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Wu H, Li M, Lin C. Influence of balloon location during proximal optimization technique (POT): A finite element analysis. J Biomech 2021; 127:110703. [PMID: 34481186 DOI: 10.1016/j.jbiomech.2021.110703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
Proximal Optimization Technique (POT)is a post-expansion technique that must be completed after single-stent implantation for the coronary bifurcation. The optimal location for the distal balloon shoulder during POT remains debatable. In the present study, the finite element method is applied to simulate POT after single-stent implantation in the coronary bifurcation. Three different balloon locations based on the distal shoulder relative to the carina cut plane were analyzed: 1) "proximal":1mm before carina cut plane; 2) "standard": at the carina cut plane; and 3) "distal": 1 mm after the carina cut plane. The computational results showed differences in stent, vessel morphology, and vessel wall stress due to the different balloon locations. However, when distal balloon shoulder was located between two adjacent stent rings, it formed the distal cell of the stent, the best stent apposition, least stent structs obstruction at SB ostial. Moreover, best opening effect of distal cell of the stent can be achieved, with the least damage to the vessel wall.
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Affiliation(s)
- Heng Wu
- Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
| | - Meng Li
- Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
| | - Changyan Lin
- Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China.
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Neointimal coverage of jailed side branches in coronary bifurcation lesions: an optical coherence tomography analysis. Coron Artery Dis 2019; 29:114-118. [PMID: 28926354 DOI: 10.1097/mca.0000000000000563] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The jailed strut at the side-branch (SB) orifice may be a cause of delayed neointimal coverage and SB flow disturbance after single stenting to bifurcation. The aim of this study was to characterize the exact relationship between the jailed strut pattern at the SB orifice immediately after stent implantation and neointimal coverage of the jailed SB orifice in the chronic phase. PATIENTS AND METHODS A total of 29 bifurcation (left anterior descending coronary artery and diagonal branch) lesions treated by optical coherence tomography-guide single-stent implantation and followed at 18 months after a percutaneous coronary intervention were included in this study. RESULTS Using three-dimensional optical coherence tomography images, the jailed stent strut pattern was classified into two groups on the basis of the presence of a stent strut link at the SB orifice (link group: n=11, and no-link group: n=18). SB orifice obstruction by neointima was significantly greater in the link group than in the no-link group during the 18-month follow-up period (26.8±21.9 vs. 9.5±22.1%, P=0.049). CONCLUSION This single-center observational study with a small sample size showed that a jailed strut pattern at the SB orifice might be related to neointimal coverage of the SB orifice in bifurcation lesions treated with single-stent implantation. Further large-scale studies with long-term follow-up will be necessary to determine the exact relationship between the jailed strut pattern at the SB orifice and SB flow disturbance because of delayed neointimal coverage as well as clinical outcome.
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Morris PD, Iqbal J, Chiastra C, Wu W, Migliavacca F, Gunn JP. Simultaneous kissing stents to treat unprotected left main stem coronary artery bifurcation disease; stent expansion, vessel injury, hemodynamics, tissue healing, restenosis, and repeat revascularization. Catheter Cardiovasc Interv 2018; 92:E381-E392. [PMID: 29693768 PMCID: PMC6283044 DOI: 10.1002/ccd.27640] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/01/2018] [Accepted: 03/27/2018] [Indexed: 01/09/2023]
Abstract
Objectives To perform detailed analysis of stent expansion, vessel wall stress, hemodynamics, re‐endothelialization, restenosis, and repeat PCI in the simultaneous kissing stents (SKS) technique of bifurcation left main stem (LMS) stenting. Background The SKS technique is useful to treat patients with true bifurcation disease of the LMS but remains controversial. Methods and Results Computational structural analysis of SKS expansion demonstrated undistorted and evenly expanded stents. Computational fluid dynamics modelling revealed largely undisturbed blood flow. 239 PCI procedures were performed on 217 patients with unprotected bifurcation LMS disease with SKS using DES (2004‐2017). We electively studied 13 stable patients from baseline to 10 years post‐SKS with repeat angiography and optical coherence tomography, and demonstrated tissue coverage of the stent struts at the carina, with no evidence of lacunae behind the stents. We studied all patients with symptomatic recurrence. Target lesion revascularization rate was 3.2% at 1 year and 4.6% at 2 years. Of all 20 patients with restenosis, the site was the LMS‐Cx stent in 7, the LMS‐LAD stent in 2 and both in 11. Two‐year recurrence rate was 7/32 (5.3%) for first, and 4/108 (3.7%) for second generation DES. Treatment with repeat kissing techniques was undertaken in 19/20, with sustained clinical results with re‐SKS. Conclusion The SKS technique for treating unprotected LMS bifurcation disease does not distort the stents, is associated with favorable hemodynamics, tissue coverage of the exposed struts, and a low restenosis rate when performed with contemporary stents. Re‐PCI with repeat SKS appears feasible, safe, and durable.
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Affiliation(s)
- Paul D Morris
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom
| | - Javaid Iqbal
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Wei Wu
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.,Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Julian P Gunn
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom
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Impact of branching angle on neointimal coverage of drug-eluting stents implanted in bifurcation lesions. Coron Artery Dis 2017; 27:682-689. [PMID: 27525716 DOI: 10.1097/mca.0000000000000422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the impact of branching angle (BA) on neointimal coverage of drug-eluting stents (DESs) in bifurcation lesions. BACKGROUND Previous experimental studies indicated that BA influences the local flow turbulence and wall shear stress, which are associated with neointimal coverage of DESs. METHODS Fifty-five bifurcation lesions in 47 patients were evaluated by serial optical coherence tomography (OCT) before DES implantation and at follow-up. Neointimal coverage was assessed in cross-sectional OCT images containing the side branch; regions including the side branch ostium (SO) and vessel wall (VW) were assessed separately. BA was measured using angiography (Angio-BA) and longitudinal OCT imaging (OCT-BA). RESULTS In the SO region, a significant negative correlation was found between the uncovered strut percentage and Angio-BA or OCT-BA (r=-0.41, P=0.0024; r=-0.33, P=0.0167, respectively) and a significant positive correlation was found between Angio-BA and average neointimal thickness (r=0.31, P=0.025), whereas no correlation was observed between OCT-BA and average neointimal thickness (r=0.20, P=0.158). In the VW region, no correlation was found between Angio-BA or OCT-BA and the uncovered strut percentage or average neointimal thickness. CONCLUSION BA influence the neointimal coverage over DES struts in the SO at coronary bifurcation lesions, but not in those attached to the VW.
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Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents. Int J Cardiovasc Imaging 2017; 33:1115-1124. [DOI: 10.1007/s10554-017-1106-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/01/2017] [Indexed: 01/21/2023]
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Serial changes in the three-dimensional aspect of the side-branch ostium jailed by a drug-eluting stent assessed by optical coherence tomography. Int J Cardiovasc Imaging 2017; 33:797-806. [PMID: 28168562 DOI: 10.1007/s10554-017-1080-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/20/2017] [Indexed: 01/03/2023]
Abstract
The present study investigated serial changes in the three-dimensional (3D) aspect of the jailed side-branch (SB) ostium. We evaluated 32 patients who underwent examination with optical coherence tomography (OCT) both at baseline and at follow-up. After reconstruction of the 3D images, we classified the configuration of overhanging struts at the SB orifice into three groups according to the 3D aspect of the jailing configuration. The number of compartments divided by the stent strut was counted. The side-branch flow area (SBFA), i.e., the area of the SB ostium except for jailing struts, was measured by cut-plane analysis. Forty-eight SBs of 25 patients were analyzed. Thirteen SBs were classified as the No-jail type (N-type), 19 as the Simple-jail type (S-type; no longitudinal link at the carina), and 16 as the Complex-jail type (C-type; had a link at the carina). In the N-type, the SBFA was significantly increased at follow-up (P = 0.018). In the C-type, the SBFA was significantly decreased at follow-up (P = 0.002). Percent reduction of SBFA in the C-type group was significantly greater than that in the N-type or S-type groups (S-type vs. C-type P = 0.002, N-type vs. C-type P < 0.001). 3D-OCT images showed that some of the compartments were filled with tissue. The number of compartments was significantly decreased at follow-up (P < 0.001). In the C-type group, the SBFA was significantly decreased and small compartments were filled with tissue. These findings suggest that stent jail complexity is associated with the progression of SB ostial stenosis.
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Fujino Y, Attizzani GF, Tahara S, Naganuma T, Takagi K, Yabushita H, Wang W, Tanaka K, Matsumoto T, Kawamoto H, Yamada Y, Amano S, Watanabe Y, Warisawa T, Sato T, Mitomo S, Kurita N, Ishiguro H, Hozawa K, Tsukahara T, Motosuke M, Bezerra HG, Nakamura S, Nakamura S. Difference in vascular response between sirolimus-eluting- and everolimus-eluting stents in ostial left circumflex artery after unprotected left main as observed by optical coherence tomography. Int J Cardiol 2016; 230:284-292. [PMID: 28065691 DOI: 10.1016/j.ijcard.2016.12.122] [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: 08/15/2016] [Revised: 12/01/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Kissing-balloon technique (KBT) is commonly performed during percutaneous coronary intervention of distal unprotected left main coronary artery (ULM) aiming at obtaining optimal opening of the side branch (left circumflex artery; LCX) ostium. Nonetheless, detailed evaluation of vascular response to stents in LCX ostium is lacking. We therefore evaluated the vascular response to different drug-eluting stents (DES) in ostial LCX after ULM by means of optical coherence tomography (OCT). METHODS We prospectively enrolled 38 consecutive patients with ULM disease, who were treated with single-stent procedure using DES, crossover the ULM-left anterior descending artery (LAD) followed by KBT. Twelve patients were treated with sirolimus-eluting stents (SES) and 26 patients were treated with everolimus-eluting stents (EES). OCT was conducted at post-PCI and 9-month follow-up. We evaluated the DES-vessel interactions and number of stent struts at the side branch (LCX) ostium (SO) at post-PCI, and compared the narrowing of ostial area at LCX between SES and EES. RESULTS Post-procedure, the number of stent struts at SO was significantly higher in SES compared to EES (median 14.47% vs 0.19%, p<0.001). The narrowing of LCX ostial area at follow-up was more pronounced in SES compared with EES (29.16% vs 2.46%, respectively, p<0.001). Linear regression analysis showed a high correlation between the number of stent struts in LCX ostium and ostial area narrowing (r=0.771, p<0.001). CONCLUSIONS OCT showed differences between EES- and SES-vessel interactions at ULM bifurcation PCI. Number of LCX ostium struts at post-PCI impacted the narrowing of ostial area at 9-month follow-up.
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Affiliation(s)
- Yusuke Fujino
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
| | - Guilherme F Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Satoko Tahara
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Kensuke Takagi
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Wei Wang
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Kentaro Tanaka
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | | | - Yuya Yamada
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Shinnosuke Amano
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | | | | | - Tomohiko Sato
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Satoru Mitomo
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Naoyuki Kurita
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Takahiro Tsukahara
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Masahiro Motosuke
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Hiram G Bezerra
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | | | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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Sato T, Jose J, El-Mawardy M, Sulimov DS, Tölg R, Richardt G, Abdel-Wahab M. Neointimal response to everolimus-eluting bioresorbable scaffolds implanted at bifurcating coronary segments: insights from optical coherence tomography. Int J Cardiovasc Imaging 2016; 33:169-175. [PMID: 27757563 DOI: 10.1007/s10554-016-0993-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/03/2016] [Indexed: 11/27/2022]
Abstract
Heterogeneity of neointimal thickness is observed after drug-eluting stents implantation in bifurcation lesions (BL). We evaluated the vascular response of everolimus-eluting bioresorbable scaffold (BRS) struts deployed at BL using optical coherence tomography (OCT). 50 patients (64 scaffolds) underwent follow-up OCT after BRS implantation. Cross-sectional areas of each BL with a side branch more than 1.5 mm were analyzed using OCT every 200 µm. All images were divided into three regions according to shear stress: the 1/2 circumference of the vessel opposite to the ostium (OO), the vessel wall adjacent to the ostium (AO) and the side-branch ostium (SO). The %uncovered strut and the averaged neointimal thickness (NIT) were calculated. Overall, there were significant differences in both NIT and %uncovered strut among the three regions (OO, 119.2 ± 68.5 μm vs. AO, 94.2 ± 35.7 μm vs. SO, 80.5 ± 41.4 μm, p = 0.03; OO, 0.4 %vs. AO, 1.4 %vs. SO, 4.8 %, p = 0.02). Scaffolds were divided into two groups: a large-ratio side-branch group (LRSB; n = 32) and a small-ratio side-branch group (SRSB; n = 32), based on the median value of the ratio of the diameter of side branch ostium (Ds) to that of the main branch (Dm). In the LRSB alone, there were significant differences in both NIT and %uncovered strut among the three regions (OO, 128.0 ± 61.1 μm vs. AO, 97.3 ± 34.3 μm vs. SO, 75.9 ± 39.4 μm, p < 0.01; OO, 0.3 % vs. AO, 2.3 % vs. SO, 8.7 %, p < 0.01). After BRS implantation in BL, neointimal response was pronounced at the vessel wall opposite to the side branch ostium, especially in those with large side branches.
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Affiliation(s)
- Takao Sato
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - John Jose
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Department of Cardiology, Christian Medical College Hospital, Vellore, India
| | - Mohamed El-Mawardy
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Ralph Tölg
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Am Kurpark 1, 23795, Bad Segeberg, Germany.
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Coronary bifurcation stent morphology in dual-source CT: validation with micro-CT. Int J Cardiovasc Imaging 2016; 32:1659-1665. [DOI: 10.1007/s10554-016-0953-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
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Murasato Y, Iwasaki K, Yamamoto T, Yagi T, Hikichi Y, Suematsu Y, Yamamoto T. Optimal kissing balloon inflation after single-stent deployment in a coronary bifurcation model. EUROINTERVENTION 2015; 10:934-41. [PMID: 24531354 DOI: 10.4244/eijv10i8a160] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To define the optimal kissing balloon inflation (KBI) after single-stent deployment in a coronary bifurcation model. METHODS AND RESULTS We deployed stents in main vessels (MV) followed by KBI in various conditions and compared the stent configurations. A) KBI at the operator's discretion vs. under the guidelines of minimal balloon overlapping (MBO). Various stent configurations were observed after the former option, whereas similar maximal dilation points were observed under the MBO guidelines. B) Long balloon overlapping (LBO) vs. MBO with proximal MV dilated by a large balloon. The proximal MV was dilated to an ideal round shape with MBO versus an oval shape with LBO. C) Two-link vs. 3-link stents. Although the 2-link stent was advantageous to open the side branch, it incurred a risk of overdilatation of the proximal struts, whereas the 3-link stent preserved its structure. Computed simulations of coronary flow were analysed in the following left main coronary models: circle with a diameter of 4 and 5.5 mm, ellipse with longitudinal direction and tilt position. They revealed that the overdilated side was exposed to low shear stress regardless of its shape. CONCLUSIONS Optimal KBI can be achieved with MBO and proximal dilatation by an optimally sized balloon.
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Affiliation(s)
- Yoshinobu Murasato
- Department of Cardiovascular Medicine, Heart Center, New Yukuhashi Hospital, Yukuhashi, Japan
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Silva GV, Gahremanpour A, Attizzani GF, Zeng Y, Wang W, Yamamoto H, Kanaya T, Rippy MK, Bezerra HG, Costa MA, Perin E. Comparison of scanning electron microscopy and optical coherence tomography for imaging of coronary bifurcation stents. Catheter Cardiovasc Interv 2015; 85:1141-9. [DOI: 10.1002/ccd.25612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 07/14/2014] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Yi Zeng
- Texas Heart Institute; Houston Texas
| | - Wei Wang
- Harrington Heart and Vascular Institute, Case Medical Center; Cleveland Ohio
| | - Hirosada Yamamoto
- Harrington Heart and Vascular Institute, Case Medical Center; Cleveland Ohio
| | - Tomoaki Kanaya
- Harrington Heart and Vascular Institute, Case Medical Center; Cleveland Ohio
| | | | - Hiram G. Bezerra
- Harrington Heart and Vascular Institute, Case Medical Center; Cleveland Ohio
| | - Marco A. Costa
- Harrington Heart and Vascular Institute, Case Medical Center; Cleveland Ohio
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Gargesha M, Shalev R, Prabhu D, Tanaka K, Rollins AM, Costa M, Bezerra HG, Wilson DL. Parameter estimation of atherosclerotic tissue optical properties from three-dimensional intravascular optical coherence tomography. J Med Imaging (Bellingham) 2015; 2:016001. [PMID: 26158087 DOI: 10.1117/1.jmi.2.1.016001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/25/2014] [Indexed: 01/17/2023] Open
Abstract
We developed robust, three-dimensional methods, as opposed to traditional A-line analysis, for estimating the optical properties of calcified, fibrotic, and lipid atherosclerotic plaques from in vivo coronary artery intravascular optical coherence tomography clinical pullbacks. We estimated attenuation [Formula: see text] and backscattered intensity [Formula: see text] from small volumes of interest annotated by experts in 35 pullbacks. Some results were as follows: noise reduction filtering was desirable, parallel line (PL) methods outperformed individual line methods, root mean square error was the best goodness-of-fit, and [Formula: see text]-trimmed PL ([Formula: see text]-T-PL) was the best overall method. Estimates of [Formula: see text] were calcified ([Formula: see text]), fibrotic ([Formula: see text]), and lipid ([Formula: see text]), similar to those in the literature, and tissue classification from optical properties alone was promising.
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Affiliation(s)
- Madhusudhana Gargesha
- Case Western Reserve University , Department of Biomedical Engineering, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Ronny Shalev
- Case Western Reserve University , Department of Electrical Engineering and Computer Science, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - David Prabhu
- Case Western Reserve University , Department of Biomedical Engineering, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Kentaro Tanaka
- University Hospitals Case Medical Center , Harrington Heart and Vascular Institute, Cardiovascular Imaging Core Laboratory, 11100 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Andrew M Rollins
- Case Western Reserve University , Department of Biomedical Engineering, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Marco Costa
- University Hospitals Case Medical Center , Harrington Heart and Vascular Institute, Cardiovascular Imaging Core Laboratory, 11100 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Hiram G Bezerra
- University Hospitals Case Medical Center , Harrington Heart and Vascular Institute, Cardiovascular Imaging Core Laboratory, 11100 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - David L Wilson
- Case Western Reserve University , Department of Biomedical Engineering, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States ; Case Western Reserve University , Department of Radiology, 11100 Euclid Avenue, Cleveland, Ohio 44106, United States
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Ma S, Maehara A, Hauptmann KE, Guagliumi G, Valsecchi O, Vassileva AN, Appelman Y, Sangiorgi G, Prati F, Mintz GS. Mechanism of luminal patency of the self-expanding Sideguard sidebranch stent: evaluation by intravascular ultrasound and optical coherence tomography. Catheter Cardiovasc Interv 2014; 84:734-41. [PMID: 24948549 DOI: 10.1002/ccd.25582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 04/14/2014] [Accepted: 06/14/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Cappella Sideguard (CS) sidebranch stent is a self-expanding, thin-strut, nitinol device with anatomic flaring at the sidebranch ostium designed to treat bifurcation lesions. OBJECTIVE To evaluate the mechanism of long-term lumen patency of the novel, self-expanding CS sidebranch stent compared with a balloon-expandable stent in the main vessel. METHODS We performed intravascular ultrasound postintervention and at follow-up in 24 CS stents and in 28 balloon-expandable drug-eluting stents deployed in the corresponding main vessel. Thirteen patients also had optical coherence tomography (OCT) at follow-up to evaluate neointimal hyperplasia and strut coverage. RESULTS CS stent area at the sidebranch carina increased significantly from 3.8 ± 1.2 mm(2) postintervention to 4.6 ± 1.2 mm(2) at follow-up (P < 0.001), resulting in no change in lumen area (3.8 ± 1.2 mm(2) to 3.7 ± 1.2 mm(2) , P = 0.72) despite a neointimal area at follow-up of 0.9 ± 0.8 mm(2) . Volumetric changes were similar, and the distribution of neointimal hyperplasia peaked 1-2 mm distal to the carina. Change of lumen volume inversely correlated to the neointimal volume (R = -0.48, P < 0.001), but correlated positively to the change in stent volume (R = 0.52, P < 0.0001). By OCT, most CS struts were covered (100% [98.9, 100]) at the bifurcation site, whereas 61% of floating DES struts that crossed the sidebranch were covered by smooth tissue with a similar texture compared with neointima. CONCLUSION Although neointimal hyperplasia accumulates within the CS stent mainly 1-2 mm distal to the carina, the self-expanding CS stent may be effective in maintaining an adequate patency in the sidebranch by continued stent expansion noted at follow-up.
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Affiliation(s)
- Shixin Ma
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, Columbia University Medical Center, New York, New York
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Fujino Y, Attizzani GF, Tahara S, Takagi K, Naganuma T, Wang W, Bezerra HG, Costa MA, Nakamura S. Impact of main-branch calcified plaque on side-branch stenosis in bifurcation stenting: an optical coherence tomography study. Int J Cardiol 2014; 176:1056-60. [PMID: 25156838 DOI: 10.1016/j.ijcard.2014.07.143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Yusuke Fujino
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
| | - Guilherme F Attizzani
- The Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, OH, USA; Division of Interventional Cardiology, Pitangueiras Hospital, Jundiai, SP, Brazil
| | - Satoko Tahara
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Kensuke Takagi
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Wei Wang
- The Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Hiram G Bezerra
- The Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Marco A Costa
- The Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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van Ditzhuijzen NS, Karanasos A, Bruining N, van den Heuvel M, Sorop O, Ligthart J, Witberg K, Garcia-Garcia HM, Zijlstra F, Duncker DJ, van Beusekom HMM, Regar E. The impact of Fourier-Domain optical coherence tomography catheter induced motion artefacts on quantitative measurements of a PLLA-based bioresorbable scaffold. Int J Cardiovasc Imaging 2014; 30:1013-26. [DOI: 10.1007/s10554-014-0447-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 05/09/2014] [Indexed: 11/24/2022]
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16
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Yoshimura T, Tanaka A, Mori N, Nakamura D, Taniike M, Makino N, Egami Y, Shutta R, Tanouchi J, Nishino M. Difference of neointimal growth patterns in bifurcation lesions among four kinds of drug-eluting stents: an optical coherence tomographic study. Catheter Cardiovasc Interv 2014; 84:742-9. [PMID: 24497273 DOI: 10.1002/ccd.25422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/06/2013] [Accepted: 01/27/2014] [Indexed: 01/21/2023]
Abstract
AIM Neointimal proliferation of bifurcation lesions after implantation of drug-eluting stents (DES) has not been well evaluated. Thus, we compared neointimal proliferation of bifurcation lesions among four DES using optical coherence tomography (OCT). METHODS 8-month follow-up OCT was performed in 68 bifurcation lesions treated by 15 sirolimus-eluting stents (SES) and 17 paclitaxel-eluting stents (PES) as first-generation DES, and by 17 zotarolimus-eluting stents (ZES) and 19 everolimus-eluting stents (EES) as second-generation DES. Cross-sectional images of the bifurcation lesion using OCT were analyzed every 450 µm. All images were divided into three areas: inner wall of the bifurcation (IB), outer wall of the bifurcation (OB), and ostium of the side branch (SB). We compared the incidence of uncovered struts (IUS) among three areas and the averaged neointimal thickness (NIH) between IB and OB in each stent and also compared these OCT parameters among all DES. RESULTS There were no significant differences of IUS between IB and OB in second-generation DES, while in first-generation DES, IUS of IB and OB showed significant differences. The IUS of SES in both areas was significantly higher than in the other DES (all P < 0.001). PES had a significantly higher IUS in SB than the others (all P < 0.001). NIH of OB was significantly higher than that of IB in PES, ZES, and EES, but in SES the NIH was similar in the two areas. CONCLUSIONS OCT revealed different neointimal growth patterns among SES, PES, ZES, and EES in bifurcation lesions.
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de la Torre Hernández JM, Lee DH, Garcia-Camarero T, Sainz Laso F, Zueco J. Comparison of paclitaxel-eluting vs. everolimus-eluting stents implanted simultaneously in different lesions of the same coronary artery: 12-month follow-up with optical coherence tomography. EUROINTERVENTION 2014; 9:952-8. [PMID: 24384292 DOI: 10.4244/eijv9i8a159] [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: 11/23/2022]
Abstract
AIMS Optical coherence tomography (OCT) allows a detailed assessment of intimal coverage and strut apposition which are well known substrates for late thrombosis. This study sought to assess and compare long-term coverage and apposition of PES and EES implanted in different lesions of the same coronary artery (and in the same patient). METHODS AND RESULTS A total of 30 patients were included. In these patients PES and EES were implanted in the same vessel in two similar lesions. The selection of the stent for each lesion was random. At 12 months, 30 PES were examined analysing 154±90 struts/stents and 30 EES analysing 158±72 struts/stents. The proportion of uncovered struts was 0.8±1.3% for EES and 1.5±2.9% for PES (p=0.3), and the proportion of malapposed struts was 1.25±2.1% and 0.98±2%, respectively (p=0.2). A pooled analysis was performed using the random effects model, given the significant heterogeneity found, which did not show significant differences between EES and PES for non-coverage (RR 0.73, 95% CI: 0.32-1.67) or malapposition (RR 1.60, 95% CI: 0.56-4.61). The presence of non-coverage in malapposed struts was 62% with PES and 15% with EES (p<0.0001), the maximal malapposition area being significantly larger with PES (0.6±0.3 vs. 0.25±0.2 mm², p=0.001). CONCLUSIONS In highly matched conditions, with PES and EES implanted in the same artery, both DES showed a comparable degree of intimal coverage and apposition at one-year follow-up. A smaller area of malapposition with non-covered struts was found with EES.
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Affiliation(s)
- Jose M de la Torre Hernández
- Unidad de Cardiología Intervencionista, Cardiología Valdecilla, Hospital Universitario Marques de Valdecilla, Santander, Spain
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18
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Attizzani GF, Bezerra HG, Ormiston J, Wang W, Donohoe D, Wijns W, Costa MA. Serial assessment by optical coherence tomography of early and late vascular responses after implantation of an absorbable-coating Sirolimus-Eluting stent (from the first-in-human DESSOLVE I trial). Am J Cardiol 2013; 112:1557-64. [PMID: 23992957 DOI: 10.1016/j.amjcard.2013.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
The initial enthusiasm caused by the potent antirestenotic effect of early generation drug-eluting stents was recently plagued by concerns regarding their safety profile. Investigators worldwide were stimulated, therefore, to seek for improvement in drug-eluting stent technology, such as eliminating their permanent polymer blamed for vascular inflammation and delayed healing. Optical coherence tomography (OCT) assessments of stent-vessel interactions are used as a surrogate for vessel healing after DES implantation. Herewith, we report serial OCT assessments of vascular reactions to the implantation of a novel absorbable polymer sirolimus-eluting stent (MiStent). In total, 30 patients were included. At 4-, 6-, and 8-month follow-up, different groups of 10 patients underwent OCT imaging, whereas all the patients had OCT assessments scheduled at 18-month follow-up. A total of 13,569 stent struts were analyzed. Low rates of uncovered (14.34 ± 15.35%, 6.62 ± 10.93%, 3.51 ± 2.87%, and 0.84 ± 1.15%, respectively, p <0.05 for 8- vs 18-month follow-up) and malapposed (3.74 ± 7.35%, 3.15 ± 6.13%, 0.48 ± 0.56%, and 0.09 ± 0.28%, respectively, p = NS) stent struts coupled with thin and increasingly homogenous neointimal proliferation were demonstrated. Neointimal area increased from 4- to 8-month follow-up (0.46 ± 0.29 and 1.12 ± 0.73 mm(2), respectively, p <0.05), whereas no "late catch up" was demonstrated at 18-month follow-up (1.28 ± 0.66 mm(2), p = NS vs 8-month follow-up). Early tissue maturation and reduction of low signal intensity tissue covering stent struts (8.8%, 3.1%, 0.3%, and 0%, respectively, p <0.05 for 4- vs 8-month follow-up comparison) were revealed by optical density analysis. In addition, high rates of strut coverage overlying the ostia of side branches without proliferative pattern were demonstrated. In conclusion, this comprehensive OCT analysis depicted favorable absorbable polymer sirolimus-eluting stent-vessel interactions up to 18-month follow-up.
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19
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Current applications of optical coherence tomography for coronary intervention. Int J Cardiol 2013; 165:7-16. [DOI: 10.1016/j.ijcard.2012.02.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 01/30/2012] [Accepted: 02/04/2012] [Indexed: 11/17/2022]
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20
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Setacci C, de Donato G, Setacci F, Galzerano G, Sirignano P, Cappelli A, Palasciano G. Safety and feasibility of intravascular optical coherence tomography using a nonocclusive technique to evaluate carotid plaques before and after stent deployment. J Endovasc Ther 2012; 19:303-11. [PMID: 22788878 DOI: 10.1583/12-3871r.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the safety and feasibility of optical coherence tomography (OCT) in patients with carotid stenosis undergoing carotid artery stenting (CAS). METHODS In a prospective study, 25 consecutive patients (15 men; mean age 74±4 years) undergoing protected CAS were enrolled and underwent high-definition (homoaxial resolution 10 µm) OCT image acquisition before stent deployment, immediately after stent placement, and following postdilation of the stent (3 scans/patient). Pullbacks were started during a nonocclusive flush, mechanically injecting 24 mL of 50% diluted contrast at 6 mL/s to displace blood from the artery. Two independent physicians judged the quality of images on a predefined 1-10 scale. The proportions of specific agreement and kappa values (κ) were calculated. RESULTS No procedural or in-hospital neurological complications occurred (any stroke/death 0%). The technical success of OCT pullbacks was 97.3% (73/75). The total amount of contrast was 86±18 mL/patient. No significant alteration in glomerular filtration rate or any other significant adverse event occurred. The images obtained were of high quality (mean value 8.1 out of 10), with good inter- and intraobserver agreement (κ = 0.81-0.87 and κ = 0.95, respectively). OCT images revealed innovative features such as rupture of the fibrous cap, plaque prolapse, and stent malapposition in a high percentage of the patients (range 24%-100%). CONCLUSION Intravascular OCT during a nonocclusive flush appears to be feasible and safe in carotid arteries. Since some original and unexpected information after CAS has been made available for the first time at such a high definition, future studies with OCT should focus on the interaction between carotid plaque and stent design, which might revolutionize our understanding of the mechanisms of carotid stenting, as well as influence our clinical policies.
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Affiliation(s)
- Carlo Setacci
- Department of Surgery, Vascular and Endovascular Surgery Unit, University of Siena, Italy
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21
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Poon KKC, Incani A, Raffel OC, Walters DL, Jang IK. Optical coherence tomography: research applications, potential clinical utility and future directions. Interv Cardiol 2012. [DOI: 10.2217/ica.12.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Lu H, Gargesha M, Wang Z, Chamie D, Attizzani GF, Kanaya T, Ray S, Costa MA, Rollins AM, Bezerra HG, Wilson DL. Automatic stent detection in intravascular OCT images using bagged decision trees. BIOMEDICAL OPTICS EXPRESS 2012; 3:2809-24. [PMID: 23162720 PMCID: PMC3493217 DOI: 10.1364/boe.3.002809] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/27/2012] [Accepted: 10/05/2012] [Indexed: 05/19/2023]
Abstract
Intravascular optical coherence tomography (iOCT) is being used to assess viability of new coronary artery stent designs. We developed a highly automated method for detecting stent struts and measuring tissue coverage. We trained a bagged decision trees classifier to classify candidate struts using features extracted from the images. With 12 best features identified by forward selection, recall (precision) were 90%-94% (85%-90%). Including struts deemed insufficiently bright for manual analysis, precision improved to 94%. Strut detection statistics approached variability of manual analysis. Differences between manual and automatic area measurements were 0.12 ± 0.20 mm(2) and 0.11 ± 0.20 mm(2) for stent and tissue areas, respectively. With proposed algorithms, analyst time per stent should significantly reduce from the 6-16 hours now required.
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Affiliation(s)
- Hong Lu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Madhusudhana Gargesha
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Zhao Wang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Daniel Chamie
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Guilherme F. Attizzani
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Tomoaki Kanaya
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Soumya Ray
- Department of Electrical Engineering & Computer Science, Case Western Reserve University Cleveland, OH, 44106, USA
| | - Marco A. Costa
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Hiram G. Bezerra
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - David L. Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, 44106, USA
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Viceconte N, Tyczynski P, Ferrante G, Foin N, Chan PH, Barrero EA, Di Mario C. Immediate results of bifurcational stenting assessed with optical coherence tomography. Catheter Cardiovasc Interv 2012; 81:519-28. [DOI: 10.1002/ccd.24337] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/03/2012] [Indexed: 12/15/2022]
Affiliation(s)
| | - Pawel Tyczynski
- Cardiovascular Biomedical Research Unit; Royal Brompton Hospital; London; United Kingdom
| | - Giuseppe Ferrante
- Cardiovascular Biomedical Research Unit; Royal Brompton Hospital; London; United Kingdom
| | | | - Pak Hei Chan
- Cardiovascular Biomedical Research Unit; Royal Brompton Hospital; London; United Kingdom
| | | | - Carlo Di Mario
- Cardiovascular Biomedical Research Unit; Royal Brompton Hospital; London; United Kingdom
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24
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Hamdan R, Gonzalez RG, Ghostine S, Caussin C. Optical coherence tomography: from physical principles to clinical applications. Arch Cardiovasc Dis 2012; 105:529-34. [PMID: 23062484 DOI: 10.1016/j.acvd.2012.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Revised: 02/14/2012] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
Abstract
Optical coherence tomography is a new endocoronary imaging modality employing near infrared light, with very high axial resolution. We will review the physical principles, including the old time domain and newer Fourier domain generations, clinical applications, controversies and perspectives of optical coherence tomography.
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Affiliation(s)
- Righab Hamdan
- Centre chirurgical Marie-Lannelongue, cardiologie, 133, avenue de la Resistance, 92350 Le Plessis Robinson, France.
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25
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Mehanna EA, Attizzani GF, Kyono H, Hake M, Bezerra HG. Assessment of coronary stent by optical coherence tomography, methodology and definitions. Int J Cardiovasc Imaging 2011; 27:259-69. [PMID: 21336555 DOI: 10.1007/s10554-010-9793-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 12/30/2010] [Indexed: 10/18/2022]
Abstract
Optical coherence tomography has emerged as a powerful tool for stent assessment, and in a short time, has become the modality of choice for studying stent and vascular interactions in vivo. In this review, we discuss qualitative and quantitative parameters used for stent assessment by OCT. Various qualitative/quantitative variables of stent assessment are discussed in the perspective of the clinical and research values of each of them.
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Affiliation(s)
- Emile Aziz Mehanna
- Harrington-McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Erglis A, Narbute I, Juhnevica D, Kumsars I, Jegere S. Lessons for the treatment of bifurcation lesions: from nowadays to the future. Interv Cardiol 2011. [DOI: 10.2217/ica.10.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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27
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Affiliation(s)
- Yasuhiko Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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28
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