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BACKGROUND: Coincidental extracardiac findings with increased perfusion were reported during myocardial perfusion imaging (MPI) with various retention radiotracers. Clinical parametric O-15-H 2O PET MPI yielding quantitative measures of myocardial blood flow (MBF) was recently implemented at our facility. We aim to explore whether similar extracardiac findings are observed using O-15-H 2O. METHODS AND RESULTS: All patients (2963) were scanned with O-15-H 2O PET MPI according to international guidelines and extracardiac findings were collected. In contrast to parametric O-15-H 2O MBF images, extracardiac perfusion was assessed using summed images. Biopsy histopathology and other imaging modalities served as reference standards. Various malignant lesions with increased perfusion were detected, including lymphomas, large-celled neuroendocrine tumour, breast, and lung cancer plus metastases from colonic and renal cell carcinomas. Furthermore, inflammatory and hyperplastic benign conditions with increased perfusion were observed: rib fractures, gynecomastia, atelectasis, sarcoidosis, pneumonia, chronic lung inflammation and fibrosis, benign lung nodule, chronic diffuse lung infiltrates, pleural plaques and COVID-19 infiltrates. CONCLUSIONS: Malignant and benign extracardiac coincidental findings with increased perfusion are readily visible and frequently seen on O-15-H 2O PET MPI. We recommend evaluating the summed O-15-H 2O PET images in addition to the low-dose CT attenuation images.

BACKGROUND: Primary percutaneous coronary intervention with implantation of a metallic drug-eluting stent (DES) is the standard treatment for patients presenting with ST-elevation myocardial infarction (STEMI). Implantation of a bioresorbable scaffold (BRS) during STEMI represents a novel strategy without intravascular metal.OBJECTIVE: The aim of the study was to investigate 12-month healing response in an STEMI population after implantation of either the Absorb BRS or Xience DES (Abbott Vascular, USA).METHODS: The present trial was a prospective, randomized, controlled, nonblinded, noninferiority study with planned inclusion of 120 patients with STEMI. Patients were randomly assigned 1:1 to treatment with Absorb BRS or Xience DES. Implantation result and healing response were evaluated by angiography and optical coherence tomography (OCT) at baseline and 12-month follow-up. The primary endpoint was minimum flow area (MFA) assessed at 12 months. Coronary stent healing index (CSHI) was calculated from OCT images.RESULTS: Out of 66 included patients, 58 had follow-up OCT after 12 months, and 49 entered matched analysis. One death occurred in each group; none were stent-related. MFA was 5.13 ± 1.70 mm2 (95% CI, 4.44-5.82) in the BRS group compared with 6.30 ± 2.49 mm2 (95% CI, 5.22-7.37) (P = 0.06) in the DES group. Noninferiority could not be evaluated. CSHI for both groups had a median score of 3.CONCLUSION: The DES group performed numerically better in primary and secondary endpoints, but the CSHI showed good stent healing in both groups.

Coincidental extracardiac findings with increased perfusion were reported during myocardial perfusion imaging (MPI) with various retention radiotracers. Clinical parametric O-15-HAll patients (2963) were scanned with O-15-HMalignant and benign extracardiac coincidental findings with increased perfusion are readily visible and frequently seen on O-15-H

Objectives The aims of this study were to characterize cardiac allograft vasculopathy (CAV) phenotypes using optical coherence tomography (OCT) and to evaluate the prognostic significance of OCT-determined CAV severity. Background Intravascular OCT enables in vivo characterization of CAV microstructure after heart transplantation. Methods Sixty-two patients undergoing heart transplantation were enrolled at routine angiography from September 2013 through October 2015 and prospectively followed until censoring on May 27, 2016. Optical coherence tomographic acquisitions aimed for the longest possible pull-backs, including proximal segments of all 3 major vessels. Plaques and bright spots were analyzed by delineating circumferential borders and measuring the angulation of total circumference. Layers were contoured for absolute and relative estimates. Nonfatal CAV progression (NFCP) during follow-up was registered. NFCP included occluded vessels or severe (≥70%) new angiographic coronary stenosis or percutaneous coronary intervention. Results A total of 172 vessels were categorized as follows: no CAV, n = 111; mild to moderate CAV ( Conclusions OCT enables the detection of CAV-associated plaque compositions and allows early detection and differentiation of vessel wall disease not visible on angiography. LFP was the most prevalent plaque component, was strongly associated with NFCP, and may be associated with stepwise CAV progression caused by organizing mural thrombi. (The GRAFT Study: Evaluation of Graft Function, Rejection and Cardiac Allograft Vasculopathy in First Heart Transplant Recipients; NCT02077764)

Objectives: To compare on the bench the physical and mechanical properties of Magmaris, a magnesium bioresorbable scaffold (BRS), with Absorb and DESolve polymeric BRS and a permanent metallic stent. Background: Understanding the mechanical and physical properties of BRS is crucial for appropriate implantation and postdilatation. Methods: Testing was performed in fluid at 37°C and in silicone bifurcation phantoms with a 30° angle between main branch (MB) and side branch. Results: The 3.0-mm Magmaris BRS did not fracture after MB postdilatation up to 4.4 mm in contrast to the Absorb where the safe postdilatation diameter was 3.7 mm. For dilatation through stent cells, there were no Magmaris fractures with 3.0-mm noncompliant (NC) balloons inflated to nominal pressure. Mini-kissing balloon postdilatation with two 3.0-mm NC balloons up to 17 atm was without fracture except for an outlier. Longitudinal and radial strengths were similar for Magmaris and Absorb BRS. The crossing profile for the Magmaris was larger than other devices. Recoil 120 min after deployment was the greatest for Magmaris but 120 min after 3.5 mm postdilatation all devices had similar diameters. Conclusions: The Magmaris BRS was more resistant to strut fracture than Absorb. It had a larger crossing profile than other devices and similar radial and longitudinal strengths to Absorb. While recoil after deployment was greater with Magmaris, 120 min after 3.5 mm postdilatation all devices had similar diameters.

We aimed to evaluate feasibility, early healing and self-correcting properties of the Desolve 150 bioresorbable scaffold (BRS) implanted in bifurcation lesions, using the simple, provisional side branch (SB) stenting technique. BIFSORB pilot was a proof-of-concept study enrolling 10 patients with stable angina pectoris and a bifurcation lesion with SB ≥ 2.5 mm and less than 50% diameter stenosis. Procedure and 1-month outcome was evaluated by optical coherence tomography (OCT) to assess scaffold performance and healing patterns. Nine patients were treated with Desolve 150 BRS and one delivery to the target bifurcation failed. Thrombus formation in the jailed SB ostium was seen in three cases, but was completely resolved at 1-month. OCT confirmed acute self-correcting properties. No clinical events were reported after six months. Scaffold diameter by OCT increased in the proximal main vessel from 3.09 ± 0.16 mm to 3.34 ± 0.18 mm (p = 0.01) and in distal main vessel from 2.82 ± 0.26 mm to 3.02 ± 0.29 mm (p

OBJECTIVES: To confirm clinically that coronary balloon catheter tips may be damaged during bifurcation treatment with side-branch access through the side of a stent. On the bench, we aimed to assess the susceptibility of different balloon designs to damage. We compared catheter tip widths. We tested whether balloon tip flaring can cause stent distortion.BACKGROUND: We had observed that balloon catheters that failed to cross to a side-branch frequently exhibited tip damage.METHODS AND RESULTS: We examined microscopically for damage 82 balloon tips after clinical side-branch access. In a bench study, the forces required to compress catheter tips 0.5 mm were compared to assess susceptibility to damage. We compared tip widths of balloons of different nominal inflation diameters. We examined stents after side-branch access for distortion. In 42 of 48 (88%) of balloon tips from patients with resistance to or failure to cross through the side of a stent there was tip damage. Even when the balloon crossed without perceptible resistance, tip damage occurred in over half of balloons 18/34 (53%). Some balloon designs were more resistant to damage than others. Tips from balloons of different nominal diameters from the same manufacturer had the same width. Stent distortion caused by damaged balloon tips is improved by kissing balloon post-dilatation.CONCLUSIONS: Balloon tip damage is common with crossing between stent struts. This is one cause of failure of a balloon to access a side-branch and a new balloon should be used. If stent distortion is suspected, it should be corrected with kissing balloon post-dilatation.

Optical coherence tomography (OCT) may provide important mechanistic information in restenosis after treatment using bioresorbable scaffolds (BRS). Here, we present the signature findings by OCT of a novel magnesium BRS with in-segment restenosis 7 months postimplantation. A 65-year-old male presenting with stable angina was treated for a 95% stenosis in the proximal left anterior descending artery. The lesion was predilated with a semicompliant balloon 2.5×12 mm and a scoring balloon 3.0×13 mm before implanting a 3.5×15 mm magnesium BRS (Magmaris; Biotronik AG, Bulach, Switzerland) carefully sized by OCT. The magnesium BRS was postdilated using a 3.75×8 mm noncompliant balloon. Final angiography and OCT showed good expansion and apposition of the scaffold without …

Three-dimensional (3D) intravascular optical coherence tomography (OCT) is available for online guiding during percutaneous coronary intervention and could be of particular value in detection of acute stent fracture (SF). OCT artifacts mimicking fractured stent struts are a limitation for this

PURPOSE: Coronary angiography provides no details on underlying pathology in acute coronary syndromes (ACS). Optical coherence tomography (OCT) can visualize coronary atherosclerosis, thrombus formation, and plaque rupture in patients with myocardial infarction (MI) where coronary angiography is unclear.MATERIALS AND METHODS: We present a case series containing 6 young patients with ACS, 4 of them due to non-obstructive thrombus, in whom the operators refrained from stent implantation despite an identifiable culprit lesion with OCT-validated thrombus formation.RESULTS: The median age was 31.5 years. In 4 of these 6 patients, no invasive intervention was performed while the remaining 2 patients underwent thrombus aspiration and balloon angioplasty without stent implantation. Four patients were examined at the primary evaluation and all patients were examined by OCT between 3-5 days after initial examination. This short-term follow up with OCT showed non-obstructive thrombus formation in all patients with varying degrees of thrombus resolution. No adverse cardiac events were reported after a median follow up of 5.5 months.CONCLUSIONS: OCT can visualize thrombus formation in young ACS patients with non-obstructive thrombus or following thrombus reduction by aspiration and balloon dilatation. These patients seems safely treated with a conservative medical approach rather than with stent implantation.

The aims of this study were to characterize cardiac allograft vasculopathy (CAV) phenotypes using optical coherence tomography (OCT) and to evaluate the prognostic significance of OCT-determined CAV severity.Intravascular OCT enables in vivo characterization of CAV microstructure after heart transplantation.Sixty-two patients undergoing heart transplantation were enrolled at routine angiography from September 2013 through October 2015 and prospectively followed until censoring on May 27, 2016. Optical coherence tomographic acquisitions aimed for the longest possible pull-backs, including proximal segments of all 3 major vessels. Plaques and bright spots were analyzed by delineating circumferential borders and measuring the angulation of total circumference. Layers were contoured for absolute and relative estimates. Nonfatal CAV progression (NFCP) during follow-up was registered. NFCP included occluded vessels or severe (≥70%) new angiographic coronary stenosis or percutaneous coronary intervention.A total of 172 vessels were categorized as follows: no CAV, n = 111; mild to moderate CAV (70% stenosis), n = 40; and severe CAV (≥70% stenosis), n = 21. Layered fibrotic plaque (LFP) was the most prevalent plaque component, and the extent increased with angiographic CAV severity (p 0.01). During follow-up, 22 of 172 vessels (13%) experienced NFCP. Median follow-up was 633 days (interquartile range: 432 to 808 days). The extent of LFP (hazard ratio: 5.0; 95% confidence interval: 2.1 to 12.4; p 0.0001) and the extent of bright spots (hazard ratio: 6.2; 95% confidence interval: 2.4 to 15.8, p 0.001) were strong predictors of NFCP. By combining LFP and bright spots, a strong NFCP predictive model was obtained (hazard ratio: 8.9; 95% confidence interval: 2.6 to 29.9; p 0.0001).OCT enables the detection of CAV-associated plaque compositions and allows early detection and differentiation of vessel wall disease not visible on angiography. LFP was the most prevalent plaque component, was strongly associated with NFCP, and may be associated with stepwise CAV progression caused by organizing mural thrombi. (The GRAFT Study: Evaluation of Graft Function, Rejection and Cardiac Allograft Vasculopathy in First Heart Transplant Recipients; NCT02077764).

Understanding the mechanical and structural properties of bioresorbable scaffolds (BRS) is crucial for appropriate implantation. We compared the mechanical and physical properties of the magnesium BRS, Magmaris (Biotronik, Bulach, Switzerland) with the Absorb BRS (Abbott Vascular, Santa Clara, CA