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Onea HL, Lazar FL, Olinic DM, Homorodean C, Cortese B. The role of optical coherence tomography in guiding percutaneous coronary interventions: is left main the final challenge? Minerva Cardiol Angiol 2024; 72:41-55. [PMID: 36321887 DOI: 10.23736/s2724-5683.22.06181-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Left main (LM) coronary artery disease is a high-risk lesion subset, with important prognostic implications for the patients. Recent advances in the field of interventional cardiology have narrowed the gap between surgical and percutaneous approach of this complex lesion setting. However, the rate of repeat revascularization remains higher in the case of percutaneous coronary intervention (PCI) on long-term follow-up. As such, the need for better stent optimization strategies has led to the development of intravascular imaging techniques, represented mainly by intravascular ultrasound (IVUS) and optical coherence tomography (OCT). These techniques are both able to provide excellent pre- and post-PCI guidance. While IVUS is an established modality in optimizing LM PCI, and is recommended by international revascularization guidelines, data and experience on the use of OCT are still limited. This review paper deeply analyzes the current role of OCT imaging in the setting of LM disease, particularly focusing on its utility in assessing plaque morphology and distribution, vessel dimensions and proper stent sizing, analyzing mechanisms of stent failure such as malapposition and underexpansion, guiding bifurcation stenting, as well as offering a direct comparison with IVUS in this critical clinical scenario, based on the most recent available data.
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Affiliation(s)
- Horea-Laurentiu Onea
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
- Medical Clinic Number1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Florin-Leontin Lazar
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
- Medical Clinic Number1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Calin Homorodean
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
- Medical Clinic Number1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy -
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2
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Sarwar M, Adedokun S, Narayanan MA. Role of intravascular ultrasound and optical coherence tomography in intracoronary imaging for coronary artery disease: a systematic review. J Geriatr Cardiol 2024; 21:104-129. [PMID: 38440344 PMCID: PMC10908578 DOI: 10.26599/1671-5411.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Coronary angiography has long been the standard for coronary imaging, but it has limitations in assessing vessel wall anatomy and guiding percutaneous coronary intervention (PCI). Intracoronary imaging techniques like intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can overcome these limitations. IVUS uses ultrasound and OCT uses near-infrared light to visualize coronary pathology in unique ways due to differences in temporal and spatial resolution. These techniques have evolved to offer clinical utility in plaque characterization and vessel assessment during PCI. Meta-analyses and adjusted observational studies suggest that both IVUS and OCT-guided PCI correlate with reduced cardiovascular risks compared to angiographic guidance alone. While IVUS demonstrates consistent clinical outcome benefits, OCT evidence is less robust. IVUS has progressed from early motion detection to high-resolution systems, with smaller compatible catheters. OCT utilizes near infrared light to achieve unparalleled resolutions, but requires temporary blood clearance for optimal imaging. Enhanced visualization and guidance make IVUS and OCT well-suited for higher risk PCI in patients with diabetes and chronic kidney disease by allowing detailed visualization of complex lesions and ensuring optimal stent deployment and positioning in PCI for patients with type 2 diabetes and chronic kidney disease, improving outcomes. IVUS and recent advancements in zero- and low-contrast OCT techniques can reduce nephrotoxic contrast exposure, thus helping to minimize PCI complications in these high-risk patient groups. IVUS and OCT provide valuable insights into coronary pathophysiology and guide interventions precisely compared to angiography alone. Both have comparable clinical outcomes, emphasizing the need for tailored imaging choices based on clinical scenarios. Continued refinement and integration of intravascular imaging will likely play a pivotal role in optimizing coronary interventions and outcomes. This systematic review aims to delve into the nuances of IVUS and OCT, highlighting their strengths and limitations as PCI adjuncts.
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Affiliation(s)
- Maruf Sarwar
- Department of Cardiovascular Sciences, White River Health, Batesville, AR, USA
| | - Stephen Adedokun
- Division of Cardiology, University of Tennessee at Memphis, TN, USA
| | - Mahesh Anantha Narayanan
- Department of Cardiovascular Sciences, White River Health, Batesville, AR, USA
- University of Arkansas Medical Sciences, Little Rock, AR, USA
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3
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Bouki KP, Vlad DI, Goulas N, Lambadiari VA, Dimitriadis GD, Kotsakis AA, Barοutsi K, Toutouzas KP. Diagnostic Performance of Frequency-Domain Optical Coherence Tomography to Predict Functionally Significant Left Main Coronary Artery Stenosis. J Interv Cardiol 2021; 2021:7108284. [PMID: 34867107 PMCID: PMC8608539 DOI: 10.1155/2021/7108284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/09/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
AIMS The aim of this study was to assess the safety and diagnostic efficacy of frequency-domain optical coherence tomography (FD-OCT) in identifying functional severity of the left main coronary artery (LM) stenosis determined by fractional flow reserve (FFR). METHODS AND RESULTS 101 patients with LM lesion (20-70% diameter stenosis angiographically) underwent FFR measurement and FD-OCT imaging of the LM. The following parameters were measured by FD-OCT in the LM: reference lumen area (RLA), reference lumen diameter (RLD), minimum lumen area (MLA), minimum lumen diameter (MLD), % lumen area stenosis, and % diameter stenosis. The LM lesions were analyzable by FD-OCT in 88/101 (87.1%) patients. FFR at maximum hyperemia was ≤0.80 in 39/88 (44.3%) patients. FFR values were correlated significantly with FD-OCT-derived LM lumen parameters. An MLA cutoff value of 5.38 mm2 had the highest sensitivity and specificity of 82% and 81%, respectively, followed by an MLD of 2.43 mm (sensitivity 77%, specificity 72%) and AS of 60% (sensitivity 72%, specificity 72%) for predicting FFR <0.80. CONCLUSIONS FD-OCT is a safe and feasible imaging technique for the assessment of LM stenosis. An FD-OCT-derived MLA of ≤5.38 mm2 strongly predicts the functional severity of an LM lesion.
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Affiliation(s)
| | - Delia I. Vlad
- 2 Department of Cardiology, General Hospital of Nikea-Piraeus, Nikaia, Greece
| | - Nikolaos Goulas
- 2 Department of Cardiology, General Hospital of Nikea-Piraeus, Nikaia, Greece
| | - Vaia A. Lambadiari
- 2 Department of Internal Medicine, University of Athens, Attikon Hospital, Athens, Greece
| | - George D. Dimitriadis
- 2 Department of Internal Medicine, University of Athens, Attikon Hospital, Athens, Greece
| | | | - Kyriaki Barοutsi
- Department of Medical Imaging, General Hospital of Nikea-Piraeus, Nikaia, Greece
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4
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Cortese B, de la Torre Hernandez JM, Lanocha M, Ielasi A, Giannini F, Campo G, D'Ascenzo F, Latini RA, Krestianinov O, Alfonso F, Trani C, Prati F, Linares JA, Sardella G, Wlodarczak A, Viganò E, Camarero TG, Stella P, Sozykin A, Fineschi M, Burzotta F. Optical coherence tomography, intravascular ultrasound or angiography guidance for distal left main coronary stenting. The ROCK cohort II study. Catheter Cardiovasc Interv 2021; 99:664-673. [PMID: 34582631 DOI: 10.1002/ccd.29959] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 08/07/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES to test the safety and efficacy of intravascular imaging and specifically optical coherence tomography (OCT) as a diagnostic tool for left main angioplasty and analyze the mid-term outcome accordingly. BACKGROUND Clinical data and international guidelines recommend the use of intravascular imaging ultrasound (IVUS) to guide left main (LM) angioplasty. Despite early experience using OCT in this setting is encouraging, the evidence supporting its use is still limited. METHODS ROCK II is a multicenter, investigator-driven, retrospective European study to compare the performance of IVUS and OCT versus angiography in patients undergoing distal-LM stenting. The primary study endpoint was target-lesion failure (TLF) including cardiac death, target-vessel myocardial infarction and target-lesion revascularization. We designed this study hypothesizing the superiority of intravascular imaging over angiographic guidance alone, and the non-inferiority of OCT versus IVUS. RESULTS A total of 730 patients, 377 with intravascular-imaging guidance (162 OCT, 215 IVUS) and 353 with angiographic guidance, were analyzed. The one-year rate of TLF was 21.2% with angiography and 12.7% with intravascular-imaging (p = 0.039), with no difference between OCT and IVUS (p = 0.26). Intravascular-imaging was predictor of freedom from TLF (HR 0.46; 95% CI 0.23-0.93: p = 0.03). Propensity-score matching identified three groups of 100 patients each with no significant differences in baseline characteristics. The one-year rate of TLF was 16% in the angiographic, 7% in the OCT and 6% in the IVUS group, respectively (p = 0.03 for IVUS or OCT vs. angiography). No between-group significant differences in the rate of individual components of TLF were found. CONCLUSIONS Intravascular imaging was superior to angiography for distal LM stenting, with no difference between OCT and IVUS.
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Affiliation(s)
- Bernardo Cortese
- Cardiovascular Department, Clinica Polispecialistica San Carlo, Paderno Dugnano, Milano, Italy.,Cardiovascular Department, Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy.,Cardiovascular Department, San Carlo Clinic, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | | | - Magdalena Lanocha
- Cardiovascular Department, Poznań University of Medical Sciences, Poznan, Poland
| | - Alfonso Ielasi
- Cardiovascular Department, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Francesco Giannini
- Cardiovascular Department, Interventional Cardiology, GVM, Cotignola, Italy
| | - Gianluca Campo
- Cardiovascular Department, Interventional Cardiology, University of Ferrara, Ferrara, Italy
| | - Fabrizio D'Ascenzo
- Cardiovascular Department, Division of Cardiology, University of Turin, Città della Salute e Della Scienza, Torino, Italy
| | - Roberto A Latini
- Cardiovascular Department, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Oleg Krestianinov
- Cardiovascular Department, Interventional Cardiology, NRTCP Novosibirisk, Russia
| | - Fernando Alfonso
- Cardiovascular Department, Hospital Universitario del la Princesa, Madrid, Spain
| | - Carlo Trani
- Cardiovascular Department, Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Prati
- Cardiovascular Department, Cardiology Unit, Ospedale San Giovanni, Rome, Italy
| | - Jose A Linares
- Cardiovascular Department, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | - Gennaro Sardella
- Cardiovascular Department, Interventional Cardiology, Policlinico Umberto I, Rome, Italy
| | - Adrian Wlodarczak
- Cardiovascular Department, Poznań University of Medical Sciences, Poznan, Poland
| | - Elena Viganò
- Cardiovascular Department, San Carlo Clinic, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | - Tamara Garcia Camarero
- Cardiovascular Department, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Pieter Stella
- Cardiovascular Department, Interventional Cardiology, UMC Utrecht, The Netherlands
| | - Alexander Sozykin
- Cardiovascular Department, Russian Academy of Science, Moscow, Russia
| | - Massimo Fineschi
- Cardiovascular Department, Interventional Cardiology, Policlinico Le Scotte, Siena, Italy
| | - Francesco Burzotta
- Cardiovascular Department, Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
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5
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Amabile N, Rangé G, Souteyrand G, Godin M, Boussaada M, Meneveau N, Cayla G, Casassus F, Lefèvre T, Hakim R, Bagdadi I, Motreff P, Caussin C. Optical coherence tomography to guide percutaneous coronary intervention of the left main coronary artery: the LEMON study. EUROINTERVENTION 2021; 17:e124-e131. [PMID: 33226003 PMCID: PMC9724912 DOI: 10.4244/eij-d-20-01121] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS)-guided PCI improves the prognosis of left main stem (LMS) PCI and is currently recommended by international guidelines. Although OCT resolution is greater than that of IVUS, this tool is not yet recommended in LMS angioplasty due to the absence of data. AIMS This pilot study aimed to analyse the feasibility, safety and impact of OCT-guided LMS PCI. METHODS This prospective, multicentre trial investigated whether patients might benefit from OCT-guided PCI for mid/distal LMS according to a pre-specified protocol. The primary endpoint was procedural success defined as follows: residual angiographic stenosis <50% + TIMI 3 flow in all branches + adequate OCT stent expansion (LEMON criteria). RESULTS Seventy patients were included in the final analysis (median age: 72 [64-81] years, 73% male). The OCT pre-specified protocol was applied in all patients. The primary endpoint was achieved in 86% of subjects. Adequate stent expansion was observed in 86%, significant edge dissection in 30% and residual significant strut malapposition in 24% of the cases. OCT guidance modified the operators' strategy in 26% of the patients. The rate of one-year survival free from major adverse clinical events was 98.6% (97.2-100). CONCLUSIONS This pilot study is the first to report the feasibility and performance of OCT-guided LMS PCI according to a pre-specified protocol.
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Affiliation(s)
- Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France
| | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | - Geraud Souteyrand
- Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
| | - Matthieu Godin
- Cardiology Department, Clinique St Hilaire, Rouen, France
| | - Mohamed Boussaada
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Meneveau
- Department of Cardiology, EA3920, University Hospital Jean Minjoz, Besançon, France
| | - Guillaume Cayla
- Cardiology Department, CHU Nimes, University of Montpellier, Nimes, France
| | | | - Thierry Lefèvre
- Institut Cardio-Vasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Radwane Hakim
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | - Imane Bagdadi
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Pascal Motreff
- Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
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6
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Guillon B, Tauzin H, Ecarnot F, Meneveau N. How can optical coherence tomography be used to optimize percutaneous coronary intervention? Cardiovasc Diagn Ther 2020; 10:1415-1428. [PMID: 33224765 PMCID: PMC7666932 DOI: 10.21037/cdt.2020.04.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/31/2020] [Indexed: 11/06/2022]
Abstract
Optical coherence tomography (OCT) imaging provides high resolution assessment of coronary parietal and endoluminal abnormalities. Clinical evidence and intuitive utilization make this tool relevant for use in daily practice in the catheterization laboratory. In the present review, we summarize the benefits of OCT for the optimization of percutaneous coronary intervention (PCI) in daily practice. First, we focus on the characterization of lesion type with a view to anticipating challenges during PCI. Then, we describe the utility of OCT to identify culprit lesions and ambiguous angiographic findings. Finally, we outline targets for optimization after PCI and the mechanisms underlying stent failure.
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Affiliation(s)
- Benoit Guillon
- Department of Cardiology, University Hospital Besançon, Besançon, France
- EA3920, University of Franche-Comté, Besançon, France
| | - Hélène Tauzin
- Department of Cardiology, University Hospital Besançon, Besançon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, Besançon, France
- EA3920, University of Franche-Comté, Besançon, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Besançon, Besançon, France
- EA3920, University of Franche-Comté, Besançon, France
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7
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8
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Cortese B, Burzotta F, Alfonso F, Pellegrini D, Trani C, Aurigemma C, Rivero F, Antuña P, Orrego PS, Prati F. Role of optical coherence tomography for distal left main stem angioplasty. Catheter Cardiovasc Interv 2019; 96:755-761. [DOI: 10.1002/ccd.28547] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 10/05/2019] [Indexed: 01/08/2023]
Affiliation(s)
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | | | | | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | | | - Paula Antuña
- Hospital Universitario del la Princesa Madrid Spain
| | | | - Francesco Prati
- CLI Foundation and UniCamillus‐Saint Camillus International University of Health Sciences Rome Italy
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9
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Onuma Y, Katagiri Y, Burzotta F, Holm NR, Amabile N, Okamura T, Mintz GS, Darremont O, Lassen JF, Lefèvre T, Louvard Y, Stankovic G, Serruys PW. Joint consensus on the use of OCT in coronary bifurcation lesions by the European and Japanese bifurcation clubs. EUROINTERVENTION 2019; 14:e1568-e1577. [DOI: 10.4244/eij-d-18-00391] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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10
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Burzotta F, Lassen JF, Banning AP, Lefèvre T, Hildick-Smith D, Chieffo A, Darremont O, Pan M, Chatzizisis YS, Albiero R, Louvard Y, Stankovic G. Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 14:112-120. [PMID: 29786539 DOI: 10.4244/eij-d-18-00357] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The 2017 European Bifurcation Club (EBC) meeting was held in Porto (Portugal) and allowed a multidisciplinary international faculty to review and discuss the latest data collected in the field of coronary bifurcation interventions. In particular, the topic of percutaneous coronary intervention (PCI) on left main coronary artery (LM) disease was highlighted as a contemporary priority. Herein, we summarise the key LM anatomy features, the diagnostic modalities and available data that are relevant for a patient's procedural management. Since the clinical outcomes of patients undergoing PCI on LM disease may depend on both PCI team organisation and PCI performance, the optimal catheterisation laboratory set-up and the rationales for device and technique selection are critically reviewed. The best lesion preparation modalities, the different DES implantation technique choices and the strategies to be considered during PCI on unprotected LM for optimal PCI results are reviewed step by step.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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11
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Fajadet J, Capodanno D, Stone GW. Management of left main disease: an update. Eur Heart J 2018; 40:1454-1466. [DOI: 10.1093/eurheartj/ehy238] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/24/2018] [Accepted: 04/06/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
| | - Davide Capodanno
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Gregg W Stone
- Columbia University Medical Center, New York-Presbyterian Hospital, Cardiovascular Research Foundation, New York, NY, USA
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12
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Dato I, Burzotta F, Trani C, Romano A, Paraggio L, Aurigemma C, Porto I, Maria Leone A, Niccoli G, Crea F. Data on optical coherence tomography guidance for the management of angiographically intermediate left main bifurcation lesions. Data Brief 2017; 14:635-638. [PMID: 28913391 PMCID: PMC5587878 DOI: 10.1016/j.dib.2017.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/08/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022] Open
Abstract
The data presented in this article are related to the research article entitled “Optical coherence tomography guidance for the management of angiographically intermediate left main bifurcation lesions: early clinical experience” [1]. In this article we reports details about our clinical experience with frequency domain-optical coherence tomography (FD-OCT) guidance for the management of patients with left main (LM) bifurcation lesions of intermediate angiographic severity. LM patients were assessed by FD-OCT and, on the bases of the findings, managed by myocardial revascularization or conservative treatment (revascularization deferral). The observed outcomes support the feasibility of FD-OCT guidance for LM bifurcated lesions and call for further clinical evaluations in appropriately designed prospective studies.
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Affiliation(s)
- Ilaria Dato
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Romano
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Lazzaro Paraggio
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Italo Porto
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | | | - Giampaolo Niccoli
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Crea
- Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
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