Optical Coherence Tomography Assessment Research Articles

Enhanced Plaque Stabilization Effects of Alirocumab - Insights From Artificial Intelligence-Aided Optical Coherence Tomography Analysis of the Alirocumab for Thin-Cap Fibroatheroma in Patients With Coronary Artery Disease Estimated by Optical Coherence Tomography (ALTAIR) Study.

Proprotein convertase subtilisin/kexin type 9 inhibitors stabilize vulnerable plaque, reducing cardiovascular events. However, manual optical coherence tomography (OCT) analysis of drug efficacy is challenging because of signal attenuation within lipid plaques. Twenty-four patients with thin-cap fibroatheroma were prospectively enrolled and randomized to receive alirocumab (75 mg every 2 weeks) plus rosuvastatin (10 mg/day) or rosuvastatin (10 mg/day) alone. OCT images at baseline and 36 weeks were analyzed manually and with artificial intelligence (AI)-aided software. AI-aided OCT analysis showed significantly greater percentage changes in the alirocumab+rosuvastatin vs. rosuvastatin-alone group in fibrous cap thickness (FCT; median [interquartile range] 212.3% [140.5-253.5%] vs. 88.6% [63.0-119.6%]; P=0.006) and lipid volume (median [interquartile range] -30.8% [-51.8%, -16.6%] vs. -2.1% [-21.6%, 4.3%]; P=0.015). Interobserver reproducibility for changes in minimum FCT and lipid index was relatively low for manual analysis (interobserver intraclass correlation coefficient [ICC] 0.780 and 0.499, respectively), but high for AI-aided analysis (interobserver ICC 0.999 and 1.000, respectively). Agreements between manual and AI-aided OCT analyses of FCT and the lipid index were acceptable (concordance correlation coefficients 0.859 and 0.833, respectively). AI-aided OCT analysis objectively showed greater plaque stabilization of adding alirocumab to rosuvastatin. Our results highlight the benefits of a fully automated AI-assisted approach for assessing drug efficacy, offering greater objectivity in evaluating serial changes in plaque stability vs. conventional OCT assessment.

Long-term effect of biodegradable vs durable polymer everolimus-eluting stents on neoatherosclerosis in ST-segment elevation myocardial infarction: the CONNECT trial.

Neoatherosclerosis is a leading cause of late (>1 year) stent failure following drug-eluting stent implantation. The role of biodegradable (BP) versus durable polymer (DP) drug-eluting stents on long-term occurrence of neoatherosclerosis remains unclear. Superiority of biodegradable against durable polymer current generation thin-strut everolimus-eluting stent (EES) was tested by assessing the frequency of neoatherosclerosis 3 years after primary percutaneous coronary intervention (pPCI) among patients with ST-segment elevation myocardial infarction (STEMI). The randomized controlled, multicentre (Japan and Switzerland) CONNECT trial (NCT03440801) randomly (1:1) assigned 239 STEMI patients to pPCI with BP-EES or DP-EES. The primary endpoint was the frequency of neoatherosclerosis assessed by optical coherence tomography (OCT) at 3 years. Neoatherosclerosis was defined as fibroatheroma or fibrocalcific plaque or macrophage accumulation within the neointima. Among 239 STEMI patients randomized, 236 received pPCI with stent implantation (119 BP-EES; 117 DP-EES). A total of 178 patients (75%; 88 in the BP-EES group and 90 in the DP-EES group) underwent OCT assessment at 3 years. Neoatherosclerosis did not differ between the BP-EES (11.4%) and DP-EES (13.3%; odds ratio 0.83, 95% confidence interval 0.33-2.04, p=0.69). There were no differences in the frequency of fibroatheroma (BP-EES 9.1% vs DP-EES 11.1%, p=0.66) or macrophage accumulation (BP-EES 4.5% vs DP-EES 3.3%, p=0.68), and no fibrocalcific neoatherosclerosis was observed. Rates of target lesion failure did not differ between groups (BP-EES 5.9% vs DP-EES 6.0%, p=0.97). Use of BP-EES for primary PCI in patients presenting with STEMI was not superior to DP-EES regarding frequency of neoatherosclerosis at 3 years.

Optical coherence tomography assessment of the impact of colchicine on non-culprit coronary plaque composition after myocardial infarction.

Low-dose colchicine reduces the risk of cardiovascular events after myocardial infarction (MI). The purpose of this study was to assess the effect of colchicine post-MI on coronary plaque morphology in non-culprit segments by optical coherence tomography (OCT). COCOMO-ACS was a double-blind, placebo-controlled trial that randomized 64 patients (median age 61.5 years; 9.4% female) with acute non-ST-segment elevation MI to colchicine 0.5 mg daily or placebo for a median of 17.8 months in addition to guideline-recommended therapy. Participants underwent serial OCT imaging within a matched segment of non-culprit coronary artery which contained at least one lipid-rich plaque causing ≥20% stenosis. The primary outcome was the change in minimum fibrous cap thickness (FCT) in non-culprit segments from baseline to final visit. Of those randomized, 57 (29 placebo, 28 colchicine) had evaluable imaging at baseline and follow-up. Overall, colchicine had no effect on relative (placebo +48.0±35.1% vs. colchicine +62.4±38.1%, P=0.18) or absolute changes in minimum FCT (+29.2±20.9 µm vs. +37.2±21.3 µm, P=0.18), or change in maximum lipid arc (-38.8±32.2° vs. -54.8±46.9°, P=0.18) throughout the imaged non-culprit segment. However, in patients assigned colchicine, cap rupture was less frequent (placebo 27.6% vs. colchicine 3.6%, P=0.03). In post-hoc analysis of 43 participants who had been followed for at least 16 months, minimum FCT increased to a greater extent in the colchicine group (placebo +38.7±25.4% vs. colchicine +64.7±34.1%, P=0.005). In this study, OCT failed to detect an effect of colchicine on the minimum FCT or maximum lipid arc of plaques in non-culprit segments post-MI. The post-hoc observation that minimum FCT increased to a greater extent with colchicine after more prolonged treatment suggests longer-term studies may be required to detect the effect of anti-inflammatory therapies on plaque morphology by OCT. Australian New Zealand Clinical Trials Registry Identifier, ACTRN12618000809235, registered on the 11th of May 2018.

In vivo biocompatibility of a new hydrophobic coated Al/Al2O3 nanowire surface on stents

BackgroundIntima proliferation and in-stent restenosis is a challenging situation in interventional treatment of small vessel obstruction. Al/Al2O3 nanowires have been shown to accelerate vascular endothelial cell proliferation and migration in vitro, while suppressing vascular smooth muscle cell growth. Moreover, surface modification of Al/Al2O3 nanowires with poly[bis(2,2,2-trifluoromethoxy)phosphazene (PTFEP) coating enables further advantages such as reduced platelet adhesion. Therefore, the study's goal was to compare the biocompatibility of novel Al/Al2O3 + PTFEP coated nanowire bare-metal stents to uncoated control stents in vivo using optical coherence tomography (OCT), quantitative angiography and histomorphometric assessment. Methods15 Al/Al2O3 + PTFEP coated and 19 control stents were implanted in the cervical arteries of 9 Aachen minipigs. After 90 days, in-stent stenosis, thrombogenicity, and inflammatory response were assessed. Scanning electron microscopy was used to analyse the stent surface. ResultsOCT analysis revealed that neointimal proliferation in Al/Al2O3 + PTFEP coated stents was significantly reduced compared to control stents. The neointimal area was 1.16 ± 0.77 mm2 in Al/Al2O3 + PTFEP coated stents vs. 1.98 ± 1.04 mm2 in control stents (p = 0.004), and the neointimal thickness was 0.28 ± 0.20 vs. 0.47 ± 0.10 (p = 0.003). Quantitative angiography showed a tendency to less neointimal growth in coated stents. Histomorphometry showed no significant difference between the two groups and revealed an apparent inflammatory reaction surrounding the stent struts. ConclusionsAt long-term follow-up, Al/Al2O3 + PTFEP coated stents placed in peripheral arteries demonstrated good tolerance with no treatment-associated vascular obstruction and reduced in-stent restenosis in OCT. These preliminary in vivo findings indicate that Al/Al2O3 + PTFEP coated nanowire stents may have translational potential to be used for the prevention of in-stent restenosis.

Diagnostic criteria of anterior segment swept-source optical coherence tomography to detect gonioscopic angle closure

AimsTo compare the diagnostic performance of 360° anterior segment optical coherence tomography assessment by applying normative percentile cut-offs versus iris trabecular contact (ITC) for detecting gonioscopic angle closure.MethodsIn this multicentre...

Optical coherence tomography assessment of disease activity in cryopyrin-associated periodic syndrome.

Cryopyrin-associated periodic syndrome is a rare autoinflammatory disease caused by gain-of-function mutations or variants in the NLRP3 gene. Clinically, patients suffer from a broad spectrum of both systemic and neurological symptoms. The aim of this study was to determine whether systemic inflammation demonstrated by serum amyloid A (SAA) elevation is associated with neuroinflammation assessed by optical coherence tomography (OCT). Thirty eyes of 15 patients with NLRP3 low penetrance mutations (PwNLRP3) and 20 eyes of 10 age- and sex-matched healthy controls were examined by spectral-domain OCT as part of routine clinical care. All retinal layers and clinical features were evaluated. At baseline no significant retinal neuroaxonal inflammation or degeneration was observed in all measured retinal layers amongst PwNLRP3 compared with healthy controls. In a pooled analysis of all individual OCT time points a significant difference regarding the macular retinal nerve fibre layer was detected. Increased levels of SAA showed a positive association with averaged combined outer plexiform layer and outer nuclear layer volumes (ρ < 0.0001, r2 = 0.35). In cryopyrin-associated periodic syndrome increased combined outer plexiform layer and outer nuclear layer volumes are mirrored by SAA increase, an acute phase reactant indicating systemic inflammation. Our findings identify OCT as a candidate biomarker to monitor subclinical neuroinflammation and to assess disease activity in PwNLRP3.

The Characteristics of Coronary Artery Lesions in COVID-19 Infected Patients With Coronary Artery Disease: An Optical Coherence Tomography Study

COVID-19 may predispose patients to cardiac injuries but whether COVID-19 infection affects the morphological features of coronary plaques to potentially influence the outcome of patients with coronary artery disease (CAD) remains unknown. By using optical coherence tomography (OCT), this study compared the characteristics of coronary plaque in patients with CAD with/without COVID-19 infection. The 206 patients were divided into 2 groups. The COVID-19 group had 113 patients between December 7, 2022, and March 31, 2023, who received OCT assessment after China decided to lift the restriction on COVID-19 and had a history of COVID-19 infection. The non-COVID-19 group had 93 patients without COVID-19 infection who underwent OCT before December 7, 2022. The COVID-19 group demonstrated a higher incidence of plaque ruptures (53.1% vs 38.7%, p = 0.039), erosions (28.3% vs 11.8%, p = 0.004), fibrous (96.5% vs 89.2%, p = 0.041) and diffuse lesions (73.5% vs 50.5%, p <0.001) compared with the non-COVID-19 group, whereas non-COVID-19 group exhibited a higher frequency of cholesterol crystals (83.9% vs 70.8%, p = 0.027), deep calcifications (65.6% vs 51.3%, p = 0.039) and solitary lesions (57.0% vs 34.5%, p = 0.001). Kaplan-Meier survival analysis revealed a significantly lower major adverse cardiac events-free probability in the COVID-19 group (91.6% vs 95.5%, p = 0.006) than in the non-COVID-19 group. In conclusion, OCT demonstrated that COVID-19 infection is associated with coronary pathological changes such as more plaque ruptures, erosions, fibrosis, and diffuse lesions. Further, COVID-19 infection is associated with a higher propensity for acute coronary events and a higher risk of major adverse cardiac events in patients with CAD.

Predictors of Optical Coherence Tomography-Defined Calcified Nodules in Patients With Acute Coronary Syndrome - A Substudy From the TACTICS Registry.

Recent studies suggest that the presence of calcified nodules (CN) is associated with worse prognosis in patients with acute coronary syndrome (ACS). We investigated clinical predictors of optical coherence tomography (OCT)-defined CN in ACS patients in a prospective multicenter registry.Methods and Results: We investigated 695 patients enrolled in the TACTICS registry who underwent OCT assessment of the culprit lesion during primary percutaneous coronary intervention. OCT-CN was defined as calcific nodules erupting into the lumen with disruption of the fibrous cap and an underlying calcified plate. Compared with patients without OCT-CN, patients with OCT-CN (n=28) were older (mean [±SD] age 75.0±11.3 vs. 65.7±12.7 years; P<0.001), had a higher prevalence of diabetes (50.0% vs. 29.4%; P=0.034), hemodialysis (21.4% vs. 1.6%; P<0.001), and Killip Class III/IV heart failure (21.4% vs. 5.7%; P=0.003), and a higher preprocedural SYNTAX score (median [interquartile range] score 15 [11-25] vs. 11 [7-19]; P=0.003). On multivariable analysis, age (odds ratio [OR] 1.072; P<0.001), hemodialysis (OR 16.571; P<0.001), and Killip Class III/IV (OR 4.466; P=0.004) were significantly associated with the presence of OCT-CN. In non-dialysis patients (n=678), age (OR 1.081; P<0.001), diabetes (OR 3.046; P=0.014), and Killip Class III/IV (OR 4.414; P=0.009) were significantly associated with the presence of OCT-CN. The TACTICS registry shows that OCT-CN is associated with lesion severity and poor clinical background, which may worsen prognosis.

Digital imaging of ink spot lentigo: Confocal microscopy and line‐field confocal optical coherence tomography assessment

Digital imaging of ink spot lentigo: Confocal microscopy and line‐field confocal optical coherence tomography assessment

Stent sizing by coronary CT angiography compared with optical coherence tomography

BackgroundCoronary CT angiography (CCTA) is well-established for diagnosis and stratification of coronary artery disease (CAD). Its usefulness in guiding percutaneous coronary interventions (PCI) and stent sizing is unknown. MethodsThis is a sub-analysis of the Precise Percutaneous Coronary Intervention Plan (P3) study (NCT03782688). We analyzed 65 vessels with matched CCTA and pre-PCI optical coherence tomography (OCT) assessment. The CCTA-guided stent size was defined by the mean distal reference lumen diameter rounded up to the nearest stent diameter. The OCT lumen-guided stent size was the mean distal reference lumen diameter rounded to the closest stent diameter. The agreement on stent diameters was determined with Kappa statistics, Passing–Bablok regression analysis, and the Bland-Altman method. ResultsThe distal reference lumen diameter by CCTA and OCT were 2.75 ​± ​0.53 ​mm and 2.72 ​± ​0.55 ​mm (mean difference 0.06, limits of agreement −0.7 to 0.82). There were no proportional or systematic differences (coefficient A 1.06, 95% CI 0.84 to 1.3 and coefficient B −0.22, 95% CI -0.83 to 0.36) between methods. The agreement between the CCTA and OCT stent size was substantial (Cohen's weighted Kappa 0.74, 95% CI 0.64 to 0.85). Compared to OCT stent diameter, CCTA stent size was concordant in 52.3% of the cases; CCTA overestimated stent size in 20.0% and underestimated in 27.7%. ConclusionCCTA accurately assessed the reference vessel diameter used for stent sizing. CCTA-based stent sizing showed a substantial agreement with OCT. CCTA allows for PCI planning and may aid in selecting stent diameter.

Optical Coherence Tomography Versus Optic Disc Photo Assessment in Glaucoma Screening.

Optical coherence tomography (OCT) and optic disc photography present valuable but distinct capabilities for glaucoma screening. This review article examines the strengths and limitations of OCT and optic disc photography in glaucoma screening. A comprehensive literature review was conducted, focusing on the accuracy, feasibility, cost-effectiveness, and technological advancements in OCT and optic disc photography for glaucoma screening. OCT is highly accurate and reproducible but faces limitations due to its cost and less portable nature, making widespread screening challenging. In contrast, optic disc photos are more accessible and cost-effective but are hindered by subjective interpretation and inconsistent grading reliability. A critical challenge in glaucoma screening is achieving a high PPV, particularly given the low prevalence of the disease, which can lead to a significant number of false positives. The advent of artificial intelligence (AI) and deep learning models shows potential in improving the diagnostic accuracy of optic disc photos by automating the detection of glaucomatous optic neuropathy and reducing subjectivity. However, the effectiveness of these AI models hinges on the quality of training data. Using subjective gradings as training data, will carry the limitations of human assessment into the AI system, leading to potential inaccuracies. Conversely, training AI models using objective data from OCT, such as retinal nerve fiber layer thickness, may offer a promising direction. Both OCT and optic disc photography present valuable but distinct capabilities for glaucoma screening. An approach integrating AI technology might be key in optimizing these methods for effective, large-scale screening programs.

Potential ocular indicators to distinguish posterior cortical atrophy and typical Alzheimer’s disease: a cross-section study using optical coherence tomography angiography

BackgroundPosterior cortical atrophy (PCA) is a form of dementia that frequently displays significant visual dysfunction and relatively preserved cognitive and executive functions, thus hindering early diagnosis and treatment. This study aimed to investigate possible fundus markers in PCA patients and compare them with those of typical Alzheimer’s disease (AD) patients to seek potential diagnostic patterns.MethodsAge-matched PCA and AD patients and healthy controls (HC) completed optometry, intraocular pressure measurement, neuropsychologic assessments, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) examination in one visit. Overall, six outcomes of thicknesses of various retinal layers and seven outcomes of the retinal microvascular network were calculated. After adjusting for age, sex, and years of education, the OCT and OCTA results were analyzed using analysis of covariance and generalized linear models. Correlation analyses were performed using Spearman correlation, and ROC curves were plotted.ResultsTwelve PCA patients, nineteen AD patients, and thirty HC, aged 45–80 years were included. Fifty HC, thirty AD, and twenty PCA eyes were available for foveal avascular zone (FAZ) area analysis; forty-nine HC, thirty-four AD, and eighteen PCA eyes were available for OCT and OCTA assessments. PCA patients had thinner retinal nerve fiber layer and ganglion cell layer + inner plexiform layer than HC in the 0–3 mm circle and 1–3 mm ring. Few structural differences were observed between the AD group and the other two groups. The flow area of the superficial capillary plexus and the intermediate capillary plexus was smaller in the PCA group than in the HC group in the 0–1 mm circle, 0–3 mm circle. MMSE performed better than any combination of optical parameters in identifying AD and PCA from HC (AUC = 1), while the combination of MoCA, retinal thickness and vascular density of ICP in the 1-3 mm ring, with flow area of ICP in the 0-1 mm circle showed the strongest ability to distinguish PCA from AD (AUC = 0.944).ConclusionsPCA patients exhibited similar impairment patterns to AD patients in the fundus structure and microvascular network. OCTA may aid in the non-invasive detection of AD and PCA, but still remains to be substantiated.

Quantitative assessment of OCT and OCTA parameters in diabetic retinopathy with and without macular edema: single-center cross-sectional analysis.

The retinal and choroidal parameters were analyzed to understand the impairment of microcirculation of both retina and choroid in patients with diabetic retinopathy (DR). Fifty-five treatment-naive non-proliferative diabetic retinopathy (NPDR) patients (75 eyes) with type 2 diabetes mellitus (T2DM), including 28 patients (36 eyes) with diabetic macular edema (DME) and 27 patients (39 eyes) without DME, and 25 healthy subjects (47 eyes) were enrolled in this study. The following parameters of DR patients with and without DME were evaluated: the foveal avascular zone area (FAZ-a), FAZ perimeter (FAZ-p), FAZ circularity index (FAZ-CI), total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), choriocapillaris flow area percentage, superficial capillary plexus (SCP), and deep capillary plexus (DCP). SCP, DCP, and the percentage of choriocapillaris flow area were significantly different between DR patients with and without DME. The DR patients presented lower LA, CVI, and FAZ-CI compared to those of healthy controls (all p < 0.05). The percentage of choriocapillaris flow area in DR patients with and without DME was significantly lower than that in healthy controls (p < 0.05). SCP and DCP were significantly correlated with FAZ-a and FAZ-p but presented insignificant associations with FAZ-CI. Optical coherence tomography (OCT) and OCT angiography (OCTA) parameters, such as LA, CVI, FAZ-CI, and the percentage of choriocapillaris flow area, were reduced compared to those in controls, indicating that the microcirculations of the retina and choroid in the macular area were impaired in DR patients with DME and without DME.

Selective Bowman's layer transplantation in the treatment of neurotrophic corneal ulcers.

The aim of this paper is to present the surgical technique of selective Bowman's layer transplantation as well as the results of the surgery in patients with trophic corneal ulcers. The methodology of the study included three eyes from three patients with neurotrophic corneal ulcers grafting with corneal Bowman's layer. Pre- and postoperative analyses of the anterior segment of the eye were based on optical coherence tomography and slit-lamp assessment. Postoperatively a gradual corneal stroma restoration and fast corneal epithelialization were noticed. Based on our observations, the stiff and firm structure of Bowman's layer is supposed to strengthen the corneal surface and maintain its shape. It acts also as an antipathogen and antitoxin corneal barrier. Application of this acellular corneal layer transplantation to cover trophic corneal ulcers is an interesting, modern and crucial method of neurotrophic keratitis treatment.

Association of retinal neurodegeneration with the progression of cognitive decline in Parkinson’s disease

Retinal thickness may serve as a biomarker in Parkinson’s disease (PD). In this prospective longitudinal study, we aimed to determine if PD patients present accelerated thinning rate in the parafoveal ganglion cell-inner plexiform layer (pfGCIPL) and peripapillary retinal nerve fiber layer (pRNFL) compared to controls. Additionally, we evaluated the relationship between retinal neurodegeneration and clinical progression in PD. A cohort of 156 PD patients and 72 controls underwent retinal optical coherence tomography, visual, and cognitive assessments between February 2015 and December 2021 in two Spanish tertiary hospitals. The pfGCIPL thinning rate was twice as high in PD (β [SE] = −0.58 [0.06]) than in controls (β [SE] = −0.29 [0.06], p < 0.001). In PD, the progression pattern of pfGCIPL atrophy depended on baseline thickness, with slower thinning rates observed in PD patients with pfGCIPL below 89.8 µm. This result was validated with an external dataset from Moorfields Eye Hospital NHS Foundation Trust (AlzEye study). Slow pfGCIPL progressors, characterized by older at baseline, longer disease duration, and worse cognitive and disease stage scores, showed a threefold increase in the rate of cognitive decline (β [SE] = −0.45 [0.19] points/year, p = 0.021) compared to faster progressors. Furthermore, temporal sector pRNFL thinning was accelerated in PD (βtime x group [SE] = −0.67 [0.26] μm/year, p = 0.009), demonstrating a close association with cognitive score changes (β [SE] = 0.11 [0.05], p = 0.052). This study suggests that a slower pattern of pfGCIPL tissue loss in PD is linked to more rapid cognitive decline, whereas changes in temporal pRNFL could track cognitive deterioration.

Orbital atherectomy for calcified nodule: optical coherence tomography assessment

Orbital atherectomy for calcified nodule: optical coherence tomography assessment

Naturally Occurring Atherosclerosis Progression and In-Stent Restenosis: Exploring Histomorphological Associations Using Optical Coherence Tomography.

The mechanism of in-stent restenosis (ISR) remains elusive, and in-stent neoatherosclerosis (ISNA) may hold siginificant pathophysiological implications. Nevertheless, the correlation between ISNA and the progression of untreated coronary segments affected by native atherosclerosis remains incompletely investigated. This study enrolled 225 patients diagnosed with coronary heart disease and multivessel disease (MVD). These patients underwent successful percutaneous coronary intervention (PCI) and intraoperative placement of drug-eluting stent (DES), followed by optical coherence tomography (OCT) assessment of the culprit stent. The mechanism of ISR was emamined through qualitative and quantitative analysis of OCT imaging. A significantly higher proportion of patients in the ISR with non-target lesion progression (N-TLP) group exhibited lipid plaque formation compared to the ISR without N-TLP group (69.0% versus 39.8%, P < 0.001). The incidence of thin-cap fibroatheroma (TCFA) (33.3% versus 11.4%, P = 0.001) and ISNA (60.7% versus 38.6%, P < 0.001) was markedly elevated in the ISR with N-TLP group compared to the ISR without N-TLP group. Regarding manifestations, heterogeneous hyperplasia was predominantly observed in the ISR with N-TLP group (76.2% versus 38.6%, P < 0.001), while homogeneous hyperplasia was primarily presented in the ISR without N-TLP group (61.4% versus 23.8%, P < 0.001). Patients displaying notable progression of naturally occurring atherosclerosis manifest histomorphological features of ISR, primarily characterized by heterogeneous intimal hyperplasia and a higher prevalence of ISNA. In contrast, patients without substantial progression of naturally occurring atherosclerosis exhibit histomorphologic features of ISR primarily characterized by homogeneous intimal hyperplasia.

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.

Optical coherence tomography assessment of dissection following Drug-Coated Balloon treatment in de-novo small vessel disease

Abstract Background/Introduction Several studies have shown either favorable or unfavorable effects of dissection following drug-coated balloon (DCB) angioplasty. However, there is no established method to precisely assess the extent of dissection during DCB treatment and the relationship between dissection and late lumen gain (LLG) remains unclear. Purpose The aim of this study is to develop a new method to quantify the dissection and investigate the impact of dissection volume on angiographic outcomes. Methods The present study consisted of patients enrolled in the randomized TRANSFORM-I trial, comparing novel Magic TouchTM sirolimus coated-balloon with SeQuent Please NeoTM paclitaxel coated balloon (PCB) in patients with de-novo small vessel coronary artery disease. One-hundred lesions in 98 patients were investigated with OCT after pre-dilatation to assess the dissection. A customized software (QCU-CMS, Leiden) precisely quantifies the dissection and lumen volumes separated by a common boundary connecting the two edges of the intimal fracture. Quantitative OCT analysis of dissection volume is derived from cross-sectional slices with a thickness of 200 microns. Tissue composition analysis, using OCT-Deep Learning (DL) (Pulse, Shanghai), at the starting site of the dissection was performed to elucidate the mechanisms triggering the dissection. Results The dissection was found in 96% (96/100) of the treated lesions. The median dissection volume was 1.98 (0.57 – 3.89)mm3. The median maximal dissection arc was 113 degree. The tissue composition analysis showed that the dissection occurs at the thinnest site (320 μm) of fibrous intima (83%) (Figure). The 6-month angiographic outcomes of TRANSFORM-I will be presented at the late breaking session by then the mechanistic determinant of late loss and gain will have been examined in details. Conclusions Quantitative OCT analysis of dissection demonstrated that dissection occurs during DCB treatment. Final results with 6-month outcome, relationship between the dissection volume and late lumen loss (LLL) or LLG will be presented at the time of congress.Figure

Predictors of optical coherence tomography-defined calcified nodules in patients with acute coronary syndrome: a substudy from TACTICS registry

Abstract Background We investigated the clinical predictors of optical coherence tomography (OCT)-defined calcified nodules (CN) in patients with acute coronary syndrome in a prospective multicenter registry. Methods We investigated 695 patients enrolled in TACTICS registry who underwent OCT assessment of the culprit lesion during primary percutaneous coronary intervention. OCT-CN was defined as eruptive calcific nodules into the lumen with disruption of the fibrous cap and an underlying calcified plate. Patient characteristics were compared between patients with and without OCT-CN. Results OCT-CN was detected in 28 patients (4.0%). Patients with OCT-CN were older (75.0 ± 11.3 vs. 65.7 ± 12.7 years, p &amp;lt; 0.001) and had a higher prevalence of diabetes mellitus (50.0% vs. 29.4%, p = 0.034), hemodialysis (21.4% vs. 1.6%, p &amp;lt; 0.001) and heart failure (Killip 3/4, 21.4% vs. 5.7%, p = 0.003) than patients without OCT-CN. The angiographic SYNTAX score was higher in patients with OCT-CN than those without (median, 15 [interquartile range, 11, 25] vs. 11 [7, 19], p = 0.003). Multivariable analysis demonstrated that age (odds ratio [OR], 1.072; 95% confidence interval [CI], 1.033–1.116; p &amp;lt; 0.001), Killip class 3/4 (OR, 4.466; 95% CI, 1.472–11.943; p = 0.004) and hemodialysis (OR, 16.571; 95% CI, 4.946–52.863; p &amp;lt; 0.001) were significantly associated with the presence of OCT-CN. In non-dialysis patients (n=678), age (OR, 1.081; 95% CI, 1.035–1.135; p &amp;lt; 0.001), Killip class 3/4 (OR, 4.414; 95% CI, 1.327–12.709; p = 0.009) and diabetes mellitus (OR, 3.046; 95% CI, 1.251–7.594; p = 0.014) were significantly associated with the presence of OCT-CN. Conclusions TACTICS registry demonstrated the clinical predictors of OCT-CN, which may be associated with worse prognosis.