IVUS and OCT: Current State-of-the-Art in Intravascular Coronary Imaging

AbstractPurpose of ReviewTo summarize the current state-of-the-art of intracoronary imaging with a focus on clinical outcomes, novel approaches, and anticipated future developments.Recent FindingsMultiple randomized trials have demonstrated that intravascular ultrasound (IVUS) guidance of percutaneous coronary intervention (PCI) significantly reduces major cardiac adverse events (MACE), and in particular, rates of target lesion failure or clinical restenosis. High-definition IVUS enhances the ability to visualize stent struts and plaque components. Optical coherence tomography (OCT) offers a greater resolution and can image many plaque morphology and stent characteristics that are not visualized with IVUS. Image guidance should be considered strongly in complex PCI lesions and potentially in all-comers. Multimodality imaging using near-infrared spectroscopy or fluorescence, combined with IVUS or OCT, is an exciting new approache to image plaque lipid, intraplaque hemorrhage, inflammation, and fibrin deposition.SummaryIntravascular imaging guidance of PCI utilizing IVUS or OCT definitively improves outcomes in many patient subsets but remains heavily underutilized. Emerging intravascular imaging modalities, such as near-infrared spectroscopy and near-infrared fluorescence imaging, will allow for improved plaque and stent characterization. As cath lab integration, automated image segmentation, and x-ray co-registration evolve further, we envision that intravascular imaging will...
Source: Current Cardiovascular Imaging Reports - Category: Radiology Source Type: research

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AbstractPurpose of ReviewThis review will provide recent pre-clinical and initial clinical trials exploring the efficacy of sonothrombolysis as an adjunct to current emergent therapies in acute coronary syndromes.Recent FindingsThe initial clinical trials examining the efficacy of short pulse duration diagnostic ultrasound (DUS) high mechanical index impulses in patients with ST segment elevation myocardial infarction (STEMI) have demonstrated that there is improved patency of the infarct vessel, and improved microvascular flow following percutaneous coronary intervention. Subsequent randomized prospective trials have conf...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
AbstractPurpose of ReviewDespite significant advances in stent design and procedural technique, stent failure remains the “Achilles’ heel” of percutaneous coronary intervention (PCI). It is important to understand the mechanism of stent failure to prevent major adverse events and improve clinical outcomes.Recent FindingsTwo-dimensional angiography alone is insufficient for elucidating the etiology of stent failure. Intracoronary imaging modalities, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have evolved to guide optimal stent placement during PCI, and have enabled ide...
Source: Current Cardiovascular Imaging Reports - Category: Radiology Source Type: research
Abstract BACKGROUND: Slow flow can be fatal in primary percutaneous coronary interventions for left main trunk (LMT)-acute myocardial infarction (AMI), however, risk factors for slow flow in LMT-AMI have not been well investigated. Intravascular ultrasound (IVUS) may help to stratify the high-risk lesion for slow flow in LMT-AMI. METHODS: A total of 51 LMT-AMI were included as the study population, and were divided into the slow-flow group (n=22) and the non-slow-flow group (n=29). Slow flow was defined as either transient or persistent Thrombolysis in Myocardial Infarction (TIMI) flow grade ≤2. RESUL...
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research
AbstractDuring the past three decades, since the invention of intravascular ultrasound (IVUS), it has become increasingly important as daily clinical applications. However, it evolved with no Japanese standards for the measurement of images, the index of percutaneous coronary intervention (PCI) procedures, and the reporting of results. Accordingly, the purpose of this review article is to provide an optimal and consistent approach to IVUS usage during PCI for clinicians and investigators.
Source: Cardiovascular Intervention and Therapeutics - Category: Cardiology Source Type: research
AbstractPurpose of ReviewThe purpose of this article is to review the basic principles of near-infrared spectroscopy (NIRS) and its contemporary role in intracoronary imaging.Recent FindingsNIRS has been demonstrated to effectively detect culprit lesions in acute coronary syndromes (ACS) and to potentially identify vulnerable plaque. Lipid-rich plaques detected by NIRS are also associated with higher incidence of future adverse cardiac events. Plaques with high lipid content detected by NIRS have been shown to predict periprocedural myocardial infarction during percutaneous coronary intervention (PCI). The beneficial effec...
Source: Current Cardiovascular Imaging Reports - Category: Radiology Source Type: research
We examined the outcomes of patients with abdominal circumference (AC) ≥100cm in diameter from the Standard Versus Ultrasound-Guided (US) Radial and Femoral Access (SURF) Trial.
Source: Heart, Lung and Circulation - Category: Cardiology Authors: Tags: 659 Source Type: research
CONCLUSIONS: These data provide the current PCI practice pattern with the use of FFR and IVUS in intermediate lesion. More common use of FFR for intermediate lesion should be encouraged. PMID: 31190480 [PubMed - as supplied by publisher]
Source: Korean Circulation Journal - Category: Cardiology Tags: Korean Circ J Source Type: research
Publication date: July 2019Source: American Heart Journal, Volume 213Author(s): Laurens J.C. van Zandvoort, Kaneshka Masdjedi, Maria Natalia Tovar Forero, Mattie J. Lenzen, Jurgen Ligthart, Roberto Diletti, Miguel E. Lemmert, Jeroen Wilschut, Peter P.T. de Jaegere, Felix Zijlstra, Nicolas M. van Mieghem, Joost DaemenBackgroundPost percutaneous coronary intervention (PCI) fractional flow reserve (FFR) is a significant predictor of major adverse cardiac events (MACE). The rationale for low post procedural FFR values often remains elusive based on angiographic findings alone, warranting further assessment using an FFR pullbac...
Source: American Heart Journal - Category: Cardiology Source Type: research
This study aimed to compare outcomes in unselected patients undergoing cardiac catheterisation via transradial versus transfemoral access and standard versus ultrasound-guided arterial access. METHODS AND RESULTS: This was a prospective, randomised (radial vs. femoral and standard vs. ultrasound), 2x2 factorial trial of 1,388 patients undergoing coronary angiography and percutaneous coronary intervention. The primary outcome was a composite of ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) major bleeding, MACE (death, stroke, myocardial infarction or urgent target lesion revascularisation) and v...
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
In conclusion, a few imperceptible PMI derived by hs-cTnT assay occurred after diagnostic invasive intracoronary examination. However, it was not associated with subsequent poor cardiac outcome. PMID: 31105151 [PubMed - as supplied by publisher]
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
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