The results of this prospective multicenter study demonstrate that FD-OCT provides accurate and reproducible quantitative measurements of coronary dimensions in the clinical setting.

As assessed by OCT the impact of DES on vascular healing was similar at overlapping and nonoverlapping sites. However, strut malapposition, coverage pattern, and neointimal hyperplasia differ significantly according to DES type. (Optical Coherence Tomography for Drug Eluting Stent Safety [ODESSA]; NCT00693030).

Background-We have noted abnormal angiographic findings-at the sites of drug-eluting stent implantation, suggesting contrast staining outside the stent struts-that do not fulfill the classic definition of coronary artery aneurysm. We propose a new term, peri-stent contrast staining (PSS), for these abnormal angiographic findings and assess their incidence, risk factors, and clinical sequelae. Methods and Results-Peri-stent contrast staining was defined as contrast staining outside the stent contour extending to Ն20% of the stent diameter. The study population consisted of 3081 lesions (1998 patients) that were treated exclusively with sirolimus-eluting stents and were evaluated by follow-up angiography within 12 months after sirolimus-eluting stent implantation in a single center. Late acquired PSS was observed in 58 lesions (1.9%) in 49 patients (2.5%). Independent risk factors of PSS included chronic total occlusion, whereas negative risk factors for PSS were left circumflex coronary artery lesion and in-stent restenosis lesion. Stent fracture was more frequently observed in lesions with PSS than in lesions without PSS (43.1% versus 5.4%, PϽ0.0001). Excluding 269 lesions with target-lesion revascularization within 12 months, the study population for long-term follow-up consisted of 51 lesions (42 patients) with PSS and 2761 lesions (1751 patients) without PSS. Cumulative incidence of target-lesion revascularization and definite very late stent thrombosis at 3 years in the PSS group was higher than that in the non-PSS group (15.0% versus 6.5%, and 8.2% versus 0.2%, respectively). Conclusions-Peri-stent contrast staining found within 12 months after sirolimus-eluting stent implantation appeared to be associated with subsequent target-lesion revascularization and very late stent thrombosis. (Circulation. 2011;123:2382-2391.)

Background-The safety of drug-eluting stents in ST-segment elevation myocardial infarction (STEMI) continues to be debated. Pathological studies have demonstrated an association between uncovered struts and subsequent stent thrombosis. Optical coherence tomography can detect stent strut coverage in vivo on a micron-scale level. We therefore used optical coherence tomography to examine strut coverage in patients with STEMI treated with paclitaxel-eluting stents (PES) and bare metal stents (BMS). Methods and Results-In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction(HORIZONS-AMI) trial, patients with STEMI were randomized 3:1 to PES or BMS implantation. In a formal substudy, optical coherence tomography at 13 months was performed in 118 consecutive randomized patients (89 PES, 29 BMS) in whom 188 stents were assessed (146 PES and 42 BMS). A total of 44 139 stent struts were analyzed by an independent core laboratory blinded to stent assignment. The primary prespecified end point, the percentage of uncovered stent struts per lesion at follow-up, was 1.1Ϯ2.5% in BMS lesions versus 5.7Ϯ7.

Quantitative coronary angiography (QCA) remains to play an important role in clinical trials and post-marketing surveillance related to the safety and efficacy of new PCI devices. In this document, the current standard methodology of QCA is summarized. In addition, its history, recent development and future perspectives are also reviewed.

OBJECTIVE-The aim of this study was to determine the natural history of vascular remodeling of atherosclerotic plaques in patients with type 2 diabetes and the predictors of vessel shrinkage.RESEARCH DESIGN AND METHODS-In this serial intracoronary ultrasound (IVUS) study, 237 coronary segments from 45 patients enrolled in the DIABETES I, II, and III trials were included. Quantitative volumetric IVUS analyses (motorized pullbacks at 0.5 mm/s) were performed in the same coronary segment after the index procedure and at the 9-month follow-up. Nontreated mild lesions (angiographic stenosis Ͻ25%) with Ն0.5 mm plaque thickening and length of Ն5 mm assessed by IVUS were included. Vessel shrinkage was defined as a ⌬external elastic membrane area/⌬plaque area Ͻ 0. Statistical adjustment by multiple segments and multiple lesions per patient was performed.RESULTS-Vessel shrinkage was identified in 37.1% of segments and was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 Ϯ 4 mm 2 vs. non-vessel shrinkage, 11 Ϯ 4 mm 2 ; P ϭ 0.04). Independent predictors of vessel shrinkage were insulin requirements (odds ratio 4.6 [95% CI 1.40 -15.10]; P ϭ 0.01), glycated hemoglobin (1.5 [1.05-2.10]; P ϭ 0.02), apolipoprotein B (0.96 [0.94 -0.98]; P Ͻ 0.001), hypertension (3.7 [1.40 -10.30]; P ϭ 0.009), number of diseased vessels (5.6 [2.50 -12.50]; P Ͻ 0.001), and prior revascularization (17.5 [6.50 -46.90]; P Ͻ 0.001).CONCLUSIONS-This serial IVUS study suggests that progression of coronary artery disease in patients with type 2 diabetes may be mainly attributed to vessel shrinkage. Besides, vessel shrinkage is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis. Diabetes 58:209-214, 2009 C oronary artery remodeling is a phenomenon by which vessel dimension changes in response to atherosclerotic plaque accumulation. This concept was initially described by Glagov et al. (1) in a postmortem, histopathological study and confirmed by in vivo studies using intracoronary ultrasound (IVUS) analysis (2-7). Two different patterns of coronary remodeling have been described: a compensatory enlargement of the vessel in response to an increase of atherosclerotic plaque (positive remodeling) and a failure to enlarge or even vessel shrinkage (negative remodeling). The latter is a common finding in coronary stenosis of diabetic patients (8,9). In cross-sectional studies, negative remodeling has been associated with coronary risk factors, such as hypertension (5) and smoking (4), with the type of plaque (2,7) (calcified, hard plaques), and with metabolic control in diabetic patients (10 -12). In most studies, remodeling has been evaluated only at a single time point. Therefore, the natural history of this process has not been properly addressed. In addition, remodeling index has been assessed by comparing vessel dimension at target site and that at the most normal-looking cross-section within 10 mm from the lesion taken as reference segment (2-7). Howev...

No abstract

To evaluate the role of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in intravascular large B-cell lymphoma (IVLBCL), we retrospectively analyzed four consecutive IVLBCL patients receiving FDG-PET before treatment between May 2006 and November 2007. Patients were two men and two women (median age 62 years, range 54-76 years). All patients received bone marrow biopsies and random skin biopsies and two of the four patients underwent renal biopsy for diagnosis. Accuracy of FDG-PET for the detection of organ involvements was analyzed by comparing results of pathological findings. Concordant results with respect to bone marrow involvement were accurately obtained for two patients. Skin and renal involvements were undetectable by FDG-PET regardless of positive pathological findings. One patient with a false-negative FDG-PET result showed fewer lymphoma cells in the bone marrow specimen than patients with concordant FDG-PET results. These results suggest false-negative results for some types of organ involvement. Careful interpretation of the results of FDG-PET in IVLBCL is thus required.