The Use of Intracoronary Optical Coherence Tomography in Interventional Cardiology: Safety, Feasibility and Clinical Applications

Interventional cardiology has witnessed tremendous change since 1977 when Andreas Gruentzig successfully performed the first balloon angioplasty. Whereas initial concerns revolved around maintaining vessel patency with issues of recoil and restenosis, the introduction of stents changed the landscape forever. Inherent with their use, stents, and, more specifically, drugeluting stents (DES), have become central to improved patient outcomes but, at some cost. Catastrophic, yet fortunately still rare complications such as stent thrombosis have re-ignited an intense need for greater scrutiny when developing and, subsequently implanting DES into our patients. The demand for detailed information regarding coronary artery disease has seen intravascular imaging become pivotal at delineating atherosclerosis and tissue responses following stent implantation. In fact, the strategy that relied on angiography alone is evolving to include better confirmation of disease severity and stenting technique. With this, optical coherence tomography (OCT) has grown exponentially with a broad diffusion amongst catheterisation laboratories worldwide. Optical coherence tomography is a procedurally demanding technique. Individual experience is often frustrated initially with disappointing images as a result of inadequate blood clearance. With perseverance and adequate proctorship however, one cannot help but be impressed by the clarity and resolution afforded by this imaging modality. It is these images that have attracted considerable attention at cardiology conferences internationally and have helped instil OCT as the most sensitive intravascular imaging technique available today. The aim of this thesis was to evaluate the role of OCT in contemporary coronary intervention. Part 1 embraces the principles of the technique and the physical properties of OCT (chapter 2) and gives an insight into where OCT is placed compared to other intravascular imaging modalities (chapter 3). Despite the adoption of OCT in more and more catheterisation laboratories, little has been documented as to its safety, so, in chapter 4, we review the procedural safety of intracoronary OCT in a large group of patients across six leading European centres

Five-year follow-up of underexpanded and overexpanded bioresorbable scaffolds: Self-correction and impact on shear stress

Underexpansion and overexpansion have been incriminated as causative factors of adverse cardiac events. However, dynamic biological interaction between vessel wall and scaffold may attenuate the adverse haemodynamic impact of overexpansion or underexpansion

Numerical and experimental investigations of the flow-pressure relation in multiple sequential stenoses coronary artery

Cardiovascular Aspects of Radiolog

AMS INSIGHT—Absorbable Metal Stent Implantation for Treatment of Below-the-Knee Critical Limb Ischemia: 6-Month Analysis

Endoluminal treatment of infrapopliteal artery lesions is a matter of controversy. Bioabsorbable stents are discussed as a means to combine mechanical prevention of vessel recoil with the advantages of long-term perspectives. The possibility of not having a permanent metallic implant could permit the occurrence of positive remodeling with lumen enlargement to compensate for the development of new lesions. The present study was designed to investigate the safety of absorbable metal stents (AMSs) in the infrapopliteal arteries based on 1- and 6-month clinical follow-up and efficacy based on 6-month angiographic patency. One hundred seventeen patients with 149 lesions with chronic limb ischemia (CLI) were randomized to implantation of an AMS (60 patients, 74 lesions) or stand-alone percutaneous transluminal angioplasty (PTA; 57 patients, 75 lesions). Seven PTA-group patients “crossed over” to AMS stenting. The study population consisted of patients with symptomatic CLI (Rutherford categories 4 and 5) and de novo stenotic (>50%) or occlusive atherosclerotic disease of the infrapopliteal arteries who presented with a reference diameter of between 3.0 and 3.5 mm and a lesion length of <15 mm. The primary safety endpoint was defined as absence of major amputation and/or death within 30 days after index intervention and the primary efficacy endpoint was the 6-month angiographic patency rate as confirmed by core-lab quantitative vessel analysis. The 30-day complication rate was 5.3% (3/57) and 5.0% (3/60) in patients randomized for PTA alone and PTA followed by AMS implantation, respectively. On an intention-to-treat basis, the 6-month angiographic patency rate for lesions treated with AMS (31.8%) was significantly lower (p = 0.013) than the rate for those treated with PTA (58.0%). Although the present study indicates that the AMS technology can be safely applied, it did not demonstrate efficacy in long-term patency over standard PTA in the infrapopliteal vessels