107 research outputs found
OCT-BASED THREE DIMENSIONAL MODELING OF STENT DEPLOYMENT
Stent deployment has been widely used to treat narrowed coronary artery. Its acute outcome in terms of stent under expansion and malapposition depends on the extent and shape of calcifications. However, no clear understanding as to how to quantify or categorize the impact of calcification. We have conducted ex vivo stenting characterized by the optical coherence tomography (OCT). The goal of this work is to capture the ex vivo stent deployment and quantify the effect of calcium morphology on the stenting. A three dimensional model of calcified plaque was reconstructed from ex vivo OCT images. The crimping, balloon expansion and recoil process of the Express stent were characterized. Three cross-sections with different calcium percentages were chosen to evaluated the effect of the calcium in terms of stress/strain, lumen gains and malapposition. Results will be used to the pre-surgical planning
MECHANICAL PERFORMANCE OF PLLA STENT
Stent implantation is widely used to treat blocked lumen. Stents were meshed structure made of polymers and metal alloys, including stainless steel, cobalt chrome and nitinol [1]. Clinical studies had demonstrated that stents helped to scaffold the diseased lesion up to one year when tissue adapted to the stented environment [2]. However, the permanently implanted stents inside artery were associated with complications such as stent fracture, tissue inflammation, in-stent restenosis and thrombosis [3]. Currently, biodegradable stents are attracting more attention due to its potential long-term efficacy in treating blocked lumens. The detailed characterizations of biodegradable stents are essential for the desired clinical outcomes.
In this work, the mechanical performance of Absorb GTIâ„¢ Bioresorbable stent made of PLLA (Poly-L-Lactide Acid) was studied using finite element method (FEM). Both the stent crimping and deployment were quantified towards the optimization of its scaffolding capacity in a limited time
Um papel para organismos de arqueia no desenvolvimento de placas ateroscleróticas vulneráveis e matriz mixomatosa
PURPOSE: Vulnerable plaques are characterized by a myxoid matrix, necrotic lipidic core, reactive oxygen species, and high levels of microorganisms. Aerobic microbes such as Chlamydophila pneumoniae and Mycoplasma pneumoniae usually do not survive in oxidative stress media. Archaea are anaerobic microbes with powerful anti-oxidative enzymes that allow detoxification of free radicals whose presence might favor the survival of aerobic microorganisms. We searched for archaeal organisms in vulnerable plaques, and possible associations with myxoid matrix, chlamydia, and mycoplasma bodies. METHODS: Twenty-nine tissue samples from 13 coronary artherectomies from large excentric ostial or bifurcational lesions were studied using optical and electron microscopy. Infectious agents compatible with archaea, chlamydia, and mycoplasma were semiquantified using electron micrographs and correlated with the amounts of fibromuscular tissue, myxoid matrix, and foam cells, as determined from semi-thin sections. Six of the cases were also submitted to polymerase chain reaction with archaeal primers. RESULTS: All 13 specimens showed archaeal-compatible structures and chlamydial and mycoplasmal bodies in at least 1 sample. There was a positive correlation between extent of the of myxoid matrix and archaeal bodies (r = 0.44, P = 0.02); between archaeal and mycoplasmal bodies (r = 0.41, P = 0.03), and between chlamydial bodies and foam cells (r = 0.42; P = 0.03). The PCR test was positive for archaeal DNA in 4 of the 6 fragments. DISCUSSION: DNA and forms suggestive of archaea are present in vulnerable plaques and may have a fundamental role in the proliferation of mycoplasma and chlamydia. This seems to be the first description of apparently pathogenic archaea in human internal organ lesions.PROPOSTA: Placas vulneráveis são caracterizadas por matriz mixomatosa, centro lipÃdico necrótico, espécies reativas de oxigênio e alto nÃveis de microorganismos. Micróbios aeróbicos como Chlamydophila pneumoniae e Mycoplasma pneumoniae usualmente não sobrevivem em meio de estresse oxidativo. Arquéias são microorganismos anaeróbicos com poderosas enzimas anti-oxidantes que permitem detoxificação de radicais livres e a presença delas poderia favorecer a sobrevivência de micróbios aeróbicos. Pesquisamos por elementos de arquéia em placas vulneráveis e sua possÃvel associação com degeneração mixomatosa da matriz e aumento do número de clamÃdias e micoplasmas. MÉTODOS: Vinte e nove amostras de 13 produtos de aterotomia de lesões grandes e excêntricas de óstio ou bifurcação de coronárias foram estudadas pela microscopia óptica e eletrônica. Agentes compatÃveis com arquéia, clamÃdia e micoplasma foram semiquantificados pela microscopia eletrônica e correlacionados com quantidade de tecido fibromuscular, matriz mixomatosa e células xantomatosas. Seis casos foram também submetidos à reação em cadeia da polimerase com oligonucleotÃdeos de arquéia. RESULTADOS: Os 13 casos foram positivos para estruturas sugestivas de arquéia, micoplasma ou clamÃdia, em pelo menos uma amostra. Houve correlação positiva entre intensidade de matriz mixomatosa versus arquéia (r=0.44, p=0.02); arquéia versus micoplasma (r=0.41, p=0.03) e clamÃdia versus células xantomatosas r=0,42; 0.03). PCR foi positiva para DNA de arqueia em 4 dos 6 fragmentos. DISCUSSÃO: DNA e formas compatÃveis com arquéia estão presentes em placas vulneráveis e podem ter papel fundamental na proliferação de micoplasma e clamÃdia. Este parece ser o primeiro relato de arquéia aparentemente patogênica em lesões de órgãos internos humanos
Application of ex vivo cryo-imaging technique for three-dimensional finite element analysis of atherosclerotic plaque rupture
PublishedCryo-imaging is an ex vivo vascular imaging modality that acquires serial 2D fluorescence and bright-field images at 20μm increments without sacrifice to tissue morphology. These features make Cryo-imaging an attractive approach for rendering high-resolution 3D volumes that may serve as a basis for finite element analysis (FEA) studies of plaque rupture. This work demonstrates the first use of Cryo-imaging for the imaging of a human coronary vessel and the subsequent rendering of a 3D FE model that clearly delineates critical anatomical features of atherosclerotic plaque. FEA is then performed to assess the plaque rupture conditions that result in a thrombotic episode
Serial Assessment of Vessel Interactions After Drug-Eluting Stent Implantation in Unprotected Distal Left Main Coronary Artery Disease Using Frequency-Domain Optical Coherence Tomography
ObjectivesThis study sought to assess stent-vessel interactions after drug-eluting stent (DES) implantation in unprotected left main coronary artery (ULM) by frequency-domain optical coherence tomography (FD-OCT).BackgroundPercutaneous coronary intervention using DES in ULM has been increasingly performed in routine practice. Recently, FD-OCT assessments of DES-vessel interactions have been used as surrogates for DES safety; however, there are no FD-OCT studies in ULM.MethodsWe prospectively enrolled 33 consecutive patients with ULM disease treated with sirolimus- (n = 11) and everolimus-eluting stents (n = 22). FD-OCT assessments were performed post-percutaneous coronary intervention and at 9-month follow-up. Three different segments of ULM were compared: distal (DIS), bifurcation (BIF), and ostial-body (BODY). The primary endpoints were percentages of uncovered and malapposed struts at 9-month follow-up, and the secondary endpoint was neointimal hyperplasia area.ResultsWe analyzed 25,873 stent struts. Significant differences were demonstrated for percentage of uncovered struts (3.4%, 11.7%, and 18.7%, respectively for DIS, BIF, and BODY; p < 0.05 for all the comparisons). Malapposition was also more common in BODY (5.3%) than in DIS (0.6%) and BIF (2.0%) segments (p < 0.05 for BODY vs. DIS, and BODY vs. BIF). Equivalent neointimal hyperplasia areas were demonstrated in all segments. Acute malapposition rates led to different patterns of DES-vessel interactions at 9-month follow-up.ConclusionsDistinct patterns of DES-vessel interactions were demonstrated in different segments of ULM. Acute stent strut malapposition affects these findings
Deep learning segmentation of fibrous cap in intravascular optical coherence tomography images
Thin-cap fibroatheroma (TCFA) is a prominent risk factor for plaque rupture.
Intravascular optical coherence tomography (IVOCT) enables identification of
fibrous cap (FC), measurement of FC thicknesses, and assessment of plaque
vulnerability. We developed a fully-automated deep learning method for FC
segmentation. This study included 32,531 images across 227 pullbacks from two
registries. Images were semi-automatically labeled using our OCTOPUS with
expert editing using established guidelines. We employed preprocessing
including guidewire shadow detection, lumen segmentation, pixel-shifting, and
Gaussian filtering on raw IVOCT (r,theta) images. Data were augmented in a
natural way by changing theta in spiral acquisitions and by changing intensity
and noise values. We used a modified SegResNet and comparison networks to
segment FCs. We employed transfer learning from our existing much larger,
fully-labeled calcification IVOCT dataset to reduce deep-learning training.
Overall, our method consistently delivered better FC segmentation results
(Dice: 0.837+/-0.012) than other deep-learning methods. Transfer learning
reduced training time by 84% and reduced the need for more training samples.
Our method showed a high level of generalizability, evidenced by
highly-consistent segmentations across five-fold cross-validation (sensitivity:
85.0+/-0.3%, Dice: 0.846+/-0.011) and the held-out test (sensitivity: 84.9%,
Dice: 0.816) sets. In addition, we found excellent agreement of FC thickness
with ground truth (2.95+/-20.73 um), giving clinically insignificant bias.
There was excellent reproducibility in pre- and post-stenting pullbacks
(average FC angle: 200.9+/-128.0 deg / 202.0+/-121.1 deg). Our method will be
useful for multiple research purposes and potentially for planning stent
deployments that avoid placing a stent edge over an FC.Comment: 24 pages, 9 figures, 2 tables, 2 supplementary figures, 3
supplementary table
Automated analysis of fibrous cap in intravascular optical coherence tomography images of coronary arteries
Thin-cap fibroatheroma (TCFA) and plaque rupture have been recognized as the
most frequent risk factor for thrombosis and acute coronary syndrome.
Intravascular optical coherence tomography (IVOCT) can identify TCFA and assess
cap thickness, which provides an opportunity to assess plaque vulnerability. We
developed an automated method that can detect lipidous plaque and assess
fibrous cap thickness in IVOCT images. This study analyzed a total of 4,360
IVOCT image frames of 77 lesions among 41 patients. To improve segmentation
performance, preprocessing included lumen segmentation, pixel-shifting, and
noise filtering on the raw polar (r, theta) IVOCT images. We used the
DeepLab-v3 plus deep learning model to classify lipidous plaque pixels. After
lipid detection, we automatically detected the outer border of the fibrous cap
using a special dynamic programming algorithm and assessed the cap thickness.
Our method provided excellent discriminability of lipid plaque with a
sensitivity of 85.8% and A-line Dice coefficient of 0.837. By comparing lipid
angle measurements between two analysts following editing of our automated
software, we found good agreement by Bland-Altman analysis (difference 6.7+/-17
degree; mean 196 degree). Our method accurately detected the fibrous cap from
the detected lipid plaque. Automated analysis required a significant
modification for only 5.5% frames. Furthermore, our method showed a good
agreement of fibrous cap thickness between two analysts with Bland-Altman
analysis (4.2+/-14.6 micron; mean 175 micron), indicating little bias between
users and good reproducibility of the measurement. We developed a fully
automated method for fibrous cap quantification in IVOCT images, resulting in
good agreement with determinations by analysts. The method has great potential
to enable highly automated, repeatable, and comprehensive evaluations of TCFAs.Comment: 18 pages, 9 figure
Randomized comparison of 9-month stent strut coverage of biolimus and everolimus drug-eluting stents assessed by optical coherence tomography in patients with ST-segment elevation myocardial infarction. Long-term (5-years) clinical follow-up (ROBUST trial)
Background: The aim of the study was to compare healing (assessed by optical coherence tomography [OCT]) of biolimus A9 (BES) and everolimus drug-eluting stents (EES) at 9-month follow-up in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Nine-month clinical and angiographic data were also compared in both groups as well as clinical data at 5 years of follow-up. Methods: A total of 201 patients with STEMI were enrolled in the study and randomized either to pPCI with BES or EES implantation. All patients were scheduled for 9 months of angiographic and OCT follow-up. Results: The rate of major adverse cardiovascular events (MACE) was comparable at 9 months in both groups (5% in BES vs. 6% in the EES group; p = 0.87). Angiographic data were also comparable between both groups. The main finding at 9-month OCT analysis was the greatly reduced extent of mean neointimal area at the cost of a higher proportion of uncovered struts in the BES group (1.3 mm2 vs. 0.9 mm2; p = 0.0001 and 15.9% vs. 7.0%; p = 0.0001, respectively). At 5 years of clinical follow-up the rate of MACE was comparable between both groups (16.8% vs. 14.0%, p = 0.74). Conclusions: The study demonstrates a very low rate of MACE and good 9-month stent strut coverage of second-generation BES and EES in patients with STEMI. BES showed greatly reduced extent of mean neointimal hyperplasia area at the cost of a higher proportion of uncovered struts when compared to EES. The rate of MACE was low and comparable in both groups at 5 years
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