233 research outputs found
Can the same edge-detection algorithm be applied to on-line and off-line analysis systems? Validation of a new cinefilm-based geometric coronary measurement software
In the Cardiovascular Measurement System (CMS) the edge-detection algorithm, which was primarily designed for the Philips digital cardiac imaging system (DCI), is applied to cinefilms. Comparative validation of CMS and DCI was performed in vitro and in vivo with intracoronary insertion of stenosis phantoms in anesthetized pigs. The "obstruction diameter" (OD) was measured at the artificial stenoses visualized by angiography with calibration at the isocenter (ISO) and catheter calibration (CATH) and compared with the true phantom diameters. A clinical comparison of OD, reference diameter (RD), and percentage diameter stenosis (DS) was performed on 70 corresponding images from post-PTCA angiograms. In vitro, OD (CMS) yielded an accuracy of 0.18 +/- 0.14 mm with 100% (correlation coefficient: r = 0.97, y = 0.06 + 0.75x, standard error of estimate [SEE] = 0.09) and 0.19 +/- 0.15 mm with 50% contrast (r = 0.94, y = 0.02 + 0.81 x). OD (DCI) yielded an accuracy of 0.11 +/- 0.06 mm with 100% (r = 0.99, y = -0.03 + 0.91 x, SEE = 0.05) and 0.24 +/- 0.13 mm with 50% contrast (r = 0.94, y = 0.29 + 6.69 x, SEE = 0.12). In vivo, OD (CMS) yielded an accuracy of 0.18 +/- 0.23 mm with ISO (r = 0.89, y = 0.02 + 0.83 x, SEE = 0.22) and 0.26 +/- 0.24 mm with CATH (r = 0.89, y = 0.06 + 0.72 x, SEE = 0.19). OD (DCI) yielded an accuracy of 0.08 +/- 0.15 mm with ISO (r = 0.96, y = 0.08 + 0.86 x, SEE = 0.14) and 0.18 +/- 0.21 mm with CATH (r = 0.92, y = 0.09 + 0.76 x, SEE = 0.17). The clinical comparison showed reasonable agreement for OD only (r = 0.81, y = 0.26 + 0.81 x, SEE = 0.29). Transformation of an edge-detection algorithm from a digital to a cinefilm-based system can lead to impairment of measurement reliability
Variations of remodeling in response to left main atherosclerosis assessed with intravascular ultrasound in vivo.
Histopathologic studies have demonstrated that vessels enlarge to compensate for an increase in plaque burden; this has been confirmed in vivo using intravascular ultrasound (IVUS). The initial studies suggested a biphasic course of lesion formation with (1) preservation of lumen dimensions up to a plaque burden of approximately 40%, and (2) luminal narrowing as plaque burden further increases. In this study, we used IVUS and angiography to assess the extent of left main (LM) atherosclerosis in 107 patients undergoing catheter-based procedures of the left anterior descending or left circumflex coronary arteries. Using IVUS, atherosclerotic plaques were found in all LM arteries, but only 26 (24%) had varying degrees of luminal narrowing on the angiogram. Nevertheless, there was an inverse relation (r = −0.62, p 40% (or >30%), but persisted at plaque burden values of 20% to 40%. In addition, LM arteries with a plaque burden <40% had a similar total vessel area as did LM arteries with a plaque burden ≥40% (22.9 ± 6.1 vs 21.8 ± 4.8 mm2, p = 0.30). These data suggest that lumen dimensions may not be preserved even if plaque occupies no more than 20% to 40% of the total vessel area. Thus, there is more variation in remodeling response during earlier stages of plaque accumulation within the LM artery than is commonly suggested
Electrocardiogram-gated intravascular ultrasound image acquisition after coronary stent deployment facilitates on-line three-dimensional reconstruction and automated lumen quantification
Long term outcome after coronary stent implantation: a 10 year single centre experience of 1000 patients
OBJECTIVE: To describe the long term clinical outcome (up to 11 years)
after coronary stenting. DESIGN: A single centre observational study
encompassing 1000 consecutive patients with a first stent implantation
(1560 stents) between 1986 and 1996, who were followed for at least one
year with a median follow up of 29 months (range 12-132 months). RESULTS:
Up to July 1997 the cumulative incidence of the major adverse cardiac
events (MACE) of death, non-fatal acute myocardial infarction, coronary
artery bypass grafting, and repeat percutaneous transluminal coronary
angioplasty was 8.2%, 12.8%, 13.1%, and 22.4%, respectively. Survival at
one, three, and five years was 95%, 91%, and 86%, respectively. Comparison
of MACE incidence during the "anticoagulant era" and the "ticlopidine era"
revealed significantly improved event free survival with ticlopidine (27%
v 13%; p < 0.005). Multivariable analyses showed that ejection fraction <
50% (relative risk (RR) 4. 1), multivessel disease (RR 3.0), diabetes (RR
2.9), implantation in saphenous vein graft (RR 2.1), indication for
unstable angina (RR 1. 9), and female sex (RR 1.7) were independent
predictors of increased mortality after stenting. Independent predictors
of any MACE were multivessel stenting (RR 2.0), implantation in saphenous
bypass graft (RR 1.6), diabetes (RR 1.5), anticoagulant treatment (versus
ticlopidine and aspirin) (RR 1.5), bailout stenting (RR 1.5), multivessel
disease (RR 1.4), and multiple stent implantation (RR 1. 5). CONCLUSIONS:
Long term survival and infarct free survival was good, particularly in
non-diabetic men with single vessel disease and good ventricular function,
who had a single stent implanted in a native coronary artery. A dramatic
improvement was observed in event free survival, both early and late, with
the replacement of anticoagulation by ticlopidine. This, of course, cannot
be separated from improved stent implantation techniques between 1986 and
1995. Ultimately, almost 40% of the patients experienced an adverse
cardiac event (mainly repeat intervention) in the long term. New advances
in restenosis treatments and in secondary prevention must be directed at
this aspect of patient management after stenting
Radioactive stents delay but do not prevent in-stent neointimal hyperplasia
BACKGROUND: Restenosis after conventional stenting is almost exclusively caused by neointimal hyperplasia. Beta-particle-emitting radioactive stents decrease in-stent neointimal hyperplasia at 6-month follow-up. The purpose of this study was to evaluate the 1-year outcome of (32)P radioactive stents with an initial activity of 6 to 12 microCi using serial quantitative coronary angiography and volumetric ECG-gated 3D intravascular ultrasound (IVUS). METHODS AND RESULTS: Of 40 patients undergoing initial stent implantation, 26 were event-free after the 6-month follow-up period and 22 underwent repeat catheterization and IVUS at 1 year; they comprised half of the study population. Significant luminal deterioration was observed within the stents between 6 months and 1 year, as evidenced by a decrease in the angiographic minimum lumen diameter (-0.43+/-0.56 mm; P:=0.028) and in the mean lumen diameter in the stent (-0.55+/-0. 63 mm; P:=0.001); a significant increase in in-stent neointimal hyperplasia by IVUS (18.16+/-12.59 mm(3) at 6 months to 27.75+/-11. 99 mm(3) at 1 year; P:=0.001) was also observed. Target vessel revascularization was performed in 5 patients (23%). No patient experienced late occlusion, myocardial infarction, or death. By 1 year, 21 of the initial 40 patients (65%) remained event-free. CONCLUSIONS: Neointimal proliferation is delayed rather than prevented by radioactive stent implantation. Clinical outcome 1 year after the implantation of stents with an initial activity of 6 to 12 microCi is not favorable when compared with conventional stenting
Persistent inhibition of neointimal hyperplasia after sirolimus-eluting stent implantation: long-term (up to 2 years) clinical, angiographic, and intravascular ultrasound follow-up
BACKGROUND: Early results of sirolimus-eluting stent implantation showed a nearly complete abolition of neointimal hyperplasia. The question remains, however, whether the early promising results will still be evident at long-term follow-up. The objective of our study was to evaluate the efficiency of sirolimus-eluting stent implantation for up to 2 years of follow-up. METHODS AND RESULTS: Fifteen patients with de novo coronary artery disease were treated with 18-mm sirolimus-eluting Bx-Velocity stents (Cordis) loaded with 140 microg sirolimus/cm2 metal surface area in a slow release formulation. Quantitative angiography (QCA) and intravascular ultrasound (IVUS) were performed according to standard protocol. Sirolimus-eluting stent implantation was successful in all 15 patients. During the in-hospital course, 1 patient died of cerebral hemorrhage after periprocedural administration of abciximab, and 1 patient underwent repeat stenting after 2 hours because of edge dissection that led to acute occlusion. Through 6 months and up to 2 years of follow-up, no additional events occurred. QCA analysis revea
Three dimensional intravascular ultrasonic assessment of the local mechanism of restenosis after balloon angioplasty
OBJECTIVE: To assess the mechanism of restenosis after balloon angioplasty. DESIGN: Prospective study. PATIENTS: 13 patients treated with balloon angioplasty. INTERVENTIONS: 111 coronary subsegments (2 mm each) were analysed after balloon angioplasty and at a six month follow up using three dimensional intravascular ultrasound (IVUS). MAIN OUTCOME MEASURES: Qualitative and quantitative IVUS analysis. Total vessel (external elastic membrane), plaque, and lumen volume were measured in each 2 mm subsegment. Delta values were calculated (follow up - postprocedure). Remodelling was defined as any (positive or negative) change in total vessel volume. RESULTS: Positive remodelling was observed in 52 subsegments while negative remodelling occurred in 44. Remodelling, plaque type, and dissection were heterogeneously distributed along the coronary segments. Plaque composition was not associated with changes in IVUS indices, whereas dissected subsegments had a greater increase in total vessel volume than those without dissection (1.7 mm(3) v -0.33 mm(3), p = 0.04). Change in total vessel volume was correlated with changes in lumen (p < 0.05, r = 0.56) and plaque volumes (p < 0.05, r = 0.64). The site with maximum lumen loss was not the same site as the minimum lumen area at follow up in the majority (n = 10) of the vessels. In the multivariate model, residual plaque burden had an influence on negative remodelling (p = 0.001, 95% confidence interval (CI) -0.391 to -0.108), whereas dissection had an effect on total vessel increase (p = 0.002, 95% CI 1.168 to 4.969). CONCLUSIONS: The mechanism of lumen renarrowing after balloon angioplasty appears to be determined by unfavourable remodelling. However, different patterns of remodelling may occur in individual injured coronary segments, which highlights the complexity and influence of local factors in the restenotic process
Azimuthal anisotropy and correlations in p+p, d+Au and Au+Au collisions at 200 GeV
We present the first measurement of directed flow () at RHIC. is
found to be consistent with zero at pseudorapidities from -1.2 to 1.2,
then rises to the level of a couple of percent over the range . The latter observation is similar to data from NA49 if the SPS rapidities
are shifted by the difference in beam rapidity between RHIC and SPS.
Back-to-back jets emitted out-of-plane are found to be suppressed more if
compared to those emitted in-plane, which is consistent with {\it jet
quenching}. Using the scalar product method, we systematically compared
azimuthal correlations from p+p, d+Au and Au+Au collisions. Flow and non-flow
from these three different collision systems are discussed.Comment: Quark Matter 2004 proceeding, 4 pages, 3 figure
Azimuthal anisotropy: the higher harmonics
We report the first observations of the fourth harmonic (v_4) in the
azimuthal distribution of particles at RHIC. The measurement was done taking
advantage of the large elliptic flow generated at RHIC. The integrated v_4 is
about a factor of 10 smaller than v_2. For the sixth (v_6) and eighth (v_8)
harmonics upper limits on the magnitudes are reported.Comment: 4 pages, 6 figures, contribution to the Quark Matter 2004 proceeding
All-optical switching and strong coupling using tunable whispering-gallery-mode microresonators
We review our recent work on tunable, ultrahigh quality factor
whispering-gallery-mode bottle microresonators and highlight their applications
in nonlinear optics and in quantum optics experiments. Our resonators combine
ultra-high quality factors of up to Q = 3.6 \times 10^8, a small mode volume,
and near-lossless fiber coupling, with a simple and customizable mode structure
enabling full tunability. We study, theoretically and experimentally, nonlinear
all-optical switching via the Kerr effect when the resonator is operated in an
add-drop configuration. This allows us to optically route a single-wavelength
cw optical signal between two fiber ports with high efficiency. Finally, we
report on progress towards strong coupling of single rubidium atoms to an
ultra-high Q mode of an actively stabilized bottle microresonator.Comment: 20 pages, 24 figures. Accepted for publication in Applied Physics B.
Changes according to referee suggestions: minor corrections to some figures
and captions, clarification of some points in the text, added references,
added new paragraph with results on atom-resonator interactio
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