Treatment of In-Stent Restenosis Using Excimer Laser Coronary Atherectomy and Bioresorbable Vascular Scaffold Guided by Optical Coherence Tomography.

The rate of in-stent restenosis (ISR) has become increasingly prevalent with the exponential growth in stent implantation due to an aging population and a higher life expectancy, in addition to the high rates of obesity and diabetes. In this prospective, single operator, all-comer study, we sought to analyze the performance of ELCA followed by bioresorbable vascular scaffold (BVS) placement in patients undergoing percutaneous coronary intervention (PCI) for ISR. A total of 13 patients had ISR treated with a combination of ELCA and BVS, with 9 patients having matched OCT pre, post ELCA and post BVS.

Novel Indices of Coronary Physiology: Do We Need Alternatives to Fractional Flow Reserve?

Fractional flow reserve is the current invasive gold standard for assessing the ischemic potential of an angiographically intermediate coronary stenosis. Procedural cost and time, the need for coronary vessel instrumentation, and the need to administer adenosine to achieve maximal hyperemia remain integral components of invasive fractional flow reserve. The number of new alternatives to fractional flow reserve has proliferated over the last ten years using techniques ranging from alternative pressure wire metrics to anatomic simulation via angiography or intravascular imaging.

Rotational Atherectomy and Mechanical Support to Treat Left Main.

We describe a complex percutaneous coronary intervention using rotational atherectomy (Rotablator, Boston Scientific, Marlborough, Massachusetts) and mechanical circulatory support (Impella, Abiomed, Danvers, Massachusetts) in a patient with multiple comorbidities scheduled to undergo a left main coronary percutaneous coronary intervention using a 2-stent technique based on angiography. However, intracoronary optical coherence tomography changed our strategy to a successful single-stent procedure. ().

Feasibility of coronary angiogram-derived vessel fractional flow reserve in the setting of standard of care percutaneous coronary intervention and its correlation with invasive FFR.

Background: Vessel Fractional Flow Reserve (vFFR), a new angiography-derived method for the functional assessment of coronaries, was recently shown to have good correlation with invasive wire-derived FFR, when vFFR-specific image acquisition requirements were followed. We sought to investigate the feasibility of vFFR analysis and its correlation with FFR in the situation where angiography is completed in routine fashion, without intention for virtual analysis.

Methods: Utilizing an anonymized database maintained at our Cardiovascular Imaging Core Laboratory, we included angiographic images from patients that underwent pre- and post-PCI FFR.

Predicted Coronary Occlusion and Impella Salvage During Valve-in-Valve Transcatheter Aortic Valve Replacement.

We describe an interesting case of a 71 years old fragile female, with progressive shortness of breath on exertion and ankle swelling, cardiac failure NYHA class III. She also had chest irradiation due to Hodgkin's disease many years before, previous surgical aortic valve replacement using bioprosthetic stent-less Freestyle #25 mm valve (Medtronic, Inc) in 2000 for severe aortic stenosis, history of cardiac arrest in 2012 and angioplasty to ostial RCA, PCI to ostial RCA in 2014, CABG (RA graft to RCA) in 2014 (RCA intra-stent restenosis with refractory ischemia), anemia requiring regular transfusions, bronchiectasis and chronic kidney disease. Because of the great comorbidities, STS 4.

Impact of Neointimal Calcifications on Acute Stent Performance during the Treatment of In-Stent Restenosis.

Optical coherence tomography (OCT) has become the invasive imaging modality of choice for coronary stent assessment due to its unmatched spatial resolution. Neointimal calcification (NC) is a rare finding, observed in 5-10% of in-stent restenosis (ISR) neointima. The impact of NC on percutaneous coronary intervention of ISR is unknown.

Impact of stenting and oral sirolimus on endothelium-dependent and independent coronary vasomotion.

Background: There is no consensus regarding the impact of stenting on long-term endothelial function. There have been reports of increased endothelial dysfunction with sirolimus-eluting stents as compared to bare metal stenting (BMS).

Objective: This study aims to assess the impact of BMS and the effect of oral sirolimus on endothelial function.

Assessment of coronary stent by optical coherence tomography, methodology and definitions.

Optical coherence tomography has emerged as a powerful tool for stent assessment, and in a short time, has become the modality of choice for studying stent and vascular interactions in vivo. In this review, we discuss qualitative and quantitative parameters used for stent assessment by OCT. Various qualitative/quantitative variables of stent assessment are discussed in the perspective of the clinical and research values of each of them.