Optimal Coherence Tomography Research Articles

Tissue characteristics of residual lesion in patients with acute coronary syndrome caused by plaque rupture versus plaque erosion: a single-center, retrospective, observational study.

Patients with acute coronary syndrome (ACS), frequently caused by plaque rupture (PR), often have vulnerable plaques in residual lesions as well as in culprit lesions. However, whether this occurs in patients with plaque erosion (PE) as well is unknown. We retrospectively analyzed the data of 88 patients with ACS who underwent both optimal coherence tomography (OCT) and intravascular ultrasound (IVUS). Based on plaque morphology of the culprit lesions identified using OCT, patients were classified into PE (n=23) and PR (n=35) groups. The tissue characteristics of residual lesions evaluated using integrated backscatter IVUS were compared between both groups after percutaneous coronary intervention. The PE group had a significantly lower percent lipid volume and a higher percent fibrous volume than the PR group (35.0±17.8% vs 49.2±13.4%, p<0.001; 63.2±17.1% vs 50.3±13.1%, p=0.002, respectively). Receiver operating characteristic curve analysis revealed that percent lipid volume in the residual lesions was a significant discriminant factor in estimating the plaque morphology of the culprit lesion (optimal cut-off value, <43.5%; sensitivity and specificity values were 73.9% and 68.6%, respectively). In conclusion, patients with PE had a significantly lower percent lipid volume and a significantly higher percent fibrous volume in the residual lesions than those with PR, suggesting that the nature of coronary plaques in patients with PE is different from that of those with PR.

Comparison among different flushing media for intracoronary imaging with optical coherence tomography

Objective: To explore the effects and safety of saline mixed 1∶1 with contrast medium (mixed medium) and pure heparinized saline as alternative media for optimal Optical Coherence Tomography (OCT) guided percutaneous coronary intervention (PCI). Methods: This single-center, prospective cohort study enrolled patients who underwent PCI with OCT guidance for chronic stable angina or acute coronary syndrome at the Department of Cardiology, the Second Hospital of Jilin University from October 2021 to August 2022. The target vessels were examined using OCT with three different flushing media at the same anatomical positions: contrast agent, mixed medium, and pure heparinized saline. An independent observer analyzed all imaging results and evaluated the lumen imaging quality, using the proportion of the clear imaging field (CIF%) as a quantitative measure for analysis. The average luminal diameter was compared among different flushing media. The study also assessed the image quality of the luminal anatomical structures, lesion pathologies, and stents. Results: A total of 105 patients were enrolled in the study, including 110 target vessels. The age of the enrolled patients was (60.5±8.4) years, with 60 male patients (57.1%). OCT examinations were successfully completed using all three media, and no related complications were observed in any groups. The three flushing media presented with the same image quality in terms of depicting the lumen anatomical structures, lesion characteristics, and stent-related features. The mixed medium group achieved a comparable CIF% to the contrast group with both right and left coronary arteries (right coronary 100.0% (100.0%, 100.0%) vs. 100.0% (100.0%, 100.0%), P>0.05; left coronary 100.0% (95.9%, 100.0%) vs. 100.0% (100.0%, 100.0%), P>0.05). While the saline group reached a comparable CIF% to the contrast group with right coronary arteries (100.0% (97.6%, 100.0%) vs. 100.0% (95.9%, 100.0%), P>0.05) but showed a significantly lower CIF% with left coronary arteries (84.9% (75.9%, 93.4%) vs. 100.0% (100.0%, 100.0%), P<0.05). For the average diameter of the coronary lumen, there was no statistically significant difference between the mixed medium group and the saline group compared to the contrast group with both right and left coronary arteries (P>0.05). Conclusions: A 1∶1 heparinized saline and contrast mixture can serve as a substitute flushing medium for OCT examination during PCI procedure. Pure saline can also yield good results in OCT examination of the right coronary artery, and both alternatives are safe for use as flushing medium in OCT imaging.

Randomized clinical trial of abluminus DES+ sirolimus-eluting stent versus everolimus-eluting DES for percutaneous coronary intervention in patients with diabetes mellitus: An optical coherence tomography study.

Diabetic patients are at higher risk of recurrent adverse events following percutaneous coronary intervention (PCI) than the nondiabetics. Despite the introduction of new generation drug-eluting stents, their efficacy in the diabetics is still limited. To evaluate the efficacy of the Abluminus DES+ biodegradable polymer sirolimus-eluting stent in reducing neointimal hyperplasia in diabetic patients, compared to a durable polymer everolimus-eluting stent (DP-EES). A total of 131 patients with diabetes and coronary artery disease were enrolled in six Italian centers and randomized in a 2:1 fashion to PCI with Abluminus DES+ or DP-EES: 85 were assigned to Abluminus DES+ and 46 to DP-EES. The primary endpoint was optimal coherence tomography (OCT)-derived neointimal volume at 9-12 months. Secondary endpoints included OCT-derived neointimal area, neointimal volume obstruction and adverse clinical events. The primary endpoint, neointimal volume, did not differ between Abluminus DES+ and DP-EES (29.11 ± 18.90 mm3 vs. 25.48 ± 17.04 mm3 , p = 0.40) at 9-12-month follow-up. This finding remained consistent after weighing for the sum of stents lengths (1.14 ± 0.68 mm3 vs. 0.99 ± 0.74 mm3 for Abluminus DES+ and DP-EES, respectively, p = 0.38). Similarly, other OCT-derived and clinical secondary endpoints did not significantly differ between the two groups. Rate of target lesion failure was high in both groups (21.2% for Abluminus DES+ and 19.6% for DP-EES). This preliminary study failed to demonstrate the superiority of the Abluminus DES+ over the DP-EES in diabetic patients in terms of neointimal proliferation.

Natural Course of Pachychoroid Pigment Epitheliopathy.

To investigate the natural course of pachychoroid pigment epitheliopathy (PPE). A retrospective cohort study. From the Kyoto central serous chorioretinopathy (CSC) cohort consisting of 548 patients with CSC as of September 2020, we included consecutive unilateral patients with acute or chronic CSC between January 2013 and December2016. All patients underwent complete ophthalmic examination, including multimodal imaging such as fundus autofluorescence, spectral-domain optical coherence tomography, and fluorescein angiography/indocyanine green angiography and/or optimal coherence tomography angiography. The fellow eyes of eyes diagnosed with CSC were screened for PPE, and their natural course was evaluated. We also evaluated the association of ARMS2 rs10490924, CFH rs800292, TNFRSF10A rs13278062, and GATA5 rs6061548 genotypes with the natural course. Incidence of CSC, pachychoroid neovasculopathy, and pachychoroid geographic atrophy (GA). In total, 165 patients with unilateral CSC (mean age, 55.7±12.6 years; female, 22.4%) were included from the Kyoto CSC cohort. Among them, 148 (89.7%) were diagnosed as having PPE in their non-CSC eye. Survival analysis revealed that 16.8% of PPE eyes developed CSC during the 6-year follow up, whereas non-PPE eyes did not. Although genetic factors did not have significant association with CSC development (P>0.05, log-rank test), choroidal vascular hyperpermeability (CVH) and subfoveal choroidal thickness (SFCT) were significantly associated with CSC incidence (P=0.001, log-rank test). Survival analysis showed that eyes without CVH and eyes with SFCT < 300 μm did not develop CSC during the 6-year follow-up. Pachychoroid neovasculopathy developed in only 1 eye with PPE during a follow-up of 46.4 months. Pachychoroid GA did not develop in any of the studied eyes. This study revealed a natural history of PPE in a relatively large Japanese cohort. Choroidal vascular hyperpermeability and SFCT were significant risk factors for the development of CSC in PPE eyes. Although the current results cannot be generalized for all eyes with PPE, these findings present an important clinical implication.

Вплив цукрового діабету 2-го типу на стан центральної зони сітківки у хворих із проліферативною діабетичною ретинопатією

Мета. Встановлення залежності стану центральної зони сітківки у пацієнтів із проліферативною діабетичною ретинопатією (ДР) від тривалості цукрового діабету (ЦД) 2-го типу і рівня глікемії. Матеріали та методи. У дослідження ввійшли 62 пацієнти з ЦД 2-типу, в яких за результатами клініко-інструментального обстеження та відповідно до класифікації ETDRS виявлена непроліферативна (31 хворий, 31 око) і проліферативна ДР (31 пацієнт, 31 око). Офтальмологічне обстеження включало дослідження гостроти зору з оптимальною оптичною корекцією, тонометрію, біомікроскопію, офтальмоскопію, оптичну когерентну томографію. Результати. У пацієнтів із проліферативною ДР при субкомпенсованому стані ЦД товщина й об’єм макулярної сітківки становили: 309,0 ± 130,0 мкм і 7,6 ± 2,7 мм3, тоді як при декомпенсованому стані — відповідно 287,0 ± 40,0 мкм і 7,80 ± 0,57 мм3 (р &gt; 0,05). За умов прогресування ДР виявлено статистично значуще зниження корегованої гостроти зору (р = 0,012) та зростання об’єму макулярної сітківки (на 6,9 %; р = 0,034). Більш виражені демонстративні зміни сітківки (р &lt; 0,05) виявлялися у пацієнтів із проліферативною ДР, ускладненою макулярним набряком. Висновки. У хворих із проліферативною ДР не виявлено різниці стану ока при субкомпенсації і декомпенсації ЦД 2-го типу. Прогресування від непроліферативної до проліферативної ДР проявляється зниженням корегованої гостроти зору, зростанням товщини та об’єму макулярної сітківки в центральній зоні, що може бути пов’язано з розвитком набряку внаслідок прогресування патологічного процесу.

Phase quantized polar transformative with cellular automaton for early glaucoma detection

Glaucoma is the leading cause of blindness worldwide. Glaucoma being a chronic eye disease results in irreversible loss of vision. Everyone is at danger for glaucoma. But, certain groups are greater risk. Hence, accurate Classification of normal and glaucoma images is significant one. In the screening and early detection of glaucoma, Cup to Disc Ratio (CDR) method plays a significant role. The automatic segmentation for early detection from Optimal Coherence Tomography (OCT) images is a fundamental task. Several research works based on OCT were contributed for early detection of glacuoma. However, inherent feature extraction and over fitting issues while performing early glaucoma detection have been researched by the research community for long time. In this paper, we propose Artificial Intelligence architecture, called Phase Quantized Polar Transformed Cellular Automaton (PQPT-CA) method that use the displacement gradients and distance gradients for early glaucoma detection. The proposed PQPT-CA method comprises of inherent feature extraction, robust feature segmentation and early glaucoma detection based on OCT. To start with, First Order Phase Quantization model is applied to the raw input image for extracting inherent features. Next, with the extracted features, Differential Polar Transformation is applied to generate robust segmentation map. Finally, glaucoma detection is performed for three different state employing Cellular Automaton model. The experiments show that our PQPT-CA method achieves state-of-the-art early detection on ACRIMA database. Simultaneously, the proposed method also obtains the satisfactory glaucoma screening performances with calculated diagnosis accuracy on ACRIMA database. The PQPT-CA method increases the Diagnosis Accuracy by 24% and minimizes computational time and false positive rate by 21% and 54% respectively.

Abstract 15570: Pathology of In-stent Neointima in Atherosclerotic Porcine Peripheral Artery Treated by Drug-coated Balloon

Introduction: The use of drug-coated balloons (DCB) is a promising technique to treat in-stent restenosis without adding another metal scaffold. Clinical non-inferiority of DCB for treatment of in-stent restenosis (ISR) has been demonstrated compared to drug eluting stents (DES) implantation. However, pathology of neointima treated by DCB remains unclear. Aim: Pathological study of neointima after DCB treatment for ISR has not been reported. This study aimed to examine the tissue response after DCB treatment and plain old balloon angioplasty (POBA) for ISR pathologically, by using atherosclerotic femoral artery of porcine model. Methods: Using micromini pigs fed high-cholesterol, high-fat diet for 3 months, we stented bare metal stents in femoral arteries. After one month of stenting, dilatation of in-stent region by using DCB, and non-compliance balloon (NCB) as POBA were performed. Optimal coherence tomography and angioscopy showed drug adhesion on luminal surface. One month after the balloon expansion, treated arteries were dissected and stent segments were fixed with 10% buffered formalin and embedded in plastic. Stents were segmented at 3mm intervals and histologic sections were prepared. The neointimal area and blood vessel area were morphometrically evaluated, and the ratio of neointimal area per blood vessel area was calculated. Additionally, number of cells per 1mm 2 neointimal area was counted with digital morphometry. Results: We compared the histology between DCB (n=3, 18 histological sections) and POBA (n=3, 18 histological sections) lesions. The ratio of neointimal area per blood vessel area treated by DCB was 0.17 ± 0.01, while that of POBA was 0.21 ± 0.01 (P value = 0.02) respectively. Additionally, the number of cells per 1mm 2 neointimal area was significantly less in the neointima dilated by DCB (1940.9 ± 150.9), compared to that dilated by NCB (2599.8 ± 190.3) (P value = 0.01). These results suggest that DCB treatment after ISR prevents neointimal thickening by inhibiting proliferation of smooth muscle cells. Conclusions: We examined the pathology of in-stent neointima dilated by DCB in peripheral artery of atherosclerotic porcine model. Pathological analysis showed suppressed neointimal proliferation after DCB compared to POBA.

Abnormal Regional Spontaneous Neural Activity in Nonarteritic Anterior Ischemic Optic Neuropathy: A Resting-State Functional MRI Study.

Objective To explore altered regional neuronal activity in patients with nonarteritic anterior ischemic optic neuropathy (NAION) and its correlation with clinical performances using the regional homogeneity (ReHo) method, which is based on resting-state functional magnetic resonance imaging (fMRI). Method Thirty-one patients with NAION (20 males, 11 females) and 31 age- and sex-matched normal controls (NCs) (20 males, 11 females) were enrolled in the study. All patients underwent ophthalmic examination, including eyesight, intraocular pressure measurement, optimal coherence tomography (OCT), visual field analysis, and fMRI scans. After ReHo was calculated, we investigated group differences in results between the patients and NCs. We analyzed the relationship between ReHo values for different brain regions in patients with NAION and intraocular pressure, visual field analysis, and OCT. A receiver operating characteristic (ROC) curve was used to assess the diagnostic ability of the ReHo method. Results Compared with NCs, patients with NAION exhibited higher ReHo values in the left middle frontal gyrus, left middle cingulate gyrus, left superior temporal gyrus, and left inferior parietal lobule. Additionally, they exhibited lower ReHo values in the right lingual gyrus, left putamen/lentiform nucleus, and left superior parietal lobule. ReHo values in the left superior parietal lobule were negatively correlated with right retinal nerve fiber layer values (r = −0.462, P = 0.01). The area under the ROC curve for each brain region indicated that the ReHo method is a credible means of diagnosing patient with NAION. Conclusion NAION was primarily associated with dysfunction in the default mode network, which may reflect its underlying neural mechanisms.

CALCIFIED CORONARY LESION: IS IT STILL THE ACHILLES’ HEAL OF PERCUTANEOUS CORONARY INTERVENTIONS?

CALCIFIED CORONARY LESION: IS IT STILL THE ACHILLES’ HEAL OF PERCUTANEOUS CORONARY INTERVENTIONS?

Cardiac Imaging: OCT

Abstract Introduction Intracoronary imaging by means of optimal coherence tomography (OCT) provides valuable incremental information that can be used clinically to optimize stent implantation and minimize stent-related problems. Over the past decades, OCT has progressively evolved with respect to technical performance and procedural aspects. Principle OCT is a fiberoptic wire with a rotating lens emitting near infrared (1,300 nm) light and records the light reflected from the tissue. The currently used Fourier domain-OCT allows superior image quality and faster image acquisition. OCT in Acute Coronary Syndrome (ACS) It helps in accurate detection of actual event leading to ACS among plaque rupture, plaque erosion, and calcified nodule. OCT has an advantage over intravascular ultrasound for identification of vulnerable plaque and also detection of thin cap fibroatheroma &lt; 65 µm. Clinical Utility OCT helps in diagnosis of an angiographically ambiguous lesion such as dissection, thrombus, and calcified nodule. It also helps in planning different aspects of percutaneous coronary intervention such as lesion preparation, determining stent size and length and also helps in optimization of results of stent deployment.Certain nonatherosclerotic events such as coronary arteritis can be diagnosed with OCT.Continued advancement in technology, faster image acquisition, and more sophisticated coregistered image analysis will facilitate greater adoption through ease of use and interpretation.

TCTAP A-088 Prevalence and Clinical Features of Artery to Artery Embolic Myocardial Infarction: An Optimal Coherence Tomography Study

Coronary thrombosis is the most frequently final event leading to an acute coronary syndrome (ACS). The 3 most common underlying mechanisms contributing to ACS are believed to be plaque rupture (PR), plaque erosion (PE) and calcified nodule (CN). Artery to artery embolic myocardial infarction (AAEMI

The Relationships between Retinopathy and Other Vascular Complications in Adults with Long-Standing Diabetes—Results from the Canadian Study of Longevity in Type 1 Diabetes (T1D)

We aimed to measure the prevalence of retinopathy in a T1D cohort of 75 adults with T1D duration of ≥50 years, and to determine association with other vascular complications. Participants underwent ultra-widefield retinal imaging and optimal coherence tomography. Neuropathy was characterized by electrophysiology and corneal confocal microscopy. Intrarenal hemodynamic function was determined by inulin and para-aminohippurate clearance, and arterial stiffness was measured by applanation tonometry, both at baseline and in responses to intravenous angiotensin II (ANGII). Participants were classified as having no diabetic retinopathy (ⱷDR), non-proliferative (NPDR), or proliferative (PDR), and associations were determined using multivariable linear regression adjusting for age, sex, and HbA1c. Thirty-nine (52%) participants had PDR, 24 (32%) had NPDR, and 12 (16%) had ⱷDR. Those without retinopathy had lower HbA1c vs. those with NDPR and PDR (6.7±0.6% vs. 7.4±0.7% and 7.5±0.9%, p=0.019). PDR was associated with lower corneal nerve fibre density, worse electrophysiology, and a greater number of signs and symptoms of neuropathy, but not with intrarenal hemodynamic function. Retinopathy severity was associated with greater response to ANGII for carotid-radial pulse wave velocity (mean change -4.9±11.4% vs. 8.2±18.5% vs. 12.9±20.2% for ⱷDR, NPDR, and PDR respectively, p=0.043). In longstanding T1D, retinopathy associated strongly with neuropathy and arterial stiffening, but not with renal hemodynamic function. Greater understanding of the co-occurrence of microvascular complications in patients with T1D, and relationships with macrovascular abnormalities such as arterial stiffness, may improve early detection and management of diabetes-related diseases. Disclosure J.A. Lovshin: Other Relationship; Self; AstraZeneca. Consultant; Self; Novo Nordisk Inc.. Research Support; Self; Sanofi, Merck Sharp &amp; Dohme Corp.. Other Relationship; Self; Novo Nordisk Inc.. L. Lovblom: None. P. Bjornstad: Consultant; Self; Boehringer Ingelheim GmbH. Y. Lytvyn: None. G. Boulet: Advisory Panel; Self; Medtronic, Sanofi, Novo Nordisk Inc.. Other Relationship; Self; Janssen Global Services, LLC., Abbott. A. Weisman: None. V.S. Lai: None. J.M. Tse: None. L. Cham: None. A. Orszag: None. H.A. Keenan: Research Support; Self; Sanofi. Employee; Self; Sanofi Genzyme. N. Paul: None. V. Bril: Consultant; Self; Alexion Pharmaceuticals, Inc.. Research Support; Self; CSL Behring, Grifols. Advisory Panel; Self; CSL Behring. Consultant; Self; Grifols. Research Support; Self; Shire. Advisory Panel; Self; Pfizer Inc. M.H. Brent: Research Support; Self; Novartis Canada. Advisory Panel; Self; Novartis Canada. Research Support; Self; Bayer Canada. Advisory Panel; Self; Bayer Canada, Allergan Canada. Research Support; Self; Roche Canada. B.A. Perkins: Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Boehringer Ingelheim GmbH, Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc., Abbott. Speaker's Bureau; Self; Abbott, Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation, Dexcom, Inc. D. Cherney: Consultant; Self; AbbVie Inc.. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company. Consultant; Self; Sanofi. Other Relationship; Self; Merck &amp; Co., Inc.. Consultant; Self; Mitsubishi Tanabe Pharma Corporation. Other Relationship; Self; Janssen Pharmaceuticals, Inc..

A prospective cardiometabolism ApPRoach of mechanisms of coronary plaque rupture to apprehend patients at risk of recurrent events — The APPROACH registry

Despite improvement in management of coronary artery disease (CAD), recurrent coronary events remain frequent. The aim of this study is to assess predictive factors of plaque rupture, leading to an acute coronary syndrome (ACS) by combining metabolic evaluation and coronary plaque imaging. This study involved two cohorts of patients, one concerning stable CAD and one ACS patients. In both groups of patients, plaque imaging was performed with standard coronary angiogram and optimal coherence tomography (OCT) in the 3 main coronary vessels defined by diameter superior to 2.5 mm. Recurrent major adverse cardiac events were collected during follow-up. Comparison of stable and unstable CAD patients will be performed to try to characterize criteria of plaque vulnerability. The preliminary results regarding the ACS cohort are presented in this abstract. We included 48 patients with mean age of 60.5 years and 87.3% of men. A three-vessel atherosclerotic disease was found in 42% of patients. A total of 142 non-culprit coronary lesions were analysed by OCT for a mean run of 60.4 mm by artery and total of 5854 mm. B2/C complex lesions (AHA/ACC classification) were represented in 28.2% of patients. OCT analysis allowed to define coronary lesions with mean distance from ostium of 22.6 mm, mean stenosis length of 11.9 mm and mean minimum lumen area (MLA) of 3.95 mm 2 with 66.1% of patients with MLA < 4mm 2 . Lesions were distributed in 60% of fibro-fatty plaques, 34% of fibro-calcified plaques and 5% of neo-angiogenesis. Systematic plaque characterization on non-culprit lesions found 7 vulnerable thin-cap fibroatheroma plaques and 3 asymptomatic plaque ruptures. OCT analysis of non-culprit coronary lesions is feasible and allows to highlight vulnerable lesions such as asymptomatic plaque ruptures. Analysis of stable cohort, biomarkers and follow-up of patients are necessary to define predictive factors of plaque rupture.

TCT-720 Impact of stent underexpansion and tissue patterns on recurrent restenosis after paclitaxel-coated balloon angioplasty for drug-eluting stent restenosis assessed with optical coherence tomography

Residual stenosis and the heterogeneous tissue pattern are reported to be the risk factors of recurrent restenosis after paclitaxel-coated balloon (PCB) angioplasty for drug-eluting stent (DES) in-stent restenosis (ISR). Optimal coherence tomography (OCT) can assess the mechanism of restenosis. We

Optimal coherence tomography as a tool to evaluate retinal changes in idiopathic REM sleep behavior disorders and Parkinson disease

Optimal coherence tomography as a tool to evaluate retinal changes in idiopathic REM sleep behavior disorders and Parkinson disease

TCTAP A-088 Quantitative Optical Coherence Tomographic Findings After Paclitaxel-coated Balloon Angioplasty for Drug-eluting Stent Restenosis

Residual stenosis after paclitaxel-coated balloon (PCB) angioplasty for drug-eluting stent (DES) in-stent restenosis (ISR) was one of the risk factors of recurrent restenosis. Optimal coherence tomography (OCT) and optical frequency domain imaging (OFDI) enables to assess the neointimal tissue and

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main and Multivessel Coronary Artery Disease

Approximately 60 randomized controlled trials performed over the last 3 decades have failed to demonstrate statistically significant differences in death or myocardial infarction (MI) between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), apart from a few notable exceptions in which CABG was superior to PCI. The benefits for CABG have been reported in patients with diabetes mellitus with multivessel disease and in patients with and without diabetes mellitus with 3-vessel disease and intermediate or high SYNTAX trial (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) scores (≥23). 1 In theory, although PCI is limited to treatment of culprit lesions, by bypassing the length of the epicardial vessel, CABG may address both today’s and tomorrow’s culprits by bypassing vulnerable plaques responsible for future adverse events.2 This mechanism may underlie the effectiveness of CABG in patients with extensive coronary disease. However, most completed trials in multivessel disease may have limited relevance to contemporary practice because of technological and pharmacological advances that have changed the practice of PCI, including the introduction of safer and more effective drug-eluting stents; more judicious use of PCI, based on fractional flow reserve measurements; PCI optimization with intravascular ultrasound and optimal coherence tomography; and improved antithrombotic and antiplatelet agents. In addition, the use of risk stratification and assessment tools, such as the baseline and residual SYNTAX scores, which assess the potential extent of revascularization, may be helpful in identifying patients who may have …

Coronary artery bifurcation with chronic total occlusion: A “biodegradable” strategy for a challenging treatment with optical coherence tomography analysis

Coronary bifurcation lesions (CBLs) are a frequently challenging setting for interventionists. Treatment of these lesions is associated with complications and unfavorable outcomes in terms of death, myocardial infarction (MI) or repeat revascularization [ 1 Al Suwaidi J. Berger P.B. Rihal C.S. Garratt K.N. Bell M.R. Ting H.H. Bresnahan J.F. Grill D.E. Holmes D.R. Immediate and long-term outcome of intracoronary stent implantation for true bifurcation le- sions. J. Am. Coll. Cardiol. 2000; 35: 929-936 Crossref PubMed Scopus (0) Google Scholar , 2 Al Suwaidi J. Yeh W. Cohen H.A. Detre K.M. Williams D.O. Holmes Jr., D.R. Immediate and one-year outcome in patients with coronary bifurcation lesions in the modern era (NHLBI dynamic registry). Am. J. Cardiol. 2001; 87: 1139-1144 Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar ]. The difficulties encountered to treat CBLs have led to development of alternative techniques like provisional stenting, actually the recommended modality of CBL treatment, rather than two stents technique, with or without final kissing balloon inflation [ 3 Piraino D. Carella M. Buccheri D. Andolina G. Bifurcation lesions: bioresorbable vascular scaffold and drug coated balloon, an efficacy association. Lessons from optimal coherence tomography. Int. J. Cardiol. 2016; 212: 92-93 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar , 4 Lassen J.F. Holm N.R. Stankovic G. Lefèvre T. Chieffo A. Hildick-Smith D. Pan M. Darremont O. Ferenc R.A.M. Louvard Y. Percutaneous coronary intervention for coronary bifurcation disease: consensus from the first 10 years of the European bifurcation club meetings. EuroIntervention. 2014; 10: 545-560 Crossref PubMed Scopus (194) Google Scholar ].

Optical coherence tomography (OCT) prior to peroral endoscopic myotomy (POEM) reduces procedural time and bleeding: a multicenter international collaborative study.

Per-oral endoscopic myotomy (POEM) has emerged as an endoscopic treatment of achalasia. There are no pre-procedural imaging modalities to predict the safest and the most efficacious approach. To evaluate the use of optimal coherence tomography (OCT) in providing a pre-procedural esophageal assessment. Patients undergoing POEM from July 2013 to November 2015 were captured in a multicenter, international registry. Patients who underwent OCT pre-POEM ("OCT arm") were compared to patients without pre-POEM OCT ("control arm"). OCT images were assessed for the degree of vascularity and the thickness of the circular muscular layer, and an approach was determined. A total of 84 patients were captured in the registry. Fifty-one patients underwent pre-POEM OCT. Using OCT as a guide, 24 (47%) of patients underwent anterior POEM while 27 (53%) underwent posterior POEM. Technical success was achieved in 96% of patients. Significantly less bleeding occurred in the OCT arm when compared to the control group [4 (8%) vs. 14 (43%), p=0.0001]. As a result, procedural time was significantly lower in the OCT group as compared to the control group (85.8 vs. 121.7min, p=0.000097). Pre-POEM OCT results in a reduction in procedural bleeding which contributes to a reduction in overall procedural time. NCT01438385.

TCTAP C-232 Failure to Optimize a Culotte Stenting in a RCA Bifurcation Lesion: The Use of Optimal Coherence Tomography (OCT) in Managing the Problem

TCTAP C-232 Failure to Optimize a Culotte Stenting in a RCA Bifurcation Lesion: The Use of Optimal Coherence Tomography (OCT) in Managing the Problem