Intravascular OCT tissue type imaging by automated optical attenuation analysis

We developed attenuation imaging in OCT for atherosclerotic tissue characterization and validated the method ex and in-vivo. We introduced an en-face map of attenuation in the whole artery for plaque visualization. We quantified the attenuation derived from OCT and derived an index for the plaques. A single centre clinical study (OC3T study) was conducted to validate the index to identify thin cap fibroatheromas. We also demonstrated the utility of the attenuation maps and the index in clinical studies as corresponding well with a visual assessment of LCP in the OCT data by expert readers

A new technique for lipid core plaque detection by optical coherence tomography for prevention of peri-procedural myocardial infarction

Rationale: Percutaneous coronary intervention (PCI) provides effective revascularization of atherosclerotic coronary arteries but the invasive nature of treatment can result in complications. Patient concerns: A 53-year old man underwent coronary angiography due to chest pain with minimal ST-segment elevation in the inferior leads of the electrocardiogram. Diagnosis: We proceeded directly to coronary angiography and delineated a moderate stenosis with haziness in the mid right coronary artery (RCA). Interventions: Expert analysis of the pre-intervention OCT imaging demonstrated a large lipid core plaque (LCP), upstream of the culprit site, with minimal thrombus burden. Subsequent implantation of a bioresorbable vascular scaffold, protected with distal deployment of a filter protection device provided an excellent result with retrieval of plaque material. Post-hoc attenuation analysis confirmed the presence of large LCP. Outcomes: A post-procedural transthoracic echocardiogram confirmed good left ventricular function with no regional wall motion abnormality. An excellent clinical outcome was achieved. Lessons: Optical coherence tomography (OCT) derived attenuation analysis can provide with qualitative and quantitative detailed evaluation of the underlying plaque substrate. Our case shows OCT can provide the interventionist with qualitative and qualitative assessment of large LCP for prevention of periprocedural complications, which may improve outcome for PCI

OCT assessment of the long-term vascular healing response 5 years after everolimus-eluting bioresorbable vascular scaffold

AbstractBackgroundAlthough recent observations suggest a favorable initial healing process of the everolimus-eluting bioresorbable vascular scaffold (BVS), little is known regarding long-term healing response.ObjectivesThis study assessed the in vivo vascular healing response using optical coherence tomography (OCT) 5 years after elective first-in-man BVS implantation.MethodsOf the 14 living patients enrolled in the Thoraxcenter Rotterdam cohort of the ABSORB A study, 8 patients underwent invasive follow-up, including OCT, 5 years after implantation. Advanced OCT image analysis included luminal morphometry, assessment of the adluminal signal-rich layer separating the lumen from other plaque components, visual and quantitative tissue characterization, and assessment of side-branch ostia “jailed” at baseline.ResultsIn all patients, BVS struts were integrated in the vessel and were not discernible. Both minimum and mean luminal area increased from 2 to 5 years, whereas lumen eccentricity decreased over time. In most patients, plaques were covered by a signal-rich, low-attenuating layer. Minimum cap thickness over necrotic core was 155 ± 90 μm. One patient showed plaque progression and discontinuity of this layer. Side-branch ostia were preserved with tissue bridge thinning that had developed in the place of side-branch struts, creating a neo-carina.ConclusionsAt long-term BVS follow-up, we observed a favorable tissue response, with late luminal enlargement, side-branch patency, and development of a signal-rich, low-attenuating tissue layer that covered thrombogenic plaque components. The small size of the study and the observation of a different tissue response in 1 patient warrant judicious interpretation of our results and confirmation in larger studies

In-stent neoatherosclerosis: Are first generation drug eluting stents different than bare metal stents? An optical coherence tomography study

Purpose: In-stent neoatherosclerosis has been recognised in pathologic specimens of bare metal stents (BMS), and recently in first generation drug eluting stents (1st-DES), as well. However, in vivo data are scarce. By optical coherence tomography, we investigated the incidence and morphological characteristics of neoatherosclerosis (NA) very late after BMS or 1st-DES implantation. Methods: From 1/1/2007 to 31/1/2012, 52 patients from two institutions underwent >24 months follow-up OCT assessment of a BMS or a 1st-DES (13 BMS - 39 1st-DES). NA was characterized using criteria for native atherosclerosis. Results: BMS had longer follow-up interval but no differences in clinical presentation at follow-up. No significant differences were evident in the incidence of NA, neointimal rupture, lipid content, neovascularization or macrophage infiltration between BMS and 1st-DES. There was however a trend for lower fibrous cap thickness (FCT) and for higher calcification in BMS (FCT: 51±31 μm vs. 92±59 μm, p=0.057; calcifications: 46.2% vs. 15.4%, p=0.051). 1st-DES with neoatherosclerosis had longer interval from implantation compared to 1st-DES with homogeneous coverage [Median 71 months (range 25-130) vs. 57 months (24-68), p<0.05], but there was no difference for BMS with or without neoatherosclerosis [Median 125 months (range 90-201) vs. 168 months (132-168), p=0.63]. Conclusions: The incidence and morphological characteristics of NA are similar between 1st-DES and BMS of more prolonged follow-up. Our findings suggest a time-dependent pattern in the incidence of NA in 1st-DES with 2-11 years follow-up

Association of neointimal morphology by optical coherence tomography with rupture of neoatherosclerotic plaque very late after coronary stent implantation

Purpose: Neoatherosclerosis within a stent has been recently described as a culprit of late stent failure. We investigated by optical coherenc