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Journal of Nuclear Cardiology :... Aug 2022Ischemic heart disease remains one of the leading causes of death and disability worldwide. However, most patients referred for a noninvasive computed tomography... (Review)
Review
Ischemic heart disease remains one of the leading causes of death and disability worldwide. However, most patients referred for a noninvasive computed tomography coronary angiogram (CTA) or invasive coronary angiogram for the investigation of angina do not have obstructive coronary artery disease (CAD). Approximately two in five referred patients have coronary microvascular disease (CMD) as a primary diagnosis and, in addition, CMD also associates with CAD and myocardial disease (dual pathology). CMD underpins excess morbidity, impaired quality of life, significant health resource utilization, and adverse cardiovascular events. However, CMD often passes undiagnosed and the onward management of these patients is uncertain and heterogeneous. International standardized diagnostic criteria allow for the accurate diagnosis of CMD, ensuring an often overlooked patient population can be diagnosed and stratified for targeted medical therapy. Key to this is assessing coronary microvascular function-including coronary flow reserve, coronary microvascular resistance, and coronary microvascular spasm. This can be done by invasive methods (intracoronary temperature-pressure wire, intracoronary Doppler flow-pressure wire, intracoronary provocation testing) and non-invasive methods [positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), transthoracic Doppler echocardiography (TTDE), cardiac computed tomography (CT)]. Coronary CTA is insensitive for CMD. Functional coronary angiography represents the combination of CAD imaging and invasive diagnostic procedures.
Topics: Coronary Angiography; Coronary Artery Disease; Coronary Circulation; Coronary Vasospasm; Coronary Vessels; Humans; Microcirculation; Microvascular Angina; Quality of Life
PubMed: 35534718
DOI: 10.1007/s12350-022-02974-x -
JACC. Cardiovascular Interventions Sep 2014
Topics: Angioplasty, Balloon, Coronary; Cardiac Catheterization; Cardiac Catheters; Cardiology Service, Hospital; Electrophysiologic Techniques, Cardiac; Female; Humans; Laboratories, Hospital; Magnetic Resonance Imaging, Cine; Male; Myocardial Infarction; Myocardium; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 25234671
DOI: 10.1016/j.jcin.2014.05.012 -
Cardiovascular Diagnosis and Therapy Oct 2020Intracoronary near-infrared spectroscopy (NIRS) has been developed and validated for the detection of lipid-rich plaque in the coronary arteries. A combined NIRS and... (Review)
Review
Intracoronary near-infrared spectroscopy (NIRS) has been developed and validated for the detection of lipid-rich plaque in the coronary arteries. A combined NIRS and intravascular ultrasound catheter is currently in clinical use and has an emerging role in evaluating plaques both before and after percutaneous coronary intervention. NIRS has recently been shown to positively identify both vulnerable patients and vulnerable plaques. This review focuses on the principles and image interpretation of intracoronary NIRS, as well as its clinical applications, limitations, and future directions.
PubMed: 33224770
DOI: 10.21037/cdt.2020.02.02 -
Cardiovascular Diagnosis and Therapy Oct 2020
PubMed: 33224761
DOI: 10.21037/cdt-2019-ici-11 -
Frontiers in Cardiovascular Medicine 2022Evidence to support the use of intracoronary imaging (ICI) in guiding percutaneous coronary intervention (PCI) is growing, with observational and randomized controlled... (Review)
Review
Evidence to support the use of intracoronary imaging (ICI) in guiding percutaneous coronary intervention (PCI) is growing, with observational and randomized controlled trials demonstrating a benefit in acute procedural and clinical outcomes. ICI provides an opportunity to guide PCI, detailing the nature of the coronary disease, potentially influencing lesion preparation and stent selection. Following stent deployment, ICI offers a detailed assessment of lesion coverage, associated vessel trauma and stent expansion. Consensus statements have emphasized the role of ICI and detailed the parameters of stent optimization. However, intracoronary imaging is not adopted widely yet. Significant global differences in the uptake of ICI have been reported, with the vast majority of PCI being angiographically-guided. The three major barriers to the implementation of ICI include, in order of impact, prohibitive cost, prolongation of procedure time and local regulatory issues for use. However, it is our belief that a lack of education and the associated challenges of ICI interpretation provide the greatest barrier to adoption. We hope that this review of the role of ICI in PCI optimization will provide a platform for PCI operators to gain confidence in the utilization of ICI to enhance outcomes for their patients.
PubMed: 35647055
DOI: 10.3389/fcvm.2022.878801 -
Interventional Cardiology (London,... Nov 2019Heavily calcified coronary artery lesions hinder the delivery of devices and limit stent expansion, resulting in low procedural success and poor clinical outcomes driven... (Review)
Review
Heavily calcified coronary artery lesions hinder the delivery of devices and limit stent expansion, resulting in low procedural success and poor clinical outcomes driven by an increase in restenosis and stent thrombosis. Intracoronary imaging provides a more precise assessment of lesions and is a critical step when deciding whether the lesion needs to be prepared with atherectomy devices. Physiological assessment of lesion significance is an important consideration to avoid unnecessary stenting. This article summarises the current data on the value of intracoronary imaging and functional assessment for coronary calcified lesions and suggests a treatment strategy based on the findings of intracoronary imaging findings.
PubMed: 31867063
DOI: 10.15420/icr.2019.16.R1 -
Indian Heart Journal 2020Large intracoronary thrombus has been reported in significant number of patients with STEMI. Primary PCI is the current standard of care in patients of STEMI. Despite... (Review)
Review
Large intracoronary thrombus has been reported in significant number of patients with STEMI. Primary PCI is the current standard of care in patients of STEMI. Despite the availability of dual antiplatelets, GP IIb/IIIa inhibitor and effective anticoagulation regimens, large intracoronary thrombus remains one of the biggest challenge to interventional cardiologists during primary PCI. Large intracoronary thrombus may lead to distal embolization, no/slow reflow or embolization into a non-culprit vessel and is associated with adverse cardiovascular outcome. There is no ideal management strategy. We hereby discuss the current available methods/strategies to deal with large thrombus burden encountered during primary PCI, in the current manuscript.
Topics: Coronary Angiography; Coronary Thrombosis; Disease Management; Humans; Percutaneous Coronary Intervention; Thrombectomy; Thrombolytic Therapy; Treatment Outcome
PubMed: 33357638
DOI: 10.1016/j.ihj.2020.11.009 -
Interventional Cardiology (London,... Apr 2021Coronary artery calcification is prevalent in chronic total occlusions (CTO), particularly in those of longer duration and post-coronary artery bypass. The presence of... (Review)
Review
Coronary artery calcification is prevalent in chronic total occlusions (CTO), particularly in those of longer duration and post-coronary artery bypass. The presence of calcium predicts lower procedural success rates and a higher risk of complications of CTO percutaneous coronary intervention. Adjunctive imaging, including pre-procedural computed tomography and intracoronary imaging, are useful to understand the distribution and morphology of the calcium. Specialised guidewires and microcatheters, as well as penetration, subintimal entry and luminal re-entry techniques, are required to cross calcific CTOs. The use of both atherectomy devices and balloon-based calcium modification tools has been reported during CTO percutaneous coronary intervention, although they are limited by concerns regarding safety and efficacy in the subintimal space.
PubMed: 34754332
DOI: 10.15420/icr.2021.01 -
Frontiers in Cardiovascular Medicine 2020Conventional intravascular ultrasound (IVUS) devices use piezoelectric transducers to electrically generate and receive US. With this paradigm, there are numerous... (Review)
Review
Conventional intravascular ultrasound (IVUS) devices use piezoelectric transducers to electrically generate and receive US. With this paradigm, there are numerous challenges that restrict improvements in image quality. First, with miniaturization of the transducers to reduce device size, it can be challenging to achieve the sensitivities and bandwidths required for large tissue penetration depths and high spatial resolution. Second, complexities associated with manufacturing miniaturized electronic transducers can have significant cost implications. Third, with increasing interest in molecular characterization of tissue , it has been challenging to incorporate optical elements for multimodality imaging with photoacoustics (PA) or near-infrared spectroscopy (NIRS) whilst maintaining the lateral dimensions suitable for intracoronary imaging. Optical Ultrasound (OpUS) is a new paradigm for intracoronary imaging. US is generated at the surface of a fiber optic transducer via the photoacoustic effect. Pulsed or modulated light is absorbed in an engineered coating on the fiber surface and converted to thermal energy. The subsequent temperature rise leads to a pressure rise within the coating, which results in a propagating ultrasound wave. US reflections from imaged structures are received with optical interferometry. With OpUS, high bandwidths (31.5 MHz) and pressures (21.5 MPa) have enabled imaging with axial resolutions better than 50 μm and at depths >20 mm. These values challenge those of conventional 40 MHz IVUS technology and show great potential for future clinical application. Recently developed nanocomposite coating materials, that are highly transmissive at light wavelengths used for PA and NIRS light, can facilitate multimodality imaging, thereby enabling molecular characterization.
PubMed: 33173786
DOI: 10.3389/fcvm.2020.525530 -
Chonnam Medical Journal Jan 2016Recently, percutaneous coronary intervention has been the treatment of choice in most acute myocardial infarction cases. Although the results of percutaneous coronary... (Review)
Review
Recently, percutaneous coronary intervention has been the treatment of choice in most acute myocardial infarction cases. Although the results of percutaneous coronary interventions have ben good, the no-reflow phenomenon and distal embolization of intracoronary thrombus are still major problems even after successful interventions. In this article, we will briefly review the deleterious effects of no-reflow and distal embolization of intracoronary thrombus during percutaneous coronary interventions. The current trials focused on the prevention and treatment of the no-reflow phenomenon and intracoronary thrombus.
PubMed: 26865998
DOI: 10.4068/cmj.2016.52.1.38