scholarly journals Derivation and validation of myocardial bridge characteristics by optical coherence tomography: a prospective multimodality imaging study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Otsuka ◽  
Y Ueki ◽  
S Losdat ◽  
S Baer ◽  
L Raeber
Keyword(s):  
Optical Coherence Tomography ◽  
Light Intensity ◽  
Predictive Value ◽  
Vessel Wall ◽  
Multimodality Imaging ◽  
Subsequent Treatment ◽  
Optical Coherence ◽  
Imaging Data ◽  
Myocardial Bridge ◽  
Derivation Cohort

Abstract Background Optical coherence tomography (OCT) findings of myocardial bridge (MB) have not been established. Purpose We aimed to establish the OCT appearance of MB compared with the half-moon sign derived by intravascular ultrasound (IVUS) and to assess the prevalence among patients undergoing coronary angiography and OCT in clinical practice. Methods For derivation of the OCT appearance of MB, imaging data obtained from 122 patients undergoing OCT and IVUS for the left anterior descending artery (LAD) enrolled in two prospective imaging studies were analyzed. To assess the prevalence of OCT-derived MB, 470 patients undergoing OCT for LAD in clinical routine were analyzed. Results We found a homogeneous band with intermediate light intensity surrounding the vessel wall as assessed by OCT corresponding to half-moon sign derived by IVUS. Mean length, angle, and thickness of OCT-MB were 21.2±10.8mm, 205.7±56.5°, and 0.39±0.06mm, respectively. Mean length of IVUS-MB was significantly longer as compared with OCT-MB (23.7±11.9, P=0.010), while there were no significant differences in angle and thickness. MB angle was >180° in approximately 50% of frames with MB. There was a strong/moderate correlation between OCT-MB and half-moon sign (MB length: r=0.81, P=0.001, MB angle: r=0.58, P=0.001). In the derivation cohort, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of OCT-MB for the milking effect by angiography were 96.3%, 62.1%, 41.9%, 98.3%, and 69.7%, respectively, and much comparable with the IVUS half-moon sign. In the validation cohort, OCT-detected MB was observed in 139 (29.6%) patients, of whom 57.6% (n=80) did not have angiographic evidence of milking effect. Conclusion OCT is able to identify IVUS-defined MB as homogenous band with intermediate light intensity surrounding the vessel wall. There was a high concordance in terms of MB angle and thickness between OCT and IVUS. In clinically-indicated OCT cases of the LAD, more than half of OCT-MBs were angiographically silent. OCT assessment of MB may facilitate the accurate diagnosis of MB and thus provide useful information in determining the subsequent treatment strategy for the patients with MB. FUNDunding Acknowledgement Type of funding sources: None. Representative imaging of MB Case of OCT-MB without milking effect

Ex Vivo assessment of competent strut coverage after coronary stenting by optical coherence tomography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Bhoite ◽  
H Jinnouchi ◽  
F Otsuka ◽  
Y Sato ◽  
A Sakamoto ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Predictive Value ◽  
Ex Vivo ◽  
High Sensitivity ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Neointimal Thickness ◽  
Stent Strut ◽  
Oct Imaging ◽  
Definition Of

Abstract Background In many studies, struts coverage is defined as >0 mm of tissue overlying the stent struts by optical coherence tomography (OCT). However, this definition has never been validated using histology as the “gold standard”. The present study sought to assess the appropriate cut-off value of neointimal thickness of stent strut coverage by OCT using histology. Methods OCT imaging was performed on 39 human coronary arteries with stents from 25 patients at autopsy. A total of 165 cross-sectional images from 46 stents were co-registered with histology. The optimal cut-off value of strut coverage by OCT was determined. Strut coverage by histology was defined as endothelial cells with at least underlying two layers of smooth muscle cells. Considering the resolution of OCT is 10–20 μm, 3 different cut-off values (i.e. at ≥20, ≥40, and ≥60 μm) were assessed. Results A total of 2235 struts were evaluated by histology. Eventually, 1216 struts which were well-matched struts were analyzed in this study. By histology, uncovered struts were observed in 160 struts and covered struts were observed in 1056 struts. The broadly used definition of OCT-coverage which does not consider neointimal thickness yielded a poor specificity of 37.5% and high sensitivity 100%. Of 3 cut-off values, the cut-off value of >40 μm was more accurate as compared to >20 and >60 mm [sensitivity (99.3%), specificity (91.0%), positive predictive value (98.6%), and negative predictive value (95.6%)] Conclusion The most accurate cut-off value was ≥40 μm neointimal thickness by OCT in order to identify stent strut coverage validated by histology. Funding Acknowledgement Type of funding source: None

Abstract 5999: Optical Coherence Tomography Findings At Two Years Follow Up In Fully Biodegradable Everolimus Eluting Stents

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Nieves Gonzalo ◽  
Patrick W Serruys ◽  
Rafael Freire ◽  
Jurgen Ligthart ◽  
Wim vd Giessen ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Vessel Wall ◽  
Structural Changes ◽  
Optical Coherence ◽  
Very Late Stent Thrombosis ◽  
Degradable Polymer ◽  
Full Dataset ◽  
Biodegradable Stents ◽  
Time Of Presentation

Fully biodegradable stents may avoid the potential long-term complications of metallic drug-eluting stents such as late and very late stent thrombosis. We sought to evaluate the structural changes in a bioabsorbable DES and its interaction with the coronary vessel wall over time using optical coherence tomography (OCT). We investigated 14 consecutive patients undergoing implantation of a bioabsorbable everolimus-eluting coronary stent (BVS: Abbott Laboratories, IL, USA), composed of a poly-L-lactic acid backbone, coated with a degradable polymer/everolimus matrix. OCT (LightLab Imaging, Inc., Westford, MA) was performed immediately after stent implantation, at 6 months and at 24 months follow-up. All patients tolerated OCT imaging without complications. At baseline, OCT could detect the interface between the BVS stent and other tissues or fluid, but the inside of the strut appeared black, giving a unique box appearance. After 6 months, the struts were still clearly visible; however, their optical properties had changed considerably. In patients undergoing two years follow up (n=5, full dataset will be available at time of presentation) the majority of struts was not visible anymore and all visible struts were embedded into the vessel wall with complete tissue coverage. In contrast to 6months follow-up, at 2 years no intraluminal thrombi or dissections were visible. At 2 years follow-up the majority of stent struts were not visible by OCT. All the visible struts were covered and apposed. The lumen surface was smooth without intraluminal thrombi or dissections.

107Diagnostic accuracy of optical coherence tomography for the identification of in-stent fibroatheroma following stent implantation: an ex-vivo histological validation study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Shibutani ◽  
K Fujii ◽  
R Kawakami ◽  
T Imanaka ◽  
K Kawai ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Cross Sections ◽  
Stent Implantation ◽  
Predictive Value ◽  
Signal Intensity ◽  
Necrotic Core ◽  
Optical Coherence ◽  
Low Intensity ◽  
Stent Strut ◽  
Histological Images

Abstract Background Previous histopathological studies have demonstrated that new atherosclerotic formation within the neointima, called neoatherosclerosis, is one of the most important mechanisms leading to both very late in-stent restenosis and stent thrombosis after stent implantation. Therefore, to distinguish lipid-containing atherosclerotic neointima from other tissues using intracoronary imaging modalities is clinically important to prevent late stent failures. Purpose This study evaluated the diagnostic performance of optical coherence tomography (OCT) for the detection of “in-stent fibroatheroma” following stent implantation by comparing cross-sections of the model with the corresponding histological images. Methods Fifty stented coronary arteries from the 31 autopsy hearts were imaged by OCT. Coronary arterial histopathological specimens, all of which included more than 30% of %neointimal hyperplasia, were compared with the corresponding OCT cross-sections. Histological in-stent fibroatheroma was defined as neointima containing large necrotic core and inflammatory cells. OCT-derived in-stent fibroatheroma comprised a low-intensity tissue containing a poorly delineated region with invisible stent strut behind low signal intensity. Results A total of 122 OCT cross-sections were compared with histological images. OCT examination revealed that 24 images (20%) contained low-intensity tissue inside the neointima. Of those, 5 images, in which stent strut behind low signal intensity was invisible, were diagnosed as OCT-derived in-stent fibroatheroma (4%) (Figure A). By histological analysis, only 4 images were classified as in-stent fibroatheroma (3%) (Figure B). With histology as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for OCT-derived in-stent fibroatheroma were 100%, 99%, 80%, 100%, and 99%, respectively. The only histological finding underlying the false-positive-diagnosis of OCT-derived in-stent fibroatheroma was foam cells accumulation without necrotic core on the neointimal surface (Figure C and D). Most tissue that showed low-intensity tissue with visible stent strut by OCT contained proteoglycan matrix and organized thrombus in the absence of an underlying necrotic core. Coregistration of OCT with histology Conclusion This study showed the potential capability of OCT based on the visualization of stent struts behind low-intensity regions for discriminating in-stent fibroatheroma from other neointimal tissues following stent implantation.

Sign in / Sign up

Export Citation Format

Share Document