Akiko Maehara

• Columbia University

BACKGROUND Coronary stenting alters vessel dynamics, displacing hinge movement closer to stent edges. We aimed to investigate whether calcified nodules (CNs) are more frequent at stent edges associated with calcium. METHODS In vessels with previously implanted stents evaluated by optical coherence tomography, 4 different calcified lesions were stu...

Background Data supporting the use of intravascular ultrasound (IVUS) in aortoiliac and femoropopliteal endovascular intervention are becoming increasingly robust, but data in the infrapopliteal circulation remain limited. The aim of this study was to evaluate the association between IVUS use and 1-year outcomes after infrapopliteal intervention....

BACKGROUND Bioresorbable scaffolds (BRS) were developed to overcome limitations related to late stent failures of drug-eluting stents, but lumen reductions over time after implantation of BRS have been reported. This study aimed to investigate if lesion preparation with a scoring balloon compared with a standard noncompliant balloon minimizes lumen...

Purpose To assess the diagnostic performance of a coronary CT angiography (CCTA) artificial intelligence (AI)-enabled tool (AI-QCPA; HeartFlow) to quantify plaque volume, as compared with intravascular US (IVUS). Materials and Methods A retrospective subanalysis of a single-center prospective registry study was conducted in participants with ST-ele...

Background: Coronary intravascular lithotripsy (IVL) safely facilitates stent implantation in severely calcified lesions. Aims: This analysis sought to determine the relative impact of IVL on acute and long-term outcomes specifically in calcified nodules (CNs). Methods: Individual patient-level data (N=155) were pooled from the Disrupt CAD opt...

Plaque erosion (PE) with secondary thrombosis is one of the key mechanisms of acute coronary syndrome (ACS) which often leads to drastic cardiovascular events. Identification and prediction of PE are of fundamental significance for disease diagnosis, prevention and treatment. In vivo optical coherence tomography (OCT) data of eight eroded plaques a...

Background: Calcified nodules (CNs) are an increasingly important, high-risk lesion subset. Aims: We sought to identify the emergence of new CNs and the relation between underlying plaque characteristics and new CN development. Methods: Patients who had undergone two optical coherence tomography (OCT) studies that imaged the same untreated cal...

BACKGROUND Lipid content in untreated nonobstructive coronary artery lesions is associated with adverse clinical outcomes, and residual in-stent or stent edge lipid may worsen outcomes after percutaneous coronary intervention (PCI). METHODS Near-infrared spectroscopy-intravascular ultrasound was performed before and after PCI in patients with myoc...

Background The extent to which infarct artery impacts the extent of myocardial injury and outcomes in patients with ST‐segment–elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention is uncertain. Methods and Results We performed a pooled analysis using individual patient data from 7 randomized STEMI trials in...

Background and Aims Observational registries have suggested that optical coherence tomography (OCT) imaging-derived parameters may predict adverse events after drug-eluting stent (DES) implantation. The present analysis sought to determine the OCT predictors of clinical outcomes from the large-scale ILUMIEN IV trial. Methods ILUMIEN IV was a prosp...

Introduction: Bioresorbable scaffolds (BRS) have been developed to overcome limitations related to late stent failures of drug-eluting-stents, but previous studies have observed lumen reduction over time after implantation of BRS. The aim of the study was to investigate if lesion preparation with a scoring balloon compared to a standard non-complia...

Background Coronary angiography and percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD) is associated with increased risk of contrast induced nephropathy (CIN) and requirement for renal replacement therapy (RRT). Objectives We aimed to evaluate our single center experience of ultra‐low contrast PCI in patients wi...

Although multiple randomized clinical trials (RCTs) have shown that intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) is associated with improved clinical outcomes compared with angiography-guided PCI, its benefits specifically in calcified coronary lesions is unclear due to the small number of patients included in individ...

Purpose of Review To provide a summary of prevalence, pathogenesis, and treatment of coronary calcified nodules (CNs). Recent Findings CNs are most frequently detected at the sites of hinge motion of severely calcified lesions such as in the middle segment of right coronary artery and left main coronary bifurcation. On histopathology, CNs exhibit...

BACKGROUND While it has been hypothesized that high plaque stress and strain may be related to plaque rupture, its direct verification using in vivo coronary plaque rupture data and full 3-dimensional fluid-structure interaction models is lacking in the current literature due to difficulty in obtaining in vivo plaque rupture imaging data from patie...

Aims Coronary computed tomography angiography provides noninvasive assessment of coronary stenosis severity and flow impairment. Automated artificial intelligence analysis may assist in precise quantification and characterization of coronary atherosclerosis, enabling patient-specific risk determination and management strategies. This multicenter in...

Introduction Mechanical stress and strain conditions play an important role in atherosclerosis plaque progression, remodeling and potential rupture and may be used in plaque vulnerability assessment for better clinical diagnosis and treatment decisions. Single layer plaque models without residual stress have been widely used due to unavailability o...

Background Stent underexpansion, typically related to lesion calcification, is the strongest predictor of adverse events after percutaneous coronary intervention (PCI). Although uncommon, underexpansion may also occur in non‐severely calcified lesions. Aim We sought to identify the prevalence and anatomical characteristics of underexpansion in non...

Background Supersaturated oxygen (SSO2) delivered into the left anterior descending coronary artery after percutaneous coronary intervention (PCI) for anterior ST-segment elevation myocardial infarction (STEMI) has been shown to reduce infarct size, but its effects on microvascular obstruction (MVO) are unknown. The aim of this study was to compare...

BACKGROUND Intravascular imaging and intracoronary physiology may both be used to guide and optimize percutaneous coronary intervention; however, they are rarely used together. The virtual flow reserve (VFR) is an optical coherence tomography (OCT)–based model of fractional flow reserve (FFR) facilitating the assessment of the physiological signifi...

The prevalence of calcification in obstructive coronary artery disease is on the rise. Percutaneous coronary intervention of these calcified lesions is associated with increased short-term and long-term risks. To optimize percutaneous coronary intervention results, there is an expanding array of treatment modalities geared toward calcium modificati...

Background: Outcomes after percutaneous coronary intervention (PCI) for de novo ostial right coronary artery (RCA) lesions are poor. Aims: We used intravascular ultrasound (IVUS) to clarify the morphological patterns of de novo ostial RCA lesions and their associated clinical outcome. Methods: Among 5,102 RCA IVUS studies, 170 de novo ostial R...

Introduction Percutaneous coronary intervention with implantation of a bioresorbable scaffold (BRS) provide the vessel support for a limited period allowing the vessel to restore normal vasomotion after degradation of the BRS, opposed to treatment with drug-eluting stents where the metal persist in the vessel wall. Late lumen loss and reduction in...

Background While not available for clinical use in the United States, dedicated drug-coated balloons (DCB) are currently under investigation for the management of coronary in-stent restenosis (ISR). Peripheral drug-coated balloons (P-DCB) have been used off-label for coronary ISR. Further data regarding this practice are needed. We aimed to describ...

Background Despite the initial evidence supporting the utility of intravascular imaging to guide percutaneous coronary intervention (PCI), adoption remains low. Recent new trial data have become available. An updated study‐level meta‐analysis comparing intravascular imaging to angiography to guide PCI was performed. This study aimed to evaluate the...

Background: Anatomical vessel location affects post-percutaneous coronary intervention (PCI) physiology. Aims: We aimed to compare the post-PCI instantaneous wave-free ratio (iFR) in left anterior descending (LAD) versus non-LAD vessels and to identify the factors associated with a suboptimal post-PCI iFR. Methods: DEFINE PCI was a multicentre...

BACKGROUND Coronary intravascular lithotripsy (IVL) safely facilitates successful stent implantation in severely calcified lesions. This analysis sought to determine the relative impact of lesion calcium eccentricity on the safety and effectiveness of IVL using high-resolution optical coherence tomography imaging. METHODS Individual patient-level...

Background Accurate intravascular ultrasound (IVUS) measurements are important in IVUS-guided percutaneous coronary intervention optimization by choosing the appropriate device size and confirming stent expansion. Objectives The purpose of this study was to assess the accuracy of machine learning (ML) automatic segmentation of coronary artery vess...

Background: Data regarding clinical outcomes after optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) as compared with angiography-guided PCI are limited. Methods: In this prospective, randomized, single-blind trial, we randomly assigned patients with medication-treated diabetes or complex coronary-artery lesions...

Mechanical stress and strain conditions are closely related to atherosclerotic plaque progression and rupture and have been under intensive investigations in recent years. It is well known that arteries have a three-layer structure: intima, media and adventitia. However, in vivo image-based multilayer plaque models are not available in the current...

Background: Despite a high rate of in-stent restenosis (ISR) after stenting the right coronary artery (RCA) ostium, the mechanism of ostial RCA ISR is not well understood. Aims: We aimed to clarify the cause of ostial RCA ISR using intravascular ultrasound (IVUS). Methods: Overall, 139 ostial RCA ISR lesions were identified with IVUS, pre-reva...

Background: Whether an eruptive or noneruptive target lesion calcified nodule (CN) portends worse acute and long-term clinical outcomes after stenting has not been established. Objectives: The authors sought to compare acute and long-term clinical outcomes in eruptive CN vs noneruptive CN morphology. Methods: Using optical coherence tomography...

Stent failure remains the major drawback to the use of coronary stents as a revascularization strategy. Recent advances in imaging have substantially improved our understanding of the mechanisms underlying these occurrences, which have in common numerous clinical risk factors and mechanical elements at the time of stent implantation. In-stent reste...

Aims Prospective studies show that only a minority of plaques with higher-risk features develop future major adverse cardiovascular events (MACE), indicating the need for more predictive markers. Biomechanical estimates such as plaque structural stress (PSS) improve risk prediction but require expert analysis. In contrast, complex and asymmetric co...

Optical coherence tomography (OCT) provides high-resolution imaging of coronary arteries and can be used to optimize percutaneous coronary intervention (PCI). Intracoronary OCT, however, has had limited adoption in clinical practice. Novelty and relative complexity of OCT interpretation compared with the more established intravascular ultrasound, l...

Studies utilizing intravascular imaging have replicated the findings of histopathological studies, identifying the most common substrates for acute coronary syndromes (ACS) as plaque rupture, erosion, and calcified nodule, with spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constituting the less common etiologi...

Background: Cardiac computed tomography angiography was used to identify anatomical characteristics of the aortic root in patients with severe aortic regurgitation (AR) as compared to those with aortic stenosis (AS) to judge feasibility of transcatheter aortic valve replacement (TAVR) with the JenaValve Trilogy system. Methods: Cardiac computed...

Coronary angiography has historically served as the gold standard for diagnosis of coronary artery disease and guidance of percutaneous coronary intervention (PCI). Adjunctive use of contemporary intravascular imaging (IVI) technologies has emerged as a complement to conventional angiography-to further characterize plaque morphology and optimize th...

Assessment and prediction of vulnerable plaque progression and rupture risk are of utmost importance for diagnosis, management and treatment of cardiovascular diseases and possible prevention of acute cardiovascular events such as heart attack and stroke. However, accurate assessment of plaque vulnerability assessment and prediction of its future c...