Hector M Garcia-Garcia

• MD, PhD
• Washington Hospital Center

BACKGROUND Patients with bicuspid aortic stenosis who receive transcatheter aortic valve replacement (TAVR) may require subsequent valve interventions in their lifetime; however, the feasibility of redo-TAVR in this population is uncertain. We aimed to assess redo-TAVR feasibility in bicuspid patients and develop a predictive virtual valve planning...

Background Third‐generation resorbable magnesium scaffold (RMS) was developed with stronger mechanical properties and thinner struts compared to its predecessor. This study aimed to assess the influence of the OCT‐derived underlying plaque characteristics on in‐scaffold late lumen loss (LLL) in patients treated with RMS up to 12‐months. Methods Pa...

Aims Near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) and optical coherence tomography (OCT) can assess coronary plaque pathology but are limited by time-consuming and expertise-driven image analysis. Recently introduced machine learning(ML)-classifiers have expedited image processing, but their performance in assessing plaque pathol...

Background Intravascular ultrasound (IVUS) is essential for assessing complex coronary lesions, but remains underutilized in part due to difficulties in image interpretation. The AVVIGO IVUS Automated Lesion Assessment (ALA) software, which uses machine learning (ML) for automatic segmentation, promises to simplify lesion assessment. This study eva...

Objective Interventionalists have noted significant venous luminal gain with nitinol venous stents although post-placement lumen shape differed from the circular shape observed with elgiloy stents. The goal of this study was to determine the characteristics of a stented vein lumen that correspond with clinical outcomes, and to identify metrics that...

Background/Objectives: Drug-eluting stents (DESs) remain the standard of treatment for patients with ST-elevation myocardial infarction (STEMI). However, complications such as stent thrombosis and in-stent restenosis still pose significant risks. Drug-coated balloons (DCBs) have emerged as a promising alternative, but data for this clinical scenari...

Accurate evaluation of coronary artery pathology is essential for risk stratification and tailoring appropriate treatment. Intravascular imaging was introduced for this purpose 40 years ago enabling for the first time in vivo plaque characterization. Since then, several studies have evaluated the efficacy of the existing intravascular imaging modal...

Introduction and objectives: Patients undergoing percutaneous coronary intervention in vessels with moderate-to-severe tortuosity are at higher risk of adverse outcomes, but data are scarce in the era of newer-generation stents. We compared outcomes following percutaneous coronary intervention in vessels with moderate-to-severe tortuosity using a...

Background Long‐term clinical data on biodegradable‐polymer (BP) drug‐eluting stents (DES) are limited. The objective of this study was to assess the long‐term safety and efficacy of the BP‐DES SYNERGY compared to XIENCE V, a durable‐polymer (DP)‐DES. Methods We compared patients treated with BP‐DES or DP‐DES at our center from 2008 to 2020. The p...

Background: The 12-month outcomes of BIOMAG-I - the first-in-human study investigating the third-generation drug-eluting resorbable magnesium scaffold (DREAMS 3G) - showed promising results regarding clinical outcomes and late lumen loss. Aims: The current study aimed to investigate vascular healing parameters assessed by optical coherence tomog...

Many lesions in patients undergoing percutaneous coronary intervention (PCI) exhibit significant calcification. Several techniques have been developed to improve outcomes in this setting. However, their impact on coronary microcirculation remains unknown. The aim of this study is to evaluate the influence of plaque modification techniques on corona...

In the original publication [...]

Coronary atherosclerosis remains a leading cause of morbidity and mortality worldwide. The underlying pathophysiology includes a complex interplay of endothelial dysfunction, lipid accumulation and inflammatory pathways. Multiple structural and inflammatory features of the atherosclerotic lesions have become targets to identify high-risk lesions. V...

Coronary artery disease is defined by the existence of atherosclerotic plaque on the arterial wall, which can cause blood flow impairment, or plaque rupture, and ultimately lead to myocardial ischemia. Intravascular ultrasound (IVUS) imaging can provide a detailed characterization of lumen and vessel features, and so plaque burden, in coronary vess...

Cardiac allograft vasculopathy (CAV) is a significant determinant of long-term survival in heart transplant recipients. Standard CAV screening typically utilizes invasive coronary angiography (ICA). Quantitative flow ratio (QFR) is a computational method for functional testing of coronary stenosis, and may add diagnostic value to ICA in assessing C...

Background Nonhyperemic pressure ratios (NHPRs) have been proposed as alternatives to fractional flow reserve (FFR) without induction of hyperemia. More recently, imaging based-FFR estimation, especially coronary angiography-derived FFR (Angio-FFR) measurement, is proposed to estimate wire-based FFR. However, little is known about the diagnostic pe...

Background Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is recommended in the guidelines of revascularization for patients presenting with coronary artery disease (CAD) with intermediate lesion severity. However, recently published studies comparing FFR-guided PCI with non-physiology guided revascularization strateg...

Background The first-in-human trial of the latest resorbable magnesium scaffold (RMS), DREAMS 3G, showed favorable clinical and angiographic outcomes up to 6-months. An intravascular optical coherence tomography (OCT) assessment of the vascular healing profile at 6 months and 12 months follow-up may serve as additional supportive evidence for devic...

Background Second-generation resorbable magnesium scaffold (RMS) Magmaris showed favorable outcomes in clinical trials, especially regarding the incidence of scaffold thrombosis. The earlier studies reported a higher occurrence of scaffold recoil with this RMS owing to vessel constriction. This finding was shown to be more prominent in presence of...

Aims The aim of the study is to assess the impact of the baseline plaque composition on the DREAMS 3G luminal late loss and to compare the serial plaque changes between baseline and 6 and 12 months (M) follow-up. Methods and results A total of 116 patients were enrolled in the BIOMAG-I trial. Patients were imaged with optical coherence tomography...

Recently developed handheld ultrasound devices (HHUD) represent a promising method to evaluate the cardiovascular abnormalities at the point of care. However, this technology has not been rigorously evaluated. The aim of this study was to explore the correlation and the agreement between the LVEF (Left Ventricular Ejection Fraction) visually assess...

Background: Among patients with chronic limb-threatening ischemia (CLTI) and infrapopliteal artery disease, angioplasty has been associated with frequent reintervention and adverse limb outcomes from restenosis. The effect of the use of drug-eluting resorbable scaffolds on these outcomes remains unknown. Methods: In this multicenter, randomized,...

Background Although invasive measurement of fractional flow reserve (FFR) is recommended to guide revascularization, its routine use is underutilized. Recently, a novel non-invasive software that can instantaneously produce FFR values from the diagnostic angiograms, derived completely from artificial intelligence (AI) algorithms has been developed....

Objective The role of coronary calcification on clinical outcomes among different revascularization strategies in patients presenting with acute coronary syndromes (ACS) has been rarely investigated. The aim of this investigation is to evaluate the role of coronary calcification, detected by coronary angiography, in the whole spectrum of patients p...

Patients with non-obstructive lipid-rich plaques (LRPs) on combined intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) are at high risk for future events. Local pre-emptive percutaneous treatment of LRPs with a paclitaxel-eluting drug-coated balloon (PE-DCB) may be a novel therapeutic strategy to prevent future adverse coronary e...

Background: Ultrathin strut coronary drug-eluting stents (DES) have demonstrated improved safety and efficacy in large contemporary trials. The evaluation of an ultrathin strut DES in a post-market United States (US) patient population was undertaken. Objective: The purpose of this post-approval study is to confirm that the clinical performance...

Fibrous cap thickness (FCT) of a coronary atherosclerotic plaque is a known and recognized factor affecting the risk of plaque rupture.¹ A thin fibrous cap (especially with FCT < 65 μm) overlying a large lipid core is considered the precursor lesion for plaque rupture and acute coronary syndrome (ACS). Intra-coronary optical coherence tomography (O...

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is recommended in revascularization guidelines for intermediate lesions. However, recent studies comparing FFR-guided PCI with non-physiology-guided revascularization have reported conflicting results. PubMed and Embase were searched for studies comparing FFR-guided PCI w...

Background: To assess the reproducibility of coronary tissue characterization by an Artificial Intelligence Optical Coherence Tomography software (OctPlus, Shanghai Pulse Medical Imaging Technology Inc.). Methods: 74 patients presenting with multivessel ST-segment elevation myocardial infarction (STEMI) underwent optical coherence tomography (OC...

Cardiovascular imaging has faced a momentous development in the last few decades thanks to refinements in imaging technologies, multimodality integration, and focus on different clinical applications ranging from prevention to diagnosis, prognosis, decision making, and follow-up. These developments equally apply to standard non-invasive imaging mod...

Introduction Stable angina affects 1.3 million people in the UK. Stent implantation in diseased coronary arteries helps to reduce the symptoms of angina and the long-term risk of heart attacks. we, and others, have shown that nitric oxide (NO) delivery utilising the nitrate/nitrite/NO pathway improves endothelial function, decreases platelet reacti...

Introduction Stable angina affects 1.3 million people in the UK. Stent implantation in diseased coronary arteries helps to reduce the symptoms of angina and the long-term risk of heart attacks. we, and others, have shown that nitric oxide (NO) delivery utilising the nitrate/nitrite/NO pathway improves endothelial function, decreases platelet reacti...

Background: The third-generation coronary sirolimus-eluting magnesium scaffold, DREAMS 3G, is a further development of the DREAMS 2G (commercial name Magmaris), aiming to provide performance outcomes similar to drug-eluting stents (DES). Aims: The BIOMAG-I study aims to assess the safety and performance of this new-generation scaffold. Methods:...