Innovations in the clinical use of OCT

Optical coherence tomography (OCT) is an infrared light-based imaging modality with near-histological resolution (5-15μm) allowing the comprehensive evaluation of the vascular wall and intracoronary devices. This imaging modality has been widely used in clinical practice for the assessment of atherosclerosis and of the impact of interventions on the vascular wall, but also for the guidance of coronary intervention. The aim of this thesis is to outline the contemporary use of optical coherence tomography in clinical practice and summarize insights gained by this imaging modality into the acute and chronic vascular response after intravascular interventions. In specific, this thesis intends to: - Summarize the current status of OCT in clinical practice - Describe and validate new analysis tools for optical coherence tomography, that allow to overcome some of the current limitations - Examine the pathomechanisms of very late metallic stent failure with particular emphasis on the role of neoatherosclerosis - Assess the acute and chronic vascular healing response after bioresorbable vascular scaffold implantation and provide pilot observations regarding the pathomechanisms of early and late bioresorbable scaffold failure - Evaluate the acute effects of catheter-based renal denervation on the renal artery integrit

Late Onset of Severe Symptoms in a Patient with Wolff-Parkinson-White Syndrome with Misleading ECG Pattern of the Accessory Pathway Origin Undergoing Successful Ablation

The case of a female patient with symptomatic Wolff-Parkinson-White syndrome is presented with very late onset of symptoms at the age of 65 years, who had an apparent left-sided posteroseptal accessory pathway, which was ablated via a right-sided approach. A subepicardial location was strongly suspected within the coronary sinus ostium at the origin of the middle cardiac vein by applying both ECG and fluoroscopic criteria. Rhythmos 2016;11(3):73-75.

Association of systemic inflammatory biomarkers with morphological characteristics of coronary atherosclerotic plaque by intravascular optical coherence tomography

Despite significant advances in preventive, medical, and interventional management, coronary artery disease remains the leading cause of death worldwide. We now know that in the majority of acute coronary syndromes, a thrombotic event is triggered either by the rupture or erosion of the so-called high-risk or ‘vulnerable’ plaque. However, accurately identifying the individual who is at significant risk of acute event remains the holy grail of preventive cardiology. To better stratify an individual's risk of developing and suffering a cardiovascular event, biomarkers are needed that can accurately predict coronary events and, if possible, monitor disease activity in response to medical or interventional therapies. In order to be able to understand the association of these biomarkers with the morphological substrate of high-risk plaques, intravascular imaging modalities can provide invaluable assistance. Novel imaging tools such as optical coherence tomography (OCT) have not only helped in identifying atherosclerotic plaque characteristics that are unstable but also in estimating global plaque burden. In this study, we provide an overview of our current knowledge of association of various inflammatory markers with atherosclerotic plaque characteristics seen on OCT

Is it safe to implant bioresorbable scaffolds in ostial side-branch lesions? Impact of 'neo-carina' formation on main-branch flow pattern. Longitudinal clinical observations

Formation of a 'neo-carina' has been reported after bioresorbable vascular scaffolds (BVS) implantation over side-branches. However, as this 'neo-carina' could protrude into the main-branch, its hemodynamic impact remains unknown. We present two cases of BVS implantation for ostial side-branch lesions, and investigate the flow patterns at follow-up and their potential impact. Computational fluid dynamics analysis was performed, using a 3D mesh created by fusion of 3-dimensional angiogram with optical coherence tomography images. In our first case, mild disturbances were seen when 'neo-carina' did not protrude perpendicularly into the main branch. In the second case, extensive flow re-distribution was observed due to a more pronounced protrusion of the 'neo-carina'. Importantly, these areas of hemodynamic disturbance were observed together with lumen narrowing in a non-stenotic vessel segment. Our case observations highlight the importance of investigating the hemodynamic consequences of BVS implantation in bifurcation lesions and illustrate a novel method to do so invivo