Publications by authors named "Juan Luis Gutiérrez-Chico"

71 Publications

Automatic Characterisation of Human Atherosclerotic Plaque Composition from Intravascular Optical Coherence Tomography Using Artificial Intelligence.

EuroIntervention 2021 Feb 2. Epub 2021 Feb 2.

School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.

Background: Intravascular optical coherence tomography (IVOCT) enables detailed plaque characterisation in-vivo, but visual assessment is time-consuming and subjective.

Aims: This study aims to develop and validate an automatic framework for IVOCT plaque characterisation using artificial intelligence (AI).

Methods: IVOCT pullbacks from 5 international centres were analysed in a corelab, annotating basic plaque components, inflammatory markers and other structures. A deep convolutional network with encoding-decoding architecture and pseudo-3D input was developed and trained using hybrid loss. The proposed network was integrated into commercial software to be externally validated on additional IVOCT pullbacks from three international corelabs, taking the consensus among corelabs as reference.

Results: Annotated images from 509 pullbacks (391 patients) were divided into 10,517 and 1,156 cross-sections for the training and testing datasets, respectively. Dice coefficient of the model was 0.906 for fibrous plaque, 0.848 for calcium and 0.772 for lipid in the testing dataset. Excellent agreement in plaque burden quantification was observed between the model and manual measurements (R2=0.98). In the external validation, the software correctly identified 518 out of 598 plaque regions from 300 IVOCT cross-sections, with a diagnostic accuracy of 97.6%[95%CI:93.4%-99.3%] in fibrous plaque, 90.5%[95%CI:85.2%-94.1%] in lipid and 88.5%[95%CI:82.4%-92.7%] in calcium. The median time required for analysis was 21.4 (18.6-25.0) seconds per pullback.

Conclusions: A novel AI framework for automatic plaque characterisation in IVOCT was developed, providing excellent diagnostic accuracy in both internal and external validation. This model might reduce subjectivity in image interpretation and facilitate IVOCT quantification of plaque composition, with potential applications in research and IVOCT-guided PCI.
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http://dx.doi.org/10.4244/EIJ-D-20-01355DOI Listing
February 2021

Drug coated balloons and their role in bifurcation coronary angioplasty: appraisal of the current evidence and future directions.

Expert Rev Med Devices 2020 Oct 14;17(10):1021-1033. Epub 2020 Oct 14.

Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade , Belgrade, Serbia.

Introduction: Coronary Bifurcation lesions are technically more challenging and Bifurcation percutaneous coronary intervention (PCI) remains a challenge with unpredictable and sub-optimal clinical and angiographic results. Drug-Coated Balloons (DCB) are emerging devices in the field of coronary intervention with promising results that may overcome some of drug eluting stents limitations and may have potential advantages in complex bifurcation PCI.

Areas Covered: We have performed a re-appraisal about the issues with current bifurcation PCI techniques and the use of DCB in the treatment of Bifurcation lesions. Several studies performed utilizing DCB are described and critically appraised. Over the recent years, there have been tremendous developments in the DCB technology, lesion preparation, clinical experience, and clinical data during bifurcation PCI. The current review describes the advances in the DCB technology, pharmacokinetics, role of excipients, and optimization of the technique. Special emphasis in lesion preparation and potential pathway of using DCB in bifurcation PCI is proposed.

Expert Opinion: Although different proof of concept and pilot studies have shown promising results in treatment of bifurcation lesions with DCB, larger randomized trials and/or international consensus papers are required to enable worldwide translation of this idea to clinical practice.
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http://dx.doi.org/10.1080/17434440.2020.1831385DOI Listing
October 2020

Identification of the type of stent with three-dimensional optical coherence tomography: the SPQR study.

EuroIntervention 2020 Sep 15. Epub 2020 Sep 15.

Klinikum Frankfurt (Oder), Frankfurt (Oder), Germany.

Aims: The ability of optical coherence tomography (OCT) to identify specific types of stent has never been systematically studied.

Methods And Results: A series of 212 consecutive patients with OCT from six international centres were retrospectively screened, finding 294 metallic stents or scaffolds in 146 patients. The sample was analysed by two blinded operators, applying a dedicated protocol in 4 steps to identify the type of stent: 1) 3D and automatic strut detection (ASD), 2) 3D in direct tissue view, 3) Longitudinal view with ASD, 4) Mode "stent only" and ASD. The protocol correctly identified 285 stents (96.9%, kappa 0.965), with excellent interobserver agreement (kappa 0.988). The performance tended to be better in recently implanted stents (kappa 0.993) than in stents implanted ≥3 months before (kappa 0.915), and in pullback speed 18mm/s as compared with 36 mm/s (kappa 0.969 vs. 0.940, respectively).

Conclusions: The type of stent platform can be accurately identified in OCT by trained analysts following a dedicated protocol, combining 3D-OCT, ASD and longitudinal view. This might be clinically helpful in scenarios of device failure and for the quantification of apposition. The blinding of analysts in OCT studies should be revisited.
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http://dx.doi.org/10.4244/EIJ-D-20-00598DOI Listing
September 2020

Automatic stent reconstruction in optical coherence tomography based on a deep convolutional model.

Biomed Opt Express 2020 Jun 29;11(6):3374-3394. Epub 2020 May 29.

Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Hua Shan Road, 200030 Shanghai, China.

Intravascular optical coherence tomography (IVOCT) can accurately assess stent apposition and expansion, thus enabling the optimisation of a stenting procedure to minimize the risk of device failure. This paper presents a deep convolutional based model for automatic detection and segmentation of stent struts. The input of pseudo-3D images aggregated the information from adjacent frames to refine the probability of strut detection. In addition, multi-scale shortcut connections were implemented to minimize the loss of spatial resolution and refine the segmentation of strut contours. After training, the model was independently tested in 21,363 cross-sectional images from 170 IVOCT image pullbacks. The proposed model obtained excellent segmentation (0.907 Dice and 0.838 Jaccard) and detection metrics (0.943 precision, 0.940 recall and 0.936 F1-score), significantly better than conventional features-based algorithms. This performance was robust and homogenous among IVOCT pullbacks with different sources of acquisition (clinical centres, imaging operators, type of stent, time of acquisition and challenging scenarios). In addition, excellent agreement between the model and a commercialized software was observed in the quantification of clinically relevant parameters. In conclusion, the deep-convolutional model can accurately detect stent struts in IVOCT images, thus enabling the fully-automatic quantification of stent parameters in an extremely short time. It might facilitate the application of quantitative IVOCT analysis in real-world clinical scenarios.
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http://dx.doi.org/10.1364/BOE.390113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316028PMC
June 2020

Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series.

Cardiol J 2020 21;27(4):350-361. Epub 2020 May 21.

Med-X Research Institute Shanghai Jiao Tong University, No. 1954, Hua Shan Road, 200030 Shanghai, China.

Background: Evaluating prospectively the feasibility, accuracy and reproducibility of optical flow ratio (OFR), a novel method of computational physiology based on optical coherence tomography (OCT).

Methods And Results: Sixty consecutive patients (76 vessels) underwent prospectively OCT, angiography- based quantitative flow ratio (QFR) and fractional flow ratio (FFR). OFR was computed offline in a central core-lab by analysts blinded to FFR. OFR was feasible in 98.7% of the lesions and showed excellent agreement with FFR (ICCa = 0.83, r = 0.83, slope = 0.80, intercept = 0.17, kappa = 0.84). The area under curve to predict an FFR ≤ 0.80 was 0.95, higher than for QFR (0.91, p = 0.115) and for minimal lumen area (0.64, p < 0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 93%, 92%, 93%, 88%, 96%, 13.8, 0.1, respectively. Median time to obtain OFR was 1.07 (IQR: 0.98-1.16) min, with excellent intraobserver and interobserver reproducibility (0.97 and 0.95, respectively). Pullback speed had negligible impact on OFR, provided the same coronary segment were imaged (ICCa = 0.90, kappa = 0.697).

Conclusions: The prospective computation of OFR is feasible and reproducible in a real-world series, resulting in excellent agreement with FFR, superior to other image-based methods.
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http://dx.doi.org/10.5603/CJ.a2020.0071DOI Listing
May 2020

Echoes from Picasso: Explanation of an unusual artefact in optical coherence tomography.

Cardiol J 2020 ;27(1):83-84

Cardiology Department, Campo de Gibraltar Health Trust, Algeciras (Cádiz), Spain.

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http://dx.doi.org/10.5603/CJ.2020.0016DOI Listing
January 2020

Diagnostic performance of intracoronary optical coherence tomography-based versus angiography-based fractional flow reserve for the evaluation of coronary lesions.

EuroIntervention 2020 Sep;16(7):568-576

Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.

Aims: The aim of this study was to evaluate the diagnostic performance of OCT-based optical flow ratio (OFR) in unselected patients and compare it with angiography-based quantitative flow ratio (QFR), using wire-based FFR as reference standard.

Methods And Results: All patients with OCT and FFR assessment prior to revascularisation were analysed. OFR and QFR were computed in a blinded fashion and compared with FFR, applying the same cut-off value of ≤0.80 to all to define ischaemia. Paired comparison between OFR and QFR was performed in 212 vessels from 181 patients. Average FFR was 0.82±0.10 and 40.1% of vessels had an FFR ≤0.80. OFR showed a significantly better correlation and agreement with FFR than QFR (r=0.87 versus 0.77, p<0.001; SD of the difference=0.05 versus 0.07, p<0.001). The AUC was 0.97 for OFR, higher than for QFR (difference=0.05, p=0.017), and much higher than the minimal lumen area (difference=0.15, p<0.001) and diameter stenosis (difference=0.17, p<0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for OFR to identify FFR ≤0.80 were 92%, 86%, 95%, 92%, 91%, 18.2 and 0.2, respectively. The diagnostic accuracy of OFR was not significantly different in MI-related vessels (95% versus 90%, p=0.456), or in vessels with and without previously implanted stents (90% versus 93%, p=0.669).

Conclusions: OFR had an excellent agreement with FFR in consecutive patients with coronary artery disease. OFR was superior to QFR, and much better than conventional morphological parameters in determining physiological significance of coronary stenosis. The diagnostic performance of OFR was not influenced by the presence of prior myocardial infarction or implanted stents.
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http://dx.doi.org/10.4244/EIJ-D-19-01034DOI Listing
September 2020

Effects of local hemodynamics and plaque characteristics on neointimal response following bioresorbable scaffolds implantation in coronary bifurcations.

Int J Cardiovasc Imaging 2020 Feb 30;36(2):241-249. Epub 2019 Oct 30.

School of Biomedical Engineering, Shanghai Jiao Tong University, Room 123, No. 1954, Huashan Road, Shanghai, 200030, People's Republic of China.

Heterogeneous neointimal response has been observed after implantation of all generations of coronary stents. Our aim was assessing local factors of shear stress (SS) and plaque characteristics in neointimal response after implantation of bioresorbable scaffolds (BRS) in bifurcations. Ten patients from the BIFSORB pilot study were analysed. Follow-up optical frequency domain imaging (OFDI) was performed at 1 month and 2 years. Coronary lumen and BRS structure were reconstructed by fusion of OFDI and angiography and were used for subsequent flow simulation. Plaque arc degree and SS were quantified using post-procedural OFDI data and were matched with follow-up OFDI using anatomical landmarks. Strut-level and segment-level analysis were performed for 1-month and 2-year follow-up respectively. A total of 444 struts (54 jailing struts) were included at 1-month follow-up. Time-average SS (TASS) was significantly lower for covered struts than for uncovered struts in non-bifurcation segments (TASS: 1.81 ± 1.87 vs. 3.88 ± 3.72 Pa, p < 0.001). The trend remained the same for jailing struts, although statistically insignificant (TASS: 10.85 ± 13.12 vs. 13.64 ± 14.48 Pa, p = 0.328). For 2-year follow-up, a total of 66 sub-regions were analysed. Neointimal hyperplasia area (NTA) was negatively correlated with TASS in core-segments (ρ = - 0.389, p = 0.037) and positively correlated with plaque arc degree in non-core segments (ρ = 0.387, p = 0.018). Slightly stronger correlations with NTA were observed when combining TASS and plaque arc degree in both core segments (ρ = - 0.412, p = 0.026) and non-core segments (ρ = - 0.395, p = 0.015). Hemodynamic microenvironment and baseline plaque characteristics may regulate neointimal response after BRS implantation in bifurcation. These findings underline the combined role of plaque characteristics and local hemodynamics in vessel healing after stent implantation.
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http://dx.doi.org/10.1007/s10554-019-01721-7DOI Listing
February 2020

A simplified formula to calculate fractional flow reserve in sequential lesions circumventing the measurement of coronary wedge pressure: The APIS-S pilot study.

Cardiol J 2019 1;26(4):310-321. Epub 2019 Jul 1.

IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.

Background: A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen-tial coronary stenosis without balloon inflation is hereby proposed.

Methods: In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu-la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls' formula. FFR of the remaining lesion was finally recorded (measured FFR).

Results: Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls' formula showed virtually absolute agreement (ICCa 0.999, R2 = 0.997 for the proximal lesion, R2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640-0.909, R2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion.

Conclusions: The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy.
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http://dx.doi.org/10.5603/CJ.a2019.0067DOI Listing
July 2020

Extensive coronary erosion after cocaine consumption treated with branch-per-branch thrombus aspiration.

Cardiol J 2019 ;26(1):91-92

Cardiology Department, Campo de Gibraltar Health Trust, Algeciras (Cádiz), Spain.

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http://dx.doi.org/10.5603/CJ.2019.0011DOI Listing
December 2019

Elliptical stretch as a cause of side branch ostial compromise after main vessel stenting in coronary bifurcations: New insights from numerical analysis.

Cardiol J 2020 5;27(5):507-517. Epub 2018 Nov 5.

Erasmus MC, Imperial College London; Thorax Center, Cardiovascular Science Division NHLI.

Background: The side branch (SB) compromise after main vessel (MV) stenting remains a significant problem in coronary bifurcation treatment. Currently the two major hypotheses for the mechanism of SB compromise are carina shift from MV into the SB and plaque shift into the ostium of side vessel. It is proposed herein, SB ostial deformation leading to reshaping of the ostium from circle to ellipse is a third possible mechanism. In the current study, the theoretical effects and correlation of ostial deformation with fractional flow reserve (FFR) is explored.

Methods: Based on angiographic measurements and theoretical analysis formulas, three different SB ostial areas using circular ostial shape assumption and elliptical ostial shape assumption were calculated. Three different types of ostial areas with FFR values after MV stenting in 49 patients from the FIESTA registry were compared and analyzed.

Results: It was found that there is significant overestimation of stenosis severity when estimated by the circle formula, than with the ellipse formula - ASc vs. ASds with 25% ± 13%, p < 0.001, ASc vs. ASmld with 9% ± 10%, p < 0.001. The elliptical shape assumptions provide more accurate ostial area stenosis, which correlates better with FFR. This finding is more significant in less severe stenosis (< 70% area stenosis) than in a more severe one.

Conclusions: A third possible mechanism of SB compromise after MV stenting of coronary bifurcation stenosis is elliptical ostial deformation at the ostium of SBs. The ostial area, calculated based on elliptical assumption correlates better with FFR, than area stenosis calculated with the traditional circular formula.
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http://dx.doi.org/10.5603/CJ.a2018.0124DOI Listing
November 2018

A formula to calculate the contrast volume required for optimal imaging quality in optical coherence tomography with non-occlusive technique.

Cardiol J 2018 24;25(5):574-581. Epub 2018 Sep 24.

Klinikum Frankfurt (Oder), Interventional Cardiology, Germany, Frankfurt/O, Germany; Institute for Cardiovascular Translational Research of the Atlantic, ICTRA, Berlin, Germany.

Background: Non-occlusive technique is universally accepted for acquisition of coronary optical coherence tomography (OCT), but the amount of contrast infused is still inconsistently calculated. Proposed herein, is an empirical formula for accurate contrast volume calculation.

Methods: In an observational prospective study, contrast volume of consecutive patients undergoing OCT was either calculated with formula, or eyeballed based on manufacturer recommendations. The quality of pullback, defined as % of high quality cross-sections (CS) in the segment of interest (SOI), was analyzed by two independent operators and compared between groups, together with the amount of contrast per pullback.

Results: Sixty patients (115 pullbacks, 4252 CS) were imaged using the formula, vs. 18 patients (22 pullbacks, 777 CS) eyeballing the contrast volume. The formula group used 18 mm/s as pullback speed more often (82.6% vs. 40.9%, p = 0.0001), but there were no significant differences between groups in SOI length or vessel imaged. The formula resulted in higher pullback quality than eyeballing (96.55% vs. 63.55%, p < 0.0001), interobserver agreement Kappa 0.903 (p < 0.0001), and tended to use less contrast per pullback than the eyeball group (13.03 mL vs. 14.55 mL, p = 0.057). After adjusting for pullback speed, SOI length and vessel in multivariate linear regression, the use of the formula significantly reduced the amount of contrast in 4.50 mL on average.

Conclusions: Optical coherence tomography acquisition with the non-occlusive technique can be substantially eased with the use of a novel formula to calculate the contrast volume required. This method optimises the quality of the images whilst reducing the amount of contrast per pullback.
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http://dx.doi.org/10.5603/CJ.a2018.0112DOI Listing
June 2019

Rational and design of the European randomized Optical Coherence Tomography Optimized Bifurcation Event Reduction Trial (OCTOBER).

Am Heart J 2018 11 16;205:97-109. Epub 2018 Aug 16.

Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.

Background: Percutaneous coronary intervention in complex bifurcation lesions is prone to suboptimal implantation results and is associated with increased risk of subsequent clinical events. Angiographic ambiguity is high during bifurcation stenting, but it is unknown if procedural guidance by intravascular optical coherence tomography (OCT) improves clinical outcome.

Methods And Design: OCTOBER is a randomized, investigator-initiated, multicenter trial aimed to show superiority of OCT-guided stent implantation compared to standard angiographic-guided implantation in bifurcation lesions. The primary outcome measure is a 2-year composite end point of cardiac death, target lesion myocardial infarction, and ischemia-driven target lesion revascularization. The calculated sample size is 1,200 patients in total, and allocation is 1:1. Eligible patients have stable or unstable angina pectoris or stabilized non–ST elevation myocardial infarction, and a coronary bifurcation lesion with significant main vessel stenosis and more than 50 % stenosis in a side branch with a reference diameter ≥2.5mm. Treatment is performed by the provisional side branch stenting technique or 2-stent techniques, and the systematic OCT guiding protocol is aimed to evaluate (1) plaque preparation, (2) lesion length, (3) segmental reference sizes, (4) lesion coverage, (5) stent expansion, (6) malapposition, (7) wire positions, and (8) ostial results.

Implications: A positive outcome of the OCTOBER trial may establish OCT as a routine tool for optimization of complex percutaneous coronary intervention, whereas a negative result would indicate that OCT remains a tool for ad hoc evaluation in selected cases.
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http://dx.doi.org/10.1016/j.ahj.2018.08.003DOI Listing
November 2018

Intravascular imaging, histopathological analysis, and catecholamine quantification following catheter-based renal denervation in a swine model: the impact of prebifurcation energy delivery.

Hypertens Res 2018 Sep 13;41(9):708-717. Epub 2018 Jul 13.

Cardiology Department, Coimbra's Hospital and University Centre - General Hospital, Coimbra, Portugal.

The purpose of this study was to evaluate the impact of prebifurcation renal denervation in a swine model and assess its safety through optical coherence tomography (OCT). Prebifurcation renal denervation with a multi-electrode catheter was performed in one renal artery of 12 healthy pigs, with the contralateral artery and kidney being used as controls. Angiograms and OCT pullbacks were obtained peri-procedurally and 1 month post procedure. Renal tissue catecholamines were quantified, and the arterial wall and peri-adventitial tissue were analyzed histologically. Intraluminal changes (endothelial swelling, spasm, and thrombus formation) were observed acutely by OCT in most of the treated arteries and were no longer visible at follow-up. Histology revealed a statistically significant accumulation of collagen (fibrosis) and a near absence of tyrosine hydroxylase labeling in the denervated artery, suggesting a clear reduction in nervous terminals. Renal tissue catecholamine levels were similar between both sides, probably due to the low number of ablation points and the renorenal reflex. The present study demonstrates that renal denervation is associated with acute intimal disruptions, areas of fibrosis, and a reduction in nervous terminals. The lack of difference in renal tissue catecholamine levels is indicative of the need to perform the highest and safest number of ablation points in both renal arteries. These findings are important because they demonstrate the histological consequences of radiofrequency energy application and its medium-term safety.
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http://dx.doi.org/10.1038/s41440-018-0072-yDOI Listing
September 2018

Superficial wall stress: the long awaited comprehensive biomechanical parameter to objectify and quantify our intuition.

Int J Cardiovasc Imaging 2018 06 6;34(6):863-865. Epub 2018 Jun 6.

Punta de Europa University Hospital, Crtra. Getares s/n, Algeciras (Cádiz), 11207, Spain.

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http://dx.doi.org/10.1007/s10554-018-1386-1DOI Listing
June 2018

Implantation of bioresorbable scaffolds under guidance of optical coherence tomography: Feasibility and pilot clinical results of a systematic protocol.

Cardiol J 2018 18;25(4):443-458. Epub 2018 May 18.

Klinikum Frankfurt (Oder), Interventional Cardiology, Germany, Frankfurt/O, Germany; Institute of Cardiovascular Translation Research of the Atlantic (ICTRA), Berlin, Germany.

Background: Herein is hypothesised that a comprehensive optical coherence tomography (OCT)-guided implantation protocol for bioresorbable scaffolds (BRS) can improve expansion and apposition, thus resulting in better clinical outcomes, particularly in reducing thrombotic events.

Methods: Patients considered suitable for BRS therapy in de novo coronary lesions underwent OCT. The predominant type of plaque was classified as lipidic, fibrous or calcific. Accordingly they underwent tailored plaque preparation. After proper sizing, BRS was deployed and final OCT was acquired. Post-dilation was performed only in cases of suboptimal deployment. Procedural and 12 month clinical follow-up is reported.

Results: Twenty nine patients (41 lesions) who were considered clinically and angiographically suitable for BRS were enrolled, including challenging clinical scenarios such as ST-segment elevation myocardial infarction or CTOs. The OCT-guided protocol was feasible in 90.2% of the lesions: 14 (37.8%) lipidic, 11 (29.7%) fibrous, and 12 (32.4%) calcific. Three (8%) lesions classified as calcific were changed to treatment with metallic stent. BRS were implanted in 34 (91.9%) lesions, thereof 30 (88.2%) with optimal deployment in OCT. One (3.6%) periprocedural MI occurred, resulting in 3.6% target vessel failure and 0% scaffold thrombosis of any kind after a 12 month follow-up.

Conclusions: OCT-guided BRS implantation is feasible in 90.2% of de novo lesions and results in optimal expansion and apposition, correlating with 3.6% incidence of target vessel failure and 0% scaffold thrombosis at 12 m follow-up, probably due to better selection of lesions amenable for BRS treatment and to a possibility of tailoring intervention to the type of plaque. These encouraging pilot results require confirmation in larger clinical studies.
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http://dx.doi.org/10.5603/CJ.a2018.0055DOI Listing
May 2019

Endothelial Function and Shear Stress: Which Came First, the Chicken or the Egg?

J Am Coll Cardiol 2018 05;71(19):2103-2105

DRK-Klinikum Westend, Berlin, Germany; Punta de Europa University Hospital, Algeciras (Cádiz), Spain. Electronic address:

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http://dx.doi.org/10.1016/j.jacc.2018.03.452DOI Listing
May 2018

Vorticity: At the crossroads of coronary biomechanics and physiology.

Atherosclerosis 2018 06 9;273:115-116. Epub 2018 Apr 9.

Cardiovascular Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, Omaha, NE, USA.

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http://dx.doi.org/10.1016/j.atherosclerosis.2018.04.001DOI Listing
June 2018

Dislodgement of a magnesium bioresorbable scaffold from the delivery system in the left main: A true "nightmaris".

Cardiol J 2017 ;24(6):700-701

Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Berlin, Germany; Klinikum Frankfurt (Oder), Interventional Cardiology, Germany, Frankfurt/O, Germany.

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http://dx.doi.org/10.5603/CJ.2017.0144DOI Listing
May 2019

[Inferior ST elevation: beyond myocardial infarction].

Emergencias 2017 Dic;29(6):435

Klinikum Frankfurt (Oder), Interventional Cardiology, Alemania. Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Berlin, Alemania.

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March 2019

Zambomballooning: A novel technique to seal a coronary perforation complicating the intervention of a chronic total occlusion.

Cardiol J 2017 ;24(5):573-575

Head of Interventional Cardiology, DRK-Klinikum Westend, Berlin, Germany; Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Berlin, Germany.

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http://dx.doi.org/10.5603/CJ.2017.0114DOI Listing
July 2018

Very late stent thrombosis in everolimus-eluting stent with predisposing mechanical factors: Differential features.

Cardiol J 2017 ;24(4):345-349

Klinikum Frankfurt (Oder), Interventional Cardiology, Germany; Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Berlin, Germany.

no abstract.
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http://dx.doi.org/10.5603/CJ.2017.0089DOI Listing
May 2018

Macrophagic enhancement in optical coherence tomography imaging by means of superparamagnetic iron oxide nanoparticles.

Cardiol J 2017 12;24(5):459-466. Epub 2017 May 12.

Department of Interventional Cardiology, DRK-Klinikum Westend, Berlin, Germany; Institute of Cardiovascular Translation Research of the Atlantic (ICTRA), Berlin, Germany.

Background: The ability of optical coherence tomography (OCT) to visualise macrophages in vivo in coronary arteries is still controversial. We hypothesise that imaging of macrophages in OCT could be enhanced by means of superparamagnetic nanoparticles.

Methods: We compared the optical backscattering and attenuation of cell pellets containing RAW 264.7 macrophages with those of macrophagic cell pellets labelled with very small superparamagnetic oxydised nanoparticles (VSOP) by means of light intensity analysis in OCT. The labelled macrophages were incubated with VSOP at a concentration of 1 mM Fe, corresponding to intracellular iron concentrations of 8.8 pg/cell. To study the effect of intracellular accumulation on the backscattering, VSOP dilutions without cells were also compared. OCT pullbacks of the PCR tubes containing the cell pellets were obtained and light intensity analysis was performed on raw OCT images in polar view, after normalisation by the backscattering of the PCR tube. The backscattering was estimated by the peak normalised intensity, whilst the attenuation was estimated by the number of pixels between the peak and the normalised intensity 1 (peak-to-one).

Results: VSOP-loaded macrophages have higher backscattering than the corresponding unlabelled macrophages (peak normalised intensity 6.30 vs. 3.15) with also slightly higher attenuation (peak-toone 61 vs. 66 pixels). The backscattering of the nanoparticles in suspension was negligible in the light intensity analysis.

Conclusions: VSOP increase significantly the optical backscattering of macrophages in the nearinfrared region, with minimal increase in signal attenuation. This finding enables the enhancement of macrophages in conventional OCT imaging with an easily implementable methodology.
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http://dx.doi.org/10.5603/CJ.a2017.0053DOI Listing
June 2018

Endothelial progenitor cells and plaque burden in stented coronary artery segments: an optical coherence tomography study six months after elective PCI.

BMC Cardiovasc Disord 2017 04 26;17(1):103. Epub 2017 Apr 26.

Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.

Background: Endothelial progenitor cells (EPC) are involved in neovascularization and endothelial integrity. They might be protective in atherosclerosis. Optical coherence tomography (OCT) is a precise intracoronary imaging modality that allows assessment of subintimal plaque development. We evaluated the influence of EPC on coronary plaque burden in stable disease and implemented a novel computational plaque analysis algorithm using OCT.

Methods: Forty-three patients (69.8% males, 69.6 ± 7.7 years) were investigated by OCT during re-angiography 6 months after elective stent implantation. Different subpopulations of EPCs were identified by flow cytometry according to their co-expression of antigens (CD34+, CD133+, kinase domain receptor, KDR+). An algorithm was applied to calculate the underlying total plaque burden of the stented segments from OCT images. Plaque morphology was assessed according to international consensus in OCT imaging.

Results: A cumulative sub-strut plaque volume of 10.87 ± 12.7 mm and a sub-stent plaque area of 16.23 ± 17.0 mm were found within the stented vessel segments with no significant differences between different stent types. All EPC subpopulations (mean of EPC levels: CD34+/CD133+: 2.66 ± 2.0%; CD34+/KDR+: 7.50 ± 5.0%; CD34+/CD133+/KDR+: 1.12 ± 1.0%) inversely correlated with the identified underlying total plaque volume and plaque area (p ≤ 0.012).

Conclusions: This novel analysis algorithm allows for the first time comprehensive quantification of coronary plaque burden by OCT and illustration as spread out vessel charts. Increased EPC levels are associated with less sub-stent coronary plaque burden which adds to previous findings of their protective role in atherosclerosis.
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http://dx.doi.org/10.1186/s12872-017-0534-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405468PMC
April 2017

DECISION-CTO: A "negative" clinical trial? Really?

Cardiol J 2017;24(3):231-233. Epub 2017 Apr 18.

DRK-Klinikum Westend, Berlin, Germany, Germany.

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http://dx.doi.org/10.5603/CJ.a2017.0049DOI Listing
May 2018

Bas-relief in three dimensional optical coherence tomography: a novel sign after subintimal scaffolding in a chronic total occlusion.

Eur Heart J 2017 08;38(31):2445

Klinikum Frankfurt (Oder), Interventional Cardiology, Müllroser Chaussee 7, 15236 - Frankfurt (Oder), Germany.

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http://dx.doi.org/10.1093/eurheartj/ehx126DOI Listing
August 2017