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Aims Despite growing evidence supporting the clinical utility of optical coherence tomography (OCT) guidance during percutaneous coronary interventions (PCIs), there is no common agreement as to the optimal stent implantation parameters that enhance clinical outcome. Methods and results We retrospectively examined the predictive accuracy of suboptimal stent implantation definitions proposed from the CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA studies for the long-term risk of device-oriented cardiovascular events (DoCE) in the population of large all-comers CLI-OPCI project. A total of 1020 patients undergoing OCT-guided drug-eluting stent implantation in the CLI-OPCI registry with a median follow-up of 809 (quartiles 414–1376) days constituted the study population. According to CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA criteria, the incidence of suboptimal stent implantation was 31.8%, 58.1%, and 57.8%, respectively. By multivariable Cox analysis, suboptimal stent implantation criteria from the CLI-OPCI II [hazard ratio 2.75 (95% confidence interval 1.88–4.02), P < 0.001] and ILUMIEN-IV OPTIMAL PCI [1.79 (1.18–2.71), P = 0.006] studies, but not FORZA trial [1.11 (0.75–1.63), P = 0.597], were predictive of DoCE. At long-term follow-up, stent edge disease with minimum lumen area <4.5 mm2 [8.17 (5.32–12.53), P < 0.001], stent edge dissection [2.38 (1.33–4.27), P = 0.004], and minimum stent area <4.5 mm2 [1.68 (1.13–2.51), P = 0.011] were the main OCT predictors of DoCE. Conclusion The clinical utility of OCT-guided PCI might depend on the metrics adopted to define suboptimal stent implantation. Uncovered disease at the stent border, stent edge dissection, and minimum stent area <4.5 mm2 were the strongest OCT associates of stent failure. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to assess the morphological characteristics and prognostic implications of the optical coherence tomography (OCT)-derived lipid core burden index (LCBI). Methods and results OCT-LCBI was assessed in 1003 patients with 1-year follow-up from the CLIMA multicentre registry using a validated software able to automatically obtain a maximum OCT-LCBI in 4 mm (maxOCT-LCBI4mm). Primary composite clinical endpoint included cardiac death, myocardial infarction, and target-vessel revascularization. A secondary analysis using clinical outcomes of CLIMA study was performed. Patients with a maxOCT-LCBI4mm ≥ 400 showed higher prevalence of fibrous cap thickness (FCT) <75 μm [odds ratio (OR) 1.43, 95% confidence interval (CI) 1.03–1.99; P = 0.034], lipid pool arc >180° (OR 3.93, 95%CI 2.97–5.21; P < 0.001), minimum lumen area <3.5 mm2 (OR 1.5, 95%CI 1.16–1.94; P = 0.002), macrophage infiltration (OR 2.38, 95%CI 1.81–3.13; P < 0.001), and intra-plaque intimal vasculature (OR 1.34, 95%CI 1.05–1.72; P = 0.021). A maxOCT-LCBI4mm ≥400 predicted the primary endpoint [adjusted hazard ratio (HR) 1.86, 95%CI 1.1–3.2; P = 0.019] as well as the CLIMA endpoint (HR 2.56, 95%CI 1.24–5.29; P = 0.011). Patients with high lipid content and thin FCT < 75 µm were at higher risk for adverse events (HR 4.88, 95%CI 2.44–9.72; P < 0.001). Conclusions A high maxOCT-LCBI4mm was related to poor outcome and vulnerable plaque features. This study represents a step further in the automated assessment of the coronary plaque risk profile. [ABSTRACT FROM AUTHOR]

Since its ability to precisely characterized atherosclerotic plaque phenotypes, to tailor stent implantation, as well as to guide both complex percutaneous coronary interventions (PCI) and invasive diagnostic work-ups (e.g., spontaneous coronary dissections or myocardial infarction with non-obstructive arteries), the adoption of optical coherence tomography (OCT) was raised in the past decades in order to provide complementary information to the traditional angiography and to overcome its limitations. However, the impact of OCT on daily clinical practice is currently modest, firstly because of the lack of both standardized algorithms of PCI guidance and data from prospective clinical trials. Therefore, the aim of our narrative review is to provide a comprehensive overview of the basic OCT interpretation, to summarize the evidence supporting the OCT guidance procedures and applications, to discuss its current limitations, and to highlight the knowledge gaps that need to be filled with more robust evidence. [ABSTRACT FROM AUTHOR]

Background: The distal radial approach was recently introduced with the hope to improve patients' comfort, particularly during left wrist access and maybe to reduce the rate of complications (mainly radial artery occlusion). However up to now, little is known about the real incidence and type of complications related to this access site.Case Presentation: We report the case of a left distal radial pseudoaneurysm complicating a successful percutaneous recanalization of a right coronary artery chronic total occlusion with bilateral wrist approach (right radial artery retrograde and left distal radial artery antegrade). This complication was successfully resolved by percutaneous thrombin injection.Conclusion: Our case proves that dTRA is not free from conventional vascular complications and this should be considered during the planning of the best strategy for our patients. [ABSTRACT FROM AUTHOR]

Background: Bioresorbable scaffold (BRS) have the aim to combine short-term radial force by vessel scaffold (which should dissolve after few months), with drug eluting capability. It has been hypothesized that complete resorption would result in restoration of vasomotion, reduction in angina and reduction of restenosis.Case Presentation: We report a case of 7 years angiographic follow up after DESolve Novolimus eluting Bioresorbable Coronary Scaffold System implantation.Conclusion: The invasive control showed persistence of scaffold patency and evidence of restored vascular motility by the growing in vessel diameter at QCA control after nitrates administration. [ABSTRACT FROM AUTHOR]

Background: Percutaneous Coronary Interventions (PCI) of chronic total occlusions (CTOs) represent one of the most complex procedure in the whole spectrum of PCI. In the last years the success rate of CTO-PCI has improved because of the evolution in materials and in CTO-techniques. For most CTO operators, the choice of the vascular access has been driven by the desire to achieve a high success-rate. The trans-femoral access allows the use of larger caliber guide catheters with increased passive support and may help to achieve a better procedural success. Recently, the use of bi-radial approach has gained popularity, supported by evidence of non-inferiority versus the bifemoral/radial-femoral approach. At present, very limited data are available concerning the use of trans-ulnar access for this complex setting of PCI.Case Presentation: In the present manuscript, we describe in detail a case series of patients undergoing CTO PCI, with limited options in vascular access and resolved with trans-ulnar approach.Conclusions: Our case series shows the safety and feasibility of transulnar approach in CTO-PCI. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) and acute myocardial infarction (AMI) are the leading causes of death worldwide. Since only a subset of CAD patients develops myocardial infarction, it is likely that unique factors predispose to AMI. Circulating microRNAs represent diagnostic powerful biomarkers for detection of heart injuries and patients’ risk stratification. Using an array-based approach, the expression of 84 circulating miRNAs was analyzed in plasma of pooled stable CAD patients (CAD; n = 5) and unstable CAD patients (AMI_T0; n = 5) enrolled within 24 hours from an AMI event. The array experiments showed 27 miRNAs differentially expressed with a two-fold up- or down-regulation (10 up- and 17 down-regulated miRNAs). Among them, miR-423-5p dis-regulation was confirmed in a larger case study (n = 99). Circulating miR-423-5p resulted to be significantly down-regulated within 24 hours from the AMI event (FC = -2, p≤0.05). Interestingly, miR-423-5p expression resulted to be increased (FC = +2; p≤0.005) in a subgroup of the same AMI patients (AMI_T1; n = 11) analyzed after 6 months from the acute event. We extended miR-423-5p expression study on PBMCs (peripheral blood mononuclear cells), confirming also in this tissue its up-regulation at 6 months post-AMI. Receiver operating characteristic analyses (ROC) were performed to detect the power of miR-423-5p to discriminate stable and unstable CAD. In plasma, miR-423-5p expression accurately distinguishes stable and unstable CAD patients (AUC = 0.7143, p≤0.005). Interestingly, the highest discriminatory value (AUC = 0.8529 p≤0.0005) was identified in blood cells, where miR-423-5p expression is able to differentiate unstable CAD patients during an acute event (AMI_T0) from those at six months post-AMI (AMI_T1). Furthermore, cellular miR-423-5p may discriminate also stable CAD patients from unstable CAD patients after six months post-AMI (AUC = 0.7355 p≤0.05). The results of this pilot-study suggest that miR-423-5p expression level both in plasma and blood cells, could represent a new promising biomarker for risk stratification of CAD patients. [ABSTRACT FROM AUTHOR]

The ability of optical coherence tomography (OCT) to recognize intraplaque macrophage infiltration is now well acknowledged. This post-hoc analysis of the CLIMA study aimed to address the clinical impact of the circumferential extension of OCT-defined macrophages and their location at one year follow-up. The multicentre CLIMA study enrolled 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending (LAD) coronary artery. Measurements of circumferential extension of macrophages and measurements of the distance from intima-lumen contour to macrophages string were performed at the plaque cross-section judged as containing the greatest amount of macrophages. The main study endpoint was a composite of cardiac death, myocardial infarction (MI) and/or target vessel revascularization (TVR). Patients with large macrophage arc (p = 0.001) and superficial macrophage arc (p < 0.001) showed a higher one-year incidence of the main one-year composite endpoint. Consistently hypertension (p = 0.018), family history of CAD (p = 0.046), diabetes mellitus (p = 0.036), lower ejection fraction (p = 0.009) and chronic kidney disease (p = 0.019) were more frequently found in patients experiencing the main composite endpoint. At multivariate Cox regression analysis, fibrous cap thickness < 75 μm (HR 2.51, 95% 1.46–4.32), presence of large (HR 1.97, 95%CI 1.16–3.35, p = 0.012) and superficial (HR 1.72, 95%CI 1.02–2.90; p = 0.040) macrophage arc remained independent predictors of the main composite endpoint. Large macrophage arc was associated with target LAD related MI. The present post-hoc analysis of the CLIMA showed that the circumferential extension of macrophages and their location are related to a composite endpoint of cardiac death, MI and/or TVR. • Patients with intraplaque macrophages have higher risk of 1-year cardiac mortality. • Patients with large/superficial macrophage arc suffer more from 1-year cardiac events. • Large macrophage infiltration is associated with 1-year target LAD related MI. [ABSTRACT FROM AUTHOR]