Mean Lumen Area Research Articles

Impact of multiple ballooning on coronary lesions as assessed by optical coherence tomography and intravascular ultrasound.

Optimal lesion preparation for coronary lesions has been reappraised in the interventional community, given the increasing use of drug-coated balloons for de novo lesions; however, whether multiple ballooning could achieve more favorable angiographic results compared with single ballooning remains unknown. We aimed to investigate the incremental effect of multiple ballooning on de novo coronary lesions over single ballooning as assessed by optical coherence tomography (OCT) and intravascular ultrasound (IVUS) among patients undergoing percutaneous coronary intervention (PCI). Patients with chronic coronary syndrome (CCS) undergoing PCI were enrolled. Ballooning before stent implantation was repeatedly performed for three times using the same semi-compliant balloon. OCT and IVUS were performed after each balloon dilatation. Primary outcome measure was the difference in the mean lumen area between post-1st ballooning (1B) and post-3rd ballooning (3B) as assessed by OCT. A total of 32 lesions in 30 patients undergoing PCI between May 2021 and August 2022 were analyzed. Major plaque types of the lesions were fibrous (68.8%) and lipid (28.1%). Mean lumen area by OCT was significantly increased from 1B to 3B (5.9 ± 2.9 mm2 vs. 6.0 ± 2.9 mm2, difference: 0.2 ± 0.4 mm2, p = 0.040). There were significant increases from 1B to 3B in minimum lumen area by OCT (3.1 ± 1.5 mm2 vs. 3.6 ± 1.7 mm2, difference: 0.5 ± 0.6 mm2, p < 0.001) and mean dissection angle by OCT (65.6 ± 24.9° vs. 95.2 ± 34.0°, difference: 29.6 ± 25.5°, p < 0.001). Additionally, mean plaque area by IVUS was significantly decreased (8.0 ± 4.2 mm2 vs. 7.8 ± 4.1 mm2, difference: -0.2 ± 0.2 mm2, p < 0.001). Among CCS patients with mainly non-calcified lesions, multiple ballooning significantly increased the lumen area and dissection angle compared with single ballooning.

The presence of an aberrant anterior tibial artery does not depend on the patient's morphotype.

The aberrant anterior tibial artery (ATA) runs along the posterior surface of the tibial cortex making it, particularly, at risk during high tibial osteotomy (HTO). This study aimed to analyze the prevalence of the ATA according to global morphotype and its anatomical features in consideration of knee surgery. This retrospective study included 1589 knees on magnetic resonance imaging (MRI) studies with long-leg radiographs. The anatomical characteristics of the ATA, its distance in surgical areas at risk and its lumen were defined on MRI. Its presence according to the patient's morphotype (varus, valgus or neutral) was assessed using a χ2 test. The ATA was present in 33 of 1589 knees, resulting in a prevalence of 2.1%. The anteroposterior distance of the ATA to the tibial head was 6.6 ± 2.5 mm at the height of the tibial plateau, 2.7 ± 1.6 mm at the footprint of the posterior cruciate ligament and 1.0 ± 0.6 mm under the top of the fibula (p < 0.01). For these three levels, the ratio between the distance from the ATA to the lateral tibial border and the total tibial width decreases progressively (p < 0.001). The mean lumen area of the ATA was 4.2 ± 2.5 mm2, and the lumen of the popliteal artery was 9.2 ± 3.6 mm2, representing a ratio of 49.4 ± 27.0%. The prevalence of ATA was similar between varus and valgus patients (n.s). The presence of an ATA is rare, found in one out of 50 cases, but can be easily identified on MRI in patients before knee surgery, especially before HTO. The patient's morphotype did not influence its presence, the lumen diameter is highly variable and its clinical impact has yet to be determined. Cross-sectional study. Level 3.

Prevalence of intracerebral thrombus detected by optical coherence tomography in patients with posterior circulation stroke or transient ischemic attack

BackgroundThe incidence of thrombosis in patients with intracranial atherosclerotic stenosis (ICAS) remains unclear. Optical coherence tomography (OCT) has the potential to explore the vessel wall structure of posterior-circulation ICAS because...

Twelve-months vessel healing profile following the novel resorbable magnesium scaffold implantation: an intravascular OCT analysis of the BIOMAG-I trial

Abstract Background The first-in-human trial of the latest resorbable magnesium scaffold (RMS), DREAMS 3G, showed favorable clinical and angiographic outcomes up to 6-months. An intravascular optical coherence tomography (OCT) assessment of the vascular healing profile at 6 months and 12 months follow-up may serve as additional supportive evidence for device safety and efficacy. Purpose The aim of this study was to evaluate the vessel healing process by quantifying the presence of strut protrusion (SP) and strut degradation following DREAMS 3G implantation as per intravascular OCT imaging. Methods Patients from the BIOMAG-I trial who underwent OCT imaging at both 6- and 12-months were deemed eligible. This resulted in the inclusion of a total of 51 patients and 52 lesions in the current analysis. The acquired intravascular imaging data were evaluated every 1 mm to visualize and quantify the SP and the number of visible struts at 6- and 12-months. In addition, we investigated the potential impact of SP on mean and minimum lumen area (mm2) at both time point. Results At 12 months, the mean SP area was significantly smaller in comparison to 6 months follow-up (1.87±2.22 mm2 at 6 months vs. 0.99±1.27 mm2 at 12 months, p&amp;lt;0.001). There was a positive correlation between SP area and mean lumen area at both 6 months (p&amp;lt;0.001) and 12 months (p=0.014) follow-up. Similarly, a positive correlation was observed between SP area and minimum lumen area up to 6 months (p=0.006 at 6 months, p=0.323 at 12 months). The number of visible struts was 6.44±7.59 at 6 months and 1.79±0.85 at 12 months (p&amp;lt;0.001). Conclusion The SP area was larger in lesions with greater lumen area following the implantation of the novel RMS. The observed SP area was significantly smaller at 12 months in comparison to 6 months follow-up. These results suggest that the presence of SP is part of a favorable vascular healing process following the treatment with the latest resorbable magnesium scaffold.

The impact of underlying plaque characteristics following the novel resorbable magnesium scaffold implantation: an intravascular OCT assessment up to 12-months

Abstract Background Second-generation resorbable magnesium scaffold (RMS) Magmaris showed favorable outcomes in clinical trials, especially regarding the incidence of scaffold thrombosis. The earlier studies reported a higher occurrence of scaffold recoil with this RMS owing to vessel constriction. This finding was shown to be more prominent in presence of underlying fibrous plaques rather than calcific and/or lipidic lesions. This suggest that sufficient radial force along with longer scaffolding time may improve the device performance. Against this background, DREAMS 3G was developed with stronger mechanical properties despite thinner struts by modifying the magnesium alloy of its predecessor. The first-in-man trial BIOMAG-I demonstrated promising results for the novel RMS with respect to clinical and angiographic outcomes at 6 months follow-up. Still, the data concerning the performance of DREAMS 3G scaffold up to 12-months are lacking. Purpose This study aims to assess the influence of the intravascular optical coherence tomography (OCT) -derived underlying plaque characteristics on mean lumen area (mm 2) in patients treated with DREAMS 3G at 6- and 12-months. Methods Patients enrolled in the BIOMAG-I trial and who underwent OCT imaging (i) at index-procedure, (ii) at 6-months and (iii) at 12-months follow-up were included in the current analysis. The acquired intravascular imaging data were evaluated every 1 mm on a quadrant basis to assess the presence of fibrous, calcific, or lipidic lesions. We calculated the proportions of each plaque feature per pullback, then assessed their correlation with the mean lumen area obtained at 6- and 12-months follow-up. In addition, we investigated the potential impact of scaffold edge dissection on the mean lumen area. Results Fifty-one patients and 52 lesions were evaluated in the current analysis. There was no significant correlation between the underlying plaque characteristic and mean lumen area at 6-months (p=0.767 for fibrous, p=0.761 for calcific, p=0.767 for lipid lesions). This trend was similar at 12 months follow-up (p=0.499 for fibrous, p=0.714 for calcific, p=0.569 for lipid lesions). Finally, the presence of edge dissection did not correlate with mean lumen area (p=0.559 and p=0.670 at 6- and 12-months follow-up, respectively). Conclusion The underlying plaque characteristics and the presence of edge dissection had no significant impact on the mean lumen area following DREAMS 3G implantation up to 12 months. These results suggest better device performance with the novel RMS irrespective of the underlying plaque characteristics.

Preliminary results of the feasibility and precision of optical coherence tomography guided and robotic-assisted PCI (Robo-OCT) study

Abstract Background/Introduction Optical coherence tomography (OCT) allows high resolution characterisation of coronary lesions as well as optimization of stent implantation and detection of stent-related mechanical problems leading to restenosis. Robotic assisted PCI (R-PCI) additionally enables highly precise stent positioning. Therefore, the combination of OCT with R-PCI might further improve outcome of PCI – based on a highly individualized planning of the PCI procedure, highly precise conduction of the procedure, quality assessment of stent placement, and in parallel protection of the personnel. Purpose Analyse the technical feasibility and safety of R-PCI and OCT. Methods We report preliminary data of our ongoing feasibility study of combining R-PCI with OCT (DRKS-Nr. DRKS00024995). In this pilot study, first the technical feasibility and safety of a joint application of OCT and R-PCI were investigated. Moreover, R-PCI success and quality were evaluated by post-PCI OCT imaging. Results In the eight patients treated so far, a technical success rate of 100% was achieved. However, as the mechanics of the cassettes device drive damage the sensitive OCT catheter, manual insertion of the OCT catheter via the passive drive had to be performed in all cases. Rate of complications (MACE: cardiac death, cerebrovascular event (stroke), documented myocardial infarction, target lesion repeated revascularization (PCI and/or CABG), dissection or occlusion) was 0%. Post-PCI OCT showed neither major (≥60 degrees of the circumference of the vessel at site of dissection and/or ≥3 mm in length) nor minor (&amp;lt;60 degrees of the circumference of the vessel and &amp;lt; 3 mm in length) edge dissections (both 0%). Furthermore, the rate of untreated reference segments (focal disease with untreated Mean Lumen Area (MLA) &amp;lt; 4.5 mm2 within 5 mm from the proximal and/or distal stent edges) was 0%. Conclusion Preliminary results of the Robo-OCT feasibility study showed a high technical success rate of the combination of OCT with robotic assisted PCI without any complications or vessel injuries proven by OCT.

Detection of Dolichoectasia and Atherosclerosis by Automated MRA Tortuosity Metrics in a Population-Based Study.

Intracranial vessel tortuosity is a key component of dolichoectasia and has been associated with atherosclerosis and adverse neurologic outcomes. However, the evaluation of tortuosity is mainly a descriptive assessment. To compare the performance of three automated tortuosity metrics (angle metric [AM], distance metric [DM], and distance-to-axis metric [DTA]) for detection of dolichoectasia and presence of segment-specific plaques. Observational, cross-sectional metric assessment. 1899 adults from the general population; mean age = 76 years, female = 59%, and black = 29%. 3-T, three-dimensional (3D) time-of-flight MRA and 3D vessel wall MRI. Tortuosity metrics and mean luminal area were quantified for designated segments of the internal carotid artery, middle cerebral artery, anterior cerebral artery, posterior cerebral artery, vertebral artery, and entire length of basilar artery (BA). Qualitative interpretations ofBA dolichoectasia were assessed based on Smoker's visual criteria. Descriptive statistics (2-sample t-tests, Pearson chi-square tests) for group comparisons. Receiver operating characteristics area under the curve (AUC) for detection of BA dolichoectasia or segment-specific plaque. Model inputs included 1) tortuosity metrics, 2) mean luminal area, and 3) demographics (age, race, and sex). Qualitative dolichoectasia was identified in 336 (18%) participants, and atherosclerotic plaques were detected in 192 (10%) participants. AM-, DM-, and DTA-calculated tortuosity were good individual discriminators of basilar dolichoectasia (AUCs: 0.76, 0.74, and 0.75, respectively), with model performance improving with the mean lumen area: (AUCs: 0.88, 0.87, and 0.87, respectively). Combined characteristics (tortuosity and mean luminal area) identified plaques with better performance in the anterior (AUCs ranging from 0.66 to 0.78) than posterior (AUCs ranging from 0.54 to 0.65) circulation, with all models improving by the addition of demographics (AUCs ranging from 0.62 to 0.84). Quantitative vessel tortuosity metrics yield good diagnostic accuracy for the detection of dolichoectasia. 1 TECHNICAL EFFICACY STAGE: 2.

Diagnostic significance of CT quantitative detection in chronic lung disease

Objective To explore the diagnostic value of CT quantitative detection in chronic obstructive pulmonary disease (COPD). Methods A total of 113 patients with suspected COPD who were hospitalized in an outpatient department of a hospital from January 2018 to December 2020 were selected as the subjects of study. All patients underwent CT quantitative examination, lung function and other related examinations. The results of lung function examination were used as the gold standard to detect COPD, and the application of CT quantitative examination in the diagnosis of COPD was analyzed. Results Among 157 suspected patients with C0PD, 112 (71.34%) were COPD and 20 (12.74%) were bronchial asthma; The forced expiratory volume (FEV,), forced vital capacity (FVC) and FEV,/FVC value, mean lung density (MLD) and lumen area (LA) in the first second of COPD group were lower than those in the non-COPD group. The respiratory biphasic voxel index&lt;- 950HU lung volume accounted for the percentage of total lung volume [VI-950 (%)] and the percentage of wall area (WA%) in the COPD group were higher than those in the non-COPD group, and the difference was statistically significant (P&lt;0.05); The results of bivariate Spearson correlation test showed that FEV,/FVC were negatively correlated with VI-950 and WA% (r&lt;0, P&lt;0.05), and positively correlated with MLD and LA (r&gt;0, P&lt;0.05); The ROC curve results show that the AUC of quantitative detection of VI-950, MLD, LA, WA% for COPD by rCT is more than 0.7, which has high predictive value. When the best threshold is obtained, the best predictive value can be obtained. Conclusion CT quantitative detection has high diagnostic efficiency in the differential diagnosis of COPD, and can provide objective reference for clinical early examination.

Differences in left and right carotid plaque vulnerability in patients with bilateral carotid plaques: a CARE-II study

Background and purposeAtherosclerosis is a very complex process influenced by various systemic and local factors. Therefore, in patients with bilateral carotid plaques (BCPs), there may be differences in carotid plaque...

MORPHOMETRIC AND MORPHOLOGICAL ASSESSMENT OF CORONARY ARTERIES WITH INTRAVASCULAR ULTRASOUND

The aim: To perform a morphometric assessment of the coronary arteries ostia by intravascular ultrasound with morphological evaluation among the Ukrainian population. Materials and methods: Intravascular images of the ostia of the right (48%) and left (52%) coronary arteries with the minimum diameter, maximum diameter, mean diameter and lumen area were analyzed. An intravascular ultrasound procedure was performed before percutaneous intervention. Results: A total of 25 IVUS examinations were collected from patients of both sexes and the same ages: 61,27±10,24 for males and females 68±5,83 (p=0.64).The left coronary artery (LCA) ostium assessment was performed in 13 (52%) cases: 8 men and 5 women (32% and 20%, respectively). The right coronary artery (RCA) ostium assessment was performed in 12 (48%) cases: 7 men and 5 women (28% and 20%, respectively). The maximal diameter of the coronary artery ostia was higher in men (5.95±0.66mm) than in women (4.82±0.34mm) (p<0.0001). In men, the maximal diameter of the RCA was higher than in the LCA (6.4±0.40mm and 5.56±0.60mm, respectively). The same differences were found in the mean diameter and lumen area (p<0.05). In women, the minimum diameter, mean diameter, maximum diameter and lumen area of the RCA were higher than LCA but without statistically signi#cant di"erences. The anatomic precondition explains the observed changes in echogenicity. Conclusions: IVUS analysis shows signi#cantly higher parameters of the minimum diameter, mean diameter, maximum diameter and lumen area in men than in women among the Ukrainian population. Therefore, morphological evaluation is crucial in the interpretation of intracoronary images.

Practical guidelines for quantitative wood anatomy on Ginkgo biloba L.

Summary Ginkgo biloba L., a long-lived relict species, has high ecological, cultural and economic value. Studying the quantitative wood anatomy of G. biloba is important to understand the relationships between their tree-growth and climate change, which could help in the protection of old G. biloba trees. Preparing high-quality wood thin sections is the premise of quantitative wood anatomy analysis. In addition, manual correction of image analysis is a time-consuming process. We therefore present a protocol on how to make G. biloba high-quality xylem thin sections, from sample preparation, sample embedding, blade selection to thickness selection. We also present a method to determine the necessary sample width and number of cores to establish reliable wood anatomical time series that both can capture climate signals and reduce the time used for image analysis. For microsection preparation, it is optimal to cut 20–30-μm-thick sections using Leica DB80 blades after applying the cornstarch solution on top of the sample surface. For image analysis, the reliable wood anatomical time series can be established when measuring six cores (trees) or above, and the environmental signals are captured when analyzing a 1.2-mm-wide radial strip along the increment core (deviation &lt;2%) for the parameters cell density, mean lumen area, potential hydraulic conductivity and percentage of the conductive area. This paper provides practical guidance to successfully use quantitative wood anatomy methods on G. biloba. We hope our study will be helpful for future research on the quantitative wood anatomy of G. biloba and similar tree species.

Structural and Functional Evaluation of Coronary Arteries Treated With ABSORB Bioresorbable Vascular Scaffold at 5-Year Follow-Up

Although complete bioresorbable vascular scaffold (BVS) resorption has been demonstrated at 5-year follow-up, whether corresponding vasomotor function restoration occurs remains unknown. The objective was to simultaneously assess the structural healing response along with vasomotor responses at 5-year follow-up of BVS implantation. We studied consecutive patients treated with ABSORB-BVS at 5-year follow-up (n=31), who were recruited from a multicenter registry and were contacted to undergo a research protocol-driven repeat coronary angiogram involving intracoronary optical coherence tomography (OCT) and invasive coronary endothelial function testing. Epicardial endothelium-dependent vasomotion was defined as any vasodilatation after intracoronary acetylcholine (ACh), whereas endothelium-independent vasomotion was defined as any vasodilatation after intracoronary nitroglycerine (NTG), using quantitative coronary angiography. The mean implantation time point was 60.5 ± 4.6 months. OCT imaging demonstrated complete scaffold resorption in all patients. New coronary lesions (stenosis &gt;50%) were found in 5 patients (16.1%), 3 of them underwent ad hoc percutaneous revascularization (9.7%). Intracoronary ACh (27 patients) and NTG testing (30 patients) was performed. Quantitative coronary angiography analysis demonstrated vasoconstriction after ACh administration and lack of response to NTG in BVS segments (mean lumen diameter=2.00 ± 0.61 mm at baseline vs 1.74 ± 0.70 mm post-ACh, p &lt;0.001; 2.05 ± 0.54 mm at baseline vs 2.03 ± 0.50 mm post-NTG, p=0.69). OCT lumen analysis demonstrated similar vasoconstrictive responses to ACh (mean lumen area=5.31 ± 2.26 mm² at baseline vs 5.12 ± 2.55 mm² post-ACh, p=0.007) but had a vasodilatory response to NTG (5.96 ± 2.35 mm² at baseline vs 6.17 ± 2.55 mm² post-NTG, p&lt;0.001). In conclusion, complete ABSORB-BVS resorption was demonstrated at 5-year follow-up. However, this healing response was associated with endothelium-dependent vasomotor dysfunction within the BVS segment.

Long-Term Changes in the Coronary Artery Structure After Heart Transplantation: A Prospective Optical Coherence Tomography Study

<h3>Purpose</h3> Optical coherence tomography (OCT) enables detailed characterization of plaque composition in cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). Using serial OCT scans, our research group previously demonstrated that early CAV is characterized by intimal thickening strongly associated with layered fibrotic plaques (LFPs) progression. Early changes after HTx are well-described, whereas no serial OCT studies in long-term HTx patients have been performed. We aimed to describe and characterize late changes in the coronary artery microstructure after HTx. <h3>Methods</h3> In 134 vessels from 56 long-term HTx patients (median 8.3 years), we performed OCT scans of the major coronary arteries in relation to routine annual coronary angiography at baseline and after 12 months. We contoured the vessel layers for absolute and relative measurements. Lipid plaques, calcified plaques, bright spots, and LFPs were analyzed by delineating circumferential borders and measuring angulation of total circumference. <h3>Results</h3> A total of 15.634 frames were analyzed. Mean intima area increased significantly (2.8 [1.9 to 4.4] mm² vs. 3.0 [2.0 to 4.5] mm², <i>p</i> <0.01) and mean lumen area decreased significantly (8.7 [6.9 to 10.3] mm² vs. 8.4 [6.8 to 10.3] mm², <i>p</i><0.05) during follow-up. A high prevalence of LFPs was observed and the extent increased 14 % during follow-up (38.0 [22.7 to 65.9] % vs. 43.4 [25.1 to 67.7] %, <i>p</i><0.0001). A low prevalence of lipid plaques was observed (0.65% [0.34% to 1.48%] vs. 0.71% [0.16% to 2.27%], <i>p</i>=0.11). We found no difference in the extent of bright spots (<i>p</i>=0.99), calcified plaques (<i>p</i>=0.60) or mean media area (<i>p</i>=0.23) during follow-up. <h3>Conclusion</h3> LFPs are highly prevalent in long-term HTx patients. Late progression of CAV is similar to the findings early after HTx with intimal thickening primarily characterized by progression of LFPs. In contrast, the extent of bright spots and calcified plaques remained stable, and lipid plaques were rarely observed.

Clinical and angiographic success and safety comparison of coronary intravascular lithotripsy: An updated meta-analysis.

BackgroundIntravascular lithotripsy (IVL) can be used to assist stent deployment in severe coronary artery calcifications (CAC).MethodsStudies employing IVL for CAC lesions were included. The primary outcomes included clinical and angiographic success. The secondary outcomes, including lumen gain, maximum calcium thickness, and calcium angle at the final angiography site, minimal lumen area site, and minimal stent area site, were analyzed by the random-effects model to calculate the pooled standardized mean difference. Tertiary outcomes included safety event ratios.ResultsSeven studies (760 patients) were included. The primary outcomes: pooled clinical and angiographic success event ratio parentage of IVL was 94.4% and 94.8%, respectively. On a random effect model for standard inverse variance for secondary outcomes showed: minimal lumen diameter increase with IVL was 4.68 mm (p-value < 0.0001, 95% CI 1.69–5.32); diameter decrease in the stenotic area after IVL session was −5.23 mm (95 CI –22.6–12.8). At the minimal lumen area (MLA) and final minimal stent area (MSA) sites, mean lumen area gain was 1.42 mm2 (95% CI 1.06–1.63; p < 0.00001) and 1.34 mm2 (95% CI 0.71–1.43; p < 0.00001), respectively. IVL reduced calcium thickness at the MLA site (SMD −0.22; 95% CI −0.40–0.04; P = 0.02); calcium angle was not affected at the MLA site. The tertiary outcomes: most common complication was major adverse cardiovascular events (n = 48/669), and least common complication was abrupt closure of the vessel (n = 1/669).ConclusionsEvidence suggests that IVL safely and effectively facilitates stent deployment with high angiographic and clinical success rates in treating severely calcified coronary lesions.

Assessment of the conventional radial artery with optical coherent tomography after the snuffbox approach.

BackgroundThis study aimed to evaluate acute injuries of the radial artery (RA) using optical coherence tomography (OCT) in patients who underwent coronary intervention via the snuffbox approach.MethodsForty-six patients, who underwent coronary intervention and assessment of the conventional RA using OCT via the snuffbox approach, were enrolled from two university hospitals between August 2018 and August 2019.ResultsThe mean age of the patients was 65.1 years. In this study population, 6-French (Fr) sheaths were used. The mean diameter of the conventional RA was 2.89 ± 0.33 mm, and the mean lumen area of the conventional RA was 6.68 ± 1.56 mm2. Acute injuries of the conventional RA, after the snuffbox approach, were observed in 5 (10.9%) patients. Intimal tear was observed in the RA in 1 (2.2%) case. Intraluminal thrombi, without vessel injuries, were detected in the RA in 4 (8.7%) cases. However, medial dissection was not observed in the OCT analysis.ConclusionsThis retrospective OCT-based study showed that the diameter of the conventional RA was 2.89 mm and acute vessel injury of the conventional RA was rare in patients who underwent coronary intervention via the snuffbox approach.

Ultra-Short Term Evaluation of Coronary Vessel Wall Changes in Reference Segments Adjacent to Culprit Lesions in ST-Segment Elevation Myocardial Infarction.

Culprit lesions of ST-segment elevation myocardial infarction (STEMI) patients are friable, soft, and prone to disruption during primary percutaneous coronary intervention (pPCI). The presence of dissections in reference vessel segments (RVSs), adjacent to stented culprit lesions, and dynamic luminal changes in proximal or distal RVSs have not yet been investigated. We therefore sought to assess the healing patterns of edge dissections and the changes of lumen area at RVSs within 1 week post stent implantation in patients with STEMI. In the MATRIX trial (ClinicalTrials.gov NCT01433627), optical coherence tomography (OCT) was performed at the end of pPCI and within 1 week during staged PCI. The RVS dissection was defined as: type 1 = flap; type 2 = cavity; type 3 = double barrel; and type 4 = fissure. We compared separately the fate of residual dissection and luminal area/dimension by OCT in the target vessel between pPCI and staged PCI, including 1-year clinical outcomes. Out of 151 patients, 46 patients had dissections in 50 RVSs and did not experience worse clinical outcome. Dissections were 44% type 1, 28% type 2, 12% type 3, and 16% type 4. Overall, 18% of the dissections healed. The mean lumen area of the RVS enlarged in 82 patients (59%) from pPCI to staged PCI. Compared with the proximal RVS, there was a significant increase in the lumen diameter at the distal RVS (0.06 ± 0.25 mm vs -0.01 ± 0.21 mm; P=.01). Dissections occur frequently after pPCI. One-fifth of them heal within 1 week and do not seem to negatively impact clinical outcomes. Distal RVS lumen area increased compared with proximal RVS, likely reflecting a different vasoconstriction pattern over time.

Abstract 12618: Feasibility of Non-Contrast Optical Coherence Tomography Imaging in Coronary Arteries

Background/Objectives: Contemporary high-resolution intracoronary optical coherence tomography (OCT) requires injection of flushing media for image acquisition to avoid signal attenuation by red blood cells. There is a growing need for an alternative flushing media other than iodine contrast to reduce the risk of renal dysfunction. To address this issue, we investigated the safety and feasibility of pentastarch solution as a flushing media for OCT image acquisition and compared with the contrast media flushed images. Methods/Results: We prospectively enrolled 12 patients with 15 coronary lesions (12 stented lesions and 3 non-culprit lesions). Paired OCT images were obtained by manual injection of iodine contrast (average 12 mL), followed by pentastarch (average 18-20 mL). A total of 30 runs were analyzed and each OCT pullback was assessed on a frame-by-frame basis by automated customized pixel-wise comparison algorithm. The number of clear image segments (CIS) and pre-specified quantitative measurements were compared between the paired OCT images. Image quality as assessed by proportion of CIS showed no significant difference between the contrast media and pentastarch (98.5% vs. 97.5%; p=0.850). Quantitative measurements including minimal lumen area, mean lumen area, and pixel-wise blood flushing capability correlated well between the paired image segments (p&lt;0.001) (Figure). There were no clinically relevant complications associated with OCT imaging with pentastarch administration such as anaphylactic reaction, life-threatening arrhythmia, heart failure, or acute renal deterioration. Conclusions: Intracoronary OCT using pentastarch is safe and technically feasible without affecting the optical signal intensity and overall image quality. Non-contrast imaging with pentastarch significantly reduces the obligatory iodine contrast load, therefore, could be considered as a promising strategy in high-risk patients for renal impairment.

Serial Baseline, 12-, 24-, and 60-Month Optical Coherence Tomography Evaluation of ST Segment Elevation Myocardial Infarction Patients Treated with Absorb Bioresorbable Vascular Scaffold

Data on long-term neointimal healing and neoatherosclerosis progression after primary percutaneous coronary intervention (PCI) with implantation of everolimus-eluting bioresorbable vascular scaffold (BVS) (ABSORB BVS 1.0, Abbott Vascular) are limited. The mechanisms underlying very late scaffold failure remain to be further elucidated. This study sought to assess healing pattern and presence of neoatherosclerosis. This was a single-center, prospective, longitudinal study with serial optical coherence tomography (OCT) assessment at baseline, 12, 24 and 60 months after PCI performed in 12 patients presenting with ST-segment elevation myocardial infarction (STEMI). The median follow-up was 59 months. The diameter stenosis increased from 7.11 ± 4.99% at 1-year to 21.00 ± 11.31% at 5 years, (p = 0.03), whereas minimum lumen diameter remained stable throughout the follow-up period, as assessed by angiography. Minimum and mean lumen area declined over the 5-year follow-up by 1.00 ± 1.57 mm2 and 1.75 ± 0.87 mm2, respectively; a significant decrease in minimum and mean lumen area in the first two years, was followed by stable luminal dimensions between 2 and 5 years of follow-up. The lumen eccentricity (0.85 ± 0.03) and asymmetry (0.43 ± 0.10) indexes showed no change over 60-month follow-up. The incidence of atherosclerosis was high both in the in-scaffold (IS) and out-scaffold (OS) regions consisting of calcifications (IS = 100%, OS = 92%, p = 0.99), macrophages (IS = 92% and OS = 67%, p = 0.31), neovascularization (IS = 75%, OS = 50%, p = 0.40). In conclusion, serial OCT imaging up to 5 years after implantation of BVS in STEMI indicated complete scaffold resorption, stable lumen area following period of neointima growth in the first two years after PCI and high incidence of neoatherosclerosis.

OCT-Derived Plaque Morphology and FFR-Determined Hemodynamic Relevance in Intermediate Coronary Stenoses.

Background: optical coherence tomography (OCT) might allow identifying lesion features reportedly associated with plaque vulnerability and increased risk of clinical events. Previous studies on correlation between OCT and functional lesion significance indices reported contradictory results, yet integration of complementary information from both modalities is gaining increased interest. The aim of the study was to compare plaque morphology using OCT in hemodynamically relevant vs. non-relevant lesions by fractional flow reserve (FFR). Methods: consecutive patients with intermediate grade coronary stenoses by angiography were evaluated by both FFR and OCT in this single-center study. Stenoses were labeled hemodynamically relevant in case of the FFR ≤ 0.80. Minimal lumen area (MLA), fibrous cap thickness (FCT), minimal cap thickness over the calcium, angle of the calcium, and necrotic core within the lesions were evaluated. Results: a total of 105 patients (124 vessels) were analyzed. Of them, 65 patients were identified with at least one lesion identified as hemodynamically relevant by FFR (72 vessels, 58.1%). Lesions with FFR ≤0.80 presented with lower mean and minimal lumen area (3.46 ± 1.29 vs. 4.65 ± 2.19, p =0.001 and 1.84 ± 0.97 vs. 2.66 ± 1.40, p = 0.001) compared to patients with FFR > 0.80. No differences were found between groups in the mean and minimal FCT, mean, and maximal necrotic core, calcium angle, as well as the overall rate of calcified and lipid plaques. Conclusion: hemodynamic relevance of intermediate grade lesions correlated moderately with the luminal assessment by OCT. No differences were identified in the plaque morphology between relevant and non-relevant coronary stenoses by FFR.

Assessment of Image Quality for Selective Intracoronary Contrast-Injected CT Angiography in a Hybrid Angio-CT System: A Feasibility Study in Swine.

PurposeTo compare image quality in selective intracoronary contrast-injected computed tomography angiography (Selective-CTA) with that in conventional intravenous contrast-injected CTA (IV-CTA).Materials and MethodsSix pigs (35 to 40 kg) underwent both IV-CTA using an intravenous injection (60 mL) and Selective-CTA using an intracoronary injection (20 mL) through a guide-wire during/after percutaneous coronary intervention. Images of the common coronary artery were acquired. Scans were performed using a combined machine comprising an invasive coronary angiography suite and a 320-channel multi-slice CT scanner. Quantitative image quality parameters of CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), mean lumen diameter (MLD), and mean lumen area (MLA) were measured and compared. Qualitative analysis was performed using intraclass correlation coefficient (ICC), which was calculated for analysis of interobserver agreement.ResultsQuantitative image quality, determined by assessing the uniformity of CT attenuation (399.06 vs. 330.21, p<0.001), image noise (24.93 vs. 18.43, p<0.001), SNR (16.43 vs. 18.52, p=0.005), and CNR (11.56 vs. 13.46, p=0.002), differed significantly between IV-CTA and Selective-CTA. MLD and MLA showed no significant difference overall (2.38 vs. 2.44, p=0.068, 4.72 vs. 4.95, p=0.078). The density of contrast agent was significantly lower for selective-CTA (13.13 mg/mL) than for IV-CTA (400 mg/mL). Agreement between observers was acceptable (ICC=0.79±0.08).ConclusionOur feasibility study in swine showed that compared to IV-CTA, Selective-CTA provides better image quality and requires less iodine contrast medium.