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Coronary Artery Disease: HELP
Articles by Michael Joner
Based on 31 articles published since 2008
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Between 2008 and 2019, M. Joner wrote the following 31 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Report of an ESC-EAPCI Task Force on the evaluation and use of bioresorbable scaffolds for percutaneous coronary intervention: executive summary. 2018

Byrne, Robert A / Stefanini, Giulio G / Capodanno, Davide / Onuma, Yoshinobu / Baumbach, Andreas / Escaned, Javier / Haude, Michael / James, Stefan / Joner, Michael / Jüni, Peter / Kastrati, Adnan / Oktay, Semih / Wijns, William / Serruys, Patrick W / Windecker, Stephan. ·Deutsches Herzzentrum München, Technische Universität München, Germany. ·EuroIntervention · Pubmed #28948934.

ABSTRACT: A previous Task Force of the European Society of Cardiology (ESC) and European Association of Percutaneous Cardiovascular Interventions (EAPCI) provided a report on recommendations for the non-clinical and clinical evaluation of coronary stents. Following dialogue with the European Commission, the Task Force was asked to prepare an additional report on the class of devices known as bioresorbable scaffolds (BRS). Five BRS have CE-mark approval for use in Europe. Only one device -the Absorb bioresorbable vascular scaffold- has published randomized clinical trial data and this data show inferior outcomes to conventional drug-eluting stents (DES) at 2-3 years. For this reason, at present BRS should not be preferred to conventional DES in clinical practice. The Task Force recommends that new BRS devices should undergo systematic non-clinical testing according to standardized criteria prior to evaluation in clinical studies. A clinical evaluation plan should include data from a medium sized, randomized trial against DES powered for a surrogate end point of clinical efficacy. Manufacturers of successful devices receive CE- mark approval for use and must have an approved plan for a large-scale randomized clinical trial with planned long-term follow-up.

2 Editorial The Mystery of Spotty Calcification: Can We Solve It by Optical Coherence Tomography? 2016

Yahagi, Kazuyuki / Joner, Michael / Virmani, Renu. ·From CVPath Institute Inc, Gaithersburg, MD. · From CVPath Institute Inc, Gaithersburg, MD. rvirmani@cvpath.org. ·Circ Cardiovasc Imaging · Pubmed #26743464.

ABSTRACT: -- No abstract --

3 Editorial Should CMR Become the New Darling of Noninvasive Imaging for the Monitoring of Progression and Regression of Coronary Heart Disease? 2015

Yahagi, Kazuyuki / Joner, Michael / Virmani, Renu. ·CVPath Institute, Inc., Gaithersburg, Maryland. · CVPath Institute, Inc., Gaithersburg, Maryland. Electronic address: rvirmani@cvpath.org. ·J Am Coll Cardiol · Pubmed #26184619.

ABSTRACT: -- No abstract --

4 Editorial Does neointimal characterization following DES implantation predict long-term outcomes? 2014

Sakakura, Kenichi / Joner, Michael / Virmani, Renu. ·CVPath Institute, Inc., Gaithersburg, Maryland. · CVPath Institute, Inc., Gaithersburg, Maryland. Electronic address: rvirmani@cvpath.org. ·JACC Cardiovasc Imaging · Pubmed #25124010.

ABSTRACT: -- No abstract --

5 Editorial Glagov's phenomenon: has our understanding of vascular remodeling changed? 2014

Joner, Michael / Virmani, Renu. ·CVPath Institute Inc., Gaithersburg, Maryland, USA. ·Coron Artery Dis · Pubmed #24492456.

ABSTRACT: -- No abstract --

6 Review Pathophysiology of native coronary, vein graft, and in-stent atherosclerosis. 2016

Yahagi, Kazuyuki / Kolodgie, Frank D / Otsuka, Fumiyuki / Finn, Aloke V / Davis, Harry R / Joner, Michael / Virmani, Renu. ·CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA. · Department of Medicine, Emory University Hospital, 550 Peachtree Street, Nebraska, Atlanta, GA 30308, USA. ·Nat Rev Cardiol · Pubmed #26503410.

ABSTRACT: Plaque rupture, usually of a precursor lesion known as a 'vulnerable plaque' or 'thin-cap fibroatheroma', is the leading cause of thrombosis. Less-frequent aetiologies of coronary thrombosis are erosion, observed with greatest incidence in women aged <50 years, and eruptive calcified nodules, which are occasionally identified in older individuals. Various treatments for patients with coronary artery disease, such as CABG surgery and interventional therapies, have led to accelerated atherosclerosis. These processes occur within months to years, compared with the decades that it generally takes for native disease to develop. Morphological identifiers of accelerated atherosclerosis include macrophage-derived foam cells, intraplaque haemorrhage, and thin fibrous cap. Foam-cell infiltration can be observed within 1 year of a saphenous vein graft implantation, with subsequent necrotic core formation and rupture ensuing after 7 years in over one-third of patients. Neoatherosclerosis occurs early and with greater prevalence in drug-eluting stents than in bare-metal stents and, although rare, complications of late stent thrombosis from rupture are associated with high mortality. Comparison of lesion progression in native atherosclerotic disease, atherosclerosis in saphenous vein grafts, and in-stent neoatherosclerosis provides insight into the pathogenesis of atheroma formation in natural and iatrogenic settings.

7 Review Report of a European Society of Cardiology-European Association of Percutaneous Cardiovascular Interventions task force on the evaluation of coronary stents in Europe: executive summary. 2015

Byrne, Robert A / Serruys, Patrick W / Baumbach, Andreas / Escaned, Javier / Fajadet, Jean / James, Stefan / Joner, Michael / Oktay, Semih / Jüni, Peter / Kastrati, Adnan / Sianos, George / Stefanini, Giulio G / Wijns, William / Windecker, Stephan. ·Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. · Bristol Heart Institute, Bristol, UK. · Interventional Cardiology, Hospital San Carlos, Madrid, Spain. · Interventional Cardiology, Clinique Pasteur, Toulouse, France. · Clinical Research Center, Uppsala University, Uppsala, Sweden. · CVPath Institute, Inc., Gaithersburg, USA. · Cardio Med Device Consultants, Baltimore, USA. · Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. · AHEPA University Hospital, Thessaloniki, Greece. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. · Cardiovascular Center O.L.V.Z., Aalst, Belgium. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland stephan.windecker@insel.ch. ·Eur Heart J · Pubmed #26071600.

ABSTRACT: The evaluation for European Union market approval of coronary stents falls under the Medical Device Directive that was adopted in 1993. Specific requirements for the assessment of coronary stents are laid out in supplementary advisory documents. In response to a call by the European Commission to make recommendations for a revision of the advisory document on the evaluation of coronary stents (Appendix 1 of MEDDEV 2.7.1), the European Society of Cardiology (ESC) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) established a Task Force to develop an expert advisory report. As basis for its report, the ESC-EAPCI Task Force reviewed existing processes, established a comprehensive list of all coronary drug-eluting stents that have received a CE mark to date, and undertook a systematic review of the literature of all published randomized clinical trials evaluating clinical and angiographic outcomes of coronary artery stents between 2002 and 2013. Based on these data, the TF provided recommendations to inform a new regulatory process for coronary stents. The main recommendations of the task force include implementation of a standardized non-clinical assessment of stents and a novel clinical evaluation pathway for market approval. The two-stage clinical evaluation plan includes recommendation for an initial pre-market trial with objective performance criteria (OPC) benchmarking using invasive imaging follow-up leading to conditional CE-mark approval and a subsequent mandatory, large-scale randomized trial with clinical endpoint evaluation leading to unconditional CE-mark. The data analysis from the systematic review of the Task Force may provide a basis for determination of OPC for use in future studies. This paper represents an executive summary of the Task Force's report.

8 Review Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment. 2015

Otsuka, Fumiyuki / Byrne, Robert A / Yahagi, Kazuyuki / Mori, Hiroyoshi / Ladich, Elena / Fowler, David R / Kutys, Robert / Xhepa, Erion / Kastrati, Adnan / Virmani, Renu / Joner, Michael. ·CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA. · Deutsches Herzzentrum München, Technische Universitat München, Munich, Germany. · Office of the Chief Medical Examiner, Baltimore, MD, USA. · CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA mjoner@cvpath.org michaeljoner@me.com. ·Eur Heart J · Pubmed #25994755.

ABSTRACT: Despite the reduction in late thrombotic events with newer-generation drug-eluting stents (DES), late stent failure remains a concern following stent placement. In-stent neoatherosclerosis has emerged as an important contributing factor to late vascular complications including very late stent thrombosis and late in-stent restenosis. Histologically, neoatherosclerosis is characterized by accumulation of lipid-laden foamy macrophages within the neointima with or without necrotic core formation and/or calcification. The development of neoatherosclerosis may occur in months to years following stent placement, whereas atherosclerosis in native coronary arteries develops over decades. Pathologic and clinical imaging studies have demonstrated that neoatherosclerosis occurs more frequently and at an earlier time point in DES when compared with bare metal stents, and increases with time in both types of implant. Early development of neoatherosclerosis has been identified not only in first-generation DES but also in second-generation DES. The mechanisms underlying the rapid development of neoatherosclerosis remain unknown; however, either absence or abnormal endothelial functional integrity following stent implantation may contribute to this process. In-stent plaque rupture likely accounts for most thrombotic events associated with neoatherosclerosis, while it may also be a substrate of in-stent restenosis as thrombosis may occur either symptomatically or asymptomatically. Intravascular optical coherence tomography is capable of detecting neoatherosclerosis; however, the shortcomings of this modality must be recognized. Future studies should assess the impact of iterations in stent technology and risk factor modification on disease progression. Similarly, refinements in imaging techniques are also warranted that will permit more reliable detection of neoatherosclerosis.

9 Review Impact of local flow haemodynamics on atherosclerosis in coronary artery bifurcations. 2015

Antoniadis, Antonios P / Giannopoulos, Andreas A / Wentzel, Jolanda J / Joner, Michael / Giannoglou, George D / Virmani, Renu / Chatzizisis, Yiannis S. ·Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. ·EuroIntervention · Pubmed #25983161.

ABSTRACT: Coronary artery bifurcations are susceptible to atherosclerosis as a result of the unique local flow patterns and the subsequent endothelial shear stress (ESS) environment that are conducive to the development of plaques. Along the lateral walls of the main vessel and side branches, a distinct flow pattern is observed with local low and oscillatory ESS, while high ESS develops at the flow divider (carina). Histopathologic studies have shown that the distribution of plaque at bifurcation regions is related to the local ESS patterns. The local ESS profile also influences the outcome of percutaneous coronary interventions in bifurcation lesions. A variety of invasive and non-invasive imaging modalities have enabled 3D reconstruction of coronary bifurcations and thereby detailed local ESS assessment by computational fluid dynamics. Highly effective strategies for treatment and ultimately prevention of atherosclerosis in coronary bifurcations are anticipated with the use of advanced imaging and computational fluid dynamic techniques.

10 Review Pathological aspects of bioresorbable stent implantation. 2015

Sanchez, Oscar D / Yahagi, Kazuyuki / Byrne, Robert A / Mori, Hiroyoshi / Zarpak, Roya / Wittchow, Eric / Foin, Nicolas / Virmani, Renu / Joner, Michael. ·CVPath Institute, Inc., Gaithersburg, MD, USA. ·EuroIntervention · Pubmed #25983157.

ABSTRACT: The treatment of obstructive coronary artery disease has been revolutionised by the advent of drug-eluting stent therapy. However, concerns remain about complications late after stent implantation including late stent thrombosis, hypersensitivity reactions and neoatherosclerosis. In this respect, the introduction of fully bioresorbable stents (BRS)--which resorb over time and leave the arterial wall free of any metal constraints--represents a potentially important disruptive technology. However, although the concept is intuitively attractive, a thorough understanding of the histopathological changes seen after BRS implantation and an appreciation of comparative changes versus existing metal stent technologies are vital to guide BRS clinical usage. In this respect, translational investigation of polymer chemistry, biomedical engineering, as well as in vitro and in vivo testing in animal models is an important undertaking. This article will review the pathological aspects of BRS implantation with a focus on acute and chronic vascular reactions derived from preclinical animal studies, including insights from in vivo imaging. Finally, potential future directions of this novel therapeutic approach will be discussed.

11 Review Optical coherence tomography surveillance following drug-eluting stent implantation. 2015

Koppara, T / Virmani, R / Joner, M. ·CVPath Institute Inc., Gaithersburg, MD, USA - mjoner@cvpath.org. ·Minerva Cardioangiol · Pubmed #25566936.

ABSTRACT: Drug-eluting stents are currently used in the majority of percutaneous coronary interventions. Preclinical investigations and human autopsy studies have shown that the high efficacy of drug-eluting stents (DES) in preventing restenosis is achieved at the expense of a delay in healing. Optical coherence tomography (OCT) represents a novel intracoronary imaging tool to evaluate vascular healing response after stent implantation. Owing to its outstanding resolution in the catheter near-field, quantitative morphometric measures were complemented by more qualitative description of neointimal tissue characterization. Clinical imaging studies employing these methodologies gained valuable insights into vascular healing responses after DES implantation and are reported in this review. However, an important limitation of OCT imaging analysis, despite its high resolution, remains the inability to assess the precise cellular composition and functional capability of the neointimal tissue, especially of the endothelium. Future long-term clinical studies are warranted to determine the clinical relevance of surrogate parameters derived from preliminary OCT surveillance studies.

12 Review Clinical classification of plaque morphology in coronary disease. 2014

Otsuka, Fumiyuki / Joner, Michael / Prati, Francesco / Virmani, Renu / Narula, Jagat. ·Cardiovascular Pathology Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA. · San Giovanni Addolorata Hospital and CLI Foundation, Via Amba Aradam, 8, Rome 00184, Italy. · Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA. ·Nat Rev Cardiol · Pubmed #24776706.

ABSTRACT: In published post-mortem pathological studies, more than two-thirds of acute coronary events are associated with the rupture of lipid-rich, voluminous, and outwardly remodelled plaques covered by attenuated and inflamed fibrous caps in the proximal part of coronary arteries. Superficial erosion of the plaques is responsible for most of the remaining events; the eroded plaques usually do not demonstrate much lipid burden, do not have thin fibrous caps, are not positively remodelled, and are not critically occlusive. Both noninvasive and invasive imaging studies have been performed to clinically define the plaque characteristics in acute coronary syndromes in an attempt to identify the high-risk plaque substrate susceptible to development of an acute coronary event. Optical coherence tomography (OCT)--an intravascular imaging modality with high resolution--can be used to define various stages of plaque morphology, which might allow its use for the identification of high-risk plaques vulnerable to rupture, and their amenability to pre-emptive interventional treatment. OCT might also be employed to characterize plaque pathology at the time of intervention, to provide a priori knowledge of the mechanism of the acute coronary syndrome and, therefore, to enable improved management of the condition.

13 Review Has our understanding of calcification in human coronary atherosclerosis progressed? 2014

Otsuka, Fumiyuki / Sakakura, Kenichi / Yahagi, Kazuyuki / Joner, Michael / Virmani, Renu. ·From CVPath Institute Inc, Gaithersburg, MD. ·Arterioscler Thromb Vasc Biol · Pubmed #24558104.

ABSTRACT: Coronary artery calcification is a well-established predictor of future cardiac events; however, it is not a predictor of unstable plaque. The intimal calcification of the atherosclerotic plaques may begin with smooth muscle cell apoptosis and release of matrix vesicles and is almost always seen microscopically in pathological intimal thickening, which appears as microcalcification (≥0.5 μm, typically <15 μm in diameter). Calcification increases with macrophage infiltration into the lipid pool in early fibroatheroma where they undergo apoptosis and release matrix vesicles. The confluence of calcified areas involves extracellular matrix and the necrotic core, which can be identified by radiography as speckled (≤2 mm) or fragmented (>2, <5 mm) calcification. The calcification in thin-cap fibroatheromas and plaque rupture is generally less than what is observed in stable plaques and is usually speckled or fragmented. Fragmented calcification spreads into the surrounding collagen-rich matrix forming calcified sheets, the hallmarks of fibrocalcific plaques. The calcified sheets may break into nodules with fibrin deposition, and when accompanied by luminal protrusion, it is associated with thrombosis. Calcification is highest in fibrocalcific plaques followed by healed plaque rupture and is the least in erosion and pathological intimal thickening. The extent of calcification is greater in men than in women especially in the premenopausal period and is also greater in whites compared with blacks. The mechanisms of intimal calcification remain poorly understood in humans. Calcification often occurs in the presence of apoptosis of smooth muscle cells and macrophages with matrix vesicles accompanied by expression of osteogenic markers within the vessel wall.

14 Review Drug-coated balloon therapy in coronary and peripheral artery disease. 2014

Byrne, Robert A / Joner, Michael / Alfonso, Fernando / Kastrati, Adnan. ·Deutsches Herzzentrum, Technische Universität, Lazarettstrasse 36, D-80636 Munich, Germany. · Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, c/ Diego de León 62, Madrid 28006, Spain. ·Nat Rev Cardiol · Pubmed #24189405.

ABSTRACT: Nonstent-based local drug delivery during percutaneous intervention offers potential for sustained antirestenotic efficacy without the limitations of permanent vascular implants. Preclinical studies have shown that effective local tissue concentrations of drugs can be achieved using drug-coated balloon (DCB) catheters. Matrix coatings consisting of a mixture of lipophilic paclitaxel and hydrophilic spacer (excipient) are most effective. Clinical applications most suited to DCB therapy are those for which stent implantation is not desirable or less effective, such as in-stent restenosis, bifurcation lesions, or peripheral artery stenoses. Randomized trials have shown superiority of DCBs over plain-balloon angioplasty for both bare-metal and drug-eluting coronary in-stent restenosis, and similar efficacy as repeat stenting with a drug-eluting stent (DES). Bycontrast, randomized trials of DCBs in de novo coronary stenosis have, to date, not shown similar efficacy to standard-of-care DES therapy. In peripheral artery disease, DCB therapy has proven superior to plain-balloon angioplasty for treatment of de novo femoropoliteal and below-the-knee disease, and shown promising results for in-stent restenosis. Overall, however, despite many years of clinical experience with DCBs, the number of large, high-quality, randomized clinical trials is low, and further data are urgently needed across the spectrum of clinical indications.

15 Article Randomised comparison of vascular response to biodegradable polymer sirolimus eluting and permanent polymer everolimus eluting stents: An optical coherence tomography study. 2018

Koppara, Tobias / Tada, Tomohisa / Xhepa, Erion / Kufner, Sebastian / Byrne, Robert A / Ibrahim, Tareq / Laugwitz, Karl-Ludwig / Kastrati, Adnan / Joner, Michael. ·Deutsches Herzzentrum, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany; Department of Internal Medicine I - Cardiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. · Deutsches Herzzentrum, Technische Universität München, Munich, Germany. · Deutsches Herzzentrum, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany. · Department of Internal Medicine I - Cardiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. · DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany; Department of Internal Medicine I - Cardiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. · Deutsches Herzzentrum, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany. Electronic address: michaeljoner@me.com. ·Int J Cardiol · Pubmed #29544956.

ABSTRACT: BACKGROUND: Drug-eluting stents with biodegradable polymer coatings have shown promising outcomes in randomised studies. METHODS: We compared neointimal healing patterns including strut coverage and assessed neointimal maturity using a novel algorithm in coronary lesions treated with sirolimus-eluting stents with biodegradable polymer coating (BP-SES) or everolimus eluting stents with permanent polymer coating (PP-EES) using optical coherence tomography after 6months. RESULTS: A total of 39 patients were randomised to BP-SES (n=19) or PP-EES (n=20) for the treatment of coronary lesions. Of those, 29 patients (14 BP-SES and 15 PP-EES) underwent optical coherence tomography (OCT) and angiography at 6-month follow-up. Tissue coverage and apposition were assessed in a total of 6162 struts (BP-SES, n=2889; PP-EES, n=3273). Neointimal maturity was assessed in 3672 neointimal regions above struts using grey scale intensity analysis. OCT analysis showed neointimal coverage of 2433 (BP-SES) vs. 2702 (PP-EES) struts (84.2% vs. 82.6%, p=0.70), whereas the remainder was uncovered after 6months. Mean neointimal thickness did not differ significantly between groups (54.3±7.8μm vs. 80±14.6μm, p=0.12). The rate of malapposed struts was comparable between groups (1.3% vs. 2.2%, p=0.27). Grey scale signal intensity analysis showed mature tissue coverage of struts in 46.2% in BP-SES vs. 31.8% in PP-EES (p=0.31) of neointimal regions. CONCLUSION: The present study showed comparable early vascular healing response characterised by neointimal coverage with mainly immature neointima in both BP-SES and PP-EES.

16 Article Transcatheter aortic valve implantation and off-pump coronary artery bypass surgery: an effective hybrid procedure in selected patients. 2018

Mayr, Benedikt / Firschke, Christian / Erlebach, Magdalena / Bleiziffer, Sabine / Krane, Markus / Joner, Michael / Herold, Ulf / Nöbauer, Christian / Lange, Rüdiger / Deutsch, Marcus-André. ·Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany. · Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany. · Department of Cardiology, Medical Park St. Hubertus, Bad Wiessee, Germany. · DZHK (German Center for Cardiovascular Research)-partner site Munich Heart Alliance, Munich, Germany. · Department of Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany. ·Interact Cardiovasc Thorac Surg · Pubmed #29490052.

ABSTRACT: OBJECTIVES: Simultaneous surgical off-pump coronary revascularization and transcatheter aortic valve implantation (TAVI) as a hybrid procedure may be a therapeutic option for patients with a TAVI indication who are not suitable for percutaneous coronary intervention and for patients who have an indication for combined surgical aortic valve implantation and coronary artery bypass grafting but present with a porcelain aorta. Early outcomes of these patients are analysed in this study. METHODS: From February 2011 to April 2017, hybrid TAVI/off-pump coronary artery bypass (OPCAB) was performed in 12 (60%) patients, hybrid TAVI/minimally invasive direct coronary artery bypass in 6 (30%) patients and staged TAVI/OPCAB in 2 (10%) patients. Endpoints of this study were 30-day mortality, device success and postoperative adverse events as defined by the updated Valve Academic Research Consortium (VARC-2). RESULTS: The median age at the time of surgery was 77 years [interquartile range (IQR), 70-81] with a median logistic EuroSCORE and Society of Thoracic Surgeons' Predicted Risk score of 16.1% (IQR, 9.3-28.1) and 3.9% (IQR, 2.2-5.6), respectively. The median Synergy between PCI with Taxus and Cardiac Surgery score was 16.5 (IQR, 9.8-22.8). TAVI implantation routes were transaortic in 9 (45%) patients, transapical and transfemoral in 5 (25%) patients each and trans-subclavian in 1 (5%) patient. Complete myocardial revascularization was achieved in 75% of patients. Device success rate was 100%. Paravalvular aortic regurgitation did not exceed mild in any patient. Stroke/transient ischaemic attack, vascular complications and myocardial infarction were not observed. Re-exploration for bleeding was required in 1 (5%) patient. Thirty-day mortality was 0%. CONCLUSIONS: Hybrid OPCAB/MIDCAB and TAVI prove to be a safe and effective alternative treatment option in selected higher risk patients.

17 Article Very late scaffold thrombosis: insights from optical coherence tomography and histopathology. 2018

Joner, Michael / Nicol, Philipp / Rai, Himanshu / Richter, Heiko / Foin, Nicolas / Ng, Jaryl / Cuesta, Javier / Rivero, Fernando / Serrano, Rosario / Alfonso, Fernando. ·Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. ·EuroIntervention · Pubmed #29155382.

ABSTRACT: -- No abstract --

18 Article Optimization of coronary optical coherence tomography imaging using the attenuation-compensated technique: a validation study. 2017

Teo, Jing Chun / Foin, Nicolas / Otsuka, Fumiyuki / Bulluck, Heerajnarain / Fam, Jiang Ming / Wong, Philip / Low, Fatt Hoe / Leo, Hwa Liang / Mari, Jean-Martial / Joner, Michael / Girard, Michael J A / Virmani, Renu. ·National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609. · Department of Biomedical Engineering and Duke-NUS Medical School, National University Singapore, Singapore. · CV Path Institute, Gaithersburg, MD, USA. · National Cerebral and Cardiovascular Center, Osaka, Japan. · Department of Cardiology, National University Heart Center, Singapore. · University of French Polynesia, French Polynesia. · Singapore Eye Research Institute Singapore National Eye Centre, Singapore. ·Eur Heart J Cardiovasc Imaging · Pubmed #27469587.

ABSTRACT: Aim: To optimize conventional coronary optical coherence tomography (OCT) images using the attenuation-compensated technique to improve identification of plaques and the external elastic lamina (EEL) contour. Methods and Results: The attenuation-compensated technique was optimized via manipulating contrast exponent C, and compression exponent N, to achieve an optimal contrast and signal-to-noise ratio (SNR). This was applied to 60 human coronary lesions (38 native and 22 stented) ex vivo conventional coronary OCT images acquired from heart autopsies of 10 patients and matching histology was available as reference. Three independent reviewers assessed the conventional and attenuation-compensated OCT images blindly for plaque characteristics and EEL detection. Conventional OCT and compensated OCT assessment were compared against histology. Using an optimized algorithm, the attenuation-compensated OCT images had a 2-fold improvement in contrast between different tissues in both stented and non-stented epicardial coronaries (P < 0.05). Overall sensitivity and specificity for plaque classification increased from 84 to 89% and from 92 to 94%, respectively, with substantial agreement among the three reviewers (Fleiss' Kappa k, 0.72 and 0.71, respectively). Furthermore, operators were 2.5 times more likely to identify the EEL contour in the attenuation-compensated OCT images (k = 0.72) than in the conventional OCT images (k = 0.36). Conclusion: The attenuation-compensated technique can be retrospectively applied to conventional OCT images and improves the detection of plaque characteristics and the EEL contour. This approach could complement conventional OCT imaging in the evaluation of plaque characteristics and quantify plaque burden in the clinical setting.

19 Article Additive Value of Integrated Backscatter IVUS for Detection of Vulnerable Plaque by Optical Frequency Domain Imaging: An Ex Vivo Autopsy Study of Human Coronary Arteries. 2016

Nakano, Masataka / Yahagi, Kazuyuki / Yamamoto, Hirosada / Taniwaki, Masanori / Otsuka, Fumiyuki / Ladich, Elena R / Joner, Michael / Virmani, Renu. ·CVPath Institute, Inc., Gaithersburg, Maryland. · Department of Cardiology, Teikyo University Hospital, Tokyo, Japan. · Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan. · CVPath Institute, Inc., Gaithersburg, Maryland. Electronic address: rvirmani@cvpath.org. ·JACC Cardiovasc Imaging · Pubmed #26777223.

ABSTRACT: OBJECTIVES: This study sought to evaluate the diagnostic performance of optical frequency domain imaging (OFDI) for recognition of coronary plaque morphologies and to assess additive values of integrated backscatter intravascular ultrasound (IB-IVUS) in detection of vulnerable plaque. BACKGROUND: Precise diagnosis of coronary lesions susceptible to plaque rupture and thrombosis may serve to stratify the risk of future coronary events and to make decisions for appropriate treatment of choice. METHODS: Twenty-seven coronary arteries from 14 human autopsy hearts were interrogated ex vivo by OFDI and IB-IVUS. Imaged segments were sectioned at 3 mm intervals where a total of 360 pairs of cross-sectional images coregistered to histology were investigated. RESULTS: Overall, OFDI could depict various plaque components and structures such as fibrous tissue, sheet and nodular calcification, lipid, cholesterol crystals, and healed plaque rupture. OFDI could detect 14 of 18 thin-cap fibroatheroma (TCFA), however, the diagnostic accuracy was not high (positive predictive value [PPV] = 60.9%, κ = 0.664; area under the curve [AUC]: 0.88) mainly because of signal interference from macrophages. Further, we defined IB-IVUS-derived TCFA by recursive partitioning analysis as: 1) cross-sectional % lipid area >65.1%; 2) % lipid area >32.3 but <65.1% with plaque area >10.5 mm(2), where TCFA detection by IB-IVUS alone was marginal (PPV = 50.0%, κ = 0.545; AUC: 0.82). However, when IB-IVUS was combined with OFDI, all pseudo OFDI-derived TCFA (non-TCFA on histology) were excluded. Accordingly, PPV of TCFAs diagnosed by both OFDI and IB-IVUS was improved to 100.0% (κ = 0.704; AUC: 0.93). CONCLUSIONS: OFDI could recognize detailed morphologies of human coronary plaque. However, diagnostic accuracy of both OFDI alone and IB-IVUS alone to identify TCFA is limited. Combination of IB-IVUS with OFDI improved the accuracy for TCFA detection, suggesting hybrid imaging or further development of novel devices will be required to identify coronary lesions responsible for future events.

20 Article Angiographic and clinical outcomes of patients treated with everolimus-eluting bioresorbable stents in routine clinical practice: Results of the ISAR-ABSORB registry. 2016

Hoppmann, P / Kufner, S / Cassese, S / Wiebe, J / Schneider, S / Pinieck, S / Scheler, L / Bernlochner, I / Joner, M / Schunkert, H / Laugwitz, K-L / Kastrati, A / Byrne, R A. ·1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany. · Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany. · DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, am Institut für Pharmakologie und Toxikologie der Technischen Universität München Biedersteiner Str. 29, 80802, München. ·Catheter Cardiovasc Interv · Pubmed #26708019.

ABSTRACT: OBJECTIVES: We aimed to analyze angiographic and clinical results of patients undergoing BRS implantation in a real-world setting. BACKGROUND: Angiographic and clinical outcome data from patients undergoing implantation of drug-eluting bioresorbable stents (BRS) in routine clinical practice is scant. METHODS: Consecutive patients undergoing implantation of everolimus-eluting BRS at two high-volume centers in Munich, Germany were enrolled. Data were collected prospectively. All patients were scheduled for angiographic surveillance 6-8 months after stent implantation. Quantitative coronary angiographic analysis was performed in a core laboratory. Clinical follow-up was performed to 12 months and events were adjudicated by independent assessors. RESULTS: A total of 419 patients were studied. Mean age was 66.6 ± 10.9 years, 31.5% had diabetes mellitus, 76.1% had multivessel disease, and 39.0% presented with acute coronary syndrome; 49.0% of lesions were AHA/ACC type B2/C, 13.1% had treatment of bifurcation lesions. Mean reference vessel diameter was 2.89 ± 0.46 mm. At angiographic follow-up in-stent late loss was 0.26 ± 0.51 mm, in-segment diameter stenosis was 27.5 ± 16.1, and binary angiographic restenosis was 7.5%. At 12 months, the rate of death, myocardial infarction, or target lesion revascularization was 13.1%. Definite stent thrombosis occurred in 2.6%. CONCLUSIONS: The use of everolimus-eluting BRS in routine clinical practice is associated with high antirestenotic efficacy in patients undergoing angiographic surveillance. Overall clinical outcomes at 12 months are satisfactory though stent thrombosis rates are not insignificant. Further study with longer term follow-up and larger numbers of treated patients is required before we can be sure of the role of these devices in clinical practice.

21 Article Intravascular Assessment of Arterial Disease Using Compensated OCT in Comparison With Histology. 2016

Lee, Renick / Foin, Nicolas / Otsuka, Fumiyuki / Wong, Philip / Mari, Jean-Martial / Joner, Michael / Girard, Michael J A / Virmani, Renu. · ·JACC Cardiovasc Imaging · Pubmed #25797128.

ABSTRACT: -- No abstract --

22 Article Very Late Scaffold Thrombosis: Intracoronary Imaging and Histopathological and Spectroscopic Findings. 2015

Räber, Lorenz / Brugaletta, Salvatore / Yamaji, Kyohei / O'Sullivan, Crochan J / Otsuki, Shuji / Koppara, Tobias / Taniwaki, Masanori / Onuma, Yoshinobu / Freixa, Xavier / Eberli, Franz R / Serruys, Patrick W / Joner, Michael / Sabaté, Manel / Windecker, Stephan. ·Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Bern, Switzerland. · Cardiology Department, Thorax Institute, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain. · Cardiology Department, Triemlispital, Zurich, Switzerland. · CvPath Institute, Gaithersburg, Maryland. · Thoraxcenter, Erasmus University Hospital, Rotterdam, the Netherlands. · International Centre for Cardiovascular Health, Imperial College London, London, United Kingdom. · Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: stephan.windecker@insel.ch. ·J Am Coll Cardiol · Pubmed #26493663.

ABSTRACT: BACKGROUND: Bioresorbable scaffolds provide transient lumen support followed by complete resorption. OBJECTIVES: This study examined whether very late scaffold thrombosis (VLScT) occurs when resorption is presumed to be nearly complete. METHODS: Patients with VLScT at 3 tertiary care centers underwent thrombus aspiration followed by optical coherence tomography (OCT). Thrombus aspirates were analyzed by histopathological and spectroscopic examination. RESULTS: Between March 2014 and February 2015, 4 patients presented with VLScT at 44 (case 1), 19 (cases 2 and 4), and 21 (case 3) months, respectively, after implantation of an Absorb Bioresorbable Vascular Scaffold 1.1 (Abbott Laboratories, Abbott Park, Illinois). At the time of VLScT, all patients were taking low-dose aspirin, and 2 patients were also taking prasugrel. OCT showed malapposed scaffold struts surrounded by thrombus in 7.1%, 9.0%, and 8.9% of struts in cases 1, 2, and 4, respectively. Scaffold discontinuity with struts in the lumen center was the cause of malapposition in cases 2 and 4. Uncovered scaffold struts with superimposed thrombus were the predominant findings in case 3. OCT percent area stenosis at the time of VLScT was high in case 1 (74.8%) and case 2 (70.9%) without evidence of excessive neointimal hyperplasia. Spectroscopic thrombus aspirate analysis showed persistence of intracoronary polymer fragments in case 1. CONCLUSIONS: VLScT may occur at advanced stages of scaffold resorption. Potential mechanisms specific for VLScT include scaffold discontinuity and restenosis during the resorption process, which appear delayed in humans; these findings suggest an extended period of vulnerability for thrombotic events.

23 Article Impact of smoking on coronary heart disease: is there a smoker's paradox? 2015

Yahagi, Kazuyuki / Joner, Michael / Virmani, Renu. ·CVPath Institute Inc., Gaithersburg, Maryland, USA. ·Coron Artery Dis · Pubmed #26217891.

ABSTRACT: -- No abstract --

24 Article Natural progression of atherosclerosis from pathologic intimal thickening to late fibroatheroma in human coronary arteries: A pathology study. 2015

Otsuka, Fumiyuki / Kramer, Miranda C A / Woudstra, Pier / Yahagi, Kazuyuki / Ladich, Elena / Finn, Aloke V / de Winter, Robbert J / Kolodgie, Frank D / Wight, Thomas N / Davis, Harry R / Joner, Michael / Virmani, Renu. ·CVPath Institute, Inc., Gaithersburg, MD, USA. · Academic Medical Centre, University of Amsterdam, The Netherlands. · Emory University School of Medicine, Atlanta, GA, USA. · The Matrix Biology Program, Benaroya Research Institute, Seattle, WA, USA. · CVPath Institute, Inc., Gaithersburg, MD, USA. Electronic address: rvirmani@cvpath.org. ·Atherosclerosis · Pubmed #26058741.

ABSTRACT: OBJECTIVE: Smooth muscle cells, macrophage infiltration and accumulation of lipids, proteoglycans, collagen matrix and calcification play a central role in atherosclerosis. The early histologic changes of plaque progression from pathologic intimal thickenings (PIT) to late fibroatheroma lesions have not been fully characterized. METHODS: A total of 151 atherosclerotic coronary lesions were collected from 67 sudden death victims. Atherosclerotic plaques were classified as PIT without macrophage infiltration, PIT with macrophages, and early and late fibroatheromas. Presence of macrophages and proteoglycans (versican, decorin and biglycan) were recognized by specific antibodies while hyaluronan was detected by affinity histochemistry. Lipid deposition was identified by oil-red-O, and calcification was assessed following von Kossa and alizarin red staining. RESULTS: Lesion progression from PIT to late fibroatheroma was associated with increase in macrophage accumulation (p < 0.001) and decreasing apoptotic body clearance by macrophages (ratio of engulfed-to-total apoptotic bodies) (p < 0.001). Lipid deposition in lipid pool of PIT had a microvesicular appearance whereas those in the necrotic core were globular in nature. Overall, the accumulation of hyaluronan (p < 0.001), and proteoglycan versican (p < 0.001) and biglycan (p = 0.013) declined along with lesion progression from PIT to fibroatheromas. Microcalcification was first observed only within areas of lipid pools and its presence and size increased in lesions with necrotic core. CONCLUSIONS: PIT to fibroatheroma lesions are accompanied by early lipid accumulation, followed by macrophage infiltration with defective clearance of apoptotic bodies along with decrease in proteoglycan and hyaluronan in lipid pools that convert to necrotic cores. Calcification starts in PIT and increases with plaque progression.

25 Article What about the risk of thrombosis with bioresorbable scaffolds? 2015

Capodanno, Davide / Joner, Michael / Zimarino, Marco. ·Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy. ·EuroIntervention · Pubmed #25983162.

ABSTRACT: Bioresorbable scaffolds promise to counteract late thrombosis by the absence of residual foreign material over time and the restoration of functional endothelial coverage. However, although currently available data are controversial, initial post-marketing studies have raised some concerns about the putative increased early thrombogenicity of bioresorbable scaffolds as compared to currently available second-generation drug-eluting stents. This article focuses on incidence rates, putative mechanisms and prevention strategies of scaffold thrombosis.

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