| | - Antonios Karanasos
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Maria Radu
- Copenhagen University Hospital; Copenhagen Denmark
| | - Ancong Wang
- Leiden University Medical Center; Leiden The Netherlands
| | | | | | | | - Evelyn Regar
- Department of Cardiovascular Surgery; University Hospital Zürich; Switzerland
| | | | | | - Robert T. Pyo
- Albert Einstein College of Medicine; Montefiore Medical Center; NY
| | - Yoshinobu Onuma
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
| | - Patrick W. Serruys
- Erasmus University Medical Centre, Thoraxcenter; Rotterdam The Netherlands
- International Centre for Circulatory Health, Imperial College; London United Kingdom
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Sugiyama T, Jang IK. Optical Coherence Tomography for Study of In Vivo Pathobiology and for Optimization of Percutaneous Coronary Intervention. ACTA ACUST UNITED AC 2017. [DOI: 10.15791/angioscopy.re.17.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tomoyo Sugiyama
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School
- Division of Cardiology, Kyung Hee University Hospital
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16
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Kilic ID, Serdoz R, Fabris E, Jaffer FA, Di Mario C. Optical Coherence Tomography, Near-Infrared Spectroscopy, and Near-Infrared Fluorescence Molecular Imaging. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ismail Dogu Kilic
- Department of Cardiology; Pamukkale University Hospitals; Denizli Turkey
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London
- NHLI Imperial College; London UK
| | - Roberta Serdoz
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London
- NHLI Imperial College; London UK
| | - Enrico Fabris
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London
- NHLI Imperial College; London UK
- Cardiovascular Department; Ospedali Riuniti and University of Trieste; Trieste Italy
| | - Farouc Amin Jaffer
- Cardiology Division, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Carlo Di Mario
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London
- NHLI Imperial College; London UK
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Optical coherence tomography assessment of incidence, morphological characteristics, and spontaneous healing course of edge dissections following percutaneous coronary intervention with stent implantation in patients with non-ST segment elevation myocardial infarction. Int J Cardiol 2016; 223:466-474. [PMID: 27544607 DOI: 10.1016/j.ijcard.2016.08.245] [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: 02/21/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stenting-induced edge dissections (ED) can be assessed in detail by optical coherence tomography (OCT). This study sought to investigate the incidence, morphological characteristics, and spontaneous healing course of OCT-identified EDs following drug-eluting stent (DES) implantation in a non-ST segment elevation myocardial infarction (NSTEMI) patient-population. METHODS Acute vessel wall injury at the 5-mm stent adjacent distal and proximal reference segments was assessed by post-procedure OCT and intravascular ultrasound (IVUS) in n=97 NSTEMI-patients (n=97 lesions). Six months OCT follow-up was available in 82 patients (including 35 untreated post-procedure EDs). RESULTS The overall incidence of post-procedure OCT-detected ED was 38 per 97 patients (39.2%), and 47 per 182 stent edges (25.8%). None of the EDs were angiographically visualizable, while 10 (21.3%) were visible on concomitant IVUS-analysis. Morphologically, there was a significant difference in plaque type present at ED-edges vs. non-ED-edges when assessed with OCT; (1) lipid-rich and calcified plaques: 80.9% vs. 57.0%, (2) fibrous plaques: 17.0% vs. 26.7%, and (3) normal coronary vessels: 2.1% vs. 16.3%, p<0.01. Plaqueburden, assessed by IVUS, was substantially larger at ED-containing borders: 54.5±10.0% vs. 43.7±11.6%, p=0.01. Three dissections (8.6%) were incompletely healed at 6-month OCT follow-up. None of the EDs caused cardiac events during the 6-month follow-up, however, 1 ED-patient had target lesion revascularization with PCI and DES-implantation in extension of the scheduled OCT-control. CONCLUSIONS OCT-detected EDs were frequent after stent implantation due to NSTEMI, and the majority of these EDs healed without leading to an adverse prognosis at 6months.
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18
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Davis LA, Stewart SE, Carsten CG, Snyder BA, Sutton MA, Lessner SM. Characterization of fracture behavior of human atherosclerotic fibrous caps using a miniature single edge notched tensile test. Acta Biomater 2016; 43:101-111. [PMID: 27431877 DOI: 10.1016/j.actbio.2016.07.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 07/05/2016] [Accepted: 07/14/2016] [Indexed: 01/13/2023]
Abstract
UNLABELLED One well-established cause of ischemic stroke is atherosclerotic plaque rupture in the carotid artery. Rupture occurs when a tear in the fibrous cap exposes highly thrombogenic material in the lipid core. Though some fibrous cap material properties have been measured, such as ultimate tensile strength and stress-strain responses, there has been very little, if any, data published regarding the fracture behavior of atherosclerotic fibrous caps. This study aims to characterize the qualitative and quantitative fracture behavior of human atherosclerotic plaque tissue obtained from carotid endarterectomy samples using two different metrics. Uniaxial tensile experiments along with miniature single edge notched tensile (MSENT) experiments were performed on strips of isolated fibrous cap. Crack tip opening displacement (CTOD) and stress in the un-cracked segment (UCS) were measured at failure in fibrous cap MSENT specimens subjected to uniaxial tensile loading. Both CTOD and the degree of crack blunting, measured as the radius of curvature of the crack tip, increased as tearing propagated through the tissue. Higher initial stress in the UCS is significantly correlated with higher collagen content and lower macrophage content in the fibrous cap (ρ=0.77, P=0.009; ρ=-0.64, P=0.047; respectively). Trends in the data show that higher CTOD is inversely related to collagen content, though the sample size in this study is insufficient to statistically substantiate this relationship. To the authors' knowledge, this is the pioneering study examining the fracture behavior of fibrous caps and the first use of the CTOD metric in vascular tissue. STATEMENT OF SIGNIFICANCE A tear in the fibrous cap of atherosclerotic plaque can lead to ischemic stroke or myocardial infarction. While there is some information in the literature regarding quantitative measures of fibrous cap failure, there is little information regarding the behavior of the tissue during failure. This study examines the failure behavior of fibrous caps both qualitatively, by examining how and where the tissue fails, and quantitatively, by measuring (a) crack tip opening displacement (CTOD) in vascular tissue for the first time and (b) uniaxial stress in the un-cracked segment (UCS). This study shows that both metrics should be evaluated when assessing plaque vulnerability.
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Affiliation(s)
- Lindsey A Davis
- Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208 USA; Department of Cell Biology and Anatomy, University of South Carolina, School of Medicine, 6439 Garners Ferry Road, Columbia, SC 29209 USA
| | - Samantha E Stewart
- Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208 USA; Department of Cell Biology and Anatomy, University of South Carolina, School of Medicine, 6439 Garners Ferry Road, Columbia, SC 29209 USA
| | - Christopher G Carsten
- Division of Vascular Surgery, Greenville Health System, 701 Grove Road, Greenville, SC 29605 USA
| | - Bruce A Snyder
- Division of Vascular Surgery, Greenville Health System, 701 Grove Road, Greenville, SC 29605 USA
| | - Michael A Sutton
- Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208 USA; Department of Mechanical Engineering, University of South Carolina, Columbia, SC 29208 USA
| | - Susan M Lessner
- Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208 USA; Department of Cell Biology and Anatomy, University of South Carolina, School of Medicine, 6439 Garners Ferry Road, Columbia, SC 29209 USA.
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19
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The effect of statin treatment on the prevention of stent mediated flow limited edge dissections during PCI in patients with stable angina. Int J Cardiol 2016; 220:365-70. [PMID: 27390956 DOI: 10.1016/j.ijcard.2016.06.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/25/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The effect of statin therapy before PCI with direct stenting may reduce the development of flow limited edge dissections (ED) in patients with stable angina. BACKGROUND Flow limited ED after PCI is associated with an increased risk of major adverse cardiovascular events. Statin therapy induces important changes in the plaque composition which have been previously identified as strong predictors of ED. MATERIAL AND METHODS 100 patients complicated with flow limited ED and 100 control patients with successful procedure were enrolled into the study. EDs were described as the 5-mm regions that were immediately adjacent to the stent borders, both distally and proximally on the coronary angiography. RESULTS Rate of statin use and duration of statin use were significantly higher in patients with non-ED group (63%) versus ED group (25%) (p<0.001). In addition, patients in ED group had significantly higher levels of C-reactive protein (CRP) at admission (9.9mg/dL (5.89-16.45) vs. 4.40mg/dL (3.5-7.09), respectively, p=0.014). CONCLUSIONS Our findings suggested that maintenance statin treatment before PCI with direct stenting may reduce the development of flow limited ED in patients with stable angina.
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20
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Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation. Circ Cardiovasc Interv 2016; 9:e003553. [DOI: 10.1161/circinterventions.115.003553] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/25/2016] [Indexed: 01/24/2023]
Abstract
Background—
Intravascular ultrasound detects stent edge dissections after percutaneous coronary intervention that are not seen angiographically. This study investigated the association between stent edge dissections and clinical outcomes.
Methods and Results—
ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a large-scale, prospective, multicenter study of patients undergoing drug-eluting stent implantation. In this prospective substudy, 2062 patients (2433 lesions) were evaluated with intravascular ultrasound to characterize the morphological features and clinical outcomes of stent edge dissection after percutaneous coronary intervention. The prevalence of post–percutaneous coronary intervention stent edge dissection was 6.6% per lesion (161 of 2433). Calcified plaque at the proximal stent edge (relative risk [RR]=1.72;
P
=0.04) and proximal stent edge expansion (RR=1.18;
P
=0.004) were predictors for proximal dissection; attenuated plaque at the distal stent edge (RR=3.52;
P
=0.004), distal reference plaque burden (RR=1.56;
P
<0.0001), and distal edge stent expansion (RR=1.11;
P
=0.02) were predictors for distal dissection. At 1-year follow-up, target lesion revascularization was more common in lesions with versus without dissection (5.2% versus 2.7%;
P
=0.04). Multivariable analysis indicated that residual dissection was associated with target lesion revascularization at 1-year follow-up (RR=2.67;
P
=0.02). Among lesions with dissection, smaller effective lumen area increased the risk of target lesion revascularization at 1-year follow-up (cutoff value of 5.1 mm
2
;
P
=0.05).
Conclusions—
Greater stent expansion and the presence of large, calcified, and/or attenuated plaques were independent predictors of stent edge dissection. Residual stent edge dissection, especially with a smaller effective lumen area, was associated with target lesion revascularization during 1-year follow-up after drug-eluting stent implantation.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00638794.
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21
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Matsuo Y, Kubo T, Akasaka T. The use of optical coherence tomography in acute coronary syndrome. Expert Rev Cardiovasc Ther 2016; 14:649-57. [DOI: 10.1586/14779072.2016.1145054] [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: 11/08/2022]
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22
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Li J, Chen Z. Integrated intravascular ultrasound and optical coherence tomography technology: a promising tool to identify vulnerable plaques [INVITED PAPER]. JOURNAL OF BIOMEDICAL PHOTONICS & ENGINEERING 2016; 1. [PMID: 28966987 DOI: 10.18287/jbpe-2015-1-4-209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Heart attack is mainly caused by the rupture of a vulnerable plaque. IVUS-OCT is a novel medical imaging modality that provides opportunities for accurate assessment of vulnerable plaques in vivo in patients. IVUS provides deep penetration to image the whole necrotic core while OCT enables accurate measurement of the fibrous cap of a plaque owing to its high resolution. In this paper, the authors describe the fundamentals, the technical designs and the applications of IVUS-OCT technology. Results from cadaver specimens are summarized, which indicated the complementary nature of OCT and IVUS for assessment of vulnerable plaques, plaque composition, and stent-tissue interactions. Furthermore, previously reported in vivo animal experiments are reviewed to assess the clinical adaptability of IVUS-OCT. Future directions for this technology are also discussed in this review.
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Affiliation(s)
- Jiawen Li
- Beckman Laser Institute, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92612, USA
| | - Zhongping Chen
- Beckman Laser Institute, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92612, USA
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23
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Contribution of optical coherence tomography imaging in management of iatrogenic coronary dissection. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:138-42. [PMID: 26994747 DOI: 10.1016/j.carrev.2016.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 11/22/2022]
Abstract
Iatrogenic coronary dissection is a rare but potentially serious complication of coronary angiography and angioplasty. Treatment with angioplasty guided only by angiography is often difficult. Optical coherence tomography imaging seems to be an interesting technique to lead the management of iatrogenic coronary dissection. Diagnosis can be made by optical coherence tomography; it can also eliminate differential diagnosis. Furthermore, this technique can guide safely the endovascular treatment.
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24
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Soeda T, Uemura S, Park SJ, Jang Y, Lee S, Cho JM, Kim SJ, Vergallo R, Minami Y, Ong DS, Gao L, Lee H, Zhang S, Yu B, Saito Y, Jang IK. Incidence and Clinical Significance of Poststent Optical Coherence Tomography Findings. Circulation 2015; 132:1020-9. [DOI: 10.1161/circulationaha.114.014704] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 07/06/2015] [Indexed: 11/16/2022]
Abstract
Background—
Optical coherence tomography (OCT) was recently introduced to optimize percutaneous coronary intervention. However, the exact incidence and significance of poststent OCT findings are unknown.
Methods and Results—
A total of 900 lesions treated with 1001 stents in 786 patients who had postprocedure OCT imaging were analyzed to evaluate the incidence of poststent OCT findings and to identify the OCT predictors for device-oriented clinical end points, including cardiac death, target vessel–related myocardial infarction, target lesion revascularization, and stent thrombosis. Patients were followed up to 1 year. Stent edge dissection was detected in 28.7% of lesions, and incomplete stent apposition was detected in 39.1% of lesions. The incidences of smooth protrusion, disrupted fibrous tissue protrusion, and irregular protrusion were 92.9%, 61.0%, and 53.8%, respectively. Small minimal stent area, defined as a lesion with minimal stent area <5.0 mm
2
in a drug-eluting stent or <5.6 mm
2
in a bare metal stent, was observed in 40.4% of lesions. One-year device-oriented clinical end points occurred in 33 patients (4.5%). Following adjustment, irregular protrusion and small minimal stent area were independent OCT predictors of 1-year device-oriented clinical end points (
P
=0.003 and
P
=0.012, respectively).
Conclusions—
Abnormal poststent OCT findings were frequent. Irregular protrusion and small minimal stent area were independent predictors of 1-year device-oriented clinical end points, which were primarily driven by target lesion revascularization.
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Affiliation(s)
- Tsunenari Soeda
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Shiro Uemura
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Seung-Jung Park
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Yangsoo Jang
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Stephen Lee
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Jin-Man Cho
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Soo-Joong Kim
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Rocco Vergallo
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Yoshiyasu Minami
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Daniel S. Ong
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Lei Gao
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Hang Lee
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Shaosong Zhang
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Bo Yu
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Yoshihiko Saito
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
| | - Ik-Kyung Jang
- From Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.S., R.V., Y.M., D.S.O., L.G., I.-K.J.); First Department of Medicine, Nara Medical University, Kashihara, Japan (T.S., S.U., Y.S.); Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.-J.P.,); Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.J.); Queen Mary Hospital, Hong Kong University,
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25
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Serial three-dimensional optical coherence tomography to assess contained coronary artery perforation. Coron Artery Dis 2015; 26 Suppl 1:e71-2. [PMID: 26247274 DOI: 10.1097/mca.0000000000000245] [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: 11/26/2022]
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26
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Bernelli C, Sirbu V, Guagliumi G. Percutaneous Coronary Intervention Planning and Optimization with Optical Coherence Tomography. Interv Cardiol Clin 2015; 4:251-284. [PMID: 28581944 DOI: 10.1016/j.iccl.2015.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Coronary angiography confirms or excludes coronary artery disease, assesses lesions severity, and helps to decide percutaneous coronary interventions (PCI). Coronary angiography has clear limitations. Intravascular imaging guides PCI. Frequency domain optical coherence tomography (OCT) gained attention for accurate planning and guidance of complex PCI. High-speed OCT image acquisition enables prompt vessel assessment in stable and unstable patients. The high-resolution images provide precise tissue characterization and a reliable quantitative assessment of the coronary pathology. Immediately after stent implantation, OCT allows accurate evaluation of stent expansion and symmetry. Real-time angio-OCT co-registration integrates OCT into the PCI workflow for accurate decision making.
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Affiliation(s)
- Chiara Bernelli
- Interventional Cardiology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, Bergamo, 24127, Italy
| | - Vasile Sirbu
- Interventional Cardiology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, Bergamo, 24127, Italy
| | - Giulio Guagliumi
- Interventional Cardiology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, Bergamo, 24127, Italy.
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27
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Mattesini A, Bellandi B, Valente S, Parodi G. Diagnosis and Evaluation of Stent Thrombosis with Optical Coherence Tomography. Interv Cardiol Clin 2015; 4:295-307. [PMID: 28581946 DOI: 10.1016/j.iccl.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Stent thrombosis (ST) is a rare complication of percutaneous coronary interventions (PCI), especially with drug-eluting stents. ST presents as acute myocardial infarction requiring emergent repeat PCI; optimal reperfusion occurs in two-thirds of patients. As a result, ST has been associated with a high mortality rate and a high rate of recurrent thrombosis. We discuss the use of optical coherence tomography (OCT) for the diagnosis and evaluation of ST. OCT-guided ST management seems a feasible, safe, and appropriate approach. Intracoronary assesses the efficacy of coronary thrombus removal procedures and detects the prevalent stent-related factor that caused ST.
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Affiliation(s)
- Alessio Mattesini
- Department of Cardiology, Careggi Hospital, Largo Brambilla n 3, Florence 50100, Italy
| | - Benedetta Bellandi
- Department of Cardiology, Careggi Hospital, Largo Brambilla n 3, Florence 50100, Italy
| | - Serafina Valente
- Department of Cardiology, Careggi Hospital, Largo Brambilla n 3, Florence 50100, Italy
| | - Guido Parodi
- Department of Cardiology, Careggi Hospital, Largo Brambilla n 3, Florence 50100, Italy.
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28
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Bouki KP, Sakkali E, Toutouzas K, Vlad D, Barmperis D, Phychari S, Riga M, Apostolou T, Stefanadis C. Impact of coronary artery stent edge dissections on long-term clinical outcome in patients with acute coronary syndrome: An optical coherence tomography study. Catheter Cardiovasc Interv 2015; 86:237-46. [DOI: 10.1002/ccd.25855] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | - Eleni Sakkali
- Second Department of Cardiology; General Hospital of Nikea; Pireaus Greece
| | | | - Delia Vlad
- Second Department of Cardiology; General Hospital of Nikea; Pireaus Greece
| | | | - Stavroula Phychari
- Second Department of Cardiology; General Hospital of Nikea; Pireaus Greece
| | - Maria Riga
- First Department of Cardiology; University of Athens Medical School; Athens Greece
| | - Thomas Apostolou
- First Department of Cardiology; University of Athens Medical School; Athens Greece
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29
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Zivelonghi C, Ghione M, Kilickesmez K, Loureiro RE, Foin N, Lindsay A, de Silva R, Ribichini F, Vassanelli C, Di Mario C. Intracoronary optical coherence tomography: a review of clinical applications. J Cardiovasc Med (Hagerstown) 2015; 15:543-53. [PMID: 24922045 DOI: 10.2459/jcm.0000000000000032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Optical coherence tomography (OCT) is a light-based technology that provides very high spatial resolution images. OCT has been initially employed as a research tool to investigate plaque morphology and stent strut coverage. The introduction of frequency domain OCT allowing fast image acquisition during a prolonged contrast injection via the guiding catheter has made OCT applicable for guidance of coronary interventions. In this manuscript, the various applications of OCT are reviewed, from assessment of plaque vulnerability and severity to characteristics of unstable lesions and thrombus burden to stent optimization and evaluation of late results.
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Affiliation(s)
- Carlo Zivelonghi
- aCardiovascular Biomedical Research Unit, Royal Brompton Hospital bImperial College, London, UK cDepartment of Medicine, University of Verona, Verona, Italy
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30
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Reeves RR, Patel M, Armstrong EJ, Sab S, Waldo SW, Yeo KK, Shunk KA, Low RI, Rogers JH, Mahmud E. Angiographic characteristics of definite stent thrombosis: role of thrombus grade, collaterals, epicardial coronary flow, and myocardial perfusion. Catheter Cardiovasc Interv 2015; 85:13-22. [PMID: 24753053 DOI: 10.1002/ccd.25519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/02/2014] [Accepted: 04/14/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To characterize the prevalence of thrombus burden, collateral vessels to the infarct-related artery, epicardial coronary artery flow, and myocardial perfusion in patients with angiographically confirmed definite stent thrombosis (ST), and to define their relationship with associated treatments and outcomes. BACKGROUND Angiographic characteristics of ST are not well defined. METHODS All cases of angiographically determined ST at five academic hospitals from 2005 to 2012 were reviewed. Demographic, procedural, and angiographic characteristics were recorded. In-hospital and 1-year follow-up data were obtained. RESULTS Among 205 cases of angiographic definite ST (60 ± 8 years; 87% male), the majority presented with late/very late ST (69%) and STEMI (66%). High-risk angiographic findings at presentation included thrombus grade 4-5 (87%), absence of collateral vessels (76%), and reduced initial TIMI 3 flow (90%). Final TIMI 3 flow was achieved in 90% of patients and was associated with greater use of aspiration thrombectomy (60% vs. 25%; P = 0.003), glycoprotein IIb/IIIa inhibitors (80% vs. 30%, P < 0.001), and repeat stenting (67% vs. 10%, P < 0.001). A final myocardial perfusion grade of 2-3 was achieved in 79% of patients and was associated with greater use of aspiration thrombectomy (61% vs. 36%, P = 0.003). After multivariable logistic regression, aspiration thrombectomy (AOR 2.6, 95% CI 1.3-5.2) and implantation of a new stent (AOR 2.1, 95% CI 1.1-4.3) were associated with optimal combined epicardial flow and myocardial perfusion. At 1-year follow-up, significantly lower risk of repeat ST (HR 0.1; 95% CI 0.1,0.2; P < 0.001) among patients with initial TIMI 3 flow at index ST was observed. CONCLUSIONS The majority of ST patients present with late/very late ST with high thrombus burden and STEMI. Presence of collateral vessels and low thrombus burden is cardioprotective, while reduced initial TIMI flow is associated with larger infarct size and recurrent ST. Aspiration thrombectomy and repeat stenting are associated with improved epicardial coronary artery flow and myocardial perfusion among patients treated for ST. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Ryan R Reeves
- Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, California
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Nonangiographic assessment of coronary artery disease: a practical approach to optical coherence tomography and fractional flow reserve. Coron Artery Dis 2014; 25:608-18. [PMID: 25203101 DOI: 10.1097/mca.0000000000000173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In an era of increased scrutiny of the appropriateness and safety of revascularization, interventional cardiologists must evolve by adding key tools to their armamentarium. This review highlights the utility of optical coherence tomography and fractional flow reserve in the catheterization lab and provides a practical guide for using these technologies during coronary intervention in various lesion subsets. We propose that fractional flow reserve informs the decision to intervene and optical coherence tomography guides the optimization of the outcome.
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Intracoronary Optical Coherence Tomography: Insights from Clinical Research—What Do We Need to Learn? CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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De Cock D, Bennett J, Ughi GJ, Dubois C, Sinnaeve P, Dhooge J, Desmet W, Belmans A, Adriaenssens T. Healing course of acute vessel wall injury after drug-eluting stent implantation assessed by optical coherence tomography. Eur Heart J Cardiovasc Imaging 2014; 15:800-9. [PMID: 24497520 DOI: 10.1093/ehjci/jeu003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vessel wall injury after drug-eluting stent (DES) implantation can be characterized in detail by optical coherence tomography (OCT). Little is known about the healing course of these phenomena. METHODS AND RESULTS In 62 lesions (62 patients), the incidence of acute vessel trauma was assessed in the stented region and the edge segments immediately after DES implantation. The healing course of these injuries was assessed at 9-month OCT follow-up using a software algorithm allowing for reliable spatial comparison of baseline and follow-up cross-sectional images. Tissue prolapse (TP) and tissue protrusions were detected in 81 and 35% of lesions, respectively. A total of 342 intra-stent dissection flaps (ISD) and 114 intra-stent dissection cavities (ISC) were visualized in 98 and 81% of lesions, respectively. Thirty-five lesions (56%) showed edge dissections (EDs). No residual TP or protrusion was observed at follow-up. Incomplete healing was seen in 8% of ISD and in 20% of ISC. For ED, a residual flap was observed in one-third of the initially dissected stent edges. Incomplete healing of acute vessel injury was associated with the presence of underlying atherosclerotic disease at baseline. Uncovered and malapposed stent struts were observed more often with incomplete healing of vessel injury at follow-up. CONCLUSIONS Acute vessel wall trauma is highly prevalent immediately after DES implantation. Most of these injuries are minor and resolve at mid-term follow-up. Incomplete healing of ISDs seems to be associated with other OCT findings suggesting delayed arterial healing.
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Affiliation(s)
- Dries De Cock
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium
| | - Johan Bennett
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium
| | - Giovanni J Ughi
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Peter Sinnaeve
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Dhooge
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Walter Desmet
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ann Belmans
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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Nammas W, Ligthart JMR, Karanasos A, Witberg KT, Regar E. Optical coherence tomography for evaluation of coronary stentsin vivo. Expert Rev Cardiovasc Ther 2014; 11:577-88. [DOI: 10.1586/erc.13.37] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Radu MD, Räber L, Heo J, Gogas BD, Jørgensen E, Kelbæk H, Muramatsu T, Farooq V, Helqvist S, Garcia-Garcia HM, Windecker S, Saunamäki K, Serruys PW. Natural history of optical coherence tomography-detected non-flow-limiting edge dissections following drug-eluting stent implantation. EUROINTERVENTION 2014; 9:1085-94. [DOI: 10.4244/eijv9i9a183] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ghione M, Kýlýçkesmez K, Zivelonghi C, Estevez Loureiro R, Foin N, Mattesini A, Secco GG, Dall’Ara G, Rama-Merchan JC, de Silva R, Di Mario C. Intracoronary Optical Coherence Tomography: Experience and Indications for Clinical Use. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Incidence, Predictors, Morphological Characteristics, and Clinical Outcomes of Stent Edge Dissections Detected by Optical Coherence Tomography. JACC Cardiovasc Interv 2013; 6:800-13. [DOI: 10.1016/j.jcin.2013.03.019] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/18/2013] [Accepted: 03/22/2013] [Indexed: 11/18/2022]
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Macías E, Medina MÁ, Gonzalo N, del Angel J, Escaned J. [Optical coherence tomography. Bases and applications of a new intravascular imaging technique]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:112-9. [PMID: 23648202 DOI: 10.1016/j.acmx.2013.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 01/20/2013] [Accepted: 01/21/2013] [Indexed: 11/16/2022] Open
Abstract
Coronary angiography is the reference technique for the diagnosis of coronary disease. However, the majority of acute coronary syndromes involve angiographically non-significant lesions. It is also the technique of choice for guiding the implantation of endovascular prostheses and their later monitoring. Optical coherence tomography is an interferometric imaging technique that penetrates tissue approximately 2-3mm and provides axial and lateral resolution. It is able to distinguish different tissue types, such as fibrous, lipid-rich, necrotic, or calcified tissue. Optical coherence tomography is able to recognize a variety of features of atherosclerotic plaques that have been associated with rapid lesion progression and clinical events, such as thin cap fibroatheroma, fibrous cap thickness, dense macrophage infiltration, and thrombus formation. Currently, there is growing interest in the value of optical coherence tomography in the area of coronary intervention, where the technique offers significant advantages over more widespread intravascular diagnostic techniques such as intravascular ultrasound. Its higher resolution permits to recognize periprocedural complications, such as microdissection of the coronary artery, stent malapposition, and neointimal hyperplasia, making this tool one of the most promising techniques in the intravascular diagnosis.
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Affiliation(s)
- Enrico Macías
- Servicio de Hemodinámica, Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, Madrid, España.
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Reith S, Battermann S, Jaskolka A, Lehmacher W, Hoffmann R, Marx N, Burgmaier M. Predictors and incidence of stent edge dissections in patients with type 2 diabetes as determined by optical coherence tomography. Int J Cardiovasc Imaging 2013; 29:1237-47. [PMID: 23558468 DOI: 10.1007/s10554-013-0213-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 03/28/2013] [Indexed: 11/28/2022]
Abstract
Patients with type 2 diabetes are at increased risk for post-PCI complications including stent thrombosis and restenosis. Stent edge dissections (SEDs) have been associated with these complications. This study assessed incidence and predictors of SEDs in patients with type 2 diabetes using optical coherence tomography (OCT). Intravascular lesion parameters and plaque morphology were investigated pre- and post-PCI using OCT in 73 type 2 diabetic patients with 90 lesions and 166 visible stent edges. We detected 42 (25.3 %) SEDs in 166 stent edges and 37 (41.1 %) SEDs in 90 lesions. More SEDs occurred if the border of the stent had been placed within diseased vessel segments with predominantly fibrous (42.9 %) and fibrocalcific (40.5 %) plaques compared to healthy vessel wall morphology (p < 0.001). Furthermore, the lumen eccentricity of the stent at its edges (SAE) (16.00 ± 6.07 vs. 13.11 ± 5.22 %, p < 0.003) and the stent-edge-to-lumen-area-ratio (1.26 ± 0.27 vs. 0.99 ± 0.20, p < 0.001) were both significantly larger in the presence of SEDs. All of the above parameters were significant predictors for SEDs on uni- and multivariate logistic regression analysis (all p < 0.01), suggesting that the lumen eccentricity of the SAE, the stent-edge-to-lumen-area-ratio and diseased vessel wall morphology of the reference segment adjacent to the stent edge are independent risk factors for the presence of SEDs. These results suggest that diseased vessel wall morphology at the stent edges may promote the occurrence of SEDs and that avoidance of longitudinal and transverse mismatch between stent and vessel could be important to reduce SEDs in cardiovascular high-risk patients with type 2 diabetes.
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Affiliation(s)
- Sebastian Reith
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Association between proximal stent edge positioning on atherosclerotic plaques containing lipid pools and postprocedural myocardial infarction (from the CLI-POOL Study). Am J Cardiol 2013. [PMID: 23206925 DOI: 10.1016/j.amjcard.2012.10.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Postprocedural myocardial infarction is an ominous complication of percutaneous coronary intervention (PCI). Despite several patient, lesion, and procedural factors that may affect its occurrence and severity, it is unclear if implanting a stent edge on a coronary lipid pool, as appraised by optical coherence tomography (OCT), adversely affects outcomes. The aim of this study was to assess the association between postprocedural myocardial infarction and the implantation of a stent edge on a lipid pool, as assessed by OCT. A database was screened for patients without ongoing myocardial infarctions; who underwent PCI with stenting for single, native, de novo lesions; without periprocedural side-branch occlusion or compromise; who underwent post-PCI OCT; and had postprocedural myocardial infarctions. These subjects were matched 1:1 with patients with similar features but without postprocedural myocardial infarctions. Plaque characterization with OCT was performed using established criteria. Specifically, lipid pools within stent edges were quantified by computing the number of involved quadrants and the degree of lipid arc on cross-sectional images. A total of 30 patients were included (15 with postprocedural myocardial infarctions and 15 controls without infarctions). Whereas no patient or control subject had lipid pools in correspondence to distal stent edges, landing of proximal stent edges on lipid pools was significantly more frequent in patients than in controls (10 [66%] vs 2 [13%], p = 0.009), Moreover, patients with postprocedural myocardial infarctions had more extensive lipid pools at proximal stent edges than those without postprocedural myocardial infarctions. Accordingly, lipid pool arc at proximal stent edge was significantly associated with peak post-PCI creatine kinase-MB/upper limit of normal ratio (Spearman's ρ = 0.49, p = 0.006). In conclusion, incomplete stent coverage of coronary lipid pools appears to be associated with an increased risk for postprocedural myocardial infarction in patients who undergo PCI.
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Gonzalo N, Alfonso F, Escaned J. Combined use of optical coherence tomography and intravascular ultrasound imaging for the evaluation of stent thrombosis. Expert Rev Cardiovasc Ther 2012; 11:5-7. [PMID: 23259439 DOI: 10.1586/erc.12.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Räber L, Radu M. Optimising cardiovascular outcomes using optical coherence tomography-guided percutaneous coronary interventions. EUROINTERVENTION 2012; 8:765-71. [DOI: 10.4244/eijv8i7a118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Papaioannou TG, Schizas D, Vavuranakis M, Katsarou O, Soulis D, Stefanadis C. Quantification of new structural features of coronary plaques by computational post-hoc analysis of virtual histology-intravascular ultrasound images. Comput Methods Biomech Biomed Engin 2012; 17:643-51. [DOI: 10.1080/10255842.2012.713940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Karanasos A, Ligthart J, Witberg K, van Soest G, Bruining N, Regar E. Optical Coherence Tomography: Potential Clinical Applications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012; 5:206-220. [PMID: 22798978 PMCID: PMC3389242 DOI: 10.1007/s12410-012-9140-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Optical coherence tomography (OCT) is a novel intravascular imaging modality using near-infrared light. By OCT it is possible to obtain high-resolution cross-sectional images of the vascular wall structure and assess the acute and long-term effects of percutaneous coronary intervention. For the time being OCT has been mainly used in research providing new insights into the pathophysiology of the atheromatic plaque and of the vascular response to stenting, however, it seems that there is potential for clinical application of OCT in various fields, such as pre-interventional evaluation of coronary arteries, procedural guidance in coronary interventions, and follow-up assessment of vascular healing after stent implantation. This review will focus on the potential and advantages of OCT in the clinical practice of a catheterization laboratory.
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Affiliation(s)
- Antonios Karanasos
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Jurgen Ligthart
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Karen Witberg
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Nico Bruining
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Porto I, Di Vito L, Burzotta F, Biasucci LM, Crea F. Superficial calcified nodules and post-stenting micro-dissections imaged through 3-dimensional optical coherence tomography. Int J Cardiol 2012; 158:e62-4. [PMID: 22100605 DOI: 10.1016/j.ijcard.2011.10.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 10/29/2011] [Indexed: 11/19/2022]
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Jaguszewski M, Landmesser U. Optical Coherence Tomography Imaging: Novel Insights into the Vascular Response After Coronary Stent Implantation. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012; 5:231-238. [PMID: 22798979 PMCID: PMC3389253 DOI: 10.1007/s12410-012-9138-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Optical coherence tomography (OCT) is a high-resolution imaging technique that is increasingly used for intracoronary imaging to characterize coronary atherosclerotic plaques and vascular responses after coronary stent implantation. Introduction of optical frequency-domain imaging (OFDI; second generation OCT) has simplified practical use of this novel imaging modality resulting in a more widespread availability in interventional cardiology. Here we highlight recent insights into the acute and chronic vascular response after coronary stent implantation by OCT imaging. OCT provides cross-sectional images with approximately 10-fold higher resolution as compared to intravascular-ultrasound (IVUS), allowing for precise evaluation of tissue coverage and malapposition of coronary stent struts. More than 30 studies using OCT to compare vascular responses to different stents have now been reported. Recent studies have examined the relation between OCT-image characteristics and tissue composition around stent struts. OCT is used for evaluation of novel stent concepts, such as bioengineered stents and bioabsorbable stents, where it provides more accurate information than IVUS. While intracoronary OCT imaging is further developed, including faster 3D-OCT-image-reconstruction, larger OCT studies/registries with standardized analysis will provide more insights into clinical implications of observations from OCT-imaging after coronary stent implantation.
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Affiliation(s)
- Milosz Jaguszewski
- Cardiology, Cardiovascular Center, University Hospital of Zurich, Raemistrassse 100, 8091 Zurich, Switzerland
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Lowe HC, Narula J, Fujimoto JG, Jang IK. Intracoronary optical diagnostics current status, limitations, and potential. JACC Cardiovasc Interv 2012; 4:1257-70. [PMID: 22192367 DOI: 10.1016/j.jcin.2011.08.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 08/04/2011] [Accepted: 08/18/2011] [Indexed: 10/14/2022]
Abstract
Optical coherence tomography (OCT), is a novel intravascular imaging modality analogous to intravascular ultrasound but uses light instead of sound. This review details the background, development, and status of current investigation using OCT, and discusses advantages, limitations, and likely future developments. It provides indications for possible future clinical use, and places OCT in the context of current intravascular imaging in what is a rapidly changing field of investigation.
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Affiliation(s)
- Harry C Lowe
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Gutiérrez-Chico JL, Alegría-Barrero E, Teijeiro-Mestre R, Chan PH, Tsujioka H, de Silva R, Viceconte N, Lindsay A, Patterson T, Foin N, Akasaka T, di Mario C. Optical coherence tomography: from research to practice. Eur Heart J Cardiovasc Imaging 2012; 13:370-84. [PMID: 22330231 PMCID: PMC3342852 DOI: 10.1093/ehjci/jes025] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Optical coherence tomography (OCT) is a high-resolution imaging technique with great versatility of applications. In cardiology, OCT has remained hitherto as a research tool for characterization of vulnerable plaques and evaluation of neointimal healing after stenting. However, OCT is now successfully applied in different clinical scenarios, and the introduction of frequency domain analysis simplified its application to the point it can be considered a potential alternative to intravascular ultrasound for clinical decision-making in some cases. This article reviews the use of OCT for assessment of lesion severity, characterization of acute coronary syndromes, guidance of intracoronary stenting, and evaluation of long-term results.
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Karjalainen PP, Nammas W. Optical coherence tomography: on the way to decipher the 'Rosetta stone'. Int J Cardiol 2012; 159:79-81. [PMID: 22330003 DOI: 10.1016/j.ijcard.2012.01.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 01/22/2012] [Indexed: 10/28/2022]
Abstract
Optical coherence tomography is an exciting light-based imaging modality with a much higher axial resolution as compared with intravascular ultrasound. The diagnostic value of optical coherence tomography resides in its ability to provide information on the stent interaction with the vessel wall at the level of individual struts. Chief clinical implications include evaluating strut neointimal coverage and strut malapposition following coronary stenting. This Editorial covers the basics of optical coherence tomography, its established and potential clinical implications, probable caveats and downsides, in addition to a future perspective, all in view of the late-breaking peer-reviewed literature.
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