Intravascular Ultrasound

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Intravascular Ultrasound"

Transcription

1 May 2008 Beth Israel Deaconess Medical Center Harvard Medical School Intravascular Ultrasound Matthew Altman, HMS III Gillian Lieberman, MD BIDMC Department of Radiology

2 Presentation Overview 1. Patient presentation, RG 2. Overview of intravascular ultrasound (IVUS) 3. Patient RG workup, diagnosis, and treatment 4. Utility and clinical indications of IVUS 5. Research uses of IVUS 6. Recent advancements and future directions of IVUS 7. Summary

3 Patient RG RG is a 73 year old gentleman with classic angina on exertion. Coronary angiography at an outside hospital showed significant coronary lesions in the left anterior descending (LAD), left circumflex (LCx), and elsewhere. There was a question of a left main coronary artery (LMCA) lesion in the left coronary ostium but it could not be adequately visualized by angiography. He was referred to the Beth Israel Deaconess Medical Center (BIDMC) for possible coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI).

4 Our patient RG: Left coronary artery branches on coronary angiogram LCx LAD Green arrows demonstrate luminal narrowings in the LAD and LCx. Image courtesy of New England Baptist Hospital

5 Our patient RG: Additional view of left coronary artery branches on coronary angiogram LCx Green arrow demonstrates a luminal narrowing in the LCx. Image courtesy of New England Baptist Hospital

6 Our patient RG: View of the LMCA on coronary angiogram LMCA Green arrow points to a possible lesion in the ostium of the LMCA. However it could not be adequately visualized on coronary angiography given the catheter insertion. Image courtesy of New England Baptist Hospital

7 Our patient RG: Treatment considerations Given the distal coronary artery lesions and a question of a LMCA lesion, PCI and CABG were both considered as possible treatment options. Thus RG was referred to BIDMC for further evaluation of the LMCA. IVUS was selected as the modality of choice to evaluate the LMCA. A general overview of IVUS follows before we look at the images from our patient RG.

8 Intravascular Ultrasound (IVUS) overview IVUS uses a miniature ultrasound transducer affixed to a flexible intravascular catheter to visualize arteries. There are 3 different devices in use: Mechanical catheter: A single transducer rotates (1800rpm) to visualize a vessel in cross section. Typically a 40MHz transducer with a resolution of ~ microns is used. The drive shaft has limited flexibility and is difficult to advance into distal coronary vessels. Phased array catheter: Multiple transducer elements are mounted along the circumference of the catheter tip to visualize a vessel in cross section. It requires complex software to combine images, and typically images are of lower quality than with a mechanical catheter. The catheter is more flexible than a mechanical catheter. Timed pullback sled : A device to pullback the catheter at a slow, fixed speed. Allows creation of a longitudinal image of the vessel in any plane.

9 Images of IVUS devices An IVUS pullback sled 2 The IVUS unit 1 Cross sectional image of a coronary artery Image courtesy of BIDMC

10 IVUS image of a coronary artery with a calcified lesion The general principles of ultrasonography apply to IVUS. Catheter: Middle of image Blood: Cellular, leading to backscatter, speckled pattern. Intima: Normally 1-2 cell layers and echoic. Enlarges in atherosclerotic disease. Media: Homogenous smooth muscle, minimal echogenicity. Adventitia: Numerous parallel collagen fibers, creating echogenic surfaces. Calcium: Highly echogenic with distal shadowing. * Image courtesy of BIDMC

11 Back to our patient RG: IVUS imaging An IVUS catheter was advanced several millimeters in the LAD, and a timed pullback through the LAD, LMCA, and into the aorta was performed. One reconstructed longitudinal image and then several selected cross sectional images follow.

12 Our patient RG: Longitudinal view of the proximal LAD and LMCA on IVUS (bottom image) image courtesy of BIDMC

13 Our patient RG: Several millimeters distal in the LAD LAD lumen image courtesy of BIDMC

14 Our patient RG: More proximal in the LAD Calcified LAD lesion image courtesy of BIDMC

15 Our patient RG: Proximal LAD image courtesy of BIDMC

16 Our patient RG: LAD and LCx bifurcation LCx LAD image courtesy of BIDMC

17 Our patient RG: Distal LMCA image courtesy of BIDMC

18 Our patient RG: Mid LMCA Small LMCA lesion image courtesy of BIDMC

19 Our patient RG: Proximal LMCA Calcified LMCA lesion image courtesy of BIDMC

20 Our patient RG: Ostium of the LMCA image courtesy of BIDMC

21 Our patient RG: Additional view of the LMCA ostium with contrast Calcified LMCA lesion Aorta image courtesy of BIDMC

22 Our patient RG: Additional view of the Proximal/Ostium LMCA with contrast Calcified LMCA lesion image courtesy of BIDMC

23 Our patient RG: LMCA lumen cross sectional areas Mid-LMCA Ostium of LMCA ~14 mm 2 ~5-7 mm 2 Normal 15 mm 2 Images courtesy of BIDMC

24 Our Patient RG: Treatment Given the lesion in the ostium of the LMCA, RG was referred for CABG. A discussion of the utility and clinical indications of IVUS follows.

25 Specific advantages of IVUS over other imaging modalities Detailed assessment of plaque morphology and size Determination of plaque composition, in particular calcium versus collagen Measurement of intimal thickness Measurement of both intraluminal and extraluminal vessel diameters

26 Clinical Indications Class IIA indications according to the ACC/AHA taskforce: Diagnostic Following angiography to evaluate a coronary obstruction that is difficult to image. To assess coronary calcium when adjunctive rotational atherectomy is contemplated. To assess plaque location and circumferential distribution in anticipation of directional coronary atherectomy. Interventional (post-stenting) Following percutaneous intervention (PCI) after a suboptimal angiographic result. Following stenting to assess adequacy of deployment (extent of stent apposition and minimal luminal diameter). To determine the mechanism of in-stent restenosis to guide therapy. Class IIB indications (ACC/AHA taskforce): To assess a symptomatic patient with no evidence of significant coronary disease on angiography. Following diagnostic angiography to assess lesion characteristics to aid in device selection. Following cardiac transplantation to aid in assessment of coronary disease. (Smith SC et al., 2006)

27 Research History and Utility (1) IVUS was first developed in the 1980s and has contributed greatly to our understanding of coronary disease processes. Natural history of coronary atherosclerosis Confirmed the presence of disease beginning in the 2nd and 3rd decades of life, well before symptom onset. (Tuzcu EM et al., 2001) Demonstrated that atherosclerosis is a diffuse process rather than focal. (Mintz GS et al., 1995) Demonstrated that outward expansion (remodeling) occurs in the early phases of coronary atherosclerosis prior to luminal narrowing. (Schoenhagen P et al., 2001) Distinguished various types of lesions with different risk implications. For example that lesions with expansive remodeling generally contain greater amounts of metalloproteinases and are more likely to result in acute coronary syndrome (ACS) than lesions with constrictive remodeling, which are more likely to result in stable angina pectoris. (Naghavi M, et al. 2003) Helped define plaque vulnerability (eg. thin cap with a large lipid core). (Nicholls SJ et al., 2006)

28 Research History and Utility (2) Mechanisms and prevention of restenosis Demonstrated that there are 3 distinct mechanisms contributing to restenosis after PCI arterial recoil, vessel remodeling, and neointimal formation. (Weissman NJ, 2008) Helped determine distinct forms of post cardiac transplant vasculopathy. A donor-transmitted mechanism leading to focal intimal thickening, and an acquired mechanism injury leading to diffuse intimal thickening. (Eisen HJ and Ross H, 2008) Validated the beneficial impact of antiproliferative agents on the progression of restenosis after PCI. (Nicholls SJ et al., 2006)

29 Provided strong evidence that aggressive LDL-C lowering strategies with atorvastatin halted plaque progression. (Nissen SE et al., 2004 (1)) Demonstrated a continuous relationship between changes in C-reactive protein levels and atheroma volume. (Nissen SE, et al., 2005) Demonstrated that infusing reconstituted HDL led to plaque regression. (Chiesa G and Sirtori CR, 2003) Revealed a continuous relationship between lowering of systolic blood pressure and plaque volume, suggesting that improved blood pressure control even within the normal range (<140 mmhg) might lead to significant clinical benefit. (Nissen SE et al., 2004 (2)) Determined that some compounds under development appear to have a negative influence on plaque progression and should not be used clinically. Pactimibe, an inhibitor of A:cholesterol acyltransferase is an example. (Nicholls SJ et al., 2006) Research History and Utility (3) Secondary prevention Plaque progression by IVUS is becoming a primary end point in a number of clinical trials. While there is significant research to suggest that changes in coronary atheroma seen on IVUS are linked to clinical outcome, definitive proof is lacking.

30 Recent Technologic Advancements (1) Luminal surface: 5% glucose injection has been used as negative contrast to eliminate backscatter from blood cell. This allows a more detailed assessment of luminal surface, in particular for investigation of plaque fracture and dissection. (Honye J et al., 1999)

31 Recent Technologic Advancements (2) Plaque composition: Integrated Backscatter (IB) IVUS A technique under development that analyzes the IB signal from the transmitted radiofrequency (RF) signal to determine and color code plaque composition. (Kawasaki M et al., 2005)

32 Recent Technologic Advancements (3) Plaque composition: Virtual Histology (VH) IVUS A technique that measures both amount of returning RF signal and distortion of the RF signal to determine plaque composition. (Nair A et al., 2002)

33 Future Directions Research needs to correlate IVUS findings with clinical outcomes. IB IVUS and VH IVUS may help further define plaque composition to better evaluate plaque vulnerability, indications for therapy, and efficacy of prevention measures. IVUS used in combination with assessment of plaque temperature, compressibility, and optical coherence tomography may help evaluate for inflammation and atheroma stress points most at risk for rupture. IVUS used in conjunction with non-invasive imaging modalities under development including MR and CT imaging of coronaries may help follow atherosclerosis non-invasively when possible.

34 Thanks to Dr. Michael Nelson Dr. Joseph Carrozza John Schneider Dr. Gillian Lieberman Maria Levantakis BIDMC Department of Radiology

35 References Chiesa G and Sirtori CR. Apolipoprotein A-I (Milano): current perspectives. Curr Opin Lipidol. 2003; 14: Eisen HJ and Ross H. Natural history and diagnosis of cardiac transplant vasculopathy. In: UpToDate, Hunt SA (ED), UpTpDate, Wellesley, MA, Honye J, et al. Clinical utility of negative contrast intravascular ultrasound to evaluate plaque morphology before and after coronary interventions. Am J Cardiol 1999 Mar 1;83(5): Kawasaki M, et al. Volumetric quantitative analysis of tissue characteristics of coronary plaques after statin therapy using three-dimensional integrated backscatter intravascular ultrasound. J Am Coll Cardiol Jun 21;45(12): Mintz GS, et al. Atherosclerosis in angiographically "normal" coronary artery reference segments: an intravascular ultrasound study with clinical correlations. J Am Coll Cardiol. 1995; 25: Naghavi M, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I.Circulation Oct 7;108(14): Nair A, et al. Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation Oct 22;106(17): Nicholls SJ, et al. Intravascular ultrasound in cardiovascular medicine. Circulation Jul 25;114(4):e55-9. Nissen SE, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA. 2004; 291: (1) Nissen SE, et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA. 2004; 292: (2) Nissen SE, et al. Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease. N Engl J Med. 2005; 352: Schoenhagen P, et al. Arterial remodeling and coronary artery disease: the concept of "dilated" versus "obstructive" coronary atherosclerosis. J Am Coll Cardiol. 2001; 38: Smith SC Jr, et al. J Am Coll Cardiol 2006; 47:e1. Available at: (accessed May 15, 2008). Tuzcu EM, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation. 2001; 103: Weissman NJ. Technique and interpretation of intravascular (intracoronary) ultrasonography. In: UpToDate, Manning WJ (ED), UpToDate, Wellesley, MA, 2008.

Imaging Atheroma The quest for the Vulnerable Plaque

Imaging Atheroma The quest for the Vulnerable Plaque Imaging Atheroma The quest for the Vulnerable Plaque P.J. de Feijter 1. Department of Cardiology 2. Department of Radiology Coronary Heart Disease Remains the Leading Cause of Death in the U.S, Causing

More information

IVUS Analysis. Myeong-Ki. Hong, MD, PhD. Cardiac Center, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea

IVUS Analysis. Myeong-Ki. Hong, MD, PhD. Cardiac Center, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea IVUS Analysis Myeong-Ki Hong, MD, PhD Cardiac Center, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea Intimal disease (plaque) is dense and will appear white Media is made of

More information

Pathology of Coronary Artery Disease

Pathology of Coronary Artery Disease Pathology of Coronary Artery Disease Seth J. Kligerman, MD Pathology of Coronary Artery Disease Seth Kligerman, MD Assistant Professor Medical Director of MRI University of Maryland Department of Radiology

More information

IVUS Virtual Histology. Listening through Walls D. Geoffrey Vince, PhD The Cleveland Clinic Foundation

IVUS Virtual Histology. Listening through Walls D. Geoffrey Vince, PhD The Cleveland Clinic Foundation IVUS Virtual Histology Listening through Walls D. Geoffrey Vince, PhD Disclosure VH is licenced to Volcano Therapeutics Grant funding from Pfizer, Inc. Grant funding from Boston-Scientific Most Myocardial

More information

Evaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013

Evaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013 Evaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013 Disclosures Consultant- St Jude Medical Boston Scientific Speaker- Volcano Corporation Heart

More information

PCI for Left Anterior Descending Artery Ostial Stenosis

PCI for Left Anterior Descending Artery Ostial Stenosis PCI for Left Anterior Descending Artery Ostial Stenosis Why do you hesitate PCI for LAD ostial stenosis? LAD Ostial Lesion Limitations of PCI High elastic recoil Involvement of the distal left main coronary

More information

CLINICAL APPLICATIONS OF OPTICAL COHERENCE TOMOGRAPHY. Konstantina P. Bouki, FESC 2 nd Department of Cardiology General Hospital Of Nikea, Pireaus

CLINICAL APPLICATIONS OF OPTICAL COHERENCE TOMOGRAPHY. Konstantina P. Bouki, FESC 2 nd Department of Cardiology General Hospital Of Nikea, Pireaus CLINICAL APPLICATIONS OF OPTICAL COHERENCE TOMOGRAPHY Konstantina P. Bouki, FESC 2 nd Department of Cardiology General Hospital Of Nikea, Pireaus OPTICAL COHERENCE TOMOGRAPHY (OCT) IVUS and OCT IVUS OCT

More information

FFR and intravascular imaging, which of which?

FFR and intravascular imaging, which of which? FFR and intravascular imaging, which of which? Ayman Khairy MD, PhD, FESC Associate professor of Cardiovascular Medicine Vice Director of Assiut University Hospitals Assiut, Egypt Diagnostic assessment

More information

Basics of Angiographic Interpretation Analysis of Angiography

Basics of Angiographic Interpretation Analysis of Angiography Basics of Angiographic Interpretation Analysis of Angiography Young-Hak Kim, MD, PhD Cardiac Center, University of Ulsan College of Medicine, Seoul, Korea What made us nervous Supervisors Stent Contrast

More information

INSIDE INFORMATION YOU CAN T IGNORE

INSIDE INFORMATION YOU CAN T IGNORE INSIDE INFORMATION YOU CAN T IGNORE Volcano, the Volcano logo and SyncVision are registered trademarks of Volcano Corporation. All other trademarks set-forth are properties of their respective owners.

More information

Medical sciences 1 (2017) 1 9

Medical sciences 1 (2017) 1 9 Medical sciences 1 (2017) 1 9 TISSUE CHARACTERISTICS OF CULPRIT CORONARY LESIONS IN ACUTE CORONARY SYNDROME AND TARGET CORONARY LESIONS IN STABLE ANGINA PECTORIS: VIRTUAL HISTOLOGY AND INTRAVASCULAR ULTRASOUND

More information

Optical Coherence Tomography (OCT): A New Imaging Tool During Carotid Artery Stenting

Optical Coherence Tomography (OCT): A New Imaging Tool During Carotid Artery Stenting Chapter 6 Optical Coherence Tomography (OCT): A New Imaging Tool During Carotid Artery Stenting Shinichi Yoshimura, Masanori Kawasaki, Kiyofumi Yamada, Arihiro Hattori, Kazuhiko Nishigaki, Shinya Minatoguchi

More information

Ruofei Jia, Zening Jin, Hong Li, Jing Han. Introduction

Ruofei Jia, Zening Jin, Hong Li, Jing Han. Introduction Case Report Re-crossing the distal cell in bifurcation verified by using an enhanced stent visualization system and optical coherence tomography: a report of two cases Ruofei Jia, Zening Jin, Hong Li,

More information

2yrs 2-6yrs >6yrs BMS 0% 22% 42% DES 29% 41% Nakazawa et al. J Am Coll Cardiol 2011;57:

2yrs 2-6yrs >6yrs BMS 0% 22% 42% DES 29% 41% Nakazawa et al. J Am Coll Cardiol 2011;57: Pathology of In-stent Neoatherosclerosis in BMS and DES 197 BMS, 103 SES, and 106 PES with implant duration >30 days The incidence of neoatherosclerosis was significantly greater in DES (31%) than BMS

More information

Solving the Dilemma of Ostial Stenting: A Case Series Illustrating the Flash Ostial System

Solving the Dilemma of Ostial Stenting: A Case Series Illustrating the Flash Ostial System Volume 1, Issue 1 Case Report Solving the Dilemma of Ostial Stenting: A Case Series Illustrating the Flash Ostial System Robert F. Riley * and Bill Lombardi University of Washington Medical Center, Division

More information

Optical Coherence Tomography

Optical Coherence Tomography Optical Coherence Tomography Disclosure Information Demetrius Lopes MD The following relationships exist related to this presentation: University Grant/Research Support: Rush University Industry Grant

More information

The Site of Plaque Rupture in Native Coronary Arteries

The Site of Plaque Rupture in Native Coronary Arteries Journal of the American College of Cardiology Vol. 46, No. 2, 2005 2005 by the American College of Cardiology Foundation ISSN 0735-1097/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.03.067

More information

Insights in Thrombosis and In-Stent Restenosis

Insights in Thrombosis and In-Stent Restenosis Clinical Value of OCT Insights in Thrombosis and In-Stent Restenosis Fernando Alfonso MD, PhD, FESC Interventional Cardiology. Cardiovascular Institute. Clinico San Carlos University Hospital. Madrid.

More information

Utility of Image-Guided Atherectomy for Optimal Treatment of Ambiguous Lesions by Angiography

Utility of Image-Guided Atherectomy for Optimal Treatment of Ambiguous Lesions by Angiography Utility of Image-Guided Atherectomy for Optimal Treatment of Ambiguous Lesions by Angiography Jon C. George, MD; Vincent Varghese, DO From the Deborah Heart and Lung Center, Browns Mills, New Jersey. ABSTRACT:

More information

UNDERSTANDING ATHEROSCLEROSIS

UNDERSTANDING ATHEROSCLEROSIS UNDERSTANDING ATHEROSCLEROSIS UNDERSTANDING ATHEROSCLEROSIS ARTERIES Arteries are blood vessels that carry oxygenated blood to all the organs of the body. Arteries are made up of three important layers:

More information

Neointimal coverage of bare-metal and sirolimuseluting stents evaluated with optical coherence tomography

Neointimal coverage of bare-metal and sirolimuseluting stents evaluated with optical coherence tomography Neointimal coverage of bare-metal and sirolimuseluting stents evaluated with optical coherence tomography B X Chen, F Y Ma, W Luo, J H Ruan, W L Xie, X Z Zhao, S H Sun, X M Guo, F Wang, T Tian, X W Chu

More information

Carotid Intravascular Imaging Technique and Indication

Carotid Intravascular Imaging Technique and Indication Nurse and Technician Forum Carotid Intravascular Imaging Technique and Indication Gianmarco de Donato Assistant Professor Vascular and Endovascular Surgery University of Siena - Italy Disclosure Speaker

More information

Journal of the American College of Cardiology Vol. 46, No. 5, by the American College of Cardiology Foundation ISSN /05/$30.

Journal of the American College of Cardiology Vol. 46, No. 5, by the American College of Cardiology Foundation ISSN /05/$30. Journal of the American College of Cardiology Vol. 46, No. 5, 2005 2005 by the American College of Cardiology Foundation ISSN 0735-1097/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.06.009

More information

Review Article Optical Coherence Tomography Imaging in Acute Coronary Syndromes

Review Article Optical Coherence Tomography Imaging in Acute Coronary Syndromes SAGE-Hindawi Access to Research Cardiology Research and Practice Volume 2011, Article ID 312978, 7 pages doi:10.4061/2011/312978 Review Article Optical Coherence Tomography Imaging in Acute Coronary Syndromes

More information

Carotid Stenosis (carotid artery disease)

Carotid Stenosis (carotid artery disease) 1 Carotid Stenosis (carotid artery disease) Overview Carotid stenosis is a narrowing of the carotid arteries, the two major arteries that carry oxygenrich blood from the heart to the brain. Also called

More information

Sirolimus-Eluting Stents for Treatment of In-Stent Restenosis

Sirolimus-Eluting Stents for Treatment of In-Stent Restenosis Clinical Investigation Alfonso Medina, MD José Suárez de Lezo, MD Manuel Pan, MD Antonio Delgado, MD José Segura, MD Djordje Pavlovic, MD Francisco Melián, MD Miguel Romero, MD Federico Segura, MD Enrique

More information

Pathology of Vulnerable Plaque Angioplasty Summit 2005 TCT Asia Pacific, Seoul, April 28-30, 2005

Pathology of Vulnerable Plaque Angioplasty Summit 2005 TCT Asia Pacific, Seoul, April 28-30, 2005 Pathology of Vulnerable Plaque Angioplasty Summit 25 TCT Asia Pacific, Seoul, April 28-3, 25 Renu Virmani, MD CVPath, A Research Service of the International Registry of Pathology Gaithersburg, MD Plaque

More information

Analysis of neointimal coverage after silolimus-eluting stent implantation using optical coherence tomography.

Analysis of neointimal coverage after silolimus-eluting stent implantation using optical coherence tomography. Analysis of neointimal coverage after silolimus-eluting stent implantation using optical coherence tomography. Division of Cardiology, Department of Internal Medicine, Fasculty of Medicine, Kinki University,

More information

Atherosclerosis Regression An Overview of Recent Findings & Issues

Atherosclerosis Regression An Overview of Recent Findings & Issues Atherosclerosis Regression An Overview of Recent Findings & Issues 13th Angioplasty Summit 2008 Cheol Whan Lee, MD University of Ulsan, Asan Medical Center, Seoul, Korea CardioVascular Research Foundation

More information

Cardiac CT Angiography

Cardiac CT Angiography Cardiac CT Angiography Dr James Chafey, Radiologist Why do we need a better test for C.A.D? 1. CAD is the leading cause of death in the US CAD 31% Cancer 23% Stroke 7% 2. The prevalence of atherosclerosis

More information

Imaging Biomarkers: utilisation for the purposes of registration. EMEA-EFPIA Workshop on Biomarkers 15 December 2006

Imaging Biomarkers: utilisation for the purposes of registration. EMEA-EFPIA Workshop on Biomarkers 15 December 2006 Imaging Biomarkers: utilisation for the purposes of registration EMEA-EFPIA Workshop on Biomarkers 15 December 2006 Vascular Imaging Technologies Carotid Ultrasound-IMT IVUS-PAV QCA-% stenosis 2 ICH E

More information

Kurdistan Technique for the Treatment of Unprotected Trifurcation Left Main Stem Coronary Artery Lesion: Case Report

Kurdistan Technique for the Treatment of Unprotected Trifurcation Left Main Stem Coronary Artery Lesion: Case Report World Journal of Cardiovascular Diseases, 2014, 4, 483-491 Published Online August 2014 in SciRes. http://www.scirp.org/journal/wjcd http://dx.doi.org/10.4236/wjcd.2014.49058 Kurdistan Technique for the

More information

Pearls & Pitfalls in nuclear cardiology

Pearls & Pitfalls in nuclear cardiology Pearls & Pitfalls in nuclear cardiology Maythinee Chantadisai, MD., NM physician Division of Nuclear Medicine, Department of radiology, KCMH Principle of myocardial perfusion imaging (MPI) Radiotracer

More information

Optical coherence tomography patterns of in-stent restenosis: Comparison between bare-metal stent and drug-eluting stent

Optical coherence tomography patterns of in-stent restenosis: Comparison between bare-metal stent and drug-eluting stent Optical coherence tomography patterns of in-stent restenosis: Comparison between bare-metal stent and drug-eluting stent heart institute, Division of cardiology, Tokyo, Japan Yusuke Watanabe, Ryuta Asano,

More information

Dr Felix Keng. Imaging of the heart is technically difficult because: Role of Cardiac MSCT. Current: Cardiac Motion Respiratory Motion

Dr Felix Keng. Imaging of the heart is technically difficult because: Role of Cardiac MSCT. Current: Cardiac Motion Respiratory Motion Siemens Philips Dr Felix Keng GE Toshiba Role of Cardiac MSCT Current: Structural / congenital heart imaging Extra-cardiac / Great vessel imaging Volumes and ejection fractions (cine + gating) Calcium

More information

OCT Findings: Lesson from Stable vs Unstable Plaques

OCT Findings: Lesson from Stable vs Unstable Plaques ANGIOPLASTY SUMMIT TCTAP 2010 Imaging Workshop OCT Findings: Lesson from Stable vs Unstable Plaques Giulio Guagliumi MD Ospedali Riuniti di Bergamo, Italy DISCLOSURE OF FINANCIAL INTERESTS Consultant Boston

More information

Percutaneous Intervention of Unprotected Left Main Disease

Percutaneous Intervention of Unprotected Left Main Disease Percutaneous Intervention of Unprotected Left Main Disease Technical feasibility and Clinical outcomes Seung-Jung Park, MD, PhD, FACC Professor of Internal Medicine Asan Medical Center, Seoul, Korea Unprotected

More information

Quinn Capers, IV, MD

Quinn Capers, IV, MD Heart Attacks Mended Hearts Presentation, January, 2017 Quinn Capers, IV, MD Associate Professor of Medicine (Cardiovascular Medicine) Director, Transradial Coronary Interventions Division of Cardiovascular

More information

RAMA-EGAT Risk Score for Predicting Coronary Artery Disease Evaluated by 64- Slice CT Angiography

RAMA-EGAT Risk Score for Predicting Coronary Artery Disease Evaluated by 64- Slice CT Angiography RAMA-EGAT Risk Score for Predicting Coronary Artery Disease Evaluated by 64- Slice CT Angiography Supalerk Pattanaprichakul, MD 1, Sutipong Jongjirasiri, MD 2, Sukit Yamwong, MD 1, Jiraporn Laothammatas,

More information

ATHEROSCLEROSIS. Sherif YOUSSEF CONCORDIA UNIVERSITY 4/4/2011

ATHEROSCLEROSIS. Sherif YOUSSEF CONCORDIA UNIVERSITY 4/4/2011 2011 ATHEROSCLEROSIS Sherif YOUSSEF CONCORDIA UNIVERSITY 4/4/2011 UNDERSTANDING ATHEROSCLEROSIS AND PLAQUE RUPTURE VULNERABITLITY Sherif YOUSSEF DEPARTMENT OF MECHANICAL ENGINEERING CONCORDIA UNIVERSITY,

More information

Landmesser U et al. Eur Heart J 2017; https://doi.org/ /eurheartj/ehx549

Landmesser U et al. Eur Heart J 2017; https://doi.org/ /eurheartj/ehx549 2017 Update of ESC/EAS Task Force on Practical Clinical Guidance for PCSK9 inhibition in Patients with Atherosclerotic Cardiovascular Disease or in Familial Hypercholesterolaemia Cardiovascular Outcomes

More information

Lessons learned From The National PCI Registry

Lessons learned From The National PCI Registry Lessons learned From The National PCI Registry w a v e On Behalf of The Publication Committee of the National PCI Registry Objectives & Anticipated Achievements To determine the epidemiology of patients

More information

Ischemic heart disease

Ischemic heart disease Ischemic heart disease Introduction In > 90% of cases: the cause is: reduced coronary blood flow secondary to: obstructive atherosclerotic vascular disease so most of the time it is called: coronary artery

More information

Head-to-Head Comparison of Coronary Plaque Evaluation Between Multislice Computed Tomography and Intravascular Ultrasound Radiofrequency Data Analysis

Head-to-Head Comparison of Coronary Plaque Evaluation Between Multislice Computed Tomography and Intravascular Ultrasound Radiofrequency Data Analysis JACC: CARDIOVASCULAR INTERVENTIONS VOL. 1, NO. 2, 2008 2008 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/08/$34.00 PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2008.01.007 Head-to-Head

More information

Evaluation of stent placement and outcomes with optical coherence tomography

Evaluation of stent placement and outcomes with optical coherence tomography REVIEW Evaluation of stent placement and outcomes with optical coherence tomography Optical coherence tomography (OCT) is an imaging modality based on fiberoptic technology. OCT imaging systems use optical

More information

In-stent Restenosis: the Achille's Heel of SFA Stenting

In-stent Restenosis: the Achille's Heel of SFA Stenting In-stent Restenosis: the Achille's Heel of SFA Stenting Yann Gouëffic, MD, PhD Department of Vascular Surgery University Hospital of Nantes, France «Unresolved problems of SFA stenting» In-stent restenosis

More information

DISRUPT CAD. Todd J. Brinton, MD Clinical Associate Professor of Medicine Adjunct Professor of Bioengineering Stanford University

DISRUPT CAD. Todd J. Brinton, MD Clinical Associate Professor of Medicine Adjunct Professor of Bioengineering Stanford University DISRUPT CAD A multicenter, prospective, single-arm study of percutaneous Lithoplasty prior to stent implantation in heavily calcified coronary lesions Todd J. Brinton, MD Clinical Associate Professor of

More information

The Final 10-Year Follow-up Results from the Bari Randomized Trial J Am Coll Cardiol (2007) 49;1600-6

The Final 10-Year Follow-up Results from the Bari Randomized Trial J Am Coll Cardiol (2007) 49;1600-6 The Final 10-Year Follow-up Results from the Bari Randomized Trial J Am Coll Cardiol (2007) 49;1600-6 n&list_uids=17433949 64-Multislice Detector Computed Tomography Coronary Angiography as Potential Alternative

More information

Sibin K Zacharias 1, Robert D Safian 1, Ryan D Madder 2, Ivan D Hanson 1, Mark C Pica 1, James L Smith 1, James A Goldstein 1 and Amr E Abbas 1

Sibin K Zacharias 1, Robert D Safian 1, Ryan D Madder 2, Ivan D Hanson 1, Mark C Pica 1, James L Smith 1, James A Goldstein 1 and Amr E Abbas 1 631420VMJ0010.1177/1358863X16631420Vascular MedicineZacharias et al. research-article2016 Original Article Invasive evaluation of plaque morphology of symptomatic superficial femoral artery stenoses using

More information

An aneurysm is a localized abnormal dilation of a blood vessel or the heart Types: 1-"true" aneurysm it involves all three layers of the arterial

An aneurysm is a localized abnormal dilation of a blood vessel or the heart Types: 1-true aneurysm it involves all three layers of the arterial An aneurysm is a localized abnormal dilation of a blood vessel or the heart Types: 1-"true" aneurysm it involves all three layers of the arterial wall (intima, media, and adventitia) or the attenuated

More information

Spontaneous Coronary Artery Dissection

Spontaneous Coronary Artery Dissection Spontaneous Coronary Artery Dissection Malissa J. Wood, MD FACC FAHA Co-Director MGH Heart Center Corrigan Women s Heart Health Program Massachusetts General Hospital 40 y/o female transferred from OSH

More information

Catheter induced left main coronary artery stenosis: A rare complication of percutaneous coronary intervention

Catheter induced left main coronary artery stenosis: A rare complication of percutaneous coronary intervention Siddiqui et al. 5 CASE SERIES OPEN ACCESS Catheter induced left main coronary artery stenosis: A rare complication of percutaneous coronary intervention Muhammad Shamim Siddiqui, Syed Muhammad Faisal Hussain,

More information

DESolve NX Trial Clinical and Imaging Results

DESolve NX Trial Clinical and Imaging Results DESolve NX Trial Clinical and Imaging Results Alexandre Abizaid, MD, PhD, Instituto Dante Pazzanese, Sao Paulo, Brazil On behalf of the DESolve Nx Trial Investigators Please refer to the TCT2014 App or

More information

Acute Aortic Syndromes

Acute Aortic Syndromes Acute Aortic Syndromes Carole J. Dennie, MD Acute Thoracic Aortic Syndromes Background Non-Traumatic Acute Thoracic Aortic Syndromes Carole Dennie MD FRCPC Associate Professor of Radiology and Cardiology

More information

Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis

Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis Young-Guk Ko, M.D. Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Etiology Fibromuscular

More information

Unexpected evolution of a non-stenotic lesion in the left main coronary artery of a patient with non ST-segment elevation myocardial infarction

Unexpected evolution of a non-stenotic lesion in the left main coronary artery of a patient with non ST-segment elevation myocardial infarction Case Report Unexpected evolution of a non-stenotic lesion in the left main coronary artery of a patient with non ST-segment elevation myocardial infarction Alexandru Florin Ispas, Lionel Mangin, Alexandru

More information

TCTAP Upendra Kaul MD,DM,FACC,FSCAI,FAMS,FCSI

TCTAP Upendra Kaul MD,DM,FACC,FSCAI,FAMS,FCSI Indian TUXEDO Trial In Medically Treated Diabetics Upendra Kaul MD,DM,FACC,FSCAI,FAMS,FCSI Executive Director and Dean Escorts Heart Institute & Medical Research Center and Fortis Hospitals, New Delhi

More information

Atherosclerotic disease regression with statins: studies using vascular markers

Atherosclerotic disease regression with statins: studies using vascular markers International Journal of Cardiology 96 (2004) 447 459 www.elsevier.com/locate/ijcard Atherosclerotic disease regression with statins: studies using vascular markers Diederick E. Grobbee*, Michiel L. Bots

More information

Total occlusion at ostial Left internal mammary graft with successful angioplasty and longterm patency result

Total occlusion at ostial Left internal mammary graft with successful angioplasty and longterm patency result DOI 10.7603/s40602-014-0017-x ASEAN Heart Journal http://www.aseanheartjournal.org/ Vol. 22, no. 1, 116 121 (2014) ISSN: 2315-4551 Case Report Total occlusion at ostial Left internal mammary graft with

More information

The SYNTAX-LE MANS Study

The SYNTAX-LE MANS Study The SYNTAX-LE MANS Study Synergy Between PCI with TAXUS Express and Cardiac Surgery: Late (15-month) Left Main Angiographic Substudy A. Pieter Kappetein, MD, PhD Erasmus MC, Rotterdam, NL SYNTAX-LE MANS

More information

Complex PCI of an LAD/Diagonal bifurcation lesion (Medina 1,1,1) utilizing the DK Crush technique ".

Complex PCI of an LAD/Diagonal bifurcation lesion (Medina 1,1,1) utilizing the DK Crush technique . Complex PCI of an LAD/Diagonal bifurcation lesion (Medina 1,1,1) utilizing the DK Crush technique ". "Σύμπλοκη αγγειοπλαστική βλάβης διχασμού LAD/Diagonal (Medina 1,1,1) με την τεχνική DK crush ". Anastasios

More information

ROTABLATORTM. Peripheral. Rotational Atherectomy System. Quick Reference Cards

ROTABLATORTM. Peripheral. Rotational Atherectomy System. Quick Reference Cards Peripheral ROTABLATORTM Rotational Atherectomy System Quick Reference Cards Technical Assistance: 1.800.949.6708 Customer Service: 1.888.272.1001 Complaints: 1.800.811.3211 Setup Video: www.bostonscientific.com/rotablatorsetup

More information

Assessment of Non-Calcified Coronary Plaques Using 64-Slice Computed Tomography: Comparison With Intravascular Ultrasound

Assessment of Non-Calcified Coronary Plaques Using 64-Slice Computed Tomography: Comparison With Intravascular Ultrasound ORIGINAL ARTICLE DOI 10.4070 / kcj.2009.39.3.95 Print ISSN 1738-5520 / On-line ISSN 1738-5555 Copyright c 2009 The Korean Society of Cardiology Assessment of Non-Calcified Coronary Plaques Using 64-Slice

More information

Morphological changes after percutaneous transluminal coronary angioplasty of unstable plaques

Morphological changes after percutaneous transluminal coronary angioplasty of unstable plaques European Heart Journal (1996) 17, 1554-1559 orphological changes after percutaneous transluminal coronary angioplasty of unstable plaques Insights from serial angioscopic follow-up C. Bauters, J.-. Lablanche,

More information

FMD 101. Esther S.H. Kim, MD, MPH, FACC, FSVM FMDSA Annual Meeting 18 May 2013

FMD 101. Esther S.H. Kim, MD, MPH, FACC, FSVM FMDSA Annual Meeting 18 May 2013 FMD 101 Esther S.H. Kim, MD, MPH, FACC, FSVM FMDSA Annual Meeting 18 May 2013 Back to basics Blood Bodily fluid that transports necessary substances (oxygen, nutrients, antibodies, hormones, etc) and waste

More information

One-Year Outcomes After Everolimus-Eluting Stents Implantation in Ostial Lesions of Left Anterior Descending Coronary Arteries

One-Year Outcomes After Everolimus-Eluting Stents Implantation in Ostial Lesions of Left Anterior Descending Coronary Arteries Elmer Press Original Article One-Year Outcomes After Everolimus-Eluting Stents Implantation in Ostial Lesions of Left Anterior Descending Coronary Arteries Zahra Golmohamadi a, c, Sepideh Sokhanvar b,

More information

Atherosclerosis. Atherosclerosis happens when the blood vessels

Atherosclerosis. Atherosclerosis happens when the blood vessels Atherosclerosis Atherosclerosis happens when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff sometimes restricting blood flow

More information

Pathology of Cardiovascular Interventions. Body and Disease 2011

Pathology of Cardiovascular Interventions. Body and Disease 2011 Pathology of Cardiovascular Interventions Body and Disease 2011 Coronary Artery Atherosclerosis Intervention Goals: Acute Coronary Syndromes: Treat plaque rupture and thrombosis Significant Disease: Prevent

More information

Recurrent Spontaneous Coronary Artery Dissection in a Patient with Fibromuscular Dysplasia

Recurrent Spontaneous Coronary Artery Dissection in a Patient with Fibromuscular Dysplasia Recurrent Spontaneous Coronary Artery Dissection in a Patient with Fibromuscular Dysplasia Craig Basman, MD; Tannaz Shoja, MD; Aditya Mangla, DO; Jaffar Raza, MD; Suresh Jain, MD; Zoran Lasic, MD Clinical

More information

An Overview of Post-EVAR Endoleaks: Imaging Findings and Management. Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC

An Overview of Post-EVAR Endoleaks: Imaging Findings and Management. Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC An Overview of Post-EVAR Endoleaks: Imaging Findings and Management Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC Disclosure Slide Mark O. Baerlocher: Current: Consultant for Boston

More information

Improved Noninvasive Assessment of Coronary Artery Bypass Grafts With 64-Slice Computed Tomographic Angiography in an Unselected Patient Population

Improved Noninvasive Assessment of Coronary Artery Bypass Grafts With 64-Slice Computed Tomographic Angiography in an Unselected Patient Population Journal of the American College of Cardiology Vol. 49, No. 9, 2007 2007 by the American College of Cardiology Foundation ISSN 0735-1097/07/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.10.066

More information

Sites of Atherosclerosis In order of Frequency

Sites of Atherosclerosis In order of Frequency Pathological Features of Peripheral Atherosclerosis: Implication for Device Development G Nakazawa Tokai Univ. Kanagawa, Japan 1 Sites of Atherosclerosis In order of Frequency carotid (3) (3) Coronary

More information

Coronary Artery Disease - Reporting and Data System (CAD-RADS)

Coronary Artery Disease - Reporting and Data System (CAD-RADS) A joint publication of the Department of Radiology and Corrigan Minehan Heart Center November 2016 Issue 66 Coronary Artery Disease - Reporting and Data System (CAD-RADS) Sandeep S. Hedgire, MD; Udo Hoffmann,

More information

Management of Non-protected Left-Main Bifurcation without Drug Eluting Stent. Masahiko Ochiai MD, FACC, FESC, FSCAI

Management of Non-protected Left-Main Bifurcation without Drug Eluting Stent. Masahiko Ochiai MD, FACC, FESC, FSCAI Management of Non-protected Left-Main Bifurcation without Drug Eluting Stent Masahiko Ochiai MD, FACC, FESC, FSCAI Division of Cardiology and Cardiovascular Surgery Showa University Northern Yokohama Hospital

More information

PCI for Chronic Total Occlusions

PCI for Chronic Total Occlusions PCI for Chronic Total Occlusions Chronic Total Occlusions Why not Medical Treatment? Medical Treatment CTO in 891 pts over 24 years High 10% Mortality Low 2 % 1 year 10 years Puma JA, et al. JACC 1994;23:390A

More information

Multislice coronary computed tomographic angiography in emergency department presentations of unsuspected acute myocardial infarction

Multislice coronary computed tomographic angiography in emergency department presentations of unsuspected acute myocardial infarction Journal of Cardiovascular Computed Tomography (2009) 3, 272 278 Case Report Multislice coronary computed tomographic angiography in emergency department presentations of unsuspected acute myocardial infarction

More information

Yukio Ozaki, M Okumura, TF Ismail 2, S Motoyama, H. Naruse, K. Hattori, H. Kawai, M. Sarai, J. Ishii, Jagat Narula 3

Yukio Ozaki, M Okumura, TF Ismail 2, S Motoyama, H. Naruse, K. Hattori, H. Kawai, M. Sarai, J. Ishii, Jagat Narula 3 Culprit Lesion Characteristics in Acute Coronary Syndrome and Stable Angina Assessed by Optical Coherence Tomography (OCT), Angioscopy, IVUS and Multidetector Computed Tomography (MDCT) Yukio Ozaki, M

More information

CARDIOLOGY SYMPOSIUM 2015 CAROLINA CARDIOLOGY CONSULTANTS OF GHS

CARDIOLOGY SYMPOSIUM 2015 CAROLINA CARDIOLOGY CONSULTANTS OF GHS CARDIOLOGY SYMPOSIUM 2015 CAROLINA CARDIOLOGY CONSULTANTS OF GHS STENT, OPERATE, OR MEDICATE? DIFFERING PERSPECTIVES ON CORONARY REVASCULARIZATION JIM BAUCUM, MD FACC SCOTT JOHNSON, MD JANUARY 24, 2015

More information

Le# main treatment with Stentys stent. Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy

Le# main treatment with Stentys stent. Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy Le# main treatment with Stentys stent Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy Disclosure Statement of Financial Interest I, Carlo Briguori DO NOT have a financial interest/ arrangement

More information

Non Invasive Diagnostic Modalities for Coronary Artery Disease. Dr. Amitesh Aggarwal

Non Invasive Diagnostic Modalities for Coronary Artery Disease. Dr. Amitesh Aggarwal Non Invasive Diagnostic Modalities for Coronary Artery Disease Dr. Amitesh Aggarwal Ebers papyrus, ca. 1555 BCE If thou examine a man for illness in his cardia, and he has pains in his arms, in his breasts

More information

Selection and Use of Basic Equipment : Guiding Catheters, Wires and Balloons

Selection and Use of Basic Equipment : Guiding Catheters, Wires and Balloons SCAI Interventional Cardiology Fall Fellows Course 2014 Selection and Use of Basic Equipment : Guiding Catheters, Wires and Balloons December 7, 2014 8:30 am John S. Douglas Jr, MD Professor of Medicine

More information

Histopathology: Vascular pathology

Histopathology: Vascular pathology Histopathology: Vascular pathology These presentations are to help you identify basic histopathological features. They do not contain the additional factual information that you need to learn about these

More information

Currently there are 3 types of sonography used to assess the

Currently there are 3 types of sonography used to assess the Published February 4, 2010 as 10.3174/ajnr.A1810 REVIEW ARTICLE H. Zacharatos A.E. Hassan A.I. Qureshi Intravascular Ultrasound: Principles and Cerebrovascular Applications SUMMARY: Intravascular sonography

More information

Imaging in the Evaluation of Coronary Artery Disease and Abdominal Aortic Aneurysm

Imaging in the Evaluation of Coronary Artery Disease and Abdominal Aortic Aneurysm Imaging in the Evaluation of Coronary Artery Disease and Abdominal Aortic Aneurysm Mark J. Sands, MD Vice Chairman, Imaging Institute Clinical Operations and Quality Objectives Review of available radiologic

More information

Hospital, 6 Lukon Road, Lukong Town, Changhua Shien, Taiwan 505, Taiwan.

Hospital, 6 Lukon Road, Lukong Town, Changhua Shien, Taiwan 505, Taiwan. Volume 1, Issue 1 Image Article Resolution of Inferior Wall Ischemia after Successful Revascularization of LAD Lesion: The Value of Myocardial Perfusion Imaging in Guiding Management of Multi-vessel CAD

More information

Arterial remodelling of native human coronary arteries in patients with unstable angina pectoris: a prospective intravascular ultrasound study

Arterial remodelling of native human coronary arteries in patients with unstable angina pectoris: a prospective intravascular ultrasound study 68 Heart 1999;82:68 74 Arterial remodelling of native human coronary arteries in patients with unstable angina pectoris: a prospective intravascular ultrasound study M Gyöngyösi, P Yang, A Hassan, F Weidinger,

More information

What is Spontaneous Coronary Artery Dissection (SCAD) & Why is Cardiac Rehabilitation Important?

What is Spontaneous Coronary Artery Dissection (SCAD) & Why is Cardiac Rehabilitation Important? What is Spontaneous Coronary Artery Dissection (SCAD) & Why is Cardiac Rehabilitation Important? Marysia Tweet, MD 25 th Annual MNACVPR State Conference October 3 rd, 2015 2015 MFMER slide-1 Goals: Learn

More information

Acta Cardiol Sin 2018;34: doi: /ACS _34(2) A

Acta Cardiol Sin 2018;34: doi: /ACS _34(2) A Original Article Acta Cardiol Sin 2018;34:124 129 doi: 10.6515/ACS.201803_34(2).20171115A Coronary Artery Disease Vascular Healing Response after Everolimus-Eluting Stent Implantation in Acute Coronary

More information

Aortic CT: Intramural Hematoma. Leslie E. Quint, M.D.

Aortic CT: Intramural Hematoma. Leslie E. Quint, M.D. Aortic CT: Intramural Hematoma Leslie E. Quint, M.D. 43 M Mid back pain X several months What type of aortic disease? A. Aneurysm with intraluminal thrombus B. Chronic dissection with thrombosed false

More information

JMSCR Vol 05 Issue 07 Page July 2017

JMSCR Vol 05 Issue 07 Page July 2017 www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i7.212 Role of 128 Slice MDCT Coronary Angiography

More information

JETSTREAM Atherectomy System DELIVERING VERSATILITY TO RESTORE FLOW

JETSTREAM Atherectomy System DELIVERING VERSATILITY TO RESTORE FLOW JETSTREAM Atherectomy System DELIVERING VERSATILITY TO RESTORE FLOW DISCOVER THE VALUE OF VERSATILITY Versatility means not having to guess the morphology! Peripheral arterial lesions can present with

More information

Complex Coronary Interventions: Bifurcations. John M. Lasala MD PhD Professor of Medicine Washington University St Louis, Missouri

Complex Coronary Interventions: Bifurcations. John M. Lasala MD PhD Professor of Medicine Washington University St Louis, Missouri Complex Coronary Interventions: Bifurcations John M. Lasala MD PhD Professor of Medicine Washington University St Louis, Missouri Disclosures Advisory Board Boston Scientific, St. Jude Medical Speaker-

More information

CHAPTER (2) THE VULNERABLE PLAQUE

CHAPTER (2) THE VULNERABLE PLAQUE CHAPTER (2) THE VULNERABLE PLAQUE UNSTABLE OR HIGH RISK ATHEROSCLEROTIC PLAQUE - Definition and Composition - Plaque Destabilization and Disruption - Fate of Disrupted Plaque - Clinical Presentation -

More information