First case of stenting of a vulnerable plaque in the SECRITT I trial—the dawn of a new era?

Ramcharitar, Steve; Gonzalo, Nieves; Geuns, Robert Jan van; García‐García, Héctor M.; Wykrzykowska, Joanna J.; Ligthart, Jürgen; Regar, Evelyn; Serruys, Patrick W.

doi:10.1038/nrcardio.2009.34

Cited by 41 publications

(21 citation statements)

References 21 publications

(16 reference statements)

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“…It was proposed that the growth of neointima tissue on the top of a vulnerable plaque might increase the thickness of the fibrous cap [103,110,111]. Brugaletta et al [112] reported the ability of bioresorbable vascular scaffold (BVS) implantation to promote the growth of neointimal tissue, which acts as a barrier to isolate vulnerable plaques.…”

Section: Optimizing Percutaneous Coronary Intervention Proceduresmentioning

confidence: 99%

“…The NIRS lipid signal could not distinguish neoatherosclerosis from fibroatheroma underlying the stent. No doubt that NIRS can detect coronary LCP, but it seems unlikely suitable as a standalone technique for accurate neoatherosclerosis detection and that the adjunction of IVUS or OCT will be required to determine the position of NIRS lipid signal relative to the underlying stent struts [110].…”

Section: Optimizing Percutaneous Coronary Intervention Proceduresmentioning

confidence: 99%

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Near-Infrared Spectroscopy (NIRS): A Novel Tool for Intravascular Coronary Imaging

Bertrand¹,

Lavoie-L'Allier²,

Jean-ClaudeTardif³

2017

Developments in Near-Infrared Spectroscopy

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Acute coronary syndrome (ACS) arising from plaque rupture is the leading cause of mortality worldwide. Near-infrared spectroscopy (NIRS) combined with intravascular ultrasound (NIRS-IVUS) is a novel catheter-based intravascular imaging modality that provides a chemogram of the coronary artery wall, which enables the detection of lipid core and specific quantification of lipid accumulation measured as the lipid-core burden index (LCBI) in patients undergoing coronary angiography. Recent studies have shown that NIRS-IVUS can identify vulnerable plaques and vulnerable patients associated with increased risk of adverse cardiovascular events, whereas an increased coronary plaque LCBI may predict a higher risk of future cardiovascular events and periprocedural events. NIRS is a promising tool for the detection of vulnerable plaques in CAD patients, PCI-guidance procedures, and assessment of lipid-lowering therapies. Previous trials have evaluated the impact of statin therapy on coronary NIRS defined lipid cores, whereas NIRS could further be used as a surrogate end point of future ACS in phase II clinical trials evaluating novel anti-atheromatous drug therapies. Multiple ongoing studies address the different potential clinical applications of NIRS-IVUS imaging as a valuable tool for coronary plaque characterization and predictor of future coronary events in CAD patients.

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Section: Optimizing Percutaneous Coronary Intervention Proceduresmentioning

confidence: 99%

Section: Optimizing Percutaneous Coronary Intervention Proceduresmentioning

confidence: 99%

Near-Infrared Spectroscopy (NIRS): A Novel Tool for Intravascular Coronary Imaging

Bertrand¹,

Lavoie-L'Allier²,

Jean-ClaudeTardif³

2017

Developments in Near-Infrared Spectroscopy

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“…Currently, local therapy for potentially vulnerable plaques is not recommended because of lack of evidence of efficacy, 12 although pilot studies using a "luminal shield" to stabilize VH-IVUSdefined vulnerable plaques have been positive. 13 A widespread change in clinical practice would require that VH-IVUS plaque classification does not vary significantly between operators, and is similar to core-laboratory analysis used for VH-IVUS validation.…”

Section: Clinical Perspective On P 93mentioning

confidence: 99%

Identification of Coronary Plaque Sub-Types Using Virtual Histology Intravascular Ultrasound Is Affected by Inter-Observer Variability and Differences in Plaque Definitions

Obaid

Calvert²,

McNab³

et al. 2012

Circ: Cardiovascular Imaging

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Background-Recent studies show that virtual histology intravascular ultrasound (VH-IVUS) can identify plaques at high risk of rupture, such as thin-capped fibroatheromata, raising the possibility of immediate targeted intervention. However, plaque classification entails border recognition and subjective assessment of plaque architecture, introducing interobserver variability without confirmation by core-labs. Furthermore, the accuracy of local versus core-laboratory VH-IVUS plaque classification and effects of different plaque definitions have not been examined. Methods and Results-Local observers classified 100 VH-IVUS-defined coronary plaques to determine single center inter-observer variability; multi-center variability was determined by comparison with VH-IVUS core-laboratory analysis, and compared with gray-scale IVUS. Frequency of plaque types using different published plaque definitions also was determined. Single-center VH-IVUS inter-observer agreement was strong (kappaϭ0.86), but lower for thin-capped fibroatheromatas (kϭ0.59) because of observer judgments on presence and location of confluent necrotic core. Multi-center inter-observer agreement for plaque classification was lower again (kϭ0.71), particularly for thin-capped fibroatheromatas (kϭ0.56). Different plaque definitions further reduced VH-IVUS-defined thin-capped fibroatheromata numbers by 44%. The diagnostic accuracy of gray-scale IVUS to identify thin-capped fibroatheromata was poor for both observers (21 and 29% correct), with low inter-observer agreement (kϭ0.14). Conclusions-VH-IVUS

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“…A new stent design with self-expanding, ultrathin struts is currently being evaluated in patients with nonobstructive TCFA, with encouraging preliminary results. 20 If proven to be of significant value, this invasive approach may well be considered as a complementary treatment strategy for patients diagnosed with high-risk TCFA by noninvasive methods. Only strict, randomized clinical studies may help us to elucidate this issue.…”

Section: What Is Next?mentioning

confidence: 99%

The High-Risk Thin-Cap Fibroatheroma

Moreno

2009

Circ: Cardiovascular Interventions

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First case of stenting of a vulnerable plaque in the SECRITT I trial—the dawn of a new era?

Abstract: Six months of follow-up has demonstrated that a patient with an IVUS-derived, thin capped fibroatheroma was successfully treated with a stent tailored to shield vulnerable plaques.

Cited by 41 publications

References 21 publications

Near-Infrared Spectroscopy (NIRS): A Novel Tool for Intravascular Coronary Imaging

Near-Infrared Spectroscopy (NIRS): A Novel Tool for Intravascular Coronary Imaging

Identification of Coronary Plaque Sub-Types Using Virtual Histology Intravascular Ultrasound Is Affected by Inter-Observer Variability and Differences in Plaque Definitions

The High-Risk Thin-Cap Fibroatheroma

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