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Lundy EF, Karimi Galougahi K, Dominguez-Sulca D, Chowdhury E, Thomas SV, Porter CR, Mintz GS, Matsumura M, Maehara A, Cohen DJ, Moses JW, Shlofmitz ES, Jeremias A, West NEJ, Robinson NB, Shlofmitz RA, Ali ZA. Visualizing Inside Conduits-Intraoperative Screening of Grafts by Optical Coherence Tomography. Ann Thorac Surg 2023; 115:266-271. [PMID: 35970228 DOI: 10.1016/j.athoracsur.2022.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Saphenous vein graft (SVG) failure is a complex phenomenon, with technical, biologic, and local factors contributing to early and medium- and long-term failure after coronary artery bypass graft. Both technical and conduit factors may have significant impact on early SVG failure. DESCRIPTION We review the complex factors that play a pathogenic role in SVG failure, followed by review of the existing literature on potential utility of high-definition optical coherence tomography (OCT) in comprehensive intraoperative assessment of SVGs. EVALUATION We describe a new technique for intraoperative acquisition of OCT images in the harvested SVGs and introduce a classification system for pathologic processes that can be detected in the harvested SVG conduits by OCT. CONCLUSIONS The potential impact on early graft failure of the exclusion of segments of SVGs that are less than optimal (ie, containing fibroatheroma, retained thrombus, sclerotic valves, or procurement injury) will be examined in the randomized controlled OCTOCAB (Intraoperative Optical Coherence Tomography of the Saphenous Vein Conduit in Patients Undergoing Coronary Artery Bypass Surgery) trial.
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Affiliation(s)
| | | | | | | | | | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York
| | - Jeffrey W Moses
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York
| | | | - Allen Jeremias
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York
| | | | | | | | - Ziad A Ali
- St Francis Hospital & Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York.
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Li Z, Tang Z, Wang Y, Liu Z, Wang G, Zhang L, Wu Y, Guo J. Assessment of radial artery atherosclerosis in acute coronary syndrome patients: an in vivo study using optical coherence tomography. BMC Cardiovasc Disord 2022; 22:120. [PMID: 35313827 PMCID: PMC8939080 DOI: 10.1186/s12872-022-02561-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Radial artery (RA) atherosclerosis in acute coronary syndrome (ACS) patients has not been systematically observed in vivo. The study aims to characterize plaque morphology and intimal hyperplasia of the RA in patients with ACS, using optical coherence tomography (OCT). Methods In this retrospective study involving 239 ACS patients underwent RA OCT without guidewire shadow, 3 groups were divided according to the following criteria: radial artery plaque (RAP) group included patients with fibrous, lipid or calcified plaque; patients without RAP were further classified into radial intimal hyperplasia (RIH) group (intima media thickness ratio [IMR] ≥ 1) or normal group (IMR < 1). The presence and characteristics of RAP and its related risk factors were identified. Results The RAP, RIH and normal groups included 76 (31.8%), 69 (28.9%) and 94 (39.3%) patients, respectively. Patients in RAP group were the oldest, compared with those in the RIH and normal groups (p < 0.001), and more frequently had triple vessel disease (p = 0.004). The percentage of plaque rupture (72.4% vs. 56.4%, p = 0.018) and calcification (42.1% vs. 27.6%, p = 0.026) at culprit lesion were significantly higher in patients with RAP than those without RAP. A total of 148 RAP were revealed by OCT, including fibrous (72, 48.6%), lipid (50, 33.8%) and calcified plaques (26, 17.6%). The microvessels were also frequently observed in the RAP group than that in RIH and normal groups (59.2% vs. 8.7% vs. 9.6%, p < 0.001). Multivariate logistic regression analysis showed that age, diabetes, and smoking history (all p < 0.05) were independent risk factors for RAP. Conclusions In terms of insights gained from OCT, RA atherosclerosis is not uncommon in ACS patients by OCT, sharing several morphological characters with early coronary atherosclerosis. Aging, diabetes, and smoking are risk factors for RAP. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02561-5.
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Affiliation(s)
- Zixuan Li
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhe Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Wang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zijing Liu
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Guozhong Wang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Libin Zhang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yongxia Wu
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jincheng Guo
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
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Tasaki D, Arai H, Yokoyama K, Yoshizaki T. Therapeutic-Dose Warfarin (International Normalized Ratio >1.6) Plus Aspirin Improved Long-Term Patency of Saphenous Vein Graft without Bleeding Complication. Ann Thorac Cardiovasc Surg 2022; 28:63-71. [PMID: 35034937 PMCID: PMC8915932 DOI: 10.5761/atcs.oa.21-00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Saphenous vein graft (SVG) is the most commonly used conduits in coronary artery bypass grafting (CABG), but the disadvantage of SVG is its tendency for progressive failure. We hypothesized that therapeutic-dose warfarin (international normalized ratio [INR] >1.6) plus aspirin improve SVG patency. This study aimed to evaluate the factors contributing to SVG patency. Methods: Since 2010–2020, 199 patients who underwent isolated CABG using SVG were divided into two groups according to their INR values in the first year: group T (INR >1.6) and group L (INR <1.6). Results: Group T had 162 SVGs (105 patients) and group L had 151 SVGs (94 patients). The 1-, 4-, and 7-year SVG patency rates were higher in group T than in group L (99%, 96%, and 92% vs. 93%, 86%, and 79%, respectively; p = 0.00378). The 1-, 4-, and 7-year freedom from repeat-revascularization was higher in group T than in group L (100%, 100%, and 99% vs. 98%, 95%, and 87%, respectively; p = 0.0264). Multivariate analysis showed that therapeutic-dose warfarin (p = 0.00204) and target vessel diameter (p <0.0001) were independent risk factors of SVG occlusion. Conclusion: Therapeutic-dose warfarin (INR >1.6) plus aspirin after CABG improved the long-term patency of SVG and decreased repeat-revascularization rate.
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Affiliation(s)
- Dai Tasaki
- Department of Cardiovascular Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenji Yokoyama
- Department of Cardiovascular Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Tomoya Yoshizaki
- Department of Cardiovascular Surgery, Musashino Red Cross Hospital, Tokyo, Japan
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Li Z, Tang Z, Wang Y, Liu Z, Wang S, Wang Y, Wang G, Wang Y, Guo J. Impact of prediabetes and duration of diabetes on radial artery atherosclerosis in acute coronary syndrome patients: An optical coherence tomography study. Diab Vasc Dis Res 2022; 19:14791641221078108. [PMID: 35184608 PMCID: PMC8866250 DOI: 10.1177/14791641221078108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prediabetes (PDM) and diabetes mellitus (DM) are common among acute coronary syndrome (ACS) patients. The present study evaluated the association between diabetes status and radial artery (RA) atherosclerosis using optical coherence tomography (OCT) in ACS patients. METHODS A total of 335 ACS patients who underwent RA OCT were categorized into the DM group, the PDM group, and the normal glucose metabolism (NGM) group. OCT characteristics and clinical variables were compared. RESULTS RA atherosclerotic plaques were more frequent in the PDM and DM groups than in the NGM group (38.7% vs. 33.3% vs. 16.1%, p = 0.001). Lipid and calcified plaque occurrence were significantly more common in the DM group, followed by the PDM and NGM groups (19.3% vs. 14.6% vs. 6.5%, p = 0.027; 11.8% vs. 6.5% vs. 1.1%, p = 0.009). The prevalence of microvessels in the PDM group was significantly higher (42.7% vs 23.7%, p = 0.017) than in the NGM group but was comparable to the DM group. Multivariate analysis revealed that HbA1c level and age were independent predictors of RA plaque formation and eccentric intimal hyperplasia (all p<0.05). CONCLUSIONS RA atherosclerosis characteristics differ according to diabetes status. HbA1c level could be a useful marker for RA atherosclerosis progression in ACS patients.
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Affiliation(s)
- Zixuan Li
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Zhe Tang
- Department of Cardiology, Beijing
Anzhen Hospital, Capital Medical
University, Beijing, China
| | - Yujie Wang
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Zijing Liu
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Senhu Wang
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Yuntao Wang
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Guozhong Wang
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Yuping Wang
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
| | - Jincheng Guo
- Department of Cardiology, Beijing
Luhe Hospital, Capital Medical
University, Beijing, China
- Jincheng Guo, Department of Cardiology,
Beijing Luhe hospital, Capital Medical University, No.82, Xinhua South Road,
Tongzhou District, Beijing 101149, China.
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5
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Intracoronary Imaging for Bypass Graft Assessment and Intervention. CURRENT CARDIOVASCULAR IMAGING REPORTS 2021. [DOI: 10.1007/s12410-021-09559-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Kim DH, Sohn SH, Hwang HY. Initial Experience with Epicardial Ultrasound Scanning in Coronary Artery Bypass Grafting. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:263-269. [PMID: 32919451 PMCID: PMC7553820 DOI: 10.5090/kjtcs.20.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022]
Abstract
Background The benefits of epicardial ultrasound scanning (EUS) in coronary artery bypass grafting (CABG) have not yet been established. The aim of this study was to evaluate the usefulness of EUS in CABG, including in the assessment of the quality of distal anastomoses, the identification of epicardial target vessels, and the evaluation of any graft issues other than the distal anastomoses. Methods Fifty-three patients undergoing CABG were enrolled between March 2018 and February 2019. Intraoperative EUS was performed along with transit-time flow measurement (TTFM). Graft evaluations were performed early (shortly after surgery) and 1 year after surgery for 53 (100%) and 47 (88.7%) patients, respectively. Results EUS was applied to assess the quality of all distal anastomoses, 32 target vessels, and 2 conduit trunks. Insufficient TTFM findings were obtained for 18 grafts. However, graft revision was performed for only 3 distal anastomoses; based on the EUS findings, the remaining 15 sites were not revised. The early and 1-year overall graft patency rates were 100% (141 anastomoses) and 96.1% (122 of 127 anastomoses), respectively. All 15 of the distal anastomoses that were not revised despite insufficient TTFM results were patent at the 1-year mark. Conclusion The routine application of EUS in CABG could be beneficial by confirming the quality of surgery and reducing unnecessary procedures.
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Affiliation(s)
- Dae Hyeon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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7
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Kanniyappan U, Wang B, Yang C, Ghassemi P, Litorja M, Suresh N, Wang Q, Chen Y, Pfefer TJ. Performance test methods for near-infrared fluorescence imaging. Med Phys 2020; 47:3389-3401. [PMID: 32304583 PMCID: PMC7496362 DOI: 10.1002/mp.14189] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/03/2020] [Accepted: 04/10/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Near-infrared fluorescence (NIRF) imaging using exogenous contrast has gained much attention as a technique for enhancing visualization of vasculature using untargeted agents, as well as for the detection and localization of cancer with targeted agents. In order to address the emerging need for standardization of NIRF imaging technologies, it is necessary to identify the best practices suitable for objective, quantitative testing of key image quality characteristics. Toward the development of a battery of test methods that are rigorous yet applicable to a wide variety of devices, we have evaluated techniques for phantom design, measurement, and calculation of specific performance metrics. METHODS Using a NIRF imaging system for indocyanine green imaging, providing excitation at 780 nm and detection above 830 nm, we explored methods to evaluate uniformity, field of view, spectral crosstalk, spatial resolution, depth of field, sensitivity, linearity, and penetration depth. These measurements were performed using fluorophore-doped multiwell plate and high turbidity planar phantoms, as well as a 3D-printed multichannel phantom and a USAF 1951 resolution target. RESULTS AND CONCLUSIONS Based on a wide range of approaches described in medical and fluorescence imaging literature, we have developed and demonstrated a cohesive battery of test methods for evaluation of fluorescence image quality in wide-field imagers. We also propose a number of key metrics that can facilitate direct, quantitative comparison of device performance. These methods have the potential to facilitate more uniform evaluation and inter-comparison of clinical and preclinical imaging systems than is typically achieved, with the long-term goal of establishing international standards for fluorescence image quality assessment.
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Affiliation(s)
- Udayakumar Kanniyappan
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA.,Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Bohan Wang
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Charles Yang
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Pejhman Ghassemi
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Maritoni Litorja
- National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Nitin Suresh
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Quanzeng Wang
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Yu Chen
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA.,Department of Biomedical Engineering, University of Massachusetts Amherst, MA, USA
| | - T Joshua Pfefer
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
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8
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Elbatarny M, Tam DY, Fremes SE. Commentary: How does the vein look? Intraoperative storage strategy and vein graft disease prevention. J Thorac Cardiovasc Surg 2019; 161:107-108. [PMID: 31831195 DOI: 10.1016/j.jtcvs.2019.10.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Malak Elbatarny
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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9
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Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol 2019; 17:155-169. [DOI: 10.1038/s41569-019-0249-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/14/2022]
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10
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Ieroncig F, Breau JB, Bélair G, David LP, Noiseux N, Hatem R, Avram R. Novel Approaches to Define Outcomes in Coronary Revascularization. Can J Cardiol 2019; 35:967-982. [DOI: 10.1016/j.cjca.2018.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 01/10/2023] Open
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11
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Pettersen Ø, Pociask E, Malinowski KP, Slezak M, Hegbom K, Wiseth R, Nordhaug DO. Reproducibility of optical coherence tomography in vein grafts used for coronary revascularization. Cardiol J 2018; 27:518-523. [PMID: 30444258 DOI: 10.5603/cj.a2018.0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/11/2018] [Accepted: 09/02/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Optical coherence tomography (OCT) is a high-resolution imaging modality able to provide near-histological images of vessel walls making it possible to distinguish intima and media layers of the vessel wall separately. The use of this imaging technique is increasing while data on the variability and reliability is lacking. The aim of this study was to investigate the reproducibility of frequency-domain OCT in vein grafts used for coronary revascularization. METHODS Five pullbacks were analyzed by the same analyst with a 1-month delay (intraobserver) and by two different analysts (interobserver). Five pairs of pullbacks from the same catheters and vein graft were also analyzed (inter pullback). RESULTS Optical coherence tomography showed low variability in intra- and interobserver analysis with relative differences of mean media and intima thicknesses and areas of less than 5% for most parameters. Relative differences of the same parameters in the inter pullback analysis were in the 5-15% range. Intra- and interobserver reliability was excellent (intraclass correlation coefficient [ICC] > 0.90) for intima thickness and intima, media and intima-media area measurements. Inter pullback reliability was good (ICC: 0.75-0.90) for intima and intima-media area measurements, and moderate to good for mean intima thickness measurements (ICC: 0.79; 0.7338-0.8284). CONCLUSIONS Optical coherence tomography provides good reproducibility for the measurements of parameters relevant for the development of atherosclerosis in vein grafts. CLINICAL TRIAL REGISTRATION ID NCT01834846.
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Affiliation(s)
- Øystein Pettersen
- Department of Cardiothoracic Surgery, St. Olav's University Hospital, Prinsesse Kristina gate 3, 7030 Trondheim, Norway. .,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway.
| | - Elżbieta Pociask
- Krakow Cardiovascular Research Institute, Krakow, Poland.,AGH University of Science and Technology, Department of Biocybernetics and Biomedical Engineering, Krakow, Poland
| | - Krzysztof P Malinowski
- Krakow Cardiovascular Research Institute, Krakow, Poland.,Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | | | - Knut Hegbom
- Department of Cardiology, St. Olav's Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Rune Wiseth
- Department of Cardiology, St. Olav's Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Dag Ole Nordhaug
- Department of Cardiothoracic Surgery, St. Olav's University Hospital, Prinsesse Kristina gate 3, 7030 Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
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Urso S, Tena MÁ, Mahillo-Fernández I, Ríos L, Bellot R, Sadaba R, Hernández JM, Abad C, Portela F. Análisis de predictores independientes del flujo del bypass coronario en pacientes intervenidos de revascularización miocárdica aislada. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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13
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A unique stenosis in saphenous vein graft visualized by optical coherence tomography. Heart Vessels 2013; 29:278-81. [PMID: 23712599 PMCID: PMC3948513 DOI: 10.1007/s00380-013-0362-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 04/26/2013] [Indexed: 11/14/2022]
Abstract
We present a case of a unique stenosis in a 12-year-old saphenous vein graft (SVG), to the right coronary artery, which was visualized by optical coherence tomography (OCT), before percutaneous coronary intervention. The patient was an 80-year-old man in whom the stenosis was documented by area-detector coronary computed tomography. OCT imaging demonstrated that the culprit lesion was a venous valve containing a thrombus before preintervention imaging. Coronary stenting was performed with a distal protection device, and pathologic examination of the aspirate verified the OCT findings. Coronary angiography 12 years previously, just after coronary artery bypass surgery (CABG), had shown a completely normal SVG without any suspicion of a venous valve. These OCT images suggested the possibility that the culprit lesion was an “upside down” venous valve that was not visualized by angiography just after surgery, but could be a cause of late SVG stenosis following CABG. OCT imaging is very useful for clarifying the etiology of the stenosis in cases of ambiguous angiographic lesions.
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14
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Wang T, van der Steen AFW, van Soest G. Numerical analysis of astigmatism correction in gradient refractive index lens based optical coherence tomography catheters. APPLIED OPTICS 2012; 51:5244-52. [PMID: 22858968 DOI: 10.1364/ao.51.005244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Endoscopic optical coherence tomography (OCT) catheters comprise a transparent tube to separate the imaging instrument from tissues. This tube acts as a cylindrical lens, introducing astigmatism into the beam. In this report, we quantified this negative effect using optical simulations of OCT catheter devices, and discuss possible compensation strategies. For esophageal imaging, the astigmatism is aggravated by the long working distance. For intracoronary imaging, the beam quality is degraded due to the liquid imaging environment. A nearly circular beam profile can be achieved by a curved focusing optics. We also consider the method of matching refractive indices, and it is shown to successfully restore a round beam.
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Affiliation(s)
- Tianshi Wang
- Thorax Center, Erasmus University Medical Center, Rotterdam, The Netherlands.
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15
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Lowe HC, Narula J, Fujimoto JG, Jang IK. Intracoronary optical diagnostics current status, limitations, and potential. JACC Cardiovasc Interv 2012; 4:1257-70. [PMID: 22192367 DOI: 10.1016/j.jcin.2011.08.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 08/04/2011] [Accepted: 08/18/2011] [Indexed: 10/14/2022]
Abstract
Optical coherence tomography (OCT), is a novel intravascular imaging modality analogous to intravascular ultrasound but uses light instead of sound. This review details the background, development, and status of current investigation using OCT, and discusses advantages, limitations, and likely future developments. It provides indications for possible future clinical use, and places OCT in the context of current intravascular imaging in what is a rapidly changing field of investigation.
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Affiliation(s)
- Harry C Lowe
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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16
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Sarantopoulos A, Beziere N, Ntziachristos V. Optical and Opto-Acoustic Interventional Imaging. Ann Biomed Eng 2012; 40:346-66. [DOI: 10.1007/s10439-011-0501-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 12/23/2011] [Indexed: 12/20/2022]
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17
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Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency. Ann Thorac Surg 2011; 91:1385-91; discussion 1391-2. [PMID: 21524447 DOI: 10.1016/j.athoracsur.2011.01.079] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 01/26/2011] [Accepted: 01/28/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent studies have suggested that endoscopic vein harvest (EVH) compromises graft patency. To test whether the learning curve for EVH alters conduit integrity owing to increased trauma compared with an open harvest, we analyzed the quality and early patency of conduits procured by technicians with varying EVH experience. METHODS During coronary artery bypass grafting, veins were harvested open (n=10) or by EVH (n=85) performed by experienced (>900 cases, >30/month) versus novice<100 cases, <3/month) technicians. Harvested conduits were imaged intraoperatively using optical coherence tomography and on day 5 to assess graft patency using computed tomographic angiography. RESULTS Conduits from experienced (n=55) versus novice (n=30) harvesters had similar lengths (33 versus 34 cm) and harvest times (32.4 versus 31.8 minutes). Conduit injury was noted in both EVH groups with similar distribution among disruption of the adventitia (62%), intimal tears at branch points (23%), and intimal or medial dissections (15%), but the incidence of these injuries was less with experienced harvesters and rare in veins procured with an open technique. Overall, the rate of graft attrition was similar between the two EVH groups (6.45% versus 4.34% of grafts; p=0.552). However, vein grafts with at least 4 intimal or medial dissections showed significantly worse patency (67% versus 96% patency; p=0.05). CONCLUSIONS High-resolution imaging confirmed that technicians inexperienced with EVH are more likely to cause intimal and deep vessel injury to the saphenous vein graft, which increases graft failure risk. Endoscopic vein harvest remains the most common technique for conduit harvest, making efforts to better monitor the learning curve an important public health issue.
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Ntziachristos V, Yoo JS, van Dam GM. Current concepts and future perspectives on surgical optical imaging in cancer. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:066024. [PMID: 21198198 DOI: 10.1117/1.3523364] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
There are vibrant developments of optical imaging systems and contrast-enhancing methods that are geared to enhancing surgical vision and the outcome of surgical procedures. Such optical technologies designed for intraoperative use can offer high integration in the operating room compared to conventional radiological modalities adapted to intraoperative applications. Simple fluorescence epi-illumination imaging, in particular, appears attractive but may lead to inaccurate observations due to the complex nature of photon-tissue interaction. Of importance therefore are emerging methods that account for the background optical property variation in tissues and can offer accurate, quantitative imaging that eliminates the appearance of false negatives or positives. In parallel, other nonfluorescent optical imaging methods are summarized and overall progress in surgical optical imaging applications is outlined. Key future directions that have the potential to shift the paradigm of surgical health care are also discussed.
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Yonetsu T, Kakuta T, Lee T, Takayama K, Kakita K, Iwamoto T, Kawaguchi N, Takahashi K, Yamamoto G, Iesaka Y, Fujiwara H, Isobe M. Assessment of acute injuries and chronic intimal thickening of the radial artery after transradial coronary intervention by optical coherence tomography. Eur Heart J 2010; 31:1608-15. [PMID: 20413398 DOI: 10.1093/eurheartj/ehq102] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Transradial coronary intervention (TRI) introduces a trauma to the radial artery (RA), possibly influencing quality as a bypass conduit if subsequently used. We sought to determine the acute and chronic effects of TRI on the RA by optical coherence tomography (OCT). METHODS AND RESULTS Immediately after TRI completion, 73 RAs in 69 patients were examined. The sheath was pulled back 2 cm distal to the puncture site, and OCT imaging was performed. The acute injuries and intimal thickening were compared between first-TRI RAs and repeat-TRI RAs. Intimal tears were observed in 49 RAs (67.1%) and were more frequent in the distal than in the proximal RA (P = 0.001). Medial dissections were not uncommon (26 RAs, 35.6%). The frequency of acute injury was significantly higher in repeat-TRI RAs (P < 0.001). Intima/medial area, the maximum intimal thickness/medial thickness ratio, and per cent narrowing were all significantly greater in repeat-TRI RAs in the distal and proximal RA. Multivariate analysis revealed that a repeated TRI procedure was the only independent predictor of intimal thickening. CONCLUSION Optical coherence tomography clearly demonstrated significant acute injuries and chronic intimal thickening of RA after TRI. Further study should evaluate the impact of these effects when TRI RAs are subsequently used as conduits, on long-term graft patency and on clinical outcomes after bypass surgery.
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Affiliation(s)
- Taishi Yonetsu
- Department of Cardiology, Tsuchiura Kyodo Hospital, 11-7, Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan.
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Themelis G, Yoo JS, Soh KS, Schulz R, Ntziachristos V. Real-time intraoperative fluorescence imaging system using light-absorption correction. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:064012. [PMID: 20059250 DOI: 10.1117/1.3259362] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
We present a novel fluorescence imaging system developed for real-time interventional imaging applications. The system implements a correction scheme that improves the accuracy of epi-illumination fluorescence images for light intensity variation in tissues. The implementation is based on the use of three cameras operating in parallel, utilizing a common lens, which allows for the concurrent collection of color, fluorescence, and light attenuation images at the excitation wavelength from the same field of view. The correction is based on a ratio approach of fluorescence over light attenuation images. Color images and video is used for surgical guidance and for registration with the corrected fluorescence images. We showcase the performance metrics of this system on phantoms and animals, and discuss the advantages over conventional epi-illumination systems developed for real-time applications and the limits of validity of corrected epi-illumination fluorescence imaging.
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Affiliation(s)
- George Themelis
- Technische Universitat München, Institute for Biological and Medical Imaging, Arcisstrasse 21, 80333 München, Germany
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Abstract
From the first description of the “systemic inflammatory response” in the early 1990s, it has been recognized that this is a multifaceted response of the body to the combined insult of cardiothoracic surgery with bypass, involving causation by “activation of complement, coagulation, fibrinolytic, and kallikrein cascades, activation of neutrophils with degranulation and protease enzyme release, oxygen radical production, and the synthesis of various cytokines from mononuclear cells.” Yet the intervening 15 years have seen a narrowing of research into individual systems and interventions naively targeted at single pathways without achieving clinically meaningful benefits. The time has come to redefine the systemic inflammatory response so that research can be more productively focused on objectively measuring and interdicting this multisystem disorder. A key concept of this new understanding is that translation into a hard adverse event occurs when the systemic imbalance is combined with a localized trigger. Triggers might be inadvertently provided by transient episodes of ischemia/malperfusion to vulnerable organs or handling trauma to major vessels. Future research should be directed at suppressing systemic activation with combinations of drugs and improved circuit coating, whereas changes in clinical practice and continuous monitoring of perfusion parameters can help eliminate localized triggering events.
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Affiliation(s)
- R. Clive Landis
- Edmund Cohen Laboratory for Vascular Research, Chronic Disease Research Centre, University of the West Indies, Bridgetown, Barbados, West Indies
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Brown EN, Burris NS, Kon ZN, Grant MC, Brazio PS, Xu C, Laird P, Gu J, Kallam S, Desai P, Poston RS. Intraoperative detection of intimal lipid in the radial artery predicts degree of postoperative spasm. Atherosclerosis 2008; 205:466-71. [PMID: 19264305 DOI: 10.1016/j.atherosclerosis.2008.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 12/01/2008] [Accepted: 12/06/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND The radial artery's (RA) tendency to spasm when used as a bypass graft may relate to features of the RA itself. We imaged RA conduits before and after CABG in order to characterize intimal abnormalities that might relate to the risk of spasm. METHODS RA conduits from thirty-two CABG patients were imaged intraoperatively using catheter-based optical coherence tomography (OCT) and again on day 5 using 64-channel MDCT angiography. The change in luminal diameter between timepoints was measured in the proximal, mid and distal RA. "Spasm" was defined as focal or diffuse luminal narrowing to a diameter less than the target coronary. Lipid content in the RA was quantified by the degree of light attenuation on the OCT image. RESULTS Postoperative spasm was diagnosed in 18 of 32 (56%) RA grafts with the distal RA showing the most severe change versus the mid and proximal portions (-24.1+/-43.2% vs. -15.3+/-40.7%, -9.0+/-42.5% change in diameter respectively, p<0.01). The degree of attenuation of the OCT signal produced by the RA was strongly correlated with % diameter change (R=0.64, p=0.0005) and was significantly more pronounced in grafts with spasm versus no spasm (-1.97+/-0.61mm(-1) vs. -0.81+/-0.57mm(-1), p<0.0001). Histology confirmed lipid deposits in areas of RA with strong attenuation. CONCLUSIONS RA conduits otherwise considered acceptable for bypass grafting were often found by OCT imaging to have a substantial amount of lipid, which in turn strongly relates to the risk of postoperative spasm. Screening conduits based on characteristics of intimal quality may improve results following RA grafting.
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Affiliation(s)
- Emile N Brown
- University of Maryland School of Medicine, Department of Surgery, Baltimore, United States
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Bibliography. Current world literature. Diseases of the aorta, pulmonary, and peripheral vessels. Curr Opin Cardiol 2008; 23:646-7. [PMID: 18830082 DOI: 10.1097/hco.0b013e328316c259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Burris NS, Brown EN, Grant M, Kon ZN, Gibber M, Gu J, Schwartz K, Kallam S, Joshi A, Vitali R, Poston RS. Optical coherence tomography imaging as a quality assurance tool for evaluating endoscopic harvest of the radial artery. Ann Thorac Surg 2008; 85:1271-7. [PMID: 18355508 DOI: 10.1016/j.athoracsur.2007.12.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 12/06/2007] [Accepted: 12/10/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Concerns about intimal disruption and spasm have limited enthusiasm for endoscopic radial artery harvest (ERAH), although the risk of these problems after this procedure remains uncertain. Radial artery conduits were screened intraoperatively before and after ERAH vs open harvest using catheter-based high-resolution optical coherence tomography (OCT) imaging. METHODS Twenty-four cadavers and 60 coronary artery bypass graft (CABG) patients scheduled to receive a RA graft underwent OCT imaging before (in situ) and after (ex vivo) open harvest or ERAH. Spasm was quantified by the percentage change in luminal volume between images. Intimal disruption was classified as minor or severe depending on whether the defect was confined to branch ostia or involved the luminal surface. Histology was used to confirm OCT findings. RESULTS Luminal volume significantly declined after harvest in all RAs from CABG patients, but there was no difference between groups: -43% +/- 29% vs -35% +/- 38% change after ERAH (n = 21) vs open harvest (n = 39; p = 0.342). Significantly more intimal injury was noted after ERAH vs open harvest (34/41 vs 9/43, intimal tears/total evaluated RAs, p < 0.0001). Most intimal injury was minor: only 2 tears involved the luminal surface of the RA (both after ERAH). Serial imaging in cadavers revealed that 86% of ostial tears occur in ERAH during the initial blunt dissection step using the endoscope. CONCLUSIONS Although branch injury is a pitfall of ERAH, OCT imaging documented that the quality of RA procured is acceptable and comparable with open harvest. Catheter-based OCT provides an important quality assurance tool for RA harvest.
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Affiliation(s)
- Nicholas S Burris
- Department of Surgery, University of Maryland, Baltimore, Maryland 21201, USA
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