Intravascular and Extravascular Microvessel Formation in Chronic Total Occlusions

Munce, Nigel R.; Strauss, Bradley H.; Qi, Xiuling; Weisbrod, Max; Anderson, K.M.; Leung, General; Sparkes, John D.; Lockwood, Julia; Jaffe, Ronen; Butany, Jagdish; Teitelbaum, Aaron A.; Qiang, Beiping; Dick, Alexander; Wright, Graham A.

doi:10.1016/j.jcmg.2010.03.013

Cited by 43 publications

(32 citation statements)

References 22 publications

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“…Yet once the CTO has matured, the number of both extra-and intravascular microchannels become much fewer, compared with the early phase (12). Upon further analysis, the longitudinal continuity of microchannels extended to approximately 85% of the entire CTO length, except in the early phase of CTO (12).…”

Section: Microchannelloosetissuesegmentsmentioning

confidence: 95%

“…In an experimental rabbit femoral artery CTO model, microcomputed tomography demonstrated that extravascular microchannels are seen mostly in the early phase of artery occlusion, and in more mature CTO, intravascular microchannels increase gradually (12). Yet once the CTO has matured, the number of both extra-and intravascular microchannels become much fewer, compared with the early phase (12).…”

Section: Microchannelloosetissuesegmentsmentioning

confidence: 99%

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Fundamental Wire Technique and Current Standard Strategy of Percutaneous Intervention for Chronic Total Occlusion With Histopathological Insights

Sumitsuji

Inoue

Ochiai

et al. 2011

JACC: Cardiovascular Interventions

162

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Currently, successful treatment of chronic total occlusion (CTO) seems markedly improved, due to several new techniques and dedicated device developments. However, this improved success rate is often limited to procedures performed by skilled, highly experienced operators. To improve the overall success rate of percutaneous coronary intervention of CTO from a worldwide perspective, a deeper understanding of CTO histopathology might offer insights into the development of new techniques and procedural strategies. In this review, CTO histopathology and wire techniques are discussed on the basis of the fundamental concepts of antegrade and retrograde approaches. Although details pertaining to wire manipulation are very difficult to explain objectively, we tried to describe this as best as possible in this article. Finally, a systematic review of the current standard CTO strategy is provided. Hopefully, this article will enhance the understanding of this complex procedure and, consequently, promote safe and effective CTO-percutaneous coronary intervention for patients who present with this challenging lesion subset.

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Section: Microchannelloosetissuesegmentsmentioning

confidence: 95%

Section: Microchannelloosetissuesegmentsmentioning

confidence: 99%

Fundamental Wire Technique and Current Standard Strategy of Percutaneous Intervention for Chronic Total Occlusion With Histopathological Insights

Sumitsuji

Inoue

Ochiai

et al. 2011

JACC: Cardiovascular Interventions

162

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“…Some noninvasive methods, such as radiological imaging techniques, have been employed to evaluate the morphologic features of vascularization in engineered tissues. 9 Micro-CT provides a good rendering of the 3D structure of the vessels, 10 and magnetic resonance imaging can be used to track groups of cells as a stream when cells are labeled with a contrast agent or reporter probe. 11 However, each of the current radiologic imaging techniques lack the cellular-level resolution required to distinguish one cell from another.…”

Section: Introductionmentioning

confidence: 99%

Analyzing Structure and Function of Vascularization in Engineered Bone Tissue by Video-Rate Intravital Microscopy and 3D Image Processing

Pang

Tsigkou

Spencer

et al. 2015

Tissue Engineering Part C: Methods

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Vascularization is a key challenge in tissue engineering. Three-dimensional structure and microcirculation are two fundamental parameters for evaluating vascularization. Microscopic techniques with cellular level resolution, fast continuous observation, and robust 3D postimage processing are essential for evaluation, but have not been applied previously because of technical difficulties. In this study, we report novel video-rate confocal microscopy and 3D postimage processing techniques to accomplish this goal. In an immune-deficient mouse model, vascularized bone tissue was successfully engineered using human bone marrow mesenchymal stem cells (hMSCs) and human umbilical vein endothelial cells (HUVECs) in a poly (d,l-lactide-co-glycolide) (PLGA) scaffold. Video-rate (30 FPS) intravital confocal microscopy was applied in vitro and in vivo to visualize the vascular structure in the engineered bone and the microcirculation of the blood cells. Postimage processing was applied to perform 3D image reconstruction, by analyzing microvascular networks and calculating blood cell viscosity. The 3D volume reconstructed images show that the hMSCs served as pericytes stabilizing the microvascular network formed by HUVECs. Using orthogonal imaging reconstruction and transparency adjustment, both the vessel structure and blood cells within the vessel lumen were visualized. Network length, network intersections, and intersection densities were successfully computed using our custom-developed software. Viscosity analysis of the blood cells provided functional evaluation of the microcirculation. These results show that by 8 weeks, the blood vessels in peripheral areas function quite similarly to the host vessels. However, the viscosity drops about fourfold where it is only 0.8 mm away from the host. In summary, we developed novel techniques combining intravital microscopy and 3D image processing to analyze the vascularization in engineered bone. These techniques have broad applicability for evaluating vascularization in other engineered tissues as well.

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“…The cellular and molecular processes control vascular healing after stent implantation in non-CTO lesion [23]. It has been reported that CTO lesions develop from a total luminal obstruction of coronary arteries by a thrombus, subsequently are organized by inflammatory cells followed by infiltrating smooth muscle cells, and generate proteoglycan matrix as well as calcification [24,25]. Thus, true-lumen in CTO lesion is pathologically different from true-lumen in non-CTO lesion.…”

Section: Discussionmentioning

confidence: 99%

Neointimal Characteristics after Everolimus-Eluting Stents Implantation for Chronic Total Occlusion: An Optical Coherence Tomographic Study

Okamoto¹,

Yasumura²,

Yasumoto³

et al. 2017

Interv Cardiol J

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Objectives: We investigated neointimal characteristics after everolimus-eluting stent (EES) implantation in chronic total occlusion (CTO) using optical coherence tomography (OCT).Background: CTO is one of the major risk factors for restenosis and reocclusion even in drug-eluting stent era, but detailed neointimal characteristics after stent implantation in CTO is unclear. Methods:We divided our patients (35 EESs) into three groups: patients with stenting for non-CTO lesions (non-CTO group), patients with subintimal stenting (CTO subintima group) and with intra true-lumen stenting for CTO lesions (CTO true lumen group). We compared OCT parameters included the percentage of neointimal hyperplasia area obstruction (%NHAO), mean neointimal hyperplasia (NIH) thickness, the proportion of uncovered struts, the proportion of malapposed struts at cross sectional level and at strut level among three groups.Results: NIH and %NHAO were significantly lowest in CTO subintima group (5 EESs) and highest in CTO true-lumen group (4 EESs) (CTO subintima vs. CTO true-lumen vs. non- , respectively) while the proportions of uncovered struts and malapposed struts were significantly highest in CTO subintima group and significantly lowest in CTO true-lumen group among the three groups (CTO subintima vs. CTO true-lumen vs. non-CTO: 109 (18.7) vs. 47 (4.7) vs. 375 (7.9) and 36 (6.2) vs. 0 (0) vs. 45 (0.95), respectively). Conclusions:We revealed by OCT that stents implanted in subintima in CTO lesions may have more risks related to stent thrombosis such as malapposed struts and uncovered struts, while stents implanted in true lumen in CTO lesions may have thicker neointimal coverage that might have occurred restenosis.

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Intravascular and Extravascular Microvessel Formation in Chronic Total Occlusions

Abstract: Differences are present in the temporal and geographic patterns of intravascular and extravascular microvessel formation during CTO maturation.

Cited by 43 publications

References 22 publications

Fundamental Wire Technique and Current Standard Strategy of Percutaneous Intervention for Chronic Total Occlusion With Histopathological Insights

Fundamental Wire Technique and Current Standard Strategy of Percutaneous Intervention for Chronic Total Occlusion With Histopathological Insights

Analyzing Structure and Function of Vascularization in Engineered Bone Tissue by Video-Rate Intravital Microscopy and 3D Image Processing

Neointimal Characteristics after Everolimus-Eluting Stents Implantation for Chronic Total Occlusion: An Optical Coherence Tomographic Study

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