ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

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2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

2018 ESC/EACTS Guidelines on myocardial revascularization.

Authors/Task Force Members: Franz-Josef Neumann* (ESC Chairperson) (Germany), Miguel Sousa-Uva* (EACTS Chairperson) (Portugal), Anders Ahlsson (Sweden), Fernando Alfonso (Spain), Adrian P. Banning (UK), Umberto Benedetto (UK), Robert A. Byrne (Germany), Jean-Philippe Collet (France), Volkmar Falk (Germany), Stuart J. Head (The Netherlands), Peter Jüni (Canada), Adnan Kastrati (Germany), Akos Koller (Hungary), Steen D. Kristensen (Denmark), Josef Niebauer (Austria), Dimitrios J. Richter (Greece), Petar M. Seferovi c (Serbia), Dirk Sibbing (Germany), Giulio G. Stefanini (Italy), Stephan Windecker (Switzerland), Rashmi Yadav (UK), Michael O. Zembala (Poland) Document Reviewers: William Wijns (ESC Review Co-ordinator) (Ireland), David Glineur (EACTS Review Co-ordinator) (Canada), Victor Aboyans (France), Stephan Achenbach (Germany), Stefan Agewall (Norway), Felicita Andreotti (Italy), Emanuele Barbato (Italy), Andreas Baumbach (UK), James Brophy (Canada), Héctor Bueno (Spain), Patrick A. Calvert (UK), Davide Capodanno (Italy), Piroze M. Davierwala

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2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).

Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of opportunity in the field of cardiovascular medicine. This consensus document concludes the following. (1) Rupture-prone plaques are not the only vulnerable plaques. All types of atherosclerotic plaques with high likelihood of thrombotic complications and rapid progression should be considered as vulnerable plaques. We propose a classification for clinical as well as pathological evaluation of vulnerable plaques. (2) Vulnerable plaques are not the only culprit factors for the development of acute coronary syndromes, myocardial infarction, and sudden cardiac death. Vulnerable blood (prone to thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play an important role in the outcome. Therefore, the term "vulnerable patient" may be more appropriate and is proposed now for the identification of subjects with high likelihood of developing cardiac events in the near future. (3) A quantitative method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood, and myocardial vulnerability. In Part I of this consensus document, we cover the new definition of vulnerable plaque and its relationship with vulnerable patients. Part II of this consensus document focuses on vulnerable blood and vulnerable myocardium and provide an outline of overall risk assessment of vulnerable patients. Parts I and II are meant to provide a general consensus and overviews the new field of vulnerable patient. Recently developed assays (eg, C-reactive protein), imaging techniques (eg, CT and MRI), noninvasive electrophysiological tests (for vulnerable myocardium), and emerging catheters (to localize and characterize vulnerable plaque) in combination with future genomic and proteomic techniques will guide us in the search for vulnerable patients. It will also lead to the development and deployment of new therapies and ultimately to reduce the incidence of acute coronary syndromes and sudden cardiac death. We encourage healthcare policy makers to promote translational research for screening and treatment of vulnerable patients.

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From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II.

Gold nanoparticles have been used in biomedical applications since their first colloidal syntheses more than three centuries ago. However, over the past two decades, their beautiful colors and unique electronic properties have also attracted tremendous attention due to their historical applications in art and ancient medicine and current applications in enhanced optoelectronics and photovoltaics. In spite of their modest alchemical beginnings, gold nanoparticles exhibit physical properties that are truly different from both small molecules and bulk materials, as well as from other nanoscale particles. Their unique combination of properties is just beginning to be fully realized in range of medical diagnostic and therapeutic applications. This critical review will provide insights into the design, synthesis, functionalization, and applications of these artificial molecules in biomedicine and discuss their tailored interactions with biological systems to achieve improved patient health. Further, we provide a survey of the rapidly expanding body of literature on this topic and argue that gold nanotechnology-enabled biomedicine is not simply an act of ‘gilding the (nanomedicinal) lily’, but that a new ‘Golden Age’ of biomedical nanotechnology is truly upon us. Moving forward, the most challenging nanoscience ahead of us will be to find new chemical and physical methods of functionalizing gold nanoparticles with compounds that can promote efficient binding, clearance, and biocompatibility and to assess their safety to other biological systems and their long-term term effects on human health and reproduction (472 references).

The golden age: gold nanoparticles for biomedicine

A device capable of performing endoscopic confocal microscopy could potentially provide physicians with a tool for performing in vivo, non-invasive, subcellular diagnostic imaging. Recently, a novel, sub-micrometer resolution, spectrally encoded confocal microscopy (SECM) imaging system has been presented. It incorporates a quasimonochromatic light source and a diffraction grating to simultaneously detect the reflectivity at multiple points along a transverse line within the sample. Since this method does not require fast spatial scanning within the probe, it is capable of being miniaturized and incorporated into a catheter or endoscope. The work in this abstract demonstrates a novel design for a 10 mm diameter SECM probe, based on a double prism GRISM, which can be used laparoscopically. Furthermore, this design can be scaled without significant modification to less than 5 mm to allow integration with large bore endoscopes.

A Novel GRISM-Based Probe for Spectrally Encoded Confocal Microscopy

Using the inherent properties of existing clinical intravascular OFDI systems, we present a robust signal processing software which resolves the polarization properties of coronary plaques and apply this method to existing patient datasets.

Reconstructing polarimetric information from existing intravascular optical frequency domain imaging data

The invention relates to methods and systems to optically analyze samples such as tissue based on speckle patterns of microscopic motion, such as Brownian motion.

Optical systems for tissue analysis

Spectral encoding is a single optical fiber imaging approach that projects different wavelengths to distinct locations on a sample, enabling a wide variety of reflectance and fluorescence medical imaging devices for macroscopic imaging and microscopy.

Spectral Encoding: A Novel Platform for Endoscopy and Microscopy

Summary Objectives To test the imaging performance and practical use of a novel dual-modality intravascular imaging system combining intravascular ultrasound (IVUS) and optical coherence tomography (OCT) into a single catheter Background IVUS enables assessing coronary plaque burden, a robust metric for patient prognosis, while OCT and OFDI provide high-resolution images of coronary microstructure and detailed assessment of stent implantation Owing to their complementary strengths, co-registering IVUS and OFDI provides a more comprehensive assessment of coronary lesions during PCI Methods We developed a 26Fr imaging catheter integrating both IVUS and OFDI, interfacing to a dual-modality imaging console through a fast interchange connector A novel algorithm fuses the IVUS and OFDI signals into a single combined image We verified the performance of the two modalities and their visualization by imaging of cadaveric coronary arteries and tested practical imaging in the catheterization laboratory in swine in vivo Results Coronary atherosclerotic lesions of cadaver hearts revealed complementary optical and acoustic image features Spatial co-registration of the modalities was confirmed by high correlation of measured lumen areas Fused into a combined visualization, dual-modality imaging offers quantitative characterization of lesions, including plaque-burden and fibrous cap thickness Imaging in vivo does not add procedural complexity compared to conventional single modality imaging Conclusion Dual-modality IVUS/OFDI imaging with fused visualization provides improved assessment of coronary atherosclerotic lesions and is compatible with a routine clinical setting Combining the strength of the two modalities offers unique opportunities both as a powerful research instrument and to improve clinical management of patients undergoing PCI Visual abstract Highlights ▪A catheter-based imaging system integrating ultrasound and optical frequency domain imaging enables real time intravascular holistic structural visualization (IV-HSV) of coronary arterial lesions with a single pullback during cardiac catheterization procedures ▪A computational method to automatically fuse images from both modalities generates a single complete map of vessel wall structures - the IV-HSV image, which offers holistic investigation of coronary plaque key features, such as fibrous cap thickness, calcification, and plaque burden ▪The visualization of plaque morphology along the entire extent of the coronary arterial wall reveals vital information for guiding percutaneous coronary interventions and for advancing our understanding of the pathophysiology of coronary artery diseases Condensed abstract To facilitate a holistic investigation of coronary arterial lesions for both basic research and clinical interventions, this work presents a catheter-based imaging system integrating IVUS and OFDI, as well as a new rendering method that computationally fuses the intrinsically co-registered images from both modalities into a single cross-sectional map of vessel structures Imaging human cadaveric coronary arteries shows the benefit of this system by revealing near-lumen microstructures and spatially correlated macrostructures deep inside the vessel wall The co-registration accuracy and operation in a clinical setting of this system was demonstrated through swine catheterization in vivo

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Brett E. Bouma

Papers

A Novel GRISM-Based Probe for Spectrally Encoded Confocal Microscopy

Reconstructing polarimetric information from existing intravascular optical frequency domain imaging data

Optical systems for tissue analysis

Spectral Encoding: A Novel Platform for Endoscopy and Microscopy

Holistic Structural Visualization of Coronary Arteries with Single-catheter Dual-modality Intravascular Imaging Combining IVUS and OFDI