Early detection of vulnerable plaques is the critical step in the prevention of acute coronary events.Morphology,composition,and mechanical property of a coronary artery have been demonstrated to be the key characteri...Early detection of vulnerable plaques is the critical step in the prevention of acute coronary events.Morphology,composition,and mechanical property of a coronary artery have been demonstrated to be the key characteristics for the identification of vulnerable plaques.Several intravascular multimodal imaging technologies providing co-registered simultaneous images have been developed and applied in clinical studies to improve the characterization of atherosclerosis.In this paper,the authors review the present system and probe designs of representative intra-vascular multimodal techniques.In addition,the scientific innovations,potential limitations,and future directions of these technologies are also discussed.展开更多
In this work,we present an intravascular dual-mode endoscopic system capable of both intravascular photoacoustic imaging(IVPAI)and intravascular optical coherence tomography(IVOCT)for recognizing spontaneous coronary ...In this work,we present an intravascular dual-mode endoscopic system capable of both intravascular photoacoustic imaging(IVPAI)and intravascular optical coherence tomography(IVOCT)for recognizing spontaneous coronary artery dissection(SCAD)phantoms.IVPAI provides high-resolution and high-penetration images of intramural hematoma(IMH)at different depths,so it is especially useful for imaging deep blood clots associated with imaging phantoms.IVOCT can readily visualize the double-lumen morphology of blood vessel walls to identify intimal tears.We also demonstrate the capability of this dual-mode endoscopic system using mimicking phantoms and biological samples of blood clots in ex vivo porcine arteries.The results of the experiments indicate that the combined IVPAI and IVOCT technique has the potential to provide a more accurate SCAD assessment method for clinical applications.展开更多
It is now more than two decades since Nico Pijls and Bernard DeBruyne introduced fractional flow reserve （FFR） as a way to assess stenosis severity in the catheterization laboratory and since Paul Yock invented gray...It is now more than two decades since Nico Pijls and Bernard DeBruyne introduced fractional flow reserve （FFR） as a way to assess stenosis severity in the catheterization laboratory and since Paul Yock invented grayscale intravascular ultrasound （IVUS） that then spawned many second-generation intravascular imaging techniques such as （1） Virtual histology-IVUS （VH-IVUS） that uses both amplitude and radiofrequency ultrasound information to classify plaque as necrotic core,展开更多
Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atheroscle...Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atherosclerotic and nonatherosclerotic mechanisms such as plaque erosion,coronary microvascular dysfunction,vasospasm,spontaneous coronary artery dissection,autoimmune and inflammatory diseases,and myocardial oxygen supply-demand imbalance.A systematic approach to diagnosis is needed due to the diverse range of underlying causes.Cardiac troponins confirm the myocardial injury and coronary angiography rules out significant obstruction.Cardiac magnetic resonance imaging differentiates ischemic from nonischemic causes,and additional investigations,such as intravascular ultrasound,optical coherence tomography,and provocative testing,play a role in identifying the etiology to guide management strategies.Atherosclerotic cases require antiplatelet therapy and statins,vasospastic cases respond to calcium channel blockers,spontaneous coronary artery dissection is typically managed conservatively,and coronary microvascular dysfunction may require vasodilators.Lifestyle modifications and cardiac rehabilitation are essential for improving outcomes.The prognosis of patients experiencing recurrent events despite treatment is uncertain,but long-term outcomes depend on the etiology,highlighting the need for personalized management.Future research should focus on refining diagnostic protocols and identifying optimal therapeutic strategies.Randomized controlled trials are necessary to establish evidence-based treatments for different subtypes of myocardial infarction with nonobstructive coronary arteries.展开更多
A fundamental challenge in endoscopy is how to fabricate a small fiber-optic probe that can achieve comparable function to devices with large,complicated optics.To achieve high resolution over an extended depth of foc...A fundamental challenge in endoscopy is how to fabricate a small fiber-optic probe that can achieve comparable function to devices with large,complicated optics.To achieve high resolution over an extended depth of focus(DOF),the application of needle-like beams has been proposed.However,existing methods for miniaturized needle-beam designs fail to adequately correct astigmatism and other monochromatic aberrations,limiting the resolution of at least one axis.Here,we describe an approach to realize freeform beam-shaping endoscopic probes via two-photon polymerization three-dimensional(3D)printing.We present a design achieving<8μm lateral resolution with a DOF of∼800μm.The probe has a diameter of<260μm(without the torque coil and catheters)and is fabricated using a single printing step directly on the optical fiber.The probe was successfully utilized for intravascular imaging in living diabetic swine at multiple time points,as well as human atherosclerotic plaques ex vivo.To the best of our knowledge,this is the first report of a 3D-printed micro-optic for in vivo imaging of the coronary arteries.These results are a substantial step to enable the clinical adoption of both 3D-printed micro-optics and beam-tailoring devices.展开更多
Current gradient-index(GRIN)lens based proximal-driven intracoronary optical coherence tomography(ICOCT)probes consist of a spacer and a GRIN lens with large gradient constant.This design provides great flexibility to...Current gradient-index(GRIN)lens based proximal-driven intracoronary optical coherence tomography(ICOCT)probes consist of a spacer and a GRIN lens with large gradient constant.This design provides great flexibility to control beam profiles,but the spacer length should be well controlled to obtain desired beam profiles and thus it sets an obstacle in mass catheter fabrication.Besides,although GRIN lens with large gradient constant can provide tight focus spot,it has short depth of focus and fast-expanded beam which leads to poor lateral resolution for deep tissue.In this paper,a type of spacer-removed probe is demonstrated with a small gradient constant GRIN lens.This design simplifies the fabrica-tion process and is suitable for mass production.The output beam of the catheter is a narrow nearly collimated light beam,referred to as pencil beam here.The full width at half maximum beam size varies from 35.1μm to 75.3μm in air over 3-mm range.Probe design principles are elaborated with probe/catheter fabrication and performance test.The in vivo imaging of the catheter was verified by a clinical ICOCT system.Those results prove that this novel pencil-beam scanning catheter is potentially a good choice for ICOCT systems.展开更多
In recent years,the use of coronary functional evaluation derived by fractional flow reserve(FFR)to guide percutaneous coronary intervention(PCI)treatment has been recommended by several mainstream guidelines.Typicall...In recent years,the use of coronary functional evaluation derived by fractional flow reserve(FFR)to guide percutaneous coronary intervention(PCI)treatment has been recommended by several mainstream guidelines.Typically,FFR>0.80 in coronary artery indicates the lesions do not affect the coronary blood flow.展开更多
AIM To statistically examine the released clinical trials and meta-analyses of polymeric bioresorbable scaffolds resuming the main accomplishments in the field with a translation to the routine clinical practice.METHO...AIM To statistically examine the released clinical trials and meta-analyses of polymeric bioresorbable scaffolds resuming the main accomplishments in the field with a translation to the routine clinical practice.METHODS The statistical power in clinical trials such as ABSORB Japan,ABSORB China,EVERBIO II,AIDA,and few meta-analyses by the post hoc odds ratio-based sample size calculation,and the patterns of artery remodeling published in papers from ABSORB A and B trials were evaluated.RESULTS The phenomenal admiration from the first ABSORB studies in 2006-2013 was replaced by the tremendous disappointment in 2014-2017 due to reported relatively higher rates of target lesion failure(a mean prevalence of 9.16%)and device thrombosis(2.38%)in randomized controlled trials.Otherwise,bioresorbable vascular scaffold(BVS)performs as well as the metallic drugeluting stent(DES)with a trend toward some benefits for cardiac mortality[risk ratio(RR),0.58-0.94,P>0.05].The underpowered design was confirmed for some studies such as ABSORB Japan,ABSORB China,EVERBIOⅡ,AIDA trials,and meta-analyses of Polimeni,Collet,and Mahmoud with some unintentional bias(judged by the asymmetrical Funnel plot).Scaffold thrombosis rates with Absorb BRS were comparable with DES performed with a so-called strategy of the BVS implantation with optimized pre-dilation(P),sizing(S)and post-dilation(P)(PSP)implantation(RR,PSP vs no PSP 0.37)achieving 0.35 per 100 patient-years,which is comparable to the RR 0.49 with bare-metal stents and the RR 1.06 with everolimus DES.Both ABSORBⅡand ABSORBⅢtrials were powered enough for a five-year follow-up,but the results were not entirely conclusive due to the mostly non-significant fashion of data.The powered metaanalyses were built mostly on statistically poor findings.CONCLUSION The misunderstanding of the pathology of transient scaffolding drives the failures of the clinical trials.More bench studies of the vascular response are required.Several next-generation BVS including multifunctional electronic scaffold grant cardiology with a huge promise to make BVS technology great again.展开更多
Patients with left main coronary artery (LMCA) atherosclerosis have a poor prognosis compared with lesions in the other coronaries. Because of the methodological problems. LMCA atherosclerotic lesions are not frequent...Patients with left main coronary artery (LMCA) atherosclerosis have a poor prognosis compared with lesions in the other coronaries. Because of the methodological problems. LMCA atherosclerotic lesions are not frequently detected by coronary angiography. The purpose of the study was to reveal the existence of LMCA disease in patients with normal coronary arteries by using intravascular ultrasound imaging. Ninety-seven patients with angiographically normal coronary arteries were examined with a 3.5 F or 4.8 F. 20 MHz intravascular ultrasound catheter. The vessel, lumen and plaque areas were determined and percent area and diameter stenosis were calculated. Plaque formation with or without calcific deposits identified by ultrasound accoustic shadowing were regarded as signs of atherosclerosis.展开更多
In order to investigate the relationship between restenosis and the morphology detected by coronary angioscopy (CASC) and introvascular ultrasound imaging (IVUS), 17 patients were detected by CASC and IVUS immediately...In order to investigate the relationship between restenosis and the morphology detected by coronary angioscopy (CASC) and introvascular ultrasound imaging (IVUS), 17 patients were detected by CASC and IVUS immediately and 3 months after percutaneous transluminal coronary angioscopy (PTCA), The results showed that the dilation index by IVUS (DIu) was significantly lower in restenosis patients than in non-restenosis patients (0.42 +/- 0.08 versus 0.78 +/- 0.16, P < 0.01) and that the elastic recoil (ER) was higher in restenosis patients than in non-restenosis patients (4.51 +/- 1.42 mm(2) versus 1.63 +/- 1.20 mm(2), P < 0.01), and that the elastic recoil rate (ERR) was also higher in restenosis patients than in non-restenosis patients (57.3 +/- 8.07% versus 21.80 +/- 16.84% P < 0.01), and that coronary dissection, atheromatous plaque and calcification as well as the colour of inner coronary artery had no relation with chronic restenosis. In conclusion, the elastic recoil is one of the important factors of chronic restenosis after PTCA.展开更多
The effect of the transducer eccentricity on grayscales of intravascualr ultrasound images was corrected based on the scattering properties of high frequency ultrasound in vessel walls. The displacement and strain dis...The effect of the transducer eccentricity on grayscales of intravascualr ultrasound images was corrected based on the scattering properties of high frequency ultrasound in vessel walls. The displacement and strain distributions of vessel walls produced by tissue microelement motion were obtained using a novel motion estimation method in steps and sum based on the optical flow and genetic algorithm. Furthermore, authors firstly reconstructed 'real' elasticity distribution images of cross section tissues of vessel walls in the world. In vitro experimental results of porcine artery demonstrated the methods mentioned above are reasonable. Experimental investigation of vascular mechanics can be advanced to 2D sub-millimeter microstructure levels. These studies have potential to provide new technology means in monitoring and evaluation of Percutaneous transluminal coronary angioplasty process.展开更多
Optical coherence tomography （OCT） has gained considerable attention in interventional cardiovascular medicine and is currently used in clinical settings to assess atherosclerotic lesions and to optimize stent place...Optical coherence tomography （OCT） has gained considerable attention in interventional cardiovascular medicine and is currently used in clinical settings to assess atherosclerotic lesions and to optimize stent placement. Artery imaging at the cellular level constitutes the first step towards cardiovascular molecular imaging, which represents a major advance in the development of personalized noninvasive therapies. In this work we demonstrate that cardiovascular OCT can be used to detect individual cells suspended in biocompatible fluids. Importantly, the combination of this catheter-based clinical technique with gold nanoshells （GNSs） as intracellular contrast agents led to a substantial enhancement in the backscattered signal produced by individual cells. This cellular contrast enhancement was attributed to the large backscattering cross-section of GNSs at the OCT laser wavelength （1,300 nm）. A simple intensity analysis of OCT cross-sectional images of suspended cells makes it possible to identify the sub-population of living cells that successfully incorporated GNSs. The generalizability of this method was demonstrated using two different cell lines （HeLa and Jurkat cells）. This work provides novel insights into cardiovascular molecular imaging using specifically modified GNSs.展开更多
BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the...BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.展开更多
The purpose of the study is to reconstruct the coronary arteries in 3 dimension (3D) from serial intravascular ultrasound (IVUS) images generated during a pullback of IVUS catheter. Slowly pullback. real-time, cross-s...The purpose of the study is to reconstruct the coronary arteries in 3 dimension (3D) from serial intravascular ultrasound (IVUS) images generated during a pullback of IVUS catheter. Slowly pullback. real-time, cross-sectional IVUS images of 18 patients (2 with normal coronary arteries. 1 with coronary aneurysm. and 15 post PTCA) were obtained by using a 20 MHz. 3.5F IVUS catheter and recorded on video tape. A series of 90-frame consecutive IVUS images were digitized into a SUN Spare 11 workstation. Digitized data were reconstructed to 3D images with use of voxel space modeling and were generated in both sagittal and cylindrical formats. The sagittal format results in a longitudinal展开更多
Medium depolarization imaging by catheter-based polarization-sensitive optical coherence tomography(PS-OCT)can provide valuable insight into significant features of lipid,macrophages,and cholesterol crystals in athero...Medium depolarization imaging by catheter-based polarization-sensitive optical coherence tomography(PS-OCT)can provide valuable insight into significant features of lipid,macrophages,and cholesterol crystals in atherosclerotic vulnerable plaques.In this paper,we demonstrate a method to achieve an accurate estimation of the medium depolarization index(EMDI)with noise immunity in catheter-based PS-OCT.EMDI is calculated by an iterative approximation based on Lu-Chipman matrix decomposition and Frobenius norm judgment of incoherent averaging of Mueller matrices.Monte Carlo simulation results verify that the medium depolarization measurement by EMDI is 3.3 times more accurate compared with those of the depolarization index(DI)and degree of polarization uniformity(DOPU).In experiments,we design a microsphere suspension with various concentrations and measure EMDI under different additive noise.Consistently,the measurement accuracy by EMDI is increased 2.85 times compared to those by DI and DOPU.For vascular plaques detection,we use protein and cholesterol gel as plaque phantoms.Based on PS-OCT images of plaque phantom in vitro and in ex vivo porcine coronary artery,the recognition rate of plaque by EMDI is 2.99 to 4.65 times higher than those by DI and DOPU evaluated by spatial response of the Laplacian operator(SRLO).展开更多
基金Theauthors acknowledge funding from National Institutes of Health(R01HL-125084.R01HL-127271,R01EY-026091,R01EY-028662)American Heart Association(18PRE34050021)the National Science Foundation(DGE-1839285).
文摘Early detection of vulnerable plaques is the critical step in the prevention of acute coronary events.Morphology,composition,and mechanical property of a coronary artery have been demonstrated to be the key characteristics for the identification of vulnerable plaques.Several intravascular multimodal imaging technologies providing co-registered simultaneous images have been developed and applied in clinical studies to improve the characterization of atherosclerosis.In this paper,the authors review the present system and probe designs of representative intra-vascular multimodal techniques.In addition,the scientific innovations,potential limitations,and future directions of these technologies are also discussed.
基金funding from the National Natural Science Foundation of China(NSFC)under grants 61627827,61705068the Natural Science Foundation of Fujian Province 2021J01813the Fujian Medical University Research Foundation of Talented Scholars XRCZX2021004.
文摘In this work,we present an intravascular dual-mode endoscopic system capable of both intravascular photoacoustic imaging(IVPAI)and intravascular optical coherence tomography(IVOCT)for recognizing spontaneous coronary artery dissection(SCAD)phantoms.IVPAI provides high-resolution and high-penetration images of intramural hematoma(IMH)at different depths,so it is especially useful for imaging deep blood clots associated with imaging phantoms.IVOCT can readily visualize the double-lumen morphology of blood vessel walls to identify intimal tears.We also demonstrate the capability of this dual-mode endoscopic system using mimicking phantoms and biological samples of blood clots in ex vivo porcine arteries.The results of the experiments indicate that the combined IVPAI and IVOCT technique has the potential to provide a more accurate SCAD assessment method for clinical applications.
文摘It is now more than two decades since Nico Pijls and Bernard DeBruyne introduced fractional flow reserve （FFR） as a way to assess stenosis severity in the catheterization laboratory and since Paul Yock invented grayscale intravascular ultrasound （IVUS） that then spawned many second-generation intravascular imaging techniques such as （1） Virtual histology-IVUS （VH-IVUS） that uses both amplitude and radiofrequency ultrasound information to classify plaque as necrotic core,
文摘Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atherosclerotic and nonatherosclerotic mechanisms such as plaque erosion,coronary microvascular dysfunction,vasospasm,spontaneous coronary artery dissection,autoimmune and inflammatory diseases,and myocardial oxygen supply-demand imbalance.A systematic approach to diagnosis is needed due to the diverse range of underlying causes.Cardiac troponins confirm the myocardial injury and coronary angiography rules out significant obstruction.Cardiac magnetic resonance imaging differentiates ischemic from nonischemic causes,and additional investigations,such as intravascular ultrasound,optical coherence tomography,and provocative testing,play a role in identifying the etiology to guide management strategies.Atherosclerotic cases require antiplatelet therapy and statins,vasospastic cases respond to calcium channel blockers,spontaneous coronary artery dissection is typically managed conservatively,and coronary microvascular dysfunction may require vasodilators.Lifestyle modifications and cardiac rehabilitation are essential for improving outcomes.The prognosis of patients experiencing recurrent events despite treatment is uncertain,but long-term outcomes depend on the etiology,highlighting the need for personalized management.Future research should focus on refining diagnostic protocols and identifying optimal therapeutic strategies.Randomized controlled trials are necessary to establish evidence-based treatments for different subtypes of myocardial infarction with nonobstructive coronary arteries.
基金supported by the National Health and Medical Research Council Development(Grant No.2022337)the Ideas Grant(Grant No.2001646),the Investigator Grant(Grant No.2008462)+9 种基金the Heart Foundation Future Leader Fellowship(Grant Nos.105608 and 106656)the Hospital Research Foundation Project(Grant No.2022-CP-IDMH-014-83100)Australia-Germany Joint Research Co-operation Scheme(UA-DAAD)Baden-Wuerttemberg-Stiftung(Opterial)European Research Council(Advanced Grant Complexplas,PoC Grant 3DPrintedOptics)Bundesministerium für Bildung und Forschung(3DPrintedOptics,Integrated3Dprint,QR.X,QR.N)Deutsche Forschungsgemeinschaft(German Research Foundation)(Grant No.431314977/GRK2642)HORIZON EUROPE European Innovation Council(Grant No.IV-Lab 101115545)Carl-Zeiss Foundation(EndoPrint3D,QPhoton)University of Stuttgart(Terra Incognita).
文摘A fundamental challenge in endoscopy is how to fabricate a small fiber-optic probe that can achieve comparable function to devices with large,complicated optics.To achieve high resolution over an extended depth of focus(DOF),the application of needle-like beams has been proposed.However,existing methods for miniaturized needle-beam designs fail to adequately correct astigmatism and other monochromatic aberrations,limiting the resolution of at least one axis.Here,we describe an approach to realize freeform beam-shaping endoscopic probes via two-photon polymerization three-dimensional(3D)printing.We present a design achieving<8μm lateral resolution with a DOF of∼800μm.The probe has a diameter of<260μm(without the torque coil and catheters)and is fabricated using a single printing step directly on the optical fiber.The probe was successfully utilized for intravascular imaging in living diabetic swine at multiple time points,as well as human atherosclerotic plaques ex vivo.To the best of our knowledge,this is the first report of a 3D-printed micro-optic for in vivo imaging of the coronary arteries.These results are a substantial step to enable the clinical adoption of both 3D-printed micro-optics and beam-tailoring devices.
基金financial supports from the National Natural Science Foundation of China(Grant No.81927805)Shenzhen Municipal Science and Technology Plan Project,China(Grant No.JCYJ20160427183803458)。
文摘Current gradient-index(GRIN)lens based proximal-driven intracoronary optical coherence tomography(ICOCT)probes consist of a spacer and a GRIN lens with large gradient constant.This design provides great flexibility to control beam profiles,but the spacer length should be well controlled to obtain desired beam profiles and thus it sets an obstacle in mass catheter fabrication.Besides,although GRIN lens with large gradient constant can provide tight focus spot,it has short depth of focus and fast-expanded beam which leads to poor lateral resolution for deep tissue.In this paper,a type of spacer-removed probe is demonstrated with a small gradient constant GRIN lens.This design simplifies the fabrica-tion process and is suitable for mass production.The output beam of the catheter is a narrow nearly collimated light beam,referred to as pencil beam here.The full width at half maximum beam size varies from 35.1μm to 75.3μm in air over 3-mm range.Probe design principles are elaborated with probe/catheter fabrication and performance test.The in vivo imaging of the catheter was verified by a clinical ICOCT system.Those results prove that this novel pencil-beam scanning catheter is potentially a good choice for ICOCT systems.
文摘In recent years,the use of coronary functional evaluation derived by fractional flow reserve(FFR)to guide percutaneous coronary intervention(PCI)treatment has been recommended by several mainstream guidelines.Typically,FFR>0.80 in coronary artery indicates the lesions do not affect the coronary blood flow.
文摘AIM To statistically examine the released clinical trials and meta-analyses of polymeric bioresorbable scaffolds resuming the main accomplishments in the field with a translation to the routine clinical practice.METHODS The statistical power in clinical trials such as ABSORB Japan,ABSORB China,EVERBIO II,AIDA,and few meta-analyses by the post hoc odds ratio-based sample size calculation,and the patterns of artery remodeling published in papers from ABSORB A and B trials were evaluated.RESULTS The phenomenal admiration from the first ABSORB studies in 2006-2013 was replaced by the tremendous disappointment in 2014-2017 due to reported relatively higher rates of target lesion failure(a mean prevalence of 9.16%)and device thrombosis(2.38%)in randomized controlled trials.Otherwise,bioresorbable vascular scaffold(BVS)performs as well as the metallic drugeluting stent(DES)with a trend toward some benefits for cardiac mortality[risk ratio(RR),0.58-0.94,P>0.05].The underpowered design was confirmed for some studies such as ABSORB Japan,ABSORB China,EVERBIOⅡ,AIDA trials,and meta-analyses of Polimeni,Collet,and Mahmoud with some unintentional bias(judged by the asymmetrical Funnel plot).Scaffold thrombosis rates with Absorb BRS were comparable with DES performed with a so-called strategy of the BVS implantation with optimized pre-dilation(P),sizing(S)and post-dilation(P)(PSP)implantation(RR,PSP vs no PSP 0.37)achieving 0.35 per 100 patient-years,which is comparable to the RR 0.49 with bare-metal stents and the RR 1.06 with everolimus DES.Both ABSORBⅡand ABSORBⅢtrials were powered enough for a five-year follow-up,but the results were not entirely conclusive due to the mostly non-significant fashion of data.The powered metaanalyses were built mostly on statistically poor findings.CONCLUSION The misunderstanding of the pathology of transient scaffolding drives the failures of the clinical trials.More bench studies of the vascular response are required.Several next-generation BVS including multifunctional electronic scaffold grant cardiology with a huge promise to make BVS technology great again.
文摘Patients with left main coronary artery (LMCA) atherosclerosis have a poor prognosis compared with lesions in the other coronaries. Because of the methodological problems. LMCA atherosclerotic lesions are not frequently detected by coronary angiography. The purpose of the study was to reveal the existence of LMCA disease in patients with normal coronary arteries by using intravascular ultrasound imaging. Ninety-seven patients with angiographically normal coronary arteries were examined with a 3.5 F or 4.8 F. 20 MHz intravascular ultrasound catheter. The vessel, lumen and plaque areas were determined and percent area and diameter stenosis were calculated. Plaque formation with or without calcific deposits identified by ultrasound accoustic shadowing were regarded as signs of atherosclerosis.
文摘In order to investigate the relationship between restenosis and the morphology detected by coronary angioscopy (CASC) and introvascular ultrasound imaging (IVUS), 17 patients were detected by CASC and IVUS immediately and 3 months after percutaneous transluminal coronary angioscopy (PTCA), The results showed that the dilation index by IVUS (DIu) was significantly lower in restenosis patients than in non-restenosis patients (0.42 +/- 0.08 versus 0.78 +/- 0.16, P < 0.01) and that the elastic recoil (ER) was higher in restenosis patients than in non-restenosis patients (4.51 +/- 1.42 mm(2) versus 1.63 +/- 1.20 mm(2), P < 0.01), and that the elastic recoil rate (ERR) was also higher in restenosis patients than in non-restenosis patients (57.3 +/- 8.07% versus 21.80 +/- 16.84% P < 0.01), and that coronary dissection, atheromatous plaque and calcification as well as the colour of inner coronary artery had no relation with chronic restenosis. In conclusion, the elastic recoil is one of the important factors of chronic restenosis after PTCA.
基金This work was supported by the National Science Foundation of China(No.69925101,39970208).
文摘The effect of the transducer eccentricity on grayscales of intravascualr ultrasound images was corrected based on the scattering properties of high frequency ultrasound in vessel walls. The displacement and strain distributions of vessel walls produced by tissue microelement motion were obtained using a novel motion estimation method in steps and sum based on the optical flow and genetic algorithm. Furthermore, authors firstly reconstructed 'real' elasticity distribution images of cross section tissues of vessel walls in the world. In vitro experimental results of porcine artery demonstrated the methods mentioned above are reasonable. Experimental investigation of vascular mechanics can be advanced to 2D sub-millimeter microstructure levels. These studies have potential to provide new technology means in monitoring and evaluation of Percutaneous transluminal coronary angioplasty process.
文摘Optical coherence tomography （OCT） has gained considerable attention in interventional cardiovascular medicine and is currently used in clinical settings to assess atherosclerotic lesions and to optimize stent placement. Artery imaging at the cellular level constitutes the first step towards cardiovascular molecular imaging, which represents a major advance in the development of personalized noninvasive therapies. In this work we demonstrate that cardiovascular OCT can be used to detect individual cells suspended in biocompatible fluids. Importantly, the combination of this catheter-based clinical technique with gold nanoshells （GNSs） as intracellular contrast agents led to a substantial enhancement in the backscattered signal produced by individual cells. This cellular contrast enhancement was attributed to the large backscattering cross-section of GNSs at the OCT laser wavelength （1,300 nm）. A simple intensity analysis of OCT cross-sectional images of suspended cells makes it possible to identify the sub-population of living cells that successfully incorporated GNSs. The generalizability of this method was demonstrated using two different cell lines （HeLa and Jurkat cells）. This work provides novel insights into cardiovascular molecular imaging using specifically modified GNSs.
文摘BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.
文摘The purpose of the study is to reconstruct the coronary arteries in 3 dimension (3D) from serial intravascular ultrasound (IVUS) images generated during a pullback of IVUS catheter. Slowly pullback. real-time, cross-sectional IVUS images of 18 patients (2 with normal coronary arteries. 1 with coronary aneurysm. and 15 post PTCA) were obtained by using a 20 MHz. 3.5F IVUS catheter and recorded on video tape. A series of 90-frame consecutive IVUS images were digitized into a SUN Spare 11 workstation. Digitized data were reconstructed to 3D images with use of voxel space modeling and were generated in both sagittal and cylindrical formats. The sagittal format results in a longitudinal
基金support from the Key Technologies Research and Development Program of China(2022YFF0706005)National Natural Science Foundation of China(61975147).
文摘Medium depolarization imaging by catheter-based polarization-sensitive optical coherence tomography(PS-OCT)can provide valuable insight into significant features of lipid,macrophages,and cholesterol crystals in atherosclerotic vulnerable plaques.In this paper,we demonstrate a method to achieve an accurate estimation of the medium depolarization index(EMDI)with noise immunity in catheter-based PS-OCT.EMDI is calculated by an iterative approximation based on Lu-Chipman matrix decomposition and Frobenius norm judgment of incoherent averaging of Mueller matrices.Monte Carlo simulation results verify that the medium depolarization measurement by EMDI is 3.3 times more accurate compared with those of the depolarization index(DI)and degree of polarization uniformity(DOPU).In experiments,we design a microsphere suspension with various concentrations and measure EMDI under different additive noise.Consistently,the measurement accuracy by EMDI is increased 2.85 times compared to those by DI and DOPU.For vascular plaques detection,we use protein and cholesterol gel as plaque phantoms.Based on PS-OCT images of plaque phantom in vitro and in ex vivo porcine coronary artery,the recognition rate of plaque by EMDI is 2.99 to 4.65 times higher than those by DI and DOPU evaluated by spatial response of the Laplacian operator(SRLO).
