Alessandro Di Giorgio - Academia.edu (original) (raw)

Papers by Alessandro Di Giorgio

Research paper thumbnail of On the optimization of energy storage system placement for protecting power transmission grids against dynamic load altering attacks

2017 25th Mediterranean Conference on Control and Automation (MED), 2017

In this paper a power system protection scheme based on energy storage system placement against c... more In this paper a power system protection scheme based on energy storage system placement against closed-loop dynamic load altering attacks is proposed. The protection design consists in formulating a non-convex optimization problem, subject to a Lyapunov stability constraint and solved using a two-step iterative procedure. Simulation results confirm the effectiveness of the approach and the potential relevance of using energy storage systems in support of primary frequency regulation services.

Research paper thumbnail of Review of Cyber-Physical Attacks in Smart Grids: A System-Theoretic Perspective

Electronics, 2021

This paper presents a review of technical works in the field of cyber-physical attacks on the sma... more This paper presents a review of technical works in the field of cyber-physical attacks on the smart grid. The paper starts by discussing two reference mathematical frameworks proposed in the literature to model a smart grid under attack. Then, a review of cyber-physical attacks on the smart grid is presented, starting from works on false data injection attacks against state estimation. The aim is to present a systematic and quantitative discussion of the basic working principles of the attacks, also in terms of the inner smart grid vulnerabilities and dynamical properties exploited by the attack. The main contribution of the paper is the attempt to provide a unifying view, highlighting the fundamental aspects and the common working principles shared by the attack models, even when targeting different subsystems of the smart grid.

Research paper thumbnail of Ensuring the Stability of Power Systems Against Dynamic Load Altering Attacks: A Robust Control Scheme Using Energy Storage Systems

2020 European Control Conference (ECC), 2020

This paper presents a robust protection scheme to protect the power transmission network against ... more This paper presents a robust protection scheme to protect the power transmission network against a class of feedback-based attacks referred in the literature as "Dynamic Load Altering Attacks" (D-LAAs). The proposed scheme envisages the usage of Energy Storage Systems (ESSs) to avoid the destabilising effects that a malicious state feedback has on the power network generators. The methodologies utilised are based on results from polytopic uncertain systems, invariance theory and Lyapunov arguments. Numerical simulations on a test scenario validate the proposed approach.

Research paper thumbnail of Efficient and Risk-Aware Control of Electricity Distribution Grids

IEEE Systems Journal, 2020

This article has been accepted for inclusion in a future issue of this journal. Content is final ... more This article has been accepted for inclusion in a future issue of this journal. Content is final as presented, with the exception of pagination.

Research paper thumbnail of Economic Model Predictive and Feedback Control of a Smart Grid Prosumer Node

Energies, 2017

This paper presents a two-level control scheme for the energy management of an electricity prosum... more This paper presents a two-level control scheme for the energy management of an electricity prosumer node equipped with controllable loads, local generation, and storage devices. The main control objective is to optimize the prosumer's energy bill by means of intelligent load shifting and storage control. A generalized tariff model including both volumetric and capacity components is considered, and user preferences as well as all technical constraints are respected. Simulations based on real household consumption data acquired with a sampling period of 1 s are discussed. The proposed control scheme bestows the prosumer node with the flexibility needed to support smart grid use cases such as bill optimization (i.e., local energy trading), control of the profile at the point of connection with the grid, demand response, and reaction to main supply faults (e.g., islanding operation), etc.

Research paper thumbnail of Assessment of Mechanisms of Acute Coronary Syndromes and Composition of Culprit Plaques in Patients With and Without Diabetes

JACC: Cardiovascular Imaging, 2019

Research paper thumbnail of Anomalous left circumflex artery occlusion: A technical challenge in primary percutaneous coronary intervention?

Cor et Vasa, 2017

S anomáliemi koronárních tepen se lze setkat přibližně u 1 % pacientů, u nichž je indikována koro... more S anomáliemi koronárních tepen se lze setkat přibližně u 1 % pacientů, u nichž je indikována koronarografi e. Většina těchto anomálií se neprojevuje žádnými známkami, symptomy ani komplikacemi a obvykle jsou zjištěny až náhodně během katetrizace. V urgentních situacích mohou pro intervenčního kardiologa anomálie koronárních tepen představovat značný problém, protože je lze obtížně nalézt a následně selektivně kanylovat. Základem úspěšné perkutánní intervence na anomálních koronárních tepnách v urgentních situacích je znalost anatomie a volba vhodných technických prostředků.

Research paper thumbnail of Role of residual acute stent malapposition in percutaneous coronary interventions

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 15, 2017

Assess clinical consequences of acute stent malapposition (ASM) in the context of the multicenter... more Assess clinical consequences of acute stent malapposition (ASM) in the context of the multicenter Centro per la Lotta Contro l'Infarto-Optimization of Percutaneous Coronary Intervention (CLI-OPCI) registry. ASM as important determinant of stent thrombosis (ST) risk remains controversial. From 2009 to 2013, we retrospectively analyzed postprocedural optical coherence tomography (OCT) findings in 864 patients undergoing percutaneous coronary intervention, assessing prevalence and magnitude of ASM and exploring correlation with outcome, especially ST. Postprocedural OCT revealed a variable grade of ASM in 72.3% of stents without correlation between maximal strut-vessel distance and longitudinal extension (R = 0.164, P < 0.01). At a median follow up of 302 (IQ 127-567) days, ASM did not affect risk of following major cardiac adverse events (MACE); residual ASM was comparable in terms of thickness (median [quartiles] 0.21[IQ 0.1-0.4] vs. 0.20[IQ 0.0-0.3], P = 0.397) and length (2....

Research paper thumbnail of Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome: The CLI-OPCI ACS Substudy (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous Coronary Intervention in Acute Coronary Syndrome)

Circulation. Cardiovascular interventions, 2016

Clinical consequences of optical coherence tomographic (OCT) high-definition visualization of pla... more Clinical consequences of optical coherence tomographic (OCT) high-definition visualization of plaque/stent structures in acute patients remain undefined. In this retrospective substudy, we assessed the prognostic impact of postprocedural culprit lesion OCT findings in patients with acute coronary syndrome undergoing percutaneous coronary intervention. In the CLI-OPCI (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous Coronary Intervention) database collecting cases from 5 independent OCT-experienced centers, we retrospectively analyzed postprocedural OCT findings in acute coronary syndrome patients and explored its possible impact (specifically that of residual intrastent plaque/thrombus protrusion) on outcome. From 2009 to 2013, 507 patients (588 lesions) were evaluated. Patients experiencing device-oriented cardiovascular events showed more frequently the features of suboptimal stent implantation defined as the presence of significant residual intrastent plaque...

Research paper thumbnail of Multi-agent quality of experience control

International Journal of Control, Automation and Systems, 2017

In the framework of the Future Internet, the aim of the Quality of Experience (QoE) Control funct... more In the framework of the Future Internet, the aim of the Quality of Experience (QoE) Control functionalities is to track the personalized desired QoE level of the applications. The paper proposes to perform such a task by dynamically selecting the most appropriate Classes of Service (among the ones supported by the network), this selection being driven by a novel heuristic Multi-Agent Reinforcement Learning (MARL) algorithm. The paper shows that such an approach offers the opportunity to cope with some practical implementation problems: in particular, it allows to face the so-called "curse of dimensionality" of MARL algorithms, thus achieving satisfactory performance results even in the presence of several hundreds of Agents.

Research paper thumbnail of Model Predictive Control of Energy Storage Systems for Power Tracking and Shaving in Distribution Grids

IEEE Transactions on Sustainable Energy, 2017

This work is partially supported by the Sapienza-Ateneo 2014 and 2013 projects no. C26A14YT4 and ... more This work is partially supported by the Sapienza-Ateneo 2014 and 2013 projects no. C26A14YT4 and no. C26A13LYTBX, on optimal ESS control strategies for RES integration in distribution networks. A.

Research paper thumbnail of An approximate dynamic programming approach to resource management in multi-cloud scenarios

International Journal of Control, 2016

The programmability and the virtualization of network resources is crucial to deploy scalable ICT... more The programmability and the virtualization of network resources is crucial to deploy scalable ICT services. The increasing demand of cloud services, mainly devoted to the storage and computing, requires a new functional element, the Cloud Management Broker (CMB), aimed at managing multiple cloud resources to meet the customers' requirements and, simultaneously, to optimize their usage. This paper proposes a multi-cloud resource allocation algorithm that manages the resource requests with the aim of maximizing the CMB revenue over time. The algorithm is based on Markov Decision Process modelling and relies on Reinforcement Learning techniques to find on-line an approximate solution.

Research paper thumbnail of Electric energy storage systems integration in distribution grids

2015 IEEE 15th International Conference on Environment and Electrical Engineering (EEEIC), 2015

This paper presents a real time control strategy for dynamically balancing electric demand and su... more This paper presents a real time control strategy for dynamically balancing electric demand and supply at local level, in a scenario characterized by a HV/MV substation with the presence of renewable energy sources in the form of photovoltaic generators and an electric energy storage system. The substation is connected to the grid and is powered by an equivalent traditional power plant playing the role of the bulk power system. A Model Predictive Control based approach is proposed, by which the active power setpoints for the traditional power plant and the storage are continually updated over the time, depending on generation costs, storage's state of charge, foreseen demand and production from renewables. The proposed approach is validated on a simulation basis, showing its effectiveness in managing fluctuations of network demand and photovoltaic generation in test and real conditions.

Research paper thumbnail of Percutaneous coronary intervention driven by combined use of intracoronary anatomy and physiology: Towards a tailored therapy for coronary artery disease

International journal of cardiology, Jan 2, 2015

Research paper thumbnail of Electric Vehicles charging control based on future internet generic enablers

2014 IEEE International Electric Vehicle Conference (IEVC), 2014

Research paper thumbnail of Early vessel healing of the Avantgarde cobalt-chromium coronary stent

Journal of Cardiovascular Medicine, 2013

The images shown within this document are of a purely illustrative nature and are not intended to... more The images shown within this document are of a purely illustrative nature and are not intended to depict reality.

Research paper thumbnail of OCT in the Clinical Practice and Data from Clinical Studies

Current Applications and Research Developments

This chapter provides a detailed description of the role of the OCT technique in the clinical pra... more This chapter provides a detailed description of the role of the OCT technique in the clinical practice. A review section on data from clinical studies is provided, underlining the extent usage of OCT during the last years. Finally, the capability of OCT to assess ambiguous lesions and deferral of interventions is discussed just before describing the role of the technique during the post procedural assessment.

Research paper thumbnail of Safety and feasibility of frequency domain optical coherence tomography to guide decision making in percutaneous coronary intervention

EuroIntervention, 2010

Aims: The purpose of this single centre registry is to assess safety and feasibility of the frequ... more Aims: The purpose of this single centre registry is to assess safety and feasibility of the frequency domain optical coherence tomography (FD-OCT) system during coronary interventions. Methods and results: Ninety patients with unstable or stable coronary artery disease were included in this study. OCT imaging was performed in a first group of 40 patients (group 1), to evaluate ambiguous/intermediate lesions (24 patients in group 1 had OCT also done post-PCI, for assessment of stent deployment); and in a second group of 50 patients (group 2), to address the adequacy of stent deployment. Therefore, 74 patients underwent FD-OCT after stent implantation. A complex-lesion population was studied (B2 type lesion=72.2% and C type lesion=20.3%). The mean time of a FD-OCT pull-back (from the set up to the completion of the pull back) was 2.1 min and in all but one (99.1%) the procedure was successful. No patients experienced major complications in terms of death, myocardial infarction, emergency revascularisation, embolisation, life-threatening arrhythmia, coronary dissection, prolonged and severe vessel spasm and contrast induced nephropathy. In the ambiguous lesion group, 60% of patients were treated with PCI, whilst in the others, PCI were deferred. In total, 113 deployed stents (33,6% chromium cobalt stent, 66,4% drug eluting stent) were imaged with OCT. OCT findings led to additional interventions in 24 out of 74 patients (32%): 15 had further balloon inflations, nine had additional stent deployment whilst two had both treatments. At clinical follow-up, (4.6±3.,2 months), there were no death, acute myocardial infarctions and cases of stent thrombosis, whilst two patients underwent revascularisation for recurrence of angina. Conclusions: The present registry shows that FD-OCT is a feasible and safe technique for guidance of coronary interventions. Randomised studies will confirm whether the use of FD-OCT will improve the clinical outcome.

Research paper thumbnail of Detection of very early stent healing after primary angioplasty: an optical coherence tomographic observational study of chromium cobaltum and first-generation drug-eluting stents. The DETECTIVE Study

Research paper thumbnail of Focus on the COCTAIL study

Interventional Cardiology, 2011

Focus on the COCTAIL study CliniCal trial Commentary Percutaneous coronary intervention (PCI), wh... more Focus on the COCTAIL study CliniCal trial Commentary Percutaneous coronary intervention (PCI), when accomplished rapidly and by experienced operators, is a highly effective therapy for acute ST-elevation myocardial infarction (STEMI). However, there is ample room for improvement, as there is a significant proportion of patients with coronary thrombus at the time of the procedure, which can lead to distal embolization and microvascular impairment when the clot is mechanically dislodged. A promising novel solution to ameliorate the outcome of angioplasty for acute coronary syndromes resides in the combined use of pharmacological and catheter-based therapies to increase local concentration of drugs such as glycoprotein IIb/IIIa inhibitors at the culprit site, prolonging their residency time. The administration of abciximab through the ClearWay™ RX therapeutic infusion catheter proved to be a valid solution, as in vitro data suggests that, at high concentrations (nearly 500 times the usual systemic dose), abciximab disaggregates existing clots. The COCTAIL study was specifically designed to verify whether administration of abciximab by local intracoronary infusion through ClearWay RX was capable of reducing thrombus burden as compared with traditional intracoronary guide catheter infusion modality in patients with acute coronary syndromes, either with STEMI or non-STEMI. Broad clinical inclusion criteria were selected to test the efficacy of such a local drug delivery approach, regardless of the amount of thrombus burden. A total of 50 patients were randomized. The mean percentage change of the thrombus score was significantly higher among patients of the ClearWay RX catheter group compared with those in the guiding catheter group (33.8 vs 3.9%; p = 0.002). Local intracoronary infusion of abciximab by means of a dedicated therapeutic infusion catheter was able to reduce thrombus burden in patients with acute coronary syndromes. keywords: abciximab n acute coronary syndrome n perfusion balloon n thrombus

Research paper thumbnail of On the optimization of energy storage system placement for protecting power transmission grids against dynamic load altering attacks

2017 25th Mediterranean Conference on Control and Automation (MED), 2017

In this paper a power system protection scheme based on energy storage system placement against c... more In this paper a power system protection scheme based on energy storage system placement against closed-loop dynamic load altering attacks is proposed. The protection design consists in formulating a non-convex optimization problem, subject to a Lyapunov stability constraint and solved using a two-step iterative procedure. Simulation results confirm the effectiveness of the approach and the potential relevance of using energy storage systems in support of primary frequency regulation services.

Research paper thumbnail of Review of Cyber-Physical Attacks in Smart Grids: A System-Theoretic Perspective

Electronics, 2021

This paper presents a review of technical works in the field of cyber-physical attacks on the sma... more This paper presents a review of technical works in the field of cyber-physical attacks on the smart grid. The paper starts by discussing two reference mathematical frameworks proposed in the literature to model a smart grid under attack. Then, a review of cyber-physical attacks on the smart grid is presented, starting from works on false data injection attacks against state estimation. The aim is to present a systematic and quantitative discussion of the basic working principles of the attacks, also in terms of the inner smart grid vulnerabilities and dynamical properties exploited by the attack. The main contribution of the paper is the attempt to provide a unifying view, highlighting the fundamental aspects and the common working principles shared by the attack models, even when targeting different subsystems of the smart grid.

Research paper thumbnail of Ensuring the Stability of Power Systems Against Dynamic Load Altering Attacks: A Robust Control Scheme Using Energy Storage Systems

2020 European Control Conference (ECC), 2020

This paper presents a robust protection scheme to protect the power transmission network against ... more This paper presents a robust protection scheme to protect the power transmission network against a class of feedback-based attacks referred in the literature as "Dynamic Load Altering Attacks" (D-LAAs). The proposed scheme envisages the usage of Energy Storage Systems (ESSs) to avoid the destabilising effects that a malicious state feedback has on the power network generators. The methodologies utilised are based on results from polytopic uncertain systems, invariance theory and Lyapunov arguments. Numerical simulations on a test scenario validate the proposed approach.

Research paper thumbnail of Efficient and Risk-Aware Control of Electricity Distribution Grids

IEEE Systems Journal, 2020

This article has been accepted for inclusion in a future issue of this journal. Content is final ... more This article has been accepted for inclusion in a future issue of this journal. Content is final as presented, with the exception of pagination.

Research paper thumbnail of Economic Model Predictive and Feedback Control of a Smart Grid Prosumer Node

Energies, 2017

This paper presents a two-level control scheme for the energy management of an electricity prosum... more This paper presents a two-level control scheme for the energy management of an electricity prosumer node equipped with controllable loads, local generation, and storage devices. The main control objective is to optimize the prosumer's energy bill by means of intelligent load shifting and storage control. A generalized tariff model including both volumetric and capacity components is considered, and user preferences as well as all technical constraints are respected. Simulations based on real household consumption data acquired with a sampling period of 1 s are discussed. The proposed control scheme bestows the prosumer node with the flexibility needed to support smart grid use cases such as bill optimization (i.e., local energy trading), control of the profile at the point of connection with the grid, demand response, and reaction to main supply faults (e.g., islanding operation), etc.

Research paper thumbnail of Assessment of Mechanisms of Acute Coronary Syndromes and Composition of Culprit Plaques in Patients With and Without Diabetes

JACC: Cardiovascular Imaging, 2019

Research paper thumbnail of Anomalous left circumflex artery occlusion: A technical challenge in primary percutaneous coronary intervention?

Cor et Vasa, 2017

S anomáliemi koronárních tepen se lze setkat přibližně u 1 % pacientů, u nichž je indikována koro... more S anomáliemi koronárních tepen se lze setkat přibližně u 1 % pacientů, u nichž je indikována koronarografi e. Většina těchto anomálií se neprojevuje žádnými známkami, symptomy ani komplikacemi a obvykle jsou zjištěny až náhodně během katetrizace. V urgentních situacích mohou pro intervenčního kardiologa anomálie koronárních tepen představovat značný problém, protože je lze obtížně nalézt a následně selektivně kanylovat. Základem úspěšné perkutánní intervence na anomálních koronárních tepnách v urgentních situacích je znalost anatomie a volba vhodných technických prostředků.

Research paper thumbnail of Role of residual acute stent malapposition in percutaneous coronary interventions

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 15, 2017

Assess clinical consequences of acute stent malapposition (ASM) in the context of the multicenter... more Assess clinical consequences of acute stent malapposition (ASM) in the context of the multicenter Centro per la Lotta Contro l'Infarto-Optimization of Percutaneous Coronary Intervention (CLI-OPCI) registry. ASM as important determinant of stent thrombosis (ST) risk remains controversial. From 2009 to 2013, we retrospectively analyzed postprocedural optical coherence tomography (OCT) findings in 864 patients undergoing percutaneous coronary intervention, assessing prevalence and magnitude of ASM and exploring correlation with outcome, especially ST. Postprocedural OCT revealed a variable grade of ASM in 72.3% of stents without correlation between maximal strut-vessel distance and longitudinal extension (R = 0.164, P < 0.01). At a median follow up of 302 (IQ 127-567) days, ASM did not affect risk of following major cardiac adverse events (MACE); residual ASM was comparable in terms of thickness (median [quartiles] 0.21[IQ 0.1-0.4] vs. 0.20[IQ 0.0-0.3], P = 0.397) and length (2....

Research paper thumbnail of Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome: The CLI-OPCI ACS Substudy (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous Coronary Intervention in Acute Coronary Syndrome)

Circulation. Cardiovascular interventions, 2016

Clinical consequences of optical coherence tomographic (OCT) high-definition visualization of pla... more Clinical consequences of optical coherence tomographic (OCT) high-definition visualization of plaque/stent structures in acute patients remain undefined. In this retrospective substudy, we assessed the prognostic impact of postprocedural culprit lesion OCT findings in patients with acute coronary syndrome undergoing percutaneous coronary intervention. In the CLI-OPCI (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous Coronary Intervention) database collecting cases from 5 independent OCT-experienced centers, we retrospectively analyzed postprocedural OCT findings in acute coronary syndrome patients and explored its possible impact (specifically that of residual intrastent plaque/thrombus protrusion) on outcome. From 2009 to 2013, 507 patients (588 lesions) were evaluated. Patients experiencing device-oriented cardiovascular events showed more frequently the features of suboptimal stent implantation defined as the presence of significant residual intrastent plaque...

Research paper thumbnail of Multi-agent quality of experience control

International Journal of Control, Automation and Systems, 2017

In the framework of the Future Internet, the aim of the Quality of Experience (QoE) Control funct... more In the framework of the Future Internet, the aim of the Quality of Experience (QoE) Control functionalities is to track the personalized desired QoE level of the applications. The paper proposes to perform such a task by dynamically selecting the most appropriate Classes of Service (among the ones supported by the network), this selection being driven by a novel heuristic Multi-Agent Reinforcement Learning (MARL) algorithm. The paper shows that such an approach offers the opportunity to cope with some practical implementation problems: in particular, it allows to face the so-called "curse of dimensionality" of MARL algorithms, thus achieving satisfactory performance results even in the presence of several hundreds of Agents.

Research paper thumbnail of Model Predictive Control of Energy Storage Systems for Power Tracking and Shaving in Distribution Grids

IEEE Transactions on Sustainable Energy, 2017

This work is partially supported by the Sapienza-Ateneo 2014 and 2013 projects no. C26A14YT4 and ... more This work is partially supported by the Sapienza-Ateneo 2014 and 2013 projects no. C26A14YT4 and no. C26A13LYTBX, on optimal ESS control strategies for RES integration in distribution networks. A.

Research paper thumbnail of An approximate dynamic programming approach to resource management in multi-cloud scenarios

International Journal of Control, 2016

The programmability and the virtualization of network resources is crucial to deploy scalable ICT... more The programmability and the virtualization of network resources is crucial to deploy scalable ICT services. The increasing demand of cloud services, mainly devoted to the storage and computing, requires a new functional element, the Cloud Management Broker (CMB), aimed at managing multiple cloud resources to meet the customers' requirements and, simultaneously, to optimize their usage. This paper proposes a multi-cloud resource allocation algorithm that manages the resource requests with the aim of maximizing the CMB revenue over time. The algorithm is based on Markov Decision Process modelling and relies on Reinforcement Learning techniques to find on-line an approximate solution.

Research paper thumbnail of Electric energy storage systems integration in distribution grids

2015 IEEE 15th International Conference on Environment and Electrical Engineering (EEEIC), 2015

This paper presents a real time control strategy for dynamically balancing electric demand and su... more This paper presents a real time control strategy for dynamically balancing electric demand and supply at local level, in a scenario characterized by a HV/MV substation with the presence of renewable energy sources in the form of photovoltaic generators and an electric energy storage system. The substation is connected to the grid and is powered by an equivalent traditional power plant playing the role of the bulk power system. A Model Predictive Control based approach is proposed, by which the active power setpoints for the traditional power plant and the storage are continually updated over the time, depending on generation costs, storage's state of charge, foreseen demand and production from renewables. The proposed approach is validated on a simulation basis, showing its effectiveness in managing fluctuations of network demand and photovoltaic generation in test and real conditions.

Research paper thumbnail of Percutaneous coronary intervention driven by combined use of intracoronary anatomy and physiology: Towards a tailored therapy for coronary artery disease

International journal of cardiology, Jan 2, 2015

Research paper thumbnail of Electric Vehicles charging control based on future internet generic enablers

2014 IEEE International Electric Vehicle Conference (IEVC), 2014

Research paper thumbnail of Early vessel healing of the Avantgarde cobalt-chromium coronary stent

Journal of Cardiovascular Medicine, 2013

The images shown within this document are of a purely illustrative nature and are not intended to... more The images shown within this document are of a purely illustrative nature and are not intended to depict reality.

Research paper thumbnail of OCT in the Clinical Practice and Data from Clinical Studies

Current Applications and Research Developments

This chapter provides a detailed description of the role of the OCT technique in the clinical pra... more This chapter provides a detailed description of the role of the OCT technique in the clinical practice. A review section on data from clinical studies is provided, underlining the extent usage of OCT during the last years. Finally, the capability of OCT to assess ambiguous lesions and deferral of interventions is discussed just before describing the role of the technique during the post procedural assessment.

Research paper thumbnail of Safety and feasibility of frequency domain optical coherence tomography to guide decision making in percutaneous coronary intervention

EuroIntervention, 2010

Aims: The purpose of this single centre registry is to assess safety and feasibility of the frequ... more Aims: The purpose of this single centre registry is to assess safety and feasibility of the frequency domain optical coherence tomography (FD-OCT) system during coronary interventions. Methods and results: Ninety patients with unstable or stable coronary artery disease were included in this study. OCT imaging was performed in a first group of 40 patients (group 1), to evaluate ambiguous/intermediate lesions (24 patients in group 1 had OCT also done post-PCI, for assessment of stent deployment); and in a second group of 50 patients (group 2), to address the adequacy of stent deployment. Therefore, 74 patients underwent FD-OCT after stent implantation. A complex-lesion population was studied (B2 type lesion=72.2% and C type lesion=20.3%). The mean time of a FD-OCT pull-back (from the set up to the completion of the pull back) was 2.1 min and in all but one (99.1%) the procedure was successful. No patients experienced major complications in terms of death, myocardial infarction, emergency revascularisation, embolisation, life-threatening arrhythmia, coronary dissection, prolonged and severe vessel spasm and contrast induced nephropathy. In the ambiguous lesion group, 60% of patients were treated with PCI, whilst in the others, PCI were deferred. In total, 113 deployed stents (33,6% chromium cobalt stent, 66,4% drug eluting stent) were imaged with OCT. OCT findings led to additional interventions in 24 out of 74 patients (32%): 15 had further balloon inflations, nine had additional stent deployment whilst two had both treatments. At clinical follow-up, (4.6±3.,2 months), there were no death, acute myocardial infarctions and cases of stent thrombosis, whilst two patients underwent revascularisation for recurrence of angina. Conclusions: The present registry shows that FD-OCT is a feasible and safe technique for guidance of coronary interventions. Randomised studies will confirm whether the use of FD-OCT will improve the clinical outcome.

Research paper thumbnail of Detection of very early stent healing after primary angioplasty: an optical coherence tomographic observational study of chromium cobaltum and first-generation drug-eluting stents. The DETECTIVE Study

Research paper thumbnail of Focus on the COCTAIL study

Interventional Cardiology, 2011

Focus on the COCTAIL study CliniCal trial Commentary Percutaneous coronary intervention (PCI), wh... more Focus on the COCTAIL study CliniCal trial Commentary Percutaneous coronary intervention (PCI), when accomplished rapidly and by experienced operators, is a highly effective therapy for acute ST-elevation myocardial infarction (STEMI). However, there is ample room for improvement, as there is a significant proportion of patients with coronary thrombus at the time of the procedure, which can lead to distal embolization and microvascular impairment when the clot is mechanically dislodged. A promising novel solution to ameliorate the outcome of angioplasty for acute coronary syndromes resides in the combined use of pharmacological and catheter-based therapies to increase local concentration of drugs such as glycoprotein IIb/IIIa inhibitors at the culprit site, prolonging their residency time. The administration of abciximab through the ClearWay™ RX therapeutic infusion catheter proved to be a valid solution, as in vitro data suggests that, at high concentrations (nearly 500 times the usual systemic dose), abciximab disaggregates existing clots. The COCTAIL study was specifically designed to verify whether administration of abciximab by local intracoronary infusion through ClearWay RX was capable of reducing thrombus burden as compared with traditional intracoronary guide catheter infusion modality in patients with acute coronary syndromes, either with STEMI or non-STEMI. Broad clinical inclusion criteria were selected to test the efficacy of such a local drug delivery approach, regardless of the amount of thrombus burden. A total of 50 patients were randomized. The mean percentage change of the thrombus score was significantly higher among patients of the ClearWay RX catheter group compared with those in the guiding catheter group (33.8 vs 3.9%; p = 0.002). Local intracoronary infusion of abciximab by means of a dedicated therapeutic infusion catheter was able to reduce thrombus burden in patients with acute coronary syndromes. keywords: abciximab n acute coronary syndrome n perfusion balloon n thrombus