scholarly journals Structural Thickening of Medial Layer in Coronary Artery With Spasm in Patients With Myocardial Infarction

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Takamitsu Nakamura ◽  
Takeo Horikoshi ◽  
Kiyotaka Kugiyama
Keyword(s):  
Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Coronary Artery ◽  
Coronary Artery Spasm ◽  
Elastic Membrane ◽  
Optical Coherence ◽  
Unique Identifier ◽  
External Elastic Membrane ◽  
Relationship Of ◽  
Medial Area

Background The underlying pathophysiology of coronary artery spasm (CAS) remains unclear. We aim to determine whether coronary artery medial layer thickness is associated with CAS using optical coherence tomography. Methods and Results A total of 50 patients with previous myocardial infarction underwent optical coherence tomography of the left anterior descending artery: 20 with CAS and 30 without CAS. Intimal and medial layer areas were measured by planimetric analysis of optical coherence tomography images. The medial area/external elastic membrane (EEM) area was significantly greater in patients with than without CAS (0.13±0.01 versus 0.09±0.01, respectively, P <0.01), whereas the intimal area/EEM area was similar in the 2 groups. In patients without CAS, the relationship of intimal area/EEM area with medial area/EEM area and coronary diameter response to intracoronary injection of acetylcholine was characterized by an inverted U‐shaped curve ( y =−1.85 x 2 +0.81 x +0.01, R 2 =0.43, P <0.001) and a U‐shaped curve ( y =2993.2 x 2 −1359.6 x +117.1, R 2 =0.53, P <0.001), respectively. Thus, the medial layer became thin and the contractile response became weak in coronary arteries with greater intimal area in the non‐CAS patients. In contrast, in patients with CAS, the intimal area/EEM area had no significant relationship with the medial area/EEM area in either linear correlation analysis or quadratic regression analysis. Thus, even when the intimal layer thickened, the medial layer did not thin in patients with CAS. Conclusions The structural thickness of the coronary medial layer was increased in patients with CAS, which may provide mechanistic insight into the pathogenesis of CAS. Registration URL: https://www.upload.umin.ac.jp ; Unique identifier: UMIN000018432.

scholarly journals ST Elevation Infarction after Heart Transplantation Induced by Coronary Spasms and Mural Thrombus Detected by Optical Coherence Tomography

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Tor Skibsted Clemmensen ◽  
Niels Ramsing Holm ◽  
Hans Eiskjær ◽  
Steen Hvitfeldt Poulsen ◽  
Michael Maeng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Coronary Artery ◽  
Thrombus Formation ◽  
Coronary Intervention ◽  
Suspected Coronary Artery Disease ◽  
Optical Coherence ◽  
Mural Thrombus ◽  
Clinical Value ◽  
Underlying Mechanisms

The case illustrates the possible link between coronary spasms, intraluminal thrombus formation, and widespread organized and layered thrombi in HTx patients. Furthermore, the case underlines the clinical value of OCT as a novel method for high-resolution vessel imaging in heart-transplanted (HTx) patients with coronary spasms and suspected coronary artery disease. Coronary spasms and sudden death are frequent complications after HTx. The underlying mechanisms leading to these complications are unknown. The present case displays the clinical course of a 19-year-old HTx patient who was hospitalized due to acute myocardial infarction induced by severe coronary spasms. The patients remained unstable on conservative therapy. Therefore, an optical coherence tomography (OCT) was performed and revealed massive, organized thrombi in the left main coronary artery, the circumflex coronary artery, and the left anterior descending coronary artery. The patient was stabilized after percutaneous coronary intervention. As a mural thrombus often goes undetected by coronary angiography, OCT may prove benefit in HTx patients with myocardial infarction or suspected coronary spasms.

scholarly journals Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
Daniel Chamié ◽  
J. Ribamar Costa ◽  
Lucas P. Damiani ◽  
Dimytri Siqueira ◽  
Sérgio Braga ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Intravascular Ultrasound ◽  
Elastic Membrane ◽  
Complication Rates ◽  
Percutaneous Coronary Interventions ◽  
Optical Coherence ◽  
Coronary Interventions ◽  
Stent Expansion ◽  
Percutaneous Coronary ◽  
External Elastic Membrane

Background: Specific algorithms for use of optical coherence tomography (OCT) to guide percutaneous coronary intervention (PCI) are scarce. Also, the relative benefits of intravascular imaging guidance have not been tested against an optimized angiography-guided PCI strategy. In iSIGHT (Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions), we aimed to investigate whether OCT-guided PCI achieves noninferior stent expansion compared with intravascular ultrasound (IVUS) guidance and if both imaging modalities lead to superior stent expansion compared with an optimized angiography-based strategy. Methods: Patients ≥18 years old undergoing PCI for ≥1 lesion in native coronaries of 2.25 to 4.00 mm in diameter were randomized 1:1:1 to OCT-, IVUS-, or angiography-guided PCI. Predetermined guidance protocols were applied in all groups. An external elastic membrane–based protocol was used for stent sizing by OCT and IVUS. The primary end point was noninferiority of stent expansion (minimum stent area ≥90% of the average reference lumen area), measured by post-PCI OCT, in OCT-guided versus IVUS-guided PCI (noninferiority margin, 6.5%). Results: One hundred fifty-one patients (156 lesions) were randomly allocated to OCT (51 lesions [32.7%]), IVUS (52 lesions [33.3%]), or angiography (53 lesions [34.0%]). Stent expansion with OCT guidance (98.01±16.14%) was noninferior to IVUS (91.69±15.75%; 1-sided lower 95% CI, 0.55 mm 2 ; P non-inferiority <0.001) and superior to angiography (90.53±14.84%, P =0.041). IVUS and angiography obtained similar stent expansions ( P =0.921). Stent edge dissection and periprocedural complication rates were not significantly different among the groups. Conclusions: Stent expansion with OCT guidance using a dedicated external elastic membrane–based sizing strategy was noninferior to that achieved with IVUS and superior to an optimized angiographic strategy. Registration: URL: plataformabrasil.saude.gov.br ; Unique identifier: 69968417.8.0000.5462.

scholarly journals Optical coherence tomography for evaluating Synergy everolimus-eluting stents with biodegradable polymer and Xience durable polymer everolimus-eluting stents following percutaneous coronary intervention in patients with left main coronary artery stenosis

2017 ◽  
Vol 21 (4) ◽  
pp. 59 ◽  
Author(s):  
R. U. Ibragimov ◽  
A. G. Badoyan ◽  
O. V. Krestyaninov ◽  
E. A. Pokushalov ◽  
I. A. Naryshkin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Coronary Artery ◽  
Conflict Of Interest ◽  
Biodegradable Polymer ◽  
Left Main Coronary Artery ◽  
Optical Coherence ◽  
Left Main ◽  
Durable Polymer

<p><strong>Aim.</strong> The development of on a new generation of stents with abluminal biodegradable polymer is aimed at accelerating the neointimal growth and reducing the inflammatory response of the vascular wall. This article presents an analysis of healing characteristics, as assessed by optical coherence tomography (OCT), of ultrathin Synergy everolimus-eluting stent with biodegradable polymer and Xience everolimus-eluting stent with durable polymer three months after implantation.<br /><strong>Methods.</strong> In this prospective, single-center study fifty patients with significant stenosis of the left main coronary artery were randomized in 2 groups for implantation of everolimus-eluting stents with durable polymer (Xience) or abluminal biodegradable polymer (Synergy). After three months all patients underwent control coronarography supported by optical coherence tomography. A Neointimal Healing Score (NIH Score) obtained at three months after stent implantation by means of optical coherence tomography was the primary endpoint. Such OCT data as percentage of uncovered or malapposed struts only and presence of both malapposed and uncovered struts were planned as the secondary endpoints. To study the freedom from adverse events, one composite endpoint including myocardial infarction, repeat left coronary artery revascularization and death within 12 months after the procedure was determined. <br /><strong>Results.</strong> There were no significant differences in the NIH score (primary endpoint) in two groups (25.6±12.3 in Xience vs 32.5±20.3 in Synergy, respectively; p = 0.12). The struts of both types of stents showed statistically similar coverage and apposition at 3-month OCT follow-up: percentage of uncovered struts only was 6.3±3.9 and 9.9±7.8 in Xience and Synergy groups, respectively (p = 0.098) and malapposed struts only 0.25±0.5 vs 0.37±0.5; p = 0.628. The presence of both malapposed and uncovered struts was 4.9±3.8 and 5.1±4.5 in two groups and didn’t differ statistically (p = 0.92). During 12-month follow-up, two cases of stent thrombosis were recorded (one in each group), which required repeat revascularization. In addition, one case of myocardial infarction related to the right coronary artery occurred in the Synergy group.<br /><strong>Conclusion.</strong> The Synergy everolimus-eluting stent with abluminal biodegradable polymer has a healing profile comparable to that of Xience everolimus-eluting stent with durable polymer with a low rate of uncovered and malapposed struts at 3-month follow-up. A low incidence of adverse events in both groups during 12-month follow-up indicates the safety of the stents under study.</p><p>Received 18 September 2017. Revised 13 December 2017. Accepted 15 December 2017.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />All authors contributed equally to the work.</p>

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