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Avcı İİ, Zeren G, Sungur MA, Akdeniz E, Şimşek B, Yılmaz MF, Can F, Gürkan U, Karagöz A, Tanboğa İH, Karabay CY. Enhanced Stent Imaging System Guided Percutaneous Coronary Intervention Is Linked to Optimize Stent Placement. Angiology 2024; 75:54-61. [PMID: 36178093 DOI: 10.1177/00033197221130203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stent under-expansion is a predictor of restenosis and stent thrombosis. It remains uncertain whether enhanced stent imaging (ESI) (CLEARstent) guidance can improve stent under-expansion. Our aim was to assess the effect of using ESI on stent under-expansion, after percutaneous coronary intervention (PCI) in a single center, cross-sectional observational study. Participants attending our cardiology clinic with stable angina or acute coronary syndrome, from March to September 2020 were recruited. A total of 164 patients who underwent post-PCI ESI (CLEARstent) were compared with 77 age- and sex-matched control patients. Post-procedural minimal lumen diameter (MLD) was calculated. The patients in the ESI-guided PCI group, had a median age of 61 (54-69 IQR 25-75) years and 76.8% (n = 126) were males. The patients in ESI-guided PCI group had a greater minimal lumen diameter compared with the X-ray guided PCI group (βeta coefficient:2.88 (95% CI:2.58-2.99) vs βeta coefficient 2.55 (95% CI 2.34-2.63), P < .001). Our finding supports the use of the ESI system to optimize stent placement as expressed by the MLD.
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Affiliation(s)
- İlhan İlker Avcı
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gönül Zeren
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Azmi Sungur
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Evliya Akdeniz
- Faculty of Medicine, Department of Cardiology, Başkent University, Istanbul, Turkey
| | - Barış Şimşek
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Fatih Yılmaz
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatma Can
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Gürkan
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Turkey
| | - İbrahim Halil Tanboğa
- Cardiology, Hisar Intercontinental Hospital, Nisantasi University Medical School, Istanbul, Turkey
| | - Can Yücel Karabay
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Nafee T, Shah A, Forsberg M, Zheng J, Ou J. State-of-art review: intravascular imaging in percutaneous coronary interventions. CARDIOLOGY PLUS 2023; 8:227-246. [PMID: 38304487 PMCID: PMC10829907 DOI: 10.1097/cp9.0000000000000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024] Open
Abstract
The history of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) reflects the relentless pursuit of innovation in interventional cardiology. These intravascular imaging technologies have played a pivotal role in our understanding of coronary atherosclerosis, vascular pathology, and the interaction of coronary stents with the vessel wall. Two decades of clinical investigations demonstrating the clinical efficacy and safety of intravascular imaging modalities have established these technologies as staples in the contemporary cardiac catheterization lab's toolbox and earning their place in revascularization clinical practice guidelines. In this comprehensive review, we will delve into the historical evolution, mechanisms, and technical aspects of IVUS and OCT. We will discuss the expanding evidence supporting their use in complex percutaneous coronary interventions, emphasizing their crucial roles in optimizing patient outcomes and ensuring procedural success. Furthermore, we will explore the substantial advances that have propelled these imaging modalities to the forefront of contemporary interventional cardiology. Finally, we will survey the latest developments in the field and explore the promising future directions that have the potential to further revolutionize coronary interventions.
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Affiliation(s)
- Tarek Nafee
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
| | - Areeb Shah
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Michael Forsberg
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
| | - Jingsheng Zheng
- Department of Cardiology, AtlantiCare Regional Medical Center, Pomona, NJ 08240, USA
| | - Jiafu Ou
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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3
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Allan RB, Wise NC, Wong YT, Delaney CL. Accuracy and Reliability of Peripheral Artery Calcium Scoring Systems Using an Intravascular Ultrasound Reference Standard. Ann Vasc Surg 2023; 91:233-241. [PMID: 36481677 DOI: 10.1016/j.avsg.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Peripheral artery calcium scoring systems are commonly used in clinical trials to categorize calcium severity but there are little data on their accuracy and reliability. The purpose of this study was to investigate the accuracy and reliability of these systems. METHODS Angiographic, computed tomography angiography, and intravascular ultrasound (IVUS) imaging were obtained from 47 consecutive cases sourced from a prospectively collected database of patients undergoing femoropopliteal artery endovascular intervention. Two independent blinded readers graded calcium severity using the Peripheral Arterial Calcium Scoring System, Peripheral Academic Research Consortium, and Fanelli calcium scoring systems. IVUS maximum arc of calcium and calcium length were compared between severity grades for each scoring system. The diagnostic accuracy of each scoring system for identifying severe calcium was calculated using the reference standard of an IVUS maximum calcium arc ≥ 180°. Agreement testing was performed between scoring systems and between and within observers for each system. RESULTS IVUS identified calcium in 85% (42/47) of cases, compared to 68% (32/47) of cases with angiography. There were no differences in IVUS calcium parameters between grades of calcium for any of the scoring systems. Severe calcium was detected by IVUS in 30 cases, in 23 cases by Peripheral Arterial Calcium Scoring System (sensitivity: 73%, specificity: 33%, positive predictive value [PPV]: 83%, negative predictive value [NPV]: 22%), in 12 cases by Peripheral Academic Research Consortium (sensitivity: 42%, specificity: 83%, PPV: 92%, NPV: 25%), and in 10 cases by Fanelli (sensitivity: 39%, specificity: 100%, PPV: 100%, NPV: 27%). Agreement between scoring systems was weak to moderate (range: k = 0.55-0.74). Interobserver agreement was weak (k = 0.41-0.54) and intraobserver agreement was highly variable ranging from k = 0.41 to k = 0.92. CONCLUSIONS The poor diagnostic accuracy and weak-to-moderate reliability of calcium scoring systems raise doubts about the use of current calcium scoring systems for use in clinical trials.
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Affiliation(s)
- Richard B Allan
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| | - Nadia C Wise
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Yew Toh Wong
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia; Department of Vascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher L Delaney
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Detection of Vulnerable Coronary Plaques Using Invasive and Non-Invasive Imaging Modalities. J Clin Med 2022; 11:jcm11051361. [PMID: 35268451 PMCID: PMC8911129 DOI: 10.3390/jcm11051361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Acute coronary syndrome (ACS) mostly arises from so-called vulnerable coronary plaques, particularly prone for rupture. Vulnerable plaques comprise a specific type of plaque, called the thin-cap fibroatheroma (TFCA). A TCFA is characterized by a large lipid-rich necrotic core, a thin fibrous cap, inflammation, neovascularization, intraplaque hemorrhage, microcalcifications or spotty calcifications, and positive remodeling. Vulnerable plaques are often not visible during coronary angiography. However, different plaque features can be visualized with the use of intracoronary imaging techniques, such as intravascular ultrasound (IVUS), potentially with the addition of near-infrared spectroscopy (NIRS), or optical coherence tomography (OCT). Non-invasive imaging techniques, such as computed tomography coronary angiography (CTCA), cardiovascular magnetic resonance (CMR) imaging, and nuclear imaging, can be used as an alternative for these invasive imaging techniques. These invasive and non-invasive imaging modalities can be implemented for screening to guide primary or secondary prevention therapies, leading to a more patient-tailored diagnostic and treatment strategy. Systemic pharmaceutical treatment with lipid-lowering or anti-inflammatory medication leads to plaque stabilization and reduction of cardiovascular events. Additionally, ongoing studies are investigating whether modification of vulnerable plaque features with local invasive treatment options leads to plaque stabilization and subsequent cardiovascular risk reduction.
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Srinivasan VM, Lazaro TT, Srivatsan A, Cooper P, Phillips M, Garcia R, Chen SR, Johnson JN, Burkhardt JK, Collins DE, Kan P. Applications of a Novel Microangioscope for Neuroendovascular Intervention. AJNR Am J Neuroradiol 2020; 42:347-353. [PMID: 33361372 DOI: 10.3174/ajnr.a6900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Visualization in neuroendovascular intervention currently relies on biplanar fluoroscopy and contrast administration. With the advent of endoscopy, direct visualization of the intracranial intravascular space has become possible with microangioscopes. We analyzed the efficacy of our novel microangioscope to enable direct observation and inspection of the cerebrovasculature, complementary to a standard fluoroscopic technique. MATERIALS AND METHODS Iterations of microangioscopes were systematically evaluated for use in neurodiagnostics and neurointerventions in both live animal and human cadaveric models. Imaging quality, trackability, and navigability were assessed. Diagnostic procedures assessed included clot identification and differentiation, plaque identification, inspection for vessel wall injury, and assessment of stent apposition. Interventions performed included angioscope-assisted stent-retriever thrombectomy, clot aspiration, and coil embolization. RESULTS The microangioscope was found helpful in both diagnosis and interventions by independent evaluators. Mean ratings of the imaging quality on a 5-point scale ranged from 3.0 (clot identification) to 4.7 (Pipeline follow-up). Mean ratings for clinical utility ranged from 3.0 (aspiration thrombectomy) to 4.7 (aneurysm treatment by coil embolization and WEB device). CONCLUSIONS This fiber optic microangioscope can safely navigate and visualize the intravascular space in human cadaveric and in vivo animal models with satisfactory resolution. It has potential value in diagnostic and neurointerventional applications.
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Affiliation(s)
- V M Srinivasan
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - T T Lazaro
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - A Srivatsan
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - P Cooper
- Vena Medical (P.C., M.P.), Kitchener, Ontario, Canada
| | - M Phillips
- Vena Medical (P.C., M.P.), Kitchener, Ontario, Canada
| | - R Garcia
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - S R Chen
- Department of Interventional Radiology (S.R.C.), The MD Anderson Cancer Center, Houston, Texas
| | - J N Johnson
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - J-K Burkhardt
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - D E Collins
- Center for Comparative Medicine (D.E.C.) Baylor College of Medicine, Houston, Texas
| | - P Kan
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
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Chen K, Irie T, Iijima T, Morita T. Double-parabolic-reflectors acoustic waveguides for high-power medical ultrasound. Sci Rep 2019; 9:18493. [PMID: 31811192 PMCID: PMC6898714 DOI: 10.1038/s41598-019-54916-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022] Open
Abstract
High intensity focused ultrasound therapeutics are widely used to noninvasively treat various types of primary tumors and metastasis. However, ultrasound penetration depth is shallowed with increasing frequency which limits the therapeutic accuracy for deep tissues. Although acoustic waveguides are commonly inserted into tissue for localized therapy, powerful ultrasound delivery is difficult. Here, we invent double-parabolic-reflectors acoustic waveguides, where high-power ultrasound emission and large mechanical vibration enhance the therapeutic efficiency. High-energy-density ultrasound with around 20 times amplification by two parabolic reflectors propagates through the thin waveguide between 1 to 2 MHz, and wideband large mechanical vibration at the waveguide tip from 1 kHz to 2.5 MHz accelerates the therapeutics. This fundamental work serves as a milestone for future biomedical applications, from therapeutics to diagnostics. Since the high-power ability at high frequencies, our waveguide will also open up new research fields in medical, bio, physics and so on.
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Affiliation(s)
- Kang Chen
- Department of Human and Engineered Environmental Studies, The University of Tokyo, Chiba, 277-8563, Japan
| | | | - Takashi Iijima
- National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, 305-8569, Japan
| | - Takeshi Morita
- Department of Human and Engineered Environmental Studies, The University of Tokyo, Chiba, 277-8563, Japan.
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7
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Lazaro T, Srinivasan VM, Cooper P, Phillips M, Garcia R, Chen SR, Johnson J, Collins DE, Kan P. A new set of eyes: development of a novel microangioscope for neurointerventional surgery. J Neurointerv Surg 2019; 11:1036-1039. [PMID: 30878951 DOI: 10.1136/neurintsurg-2018-014610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endovascular technological advances have revolutionized the field of neurovascular surgery and have become the mainstay of treatment for many cerebrovascular pathologies. Digital subtraction angiography (DSA) is the 'gold standard' for visualization of the vasculature and deployment of endovascular devices. Nonetheless, with recent technological advances in optics, angioscopy has emerged as a potentially important adjunct to DSA. Angioscopy can offer direct visualization of the intracranial vasculature, and direct observation and inspection of device deployment. However, previous iterations of this technology have not been sufficiently miniaturized or practical for modern neurointerventional practice. OBJECTIVE To describe the evolution, development, and design of a microangioscope that offers both high-quality direct visualization and the miniaturization necessary to navigate in the small intracranial vessels and provide examples of its potential applications in the diagnosis and treatment of cerebrovascular pathologies using an in vivo porcine model. METHODS In this proof-of-concept study we introduce a novel microangioscope, designed from coherent fiber bundle technology. The microangioscope is smaller than any previously described angioscope, at 1.7 F, while maintaining high-resolution images. A porcine model is used to demonstrate the resolution of the images in vivo. RESULTS Video recordings of the microangioscope show the versatility of the camera mounted on different microcatheters and its ability to navigate external carotid artery branches. The microangioscope is also shown to be able to resolve the subtle differences between red and white thrombi in a porcine model. CONCLUSION A new microangioscope, based on miniaturized fiber optic technology, offers a potentially revolutionary way to visualize the intracranial vascular space.
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Affiliation(s)
- Tyler Lazaro
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | - Robert Garcia
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen R Chen
- Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Dalis E Collins
- Center for Comparative Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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Wu X, Sanders JL, Zhang X, Yamaner FY, Oralkan O. An FPGA-Based Backend System for Intravascular Photoacoustic and Ultrasound Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:45-56. [PMID: 30442605 PMCID: PMC6384193 DOI: 10.1109/tuffc.2018.2881409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The integration of intravascular ultrasound (IVUS) and intravascular photoacoustic (IVPA) imaging produces an imaging modality with high sensitivity and specificity which is particularly needed in interventional cardiology. Conventional side-looking IVUS imaging with a single-element ultrasound (US) transducer lacks forward-viewing capability, which limits the application of this imaging mode in intravascular intervention guidance, Doppler-based flow measurement, and visualization of nearly, or totally blocked arteries. For both side-looking and forward-looking imaging, the necessity to mechanically scan the US transducer limits the imaging frame rate, and therefore, array-based solutions are desired. In this paper, we present a low-cost, compact, high-speed, and programmable imaging system based on a field-programmable gate array suitable for dual-mode forward-looking IVUS/IVPA imaging. The system has 16 US transmit and receive channels and functions in multiple modes including interleaved photoacoustic (PA) and US imaging, hardware-based high-frame-rate US imaging, software-driven US imaging, and velocity measurement. The system is implemented in the register-transfer level, and the central system controller is implemented as a finite-state machine. The system was tested with a capacitive micromachined ultrasonic transducer array. A 170-frames-per-second (FPS) US imaging frame rate is achieved in the hardware-based high-frame-rate US imaging mode while the interleaved PA and US imaging mode operates at a 60-FPS US and a laser-limited 20-FPS PA imaging frame rate. The performance of the system benefits from the flexibility and efficiency provided by the low-level implementation. The resulting system provides a convenient backend platform for research and clinical IVPA and IVUS imaging.
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Hubbard L, Ziemer B, Lipinski J, Sadeghi B, Javan H, Groves EM, Malkasian S, Molloi S. Functional Assessment of Coronary Artery Disease Using Whole-Heart Dynamic Computed Tomographic Perfusion. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005325. [PMID: 27956409 DOI: 10.1161/circimaging.116.005325] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Computed tomographic (CT) angiography is an important tool for the evaluation of coronary artery disease but often correlates poorly with myocardial ischemia. Current dynamic CT perfusion techniques can assess ischemia but have limited accuracy and deliver high radiation dose. Therefore, an accurate, low-dose, dynamic CT perfusion technique is needed. METHODS AND RESULTS A total of 20 contrast-enhanced CT volume scans were acquired in 5 swine (40±10 kg) to generate CT angiography and perfusion images. Varying degrees of stenosis were induced using a balloon catheter in the proximal left anterior descending coronary artery, and a pressure wire was used for reference fractional flow reserve (FFR) measurement. Perfusion measurements were made with only 2 volume scans using a new first-pass analysis (FPA) technique and with 20 volume scans using an existing maximum slope model (MSM) technique. Perfusion (P) and FFR measurements were related by PFPA=1.01 FFR-0.03 (R2=0.85) and PMSM=1.03 FFR-0.03 (R2=0.80) for FPA and MSM techniques, respectively. Additionally, the effective radiation doses were calculated to be 2.64 and 26.4 mSv for FPA and MSM techniques, respectively. CONCLUSIONS A new FPA-based dynamic CT perfusion technique was validated in a swine animal model. The results indicate that the FPA technique can potentially be used for improved anatomical and functional assessment of coronary artery disease at a relatively low radiation dose.
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Affiliation(s)
- Logan Hubbard
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Benjamin Ziemer
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Jerry Lipinski
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Bahman Sadeghi
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Hanna Javan
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Elliott M Groves
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Shant Malkasian
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Sabee Molloi
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine.
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Gora MJ, Suter MJ, Tearney GJ, Li X. Endoscopic optical coherence tomography: technologies and clinical applications [Invited]. BIOMEDICAL OPTICS EXPRESS 2017; 8:2405-2444. [PMID: 28663882 PMCID: PMC5480489 DOI: 10.1364/boe.8.002405] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 05/07/2023]
Abstract
In this paper, we review the current state of technology development and clinical applications of endoscopic optical coherence tomography (OCT). Key design and engineering considerations are discussed for most OCT endoscopes, including side-viewing and forward-viewing probes, along with different scanning mechanisms (proximal-scanning versus distal-scanning). Multi-modal endoscopes that integrate OCT with other imaging modalities are also discussed. The review of clinical applications of endoscopic OCT focuses heavily on diagnosis of diseases and guidance of interventions. Representative applications in several organ systems are presented, such as in the cardiovascular, digestive, respiratory, and reproductive systems. A brief outlook of the field of endoscopic OCT is also discussed.
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Affiliation(s)
- Michalina J Gora
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- ICube Laboratory, CNRS, Strasbourg University, 1 Place de l'Hopital, Strasbourg 67091, France
| | - Melissa J Suter
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Xingde Li
- Department of Biomedical Engineering, Department of Electrical and Computer Engineering, and Department of Oncology, Johns Hopkins University, 720 Rutland Avenue, Traylor 710, Baltimore, MD 21205, USA
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11
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Sugiyama T, Jang IK. Optical Coherence Tomography for Study of In Vivo Pathobiology and for Optimization of Percutaneous Coronary Intervention. ACTA ACUST UNITED AC 2017. [DOI: 10.15791/angioscopy.re.17.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tomoyo Sugiyama
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School
- Division of Cardiology, Kyung Hee University Hospital
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12
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Computer aided diagnosis of Coronary Artery Disease, Myocardial Infarction and carotid atherosclerosis using ultrasound images: A review. Phys Med 2017; 33:1-15. [DOI: 10.1016/j.ejmp.2016.12.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/21/2016] [Accepted: 12/04/2016] [Indexed: 02/08/2023] Open
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13
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Caixeta A, Maehara A, Mintz GS. Intravascular Ultrasound and Virtual Histology. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Adriano Caixeta
- Hospital Israelita Albert Einstein; Universidade Federal de São Paulo; São Paulo Brazil
| | - Akiko Maehara
- Columbia University Medical Center and the Cardiovascular Research Foundation; New York NY USA
| | - Gary S. Mintz
- Columbia University Medical Center and the Cardiovascular Research Foundation; New York NY USA
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14
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Tokunaga K, Uchino E, Tanaka H, Suetake N. Intravascular ultrasound-based tissue characterization using modular network self-organizing map. Appl Soft Comput 2016. [DOI: 10.1016/j.asoc.2016.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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White RA, Donayre C, Kopchok G, Walot I, Wilson E, deVirgilio C. Intravascular Ultrasound: The Ultimate Tool for Abdominal Aortic Aneurysm Assessment and Endovascular Graft Delivery. J Endovasc Ther 2016. [DOI: 10.1177/152660289700400109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intravascular ultrasound (IVUS) imaging is a relatively new, rapidly evolving technology that enables precise catheter-based assessment of the dimensions and morphology of vascular structures and lesions. In extensive preclinical laboratory developmental studies and in clinical cases of endograft deployment for treatment of abdominal aortic aneurysms, we have found IVUS invaluable for determining key parameters of aortic morphology before and during interventions and for assessing the accuracy of deployment after device placement. By combining the IVUS data with information obtained from angiography, magnetic resonance imaging, and computed tomography (axial and three-dimensional reconstructions), we have been able to size devices and choose optimal fixation sites to prevent endoleaks and maintain luminal patency acutely and in the long term.
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Affiliation(s)
| | | | | | - Irwin Walot
- Department of Radiology, Harbor-UCLA Medical Center, Torrance, California, USA
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16
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Abstract
Purpose: To illustrate the utility of intravascular ultrasound (IVUS) imaging during endoluminal interventions in the carotid artery. Methods and Results: A patient with symptomatic internal carotid artery occlusive disease was treated with balloon angioplasty and evaluated with both angiography (interpreted as a widely patent outcome) and IVUS, which identified a residual 70% cross-sectional area stenosis. A stent was placed across the lesion, producing a 70% increase in the lumen as documented by IVUS in comparison to the cross-sectional area of the reference vessel. Postprocedural angiography of the stented segment showed only an approximate 20% increase in diameter. Conclusions: This study highlights the utility of IVUS for accurate assessment of angioplasty outcome and for quantitative assessment of luminal volume following intervention and stent placement. The case emphasizes the need for IVUS as an integral part of the procedure to ensure adequate treatment and to accurately document the residual lesion for assessment of recurrence phenomena at follow-up.
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Affiliation(s)
- Eric P. Wilson
- Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Rodney A. White
- Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, California, USA
| | - George E. Kopchok
- Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, California, USA
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Abazid RM, Obadah Kattea M, Smettei OA, Beshir Y, Sakr H. Impact of coronary artery calcification on percutaneous coronary intervention and postprocedural complications. J Saudi Heart Assoc 2016; 29:15-22. [PMID: 28127214 PMCID: PMC5247302 DOI: 10.1016/j.jsha.2016.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 03/30/2016] [Accepted: 05/09/2016] [Indexed: 11/16/2022] Open
Abstract
Background Excessive coronary calcification can lead to adverse outcomes after percutaneous coronary intervention (PCI). We therefore evaluated the impact of coronary calcium score (CCS) measured by multidetector computed tomography (MDCT) on immediate complications of PCI and rate of restenosis. Methods We performed a single-center retrospective analysis of 84 patients with coronary stenosis diagnosed by MDCT who underwent PCI. The Agatston method was used to measure total, target-vessel, and segmental (stent deployment site) CCS. Results In 108 PCI procedures, 32 lesions (29.5%) were American College of Cardiology/American Heart Association type A, 60 (55.5%) were type B, and 16 (15%) were type C. ANOVA showed significantly higher segmental CCS in type C than in type A lesions (29 ± 51 vs. 214 ± 162; p = 0.03). Six patients (7.1%) had periprocedural complications and seven (8.3%) had in-stent restenosis and angina. Mean total, target-vessel, and segmental CCS was significantly higher in complicated than in successful PCI (199 ± 325 vs. 816 ± 624, p = 0.001; 92 ± 207 vs. 337 ± 157, p = 0.001; and 79 ± 158 vs. 256 ± 142, p = 0.003, respectively), but there was no significant difference in CCS between successful PCI and PCI complicated by late restenosis. Conclusions CCS measured by MDCT has an important role in predicting early, but not late, complications from PCI.
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Affiliation(s)
- Rami M Abazid
- Department of Cardiology, Cardiac Imaging Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, aSaudi Arabia
| | - M Obadah Kattea
- Department of Cardiology, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, bSaudi Arabia
| | - Osama A Smettei
- Department of Cardiology, Cardiac Imaging Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, aSaudi Arabia
| | - Yasir Beshir
- Department of Cardiology, Invasive Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, cSaudi Arabia
| | - Haitham Sakr
- Department of Cardiology, Invasive Department, Prince Sultan Cardiac Center, Qassim PSCCQ, Buraydah, cSaudi Arabia
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18
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Miki K, Fujii K, Kawasaki D, Shibuya M, Fukunaga M, Imanaka T, Tamaru H, Sumiyoshi A, Nishimura M, Horimatsu T, Saita T, Okada K, Kimura T, Honda Y, Fitzgerald PJ, Masuyama T, Ishihara M. Intravascular Ultrasound-Derived Stent Dimensions as Predictors of Angiographic Restenosis Following Nitinol Stent Implantation in the Superficial Femoral Artery. J Endovasc Ther 2016; 23:424-32. [PMID: 27044270 DOI: 10.1177/1526602816641669] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify intravascular ultrasound (IVUS) measurements that can predict angiographic in-stent restenosis (ISR) following nitinol stent implantation in superficial femoral artery (SFA) lesions. METHODS A retrospective review was conducted of 97 patients (mean age 72.9±8.9 years; 63 men) who underwent IVUS examination during endovascular treatment of 112 de novo SFA lesions between July 2012 and December 2014. Self-expanding bare stents were implanted in 46 lesions and paclitaxel-eluting stents in 39 lesions. Six months after stenting, follow-up angiography was conducted to assess stent patency. The primary endpoint was angiographic ISR determined by quantitative vascular angiography analysis at the 6-month follow-up. Variables associated with restenosis were sought in multivariate analysis; the results are presented as the odds ratio (OR) and 95% confidence interval (CI). RESULTS At follow-up, 27 (31.8%) angiographic ISR lesions were recorded. The lesions treated with uncoated stents were more prevalent in the ISR group compared with the no restenosis group (74.1% vs 44.8%, p=0.02). Lesion length was longer (154.4±79.5 vs 109.0±89.3 mm, p=0.03) and postprocedure minimum stent area (MSA) measured by IVUS was smaller (13.9±2.8 vs 16.3±1.6 mm(2), p<0.001) in the ISR group. Multivariate analysis revealed that bare stent use (OR 7.11, 95% CI 1.70 to 29.80, p<0.01) and longer lesion length (OR 1.08, 95% CI 1.01 to 1.16, p=0.04) were predictors of ISR, while increasing postprocedure MSA (OR 0.58, 95% CI 0.41 to 0.82, p<0.01) was associated with lower risk of ISR. Receiver operating characteristic analysis identified a MSA of 15.5 mm(2) as the optimal cutpoint below which the incidence of restenosis increased (area under the curve 0.769). CONCLUSION Postprocedure MSA can predict ISR in SFA lesions, which suggests that adequate stent enlargement during angioplasty might be required for superior patency.
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Affiliation(s)
- Kojiro Miki
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Kenichi Fujii
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Daizo Kawasaki
- Cardiovascular Center, Morinomiya Hospital, Osaka, Japan
| | - Masahiko Shibuya
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Takahiro Imanaka
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroto Tamaru
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Akinori Sumiyoshi
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Machiko Nishimura
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tetsuo Horimatsu
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ten Saita
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kozo Okada
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Tohru Masuyama
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masaharu Ishihara
- Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
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19
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[Progression and regression of atherosclerotic plaques. New results based on intracoronary ultrasound]. Herz 2015; 40:855-62. [PMID: 26272272 DOI: 10.1007/s00059-015-4339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intravascular ultrasound has been established as the gold standard for analyzing alterations in coronary artery atherosclerosis during monitoring investigations. Cross-sectional imaging can be used to visualize the area of the lumen and the vessel size and the plaque size as the difference between them. New technology allows the 3-D reconstruction of the volume for prespecified vessel segments using specific algorithms. Investigations on the natural course demonstrated predominantly progression. Even regression of coronary atherosclerosis can be visualized and quantified. Regression can only be expected when the level of low-density lipoprotein (LDL) cholesterol is below the critical level of 75 mg/dl. Prospective randomized studies with highly effective statins showed that regression occurred in up to two thirds of patients when LDL cholesterol was below a cut-off of 78 mg/dl and was, therefore, very close to the threshold, which was calculated based on investigations of the natural course. Although the absolute values for plaque volume are in the range of 1 % over 1-2 years, it must be taken into consideration that coronary artery diseases are chronic diseases and a 1 % change per year will correspond to an enormous effect on plaque growth of coronary vessels. The great success of statins in reducing cardiovascular events is due to the possibility for reduction of progression and induction of regression. New developments in medication will be measured against the effectiveness of statins.
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20
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Ma J, Martin KH, Li Y, Dayton PA, Shung KK, Zhou Q, Jiang X. Design factors of intravascular dual frequency transducers for super-harmonic contrast imaging and acoustic angiography. Phys Med Biol 2015; 60:3441-57. [PMID: 25856384 DOI: 10.1088/0031-9155/60/9/3441] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Imaging of coronary vasa vasorum may lead to assessment of the vulnerable plaque development in diagnosis of atherosclerosis diseases. Dual frequency transducers capable of detection of microbubble super-harmonics have shown promise as a new contrast-enhanced intravascular ultrasound (CE-IVUS) platform with the capability of vasa vasorum imaging. Contrast-to-tissue ratio (CTR) in CE-IVUS imaging can be closely associated with low frequency transmitter performance. In this paper, transducer designs encompassing different transducer layouts, transmitting frequencies, and transducer materials are compared for optimization of imaging performance. In the layout selection, the stacked configuration showed superior super-harmonic imaging compared with the interleaved configuration. In the transmitter frequency selection, a decrease in frequency from 6.5 MHz to 5 MHz resulted in an increase of CTR from 15 dB to 22 dB when receiving frequency was kept constant at 30 MHz. In the material selection, the dual frequency transducer with the lead magnesium niobate-lead titanate (PMN-PT) 1-3 composite transmitter yielded higher axial resolution compared to single crystal transmitters (70 μm compared to 150 μm pulse length). These comparisons provide guidelines for the design of intravascular acoustic angiography transducers.
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Affiliation(s)
- Jianguo Ma
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
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21
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Choy JS, Luo T, Huo Y, Wischgoll T, Schultz K, Teague SD, Sturek M, Kassab GS. Compensatory Enlargement of Ossabaw Miniature Swine Coronary Arteries in Diffuse Atherosclerosis. IJC HEART & VASCULATURE 2015; 6:4-11. [PMID: 25729766 PMCID: PMC4341907 DOI: 10.1016/j.ijcha.2014.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Studies in human and non-human primates have confirmed the compensatory enlargement or positive remodeling (Glagov phenomenon) of coronary vessels in the presence of focal stenosis. To our knowledge, this is the first study to document arterial enlargement in a metabolic syndrome animal model with diffuse coronary artery disease (DCAD) in the absence of severe focal stenosis. Two different groups of Ossabaw miniature pigs were fed a high fat atherogenic diet for 4 months (Group I) and 12 months (Group II), respectively. Group I (6 pigs) underwent contrast enhanced computed tomographic angiography (CCTA) and intravascular ultrasound (IVUS) at baseline and after 4 months of high fat diet, whereas Group II (7 pigs) underwent only IVUS at 12 months of high fat diet. IVUS measurements of the left anterior descending (LAD), left circumflex (LCX) and right coronary (RCA) arteries in Group I showed an average increase in their lumen cross-sectional areas (CSA) of 25.8%, 11.4%, and 43.4%, respectively, as compared to baseline. The lumen CSA values of LAD in Group II were found to be between the baseline and 4 month values in Group I. IVUS and CCTA measurements showed a similar trend and positive correlation. Fractional flow reserve (FFR) was 0.91 ± 0.07 at baseline and 0.93 ± 0.05 at 4 months with only 2.2%, 1.6% and 1% stenosis in the LAD, LCX and RCA, respectively. The relation between percent stenosis and lumen CSA shows a classical Glagov phenomenon in this animal model of DCAD.
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Affiliation(s)
- Jenny S Choy
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Tong Luo
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Yunlong Huo
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Thomas Wischgoll
- Department of Computer Science and Engineering, Wright State University, Dayton, Ohio
| | - Kyle Schultz
- Department of Cellular and Integrative Physiology, Indiana University, Indianapolis, Indiana
| | - Shawn D Teague
- Department of Radiology, Indiana University, Indianapolis, Indiana
| | - Michael Sturek
- Department of Cellular and Integrative Physiology, Indiana University, Indianapolis, Indiana
| | - Ghassan S Kassab
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana ; Department of Cellular and Integrative Physiology, Indiana University, Indianapolis, Indiana ; Department of Surgery, Indiana University, Indianapolis, Indiana
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22
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Miki K, Fujii K, Fukunaga M, Nishimura M, Horimatsu T, Saita T, Tamaru H, Imanaka T, Shibuya M, Naito Y, Masuyama T. Impact of intravascular ultrasound findings on long-term patency after self-expanding nitinol stent implantation in the iliac artery lesion. Heart Vessels 2015; 31:519-27. [DOI: 10.1007/s00380-014-0625-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
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Macías E, Tellez A, Ochoa J, Ortíz JE. [Value of the optical coherence tomography in the treatment guided of the stent failure. Case report]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:305-9. [PMID: 25108456 DOI: 10.1016/j.acmx.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 05/06/2014] [Accepted: 06/02/2014] [Indexed: 11/19/2022] Open
Abstract
Since the advent of bare metal and drug-eluting stents, the surgical revascularization have declined considerably, however the thrombosis and in-stent restenosis are important complications of these devices. There are several factors that predispose to thrombosis and in-stent restenosis. Conventional angiography has serious limitations to determine the causes of stent failure. Optical coherence tomography is a very sensitive technique to determine the cause of thrombosis and in-stent restenosis.
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Affiliation(s)
- Enrico Macías
- Departamento de Cardiología Intervencionista, Hospital de Especialidades Dr. Belisario Domínguez, México D.F., México.
| | - Alejandro Tellez
- Departamento de Cardiología Intervencionista, Hospital de Especialidades Dr. Belisario Domínguez, México D.F., México
| | - Jorge Ochoa
- Departamento de Cardiología Intervencionista, Hospital de Especialidades Dr. Belisario Domínguez, México D.F., México
| | - José E Ortíz
- Departamento de Cardiología Intervencionista, Hospital de Especialidades Dr. Belisario Domínguez, México D.F., México
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Moy AJ, Lo PC, Choi B. High-resolution visualization of mouse cardiac microvasculature using optical histology. BIOMEDICAL OPTICS EXPRESS 2013; 5:69-77. [PMID: 24466477 PMCID: PMC3891346 DOI: 10.1364/boe.5.000069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/04/2013] [Accepted: 11/15/2013] [Indexed: 05/09/2023]
Abstract
Cardiovascular disease typically is associated with dysfunction of the coronary vasculature and microvasculature. The study of cardiovascular disease typically involves imaging of the large coronary vessels and quantification of cardiac blood perfusion. These methods, however, are not well suited for imaging of the cardiac microvasculature. We used the optical histology method, which combines chemical optical clearing and optical imaging, to create high-resolution, wide-field maps of the cardiac microvasculature in ventral slices of mouse heart. We have demonstrated the ability of the optical histology method to enable wide-field visualization of the cardiac microvasculature in high-resolution and anticipate that optical histology may have significant impact in studying cardiovascular disease.
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25
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Kwon TG, Seo YH, Lee CS, Yang DJ, Song IG, Park HW, Kim KH, Kim WH, Bae JH. Discrepancy of calcium detection between gray scale intravascular ultrasound and spectral analysis of radiofrequency data. Int J Cardiol 2013; 167:2611-6. [DOI: 10.1016/j.ijcard.2012.06.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 06/23/2012] [Indexed: 11/16/2022]
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26
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Shang Y, Mintz GS, Pu J, Guo J, Kobayashi N, Franklin-Bond T, Leon MB, Moses JW, Maehara A, Shimizu T, Yakushiji T. Bypass to the left coronary artery system may accelerate left main coronary artery negative remodeling and calcification. Clin Res Cardiol 2013; 102:831-5. [DOI: 10.1007/s00392-013-0598-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
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Lam KH, Ji HF, Zheng F, Ren W, Zhou Q, Shung KK. Development of lead-free single-element ultrahigh frequency (170-320MHz) ultrasonic transducers. ULTRASONICS 2013; 53:1033-8. [PMID: 23485349 PMCID: PMC3624055 DOI: 10.1016/j.ultras.2013.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 01/17/2013] [Accepted: 01/21/2013] [Indexed: 05/03/2023]
Abstract
This paper presents the design, fabrication and characterization of single-element ultrahigh frequency (UHF) ultrasonic transducers in which the center frequency ranged from 170 to 320MHz. The center frequency of >300MHz is the highest value of lead-free ceramic ultrasonic transducers ever reported. With concern in the environmental pollution of lead-based materials, the transducer elements presented in this work were lead-free K0.5Na0.5NbO3/Bi0.5Na0.5TiO3 (KNN/BNT) composite thick films. All transducers were evaluated in a pulse-echo arrangement. The measured -6dB bandwidth of the transducers ranged from 35% to 64%. With the optimized piezoelectric properties of the composite film, the insertion loss of the UHF transducers was measured and determined to range from -50 to -60dB. In addition to the pulse-echo measurement, a 6μm tungsten wire phantom was also imaged with a 205MHz transducer to demonstrate the imaging capability. The measured -6dB axial and lateral resolutions were found to be 12μm and 50μm, respectively. The transducer performance presented in this work is shown to be better or comparable to previously reported results even though the frequency is much higher.
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Affiliation(s)
- Kwok Ho Lam
- Department of Biomedical Engineering and NIH Transducer Resource Center, University of Southern California, Los Angeles, CA 90089-1111, USA.
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28
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Seo JB, Park KW, Lee HY, Kang HJ, Koo BK, Kim SH, Kim HS. Comparison of Two Different Strategies of Intravascular Ultrasound Guidance during Percutaneous Coronary Intervention; Routine versus Selective. Korean Circ J 2013; 43:303-8. [PMID: 23755076 PMCID: PMC3675304 DOI: 10.4070/kcj.2013.43.5.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 02/26/2013] [Accepted: 03/13/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Intravascular ultrasound (IVUS) is helpful during percutaneous coronary intervention (PCI), because it can be used to confirm good apposition or optimal expansion of stents. In this study, we compared angiographic result as well as clinical outcomes between two different strategies of IVUS-guidance, the selective vs. the routine. SUBJECTS AND METHODS The study population consisted of 279 patients undergoing electric and emergency intracoronary implatation of TAXUS stent from August 2003 through September 2006. For this study, we divided physicians into two groups; doctors to perform PCI under 'routine' IVUS-guidance vs. PCI under 'selective' IVUS-guidance. Among a total of 279 patients (384 lesions) who underwent PCI with TAXUS stent, 87 patients underwent the procedure under the strategy of 'routine' IVUS-guidance, whereas 192 patients under 'selective' IVUS-guidance. RESULTS The baseline clinical features of the patients are similar between the two groups. The actual rate of IVUS usage was 89.2% in the routine group and 68.2% in the selective group (p<0.01). A high rate of adjunctive ballooning was determined as a remarkable procedure-related parameter which was comparable between the two groups (72.5% vs. 76.1% in routine vs. selective, p=0.57). The minimal lumen diameter at immediate post-PCI was significantly larger in the routine IVUS group than that in the selective group (2.58 mm vs. 2.48 mm, p=0.03). However, the difference disappeared during the follow-up period (1.98 mm vs. 1.98 mm, p=0.94). Clinical outcomes at 1 year were not different between the two groups. CONCLUSION PCI under the strategy of 'selective' IVUS-guidance was comparable to PCI under 'routine' IVUS-guidance in terms of angiographic and clinical outcomes in circumstances with frequent use of adjunctive ballooning after stenting.
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Affiliation(s)
- Jae-Bin Seo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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Huo Y, Wischgoll T, Choy JS, Sola S, Navia JL, Teague SD, Bhatt DL, Kassab GS. CT-based diagnosis of diffuse coronary artery disease on the basis of scaling power laws. Radiology 2013; 268:694-701. [PMID: 23616633 DOI: 10.1148/radiol.13122181] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To provide proof of concept for a diagnostic method to assess diffuse coronary artery disease (CAD) on the basis of coronary computed tomography (CT) angiography. MATERIALS AND METHODS The study was approved by the Cleveland Clinic Institutional Review Board, and all subjects gave informed consent. Morphometric data from the epicardial coronary artery tree, determined with CT angiography in 120 subjects (89 patients with metabolic syndrome and 31 age- and sex-matched control subjects) were analyzed on the basis of the scaling power law. Results obtained in patients with metabolic syndrome and control subjects were compared statistically. RESULTS The mean lumen cross-sectional area (ie, lumen cross-sectional area averaged over each vessel of an epicardial coronary artery tree) and sum of intravascular volume in patients with metabolic syndrome (0.039 cm(2) ± 0.015 [standard deviation] and 2.71 cm(3) ± 1.75, respectively) were significantly less than those in control subjects (0.054 cm(2)± 0.015 and 3.29 cm(3)± 1.77, respectively; P < .05). The length-volume power law showed coefficients of 27.0 cm(-4/3) ± 9.0 (R(2) = 0.91 ± 0.08) for patients with metabolic syndrome and 19.9 cm(-4/3) ± 4.3 (R(2) = 0.92 ± 0.07) for control subjects (P < .05). The probability frequency shows that more than 65% of patients with metabolic syndrome had a coefficient of 23 or more for the length-volume scaling power law, whereas approximately 90% of the control subjects had a coefficient of less than 23. CONCLUSION The retrospective scaling analysis provides a quantitative rationale for diagnosis of diffuse CAD.
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Affiliation(s)
- Yunlong Huo
- Department of Biomedical Engineering, IUPUI, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
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30
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Choi BJ, Prasad A, Gulati R, Best PJ, Lennon RJ, Barsness GW, Lerman LO, Lerman A. Coronary endothelial dysfunction in patients with early coronary artery disease is associated with the increase in intravascular lipid core plaque. Eur Heart J 2013; 34:2047-54. [PMID: 23569198 DOI: 10.1093/eurheartj/eht132] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Endothelial dysfunction is considered to play a key role in the development of atherosclerosis. However, only a limited number of human imaging studies have been available to demonstrate this hypothesis. The present study used near-infrared spectroscopy (NIRS) to investigate whether coronary endothelial dysfunction is associated with the lipid core plaque (LCP) in patients with early coronary artery disease. METHODS AND RESULTS A total of 32 patients with chest pain who had diameter stenosis <30% were enrolled. All patients underwent coronary endothelial function assessment using intracoronary acetylcholine infusion and NIRS of the proximal left anterior descending artery. The lipid core burden index (LCBI), LCBI/L (LCBI divided by the length of scanned artery), maxLCBI4mm (maximum value of LCBI for any of the 4-mm segment) and block chemogram (yellow: probability of LCP presence >0.98, tan: 0.84 ≤ P ≤ 0.98, orange: 0.57 ≤ P ≤ 0.84, red: P < 0.57) were measured. The mean percentage of yellow, tan, and orange colour blocks in patients with epicardial endothelial dysfunction was significantly higher than in those with normal epicardial endothelial function (9.5 ± 11.4 vs. 3.1 ± 6.5%, P = 0.042). There was a significant correlation between LCBI (r = -0.460, P = 0.008), LCBI/L (r = -0.453, P = 0.009), and maxLCBI4mm (r = -0.431, P = 0.014) and the degree of epicardial endothelial function. However, there was no significant correlation between LCBI (r = -0.101, P = 0.58), LCBI/L (r = -0.099, P = 0.59), and maxLCBI4mm (r = -0.063, P = 0.73) and the degree of microvascular endothelial function. CONCLUSION Patients with early coronary artery disease and endothelial dysfunction had a higher lipid content in the vascular wall than patients with normal endothelial function. The result of the present study supports the hypothesis that endothelial dysfunction is associated with pathogenesis of early atherosclerosis.
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Affiliation(s)
- Byoung-Joo Choi
- Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic Rochester, Mayo Clinic and College of Medicine, 200 First ST. SW, Rochester, MN 55905, USA
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Abstract
PURPOSE OF REVIEW Cholesteryl ester transfer protein (CETP)-inhibiting drugs effectively raise HDL cholesterol. In 2007, the CETP inhibitor torcetrapib unexpectedly showed increased fatality and cardiovascular events, possibly related to increased blood pressure and aldosterone levels caused by torcetrapib. Since then, novel CETP inhibiting drugs have been investigated. This review will discuss the safety of the CETP-inhibiting drugs. RECENT FINDINGS The novel CETP inhibitors dalcetrapib, evacetrapib and anacetrapib did not show harmful effects on blood pressure or aldosterone levels. Ultrasound brachial artery flow-mediated vasodilation, carotid MRI and (18)F-fluordeoxyglucose PET imaging studies, showed that dalcetrapib therapy had neither harmful nor beneficial effects on endothelial function, atherosclerosis progression, or vessel wall inflammation. Recently, the clinical endpoint study investigating dalcetrapib was announced to be terminated early, after the second interim analysis showed that dalcetrapib lacked clinically meaningful efficacy. SUMMARY Dalcetrapib, evacetrapib and anacetrapib did not show the harmful effects on aldosterone and blood pressure that were exhibited by torcetrapib, indicating that CETP inhibition is well tolerated. So far CETP inhibition did not show beneficial effects on clinical outcome. The phase III study with anacetrapib will give final answers on whether CETP inhibition can reduce cardiovascular events.
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Iterative Self-Organizing Atherosclerotic Tissue Labeling in Intravascular Ultrasound Images and Comparison With Virtual Histology. IEEE Trans Biomed Eng 2012; 59:3039-49. [DOI: 10.1109/tbme.2012.2213338] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Räber L, Heo JH, Radu MD, Garcia-Garcia HM, Stefanini GG, Moschovitis A, Dijkstra J, Kelbaek H, Windecker S, Serruys PW. Offline fusion of co-registered intravascular ultrasound and frequency domain optical coherence tomography images for the analysis of human atherosclerotic plaques. EUROINTERVENTION 2012; 8:98-108. [DOI: 10.4244/eijv8i1a16] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kim WH, Park HW, Kim KH, Song IG, Yang DJ, Lee CS, Seo YH, Kwon TG, Bae JH. Fibro-Fatty Component is Important for the Long-Term Clinical Events in Patients Who Have Undergone Primary Percutaneous Coronary Intervention. Korean Circ J 2012; 42:33-9. [PMID: 22363381 PMCID: PMC3283752 DOI: 10.4070/kcj.2012.42.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 09/02/2011] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives We evaluated which plaque components are associated with long-term clinical events in patients who underwent primary percutaneous coronary intervention (PCI). Subjects and Methods The study subjects consisted of 57 consecutive patients (mean age, 58.5±14.5 years; 45 males) who underwent primary PCI and a virtual histology-intravascular ultrasound examination. Major adverse cardiac events (MACEs) including death, acute myocardial infarction, stroke, and revascularization were evaluated during the mean 28 month follow-up period. Results Patients with high fibro-fatty volume (FFV >13.4 mm3, n=29; mean age, 61.3 years) had a lower ejection fraction (52.7% vs. 59.4%, p=0.022), a higher incidence of multi-vessel disease (69.0% vs. 28.6%, p=0.002), larger plaque area (25.7 mm2 vs. 15.9 mm2, p<0.001), and larger plaque volume (315 mm3 vs. 142 mm3, p<0.001) than those with a low FFV (≤13.4 mm3, n=28; mean age, 55.6 years). Patients with high FFV had a significantly higher incidence (32.1% vs. 8.3%, p=0.036) of MACE than those with low FFV. When we divided the study population according to the necrotic core volume (NCV), fibrous volume, or dense calcified volume, no significant findings in terms of demographics and MACE rates were observed. A Cox regression analysis revealed that the independent factor for MACE was FFV (hazard ratio, 6.748; 95% confidence interval, 1.168-38.971, p=0.033) in this study population. Conclusion The coronary plaque component, particularly FFV, but not NCV, was important in long-term clinical outcomes in patients who underwent primary PCI.
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Affiliation(s)
- Wan Ho Kim
- Division of Cardiology, Konyang University College of Medicine, Daejeon, Korea
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Obaid DR, Calvert PA, McNab D, West NEJ, Bennett MR. Identification of coronary plaque sub-types using virtual histology intravascular ultrasound is affected by inter-observer variability and differences in plaque definitions. Circ Cardiovasc Imaging 2012; 5:86-93. [PMID: 22109982 DOI: 10.1161/circimaging.111.965442] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies show that virtual histology intravascular ultrasound (VH-IVUS) can identify plaques at high risk of rupture, such as thin-capped fibroatheromata, raising the possibility of immediate targeted intervention. However, plaque classification entails border recognition and subjective assessment of plaque architecture, introducing inter-observer variability without confirmation by core-labs. Furthermore, the accuracy of local versus core-laboratory VH-IVUS plaque classification and effects of different plaque definitions have not been examined. METHODS AND RESULTS Local observers classified 100 VH-IVUS-defined coronary plaques to determine single center inter-observer variability; multi-center variability was determined by comparison with VH-IVUS core-laboratory analysis, and compared with gray-scale IVUS. Frequency of plaque types using different published plaque definitions also was determined. Single-center VH-IVUS inter-observer agreement was strong (kappa=0.86), but lower for thin-capped fibroatheromatas (k=0.59) because of observer judgments on presence and location of confluent necrotic core. Multi-center inter-observer agreement for plaque classification was lower again (k=0.71), particularly for thin-capped fibroatheromatas (k=0.56). Different plaque definitions further reduced VH-IVUS-defined thin-capped fibroatheromata numbers by 44%. The diagnostic accuracy of gray-scale IVUS to identify thin-capped fibroatheromata was poor for both observers (21 and 29% correct), with low inter-observer agreement (k=0.14). CONCLUSIONS VH-IVUS plaque classification, and particularly VH-IVUS-defined thin-capped fibroatheromata identification, varies significantly between local observers, and particularly in comparison with core-laboratory analysis. Differences in VH-IVUS plaque definitions introduce further variability between studies. These factors reduce the use of VH-IVUS plaque classification to guide intervention in a "live" clinical setting, and also affect comparison of diagnostic accuracy and natural history of plaques between studies.
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Affiliation(s)
- Daniel R Obaid
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
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Lee JB, Mintz GS, Lisauskas JB, Biro SG, Pu J, Sum ST, Madden SP, Burke AP, Goldstein J, Stone GW, Virmani R, Muller JE, Maehara A. Histopathologic validation of the intravascular ultrasound diagnosis of calcified coronary artery nodules. Am J Cardiol 2011; 108:1547-51. [PMID: 21872195 DOI: 10.1016/j.amjcard.2011.07.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 07/07/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
Abstract
A calcified nodule is a type of potentially vulnerable plaque accounting for approximately 2% to 7% of coronary events. Because its intravascular ultrasound (IVUS) features have never been validated, the aim of this study was to assess the IVUS characteristics of calcified nodules in comparison to histopathology. IVUS was performed in 856 pathologic slices in 29 coronary arteries (11 left anterior descending, 5 left circumflex, and 13 right coronary arteries) in 18 autopsy hearts. Pathologic sections were analyzed every 2 mm; qualitative and quantitative findings of matched IVUS were analyzed. IVUS detected calcification in 285 frames; 17 (6.0%) were calcified nodules, and 268 (94.0%) were non-nodular calcium by histopathology. Two calcified nodules (11.8%) were solitary, and 15 (88.2%) were adjacent to non-nodular calcium. IVUS characteristics of calcified nodules were (1) a convex shape of the luminal surface (94.1% in calcified nodules vs 9.7% in non-nodular calcium, p <0.001), (2) a convex shape of the luminal side of calcium (100% vs 16.0%, p <0.001), (3) an irregular luminal surface (64.7% vs 11.6%, p <0.001), and (4) an irregular leading edge of calcium (88.2% vs 19.0%, p <0.001). Luminal area at the calcified nodule site was larger (6.2 ± 2.4 vs 4.3 ± 1.6 mm(2), p <0.001) and plaque burden less (57 ± 6% vs 68 ± 5%, p <0.001) than at the minimum luminal area site. In conclusion, calcified nodules have distinct IVUS features (irregular and convex luminal surface) permitting their prospective identification in vivo.
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Kusama I, Hibi K, Kosuge M, Sumita S, Tsukahara K, Okuda J, Ebina T, Umemura S, Kimura K. Intravascular ultrasound assessment of the association between spatial orientation of ruptured coronary plaques and remodeling morphology of culprit plaques in ST-elevation acute myocardial infarction. Heart Vessels 2011; 27:541-7. [PMID: 21892739 DOI: 10.1007/s00380-011-0184-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 08/05/2011] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess the association between the spatial location of plaque rupture and remodeling pattern of culprit lesions in acute anterior myocardial infarction (MI). Positive remodeling suggests a potential surrogate marker of plaque vulnerability, whereas plaque rupture causes thrombus formation followed by coronary occlusion and MI. Intravascular ultrasound (IVUS) can determine the precise spatial orientation of coronary plaque formation. We studied 52 consecutive patients with acute anterior MI caused by plaque rupture of the culprit lesion as assessed by preintervention IVUS. The plaques were divided into those with and without positive remodeling. We divided the plaques into three categories according to the spatial orientation of plaque rupture site: myocardial (inner curve), epicardial (outer curve), and lateral quadrants (2 intermediate quadrants). Among 52 plaque ruptures in 52 lesions, 27 ruptures were oriented toward the epicardial side (52%), 18 toward the myocardial side (35%), and 7 in the 2 lateral quadrants (13%). Among 35 plaques with positive remodeling, plaque rupture was observed in 21 (52%) on the epicardial side, 12 (34%) on the myocardial side, and 2 (6%) on the lateral side. However, among 17 plaques without positive remodeling, plaque rupture was observed in 6 (35%), 6 (35%), and 5 (30%), respectively (p = 0.047). Atherosclerotic plaques with positive remodeling showed more frequent plaque rupture on the epicardial side of the coronary vessel wall in anterior MI than those without positive remodeling.
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Affiliation(s)
- Ikuyoshi Kusama
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
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Regar E. Invasive imaging technologies: can we reconcile light and sound? J Cardiovasc Med (Hagerstown) 2011; 12:562-70. [PMID: 21709573 DOI: 10.2459/jcm.0b013e3283492b5a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since the introduction of intravascular, catheter-based invasive imaging and diagnostic tools in the catheterization laboratories two decades ago, the functional assessment of angiographically moderate or ambiguous lesions by fractional flow reserve measurements represents the established standard of care today. Likewise, intravascular ultrasound (IVUS) is widely accepted to guide treatment strategy in complex lesions, such as long or left main stem lesions. Developments are driven by the clinical interest to optimize treatment, prevent periprocedural complications, understand treatment failure and understand progression of atherosclerosis. As a result, a variety of devices are now clinically available that enable detection and monitoring of specific plaque features over time, such as the presence of necrotic core by IVUS-VH, a lipid-core plaque by near infrared (NIR) spectroscopy or a thin fibrous cap atheroma by optical coherence tomography (OCT). As the physical boundaries for both light and sound are different, these imaging technologies offer different advantages and limitations. Light-based technologies offer unparalleled high image resolution (OCT) or unparalleled high sensitivity and specificity for distinct plaque components (NIR spectroscopy), whereas conventional IVUS offers a much better tissue penetration. From a clinical perspective, both types of information are valuable. Ideally, this information should easily and in real time be available in the catheterization laboratory, consisting of co-registered datasets gained during a single catheter pullback. On this background, a combined NIR spectroscopy and IVUS catheter has recently been introduced for clinical use. The article discusses the potential and limitations of these different technologies. They may allow advanced coronary plaque diagnosis in a fast, accurate, reliable, user- and patient-friendly manner and, as such, can help to improve clinical practice today and therapeutic options in the future.
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Affiliation(s)
- Evelyn Regar
- Department of Interventional Cardiology, Thoraxcenter, Erasmus, Rotterdam, The Netherlands.
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Caixeta A, Maehara A, Mintz GS. Intravascular Ultrasound: Principles, Image Interpretation, and Clinical Applications. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Cardiac allograft vasculopathy (CAV), characterized by diffuse intimal thickening and luminal narrowing in the arteries of the allograft, is the leading cause of morbidity and mortality in cardiac transplant recipients. Many transplant centers perform routine annual surveillance coronary angiography. However, angiography can underdiagnose or miss CAV due to its diffuse nature. Intravascular ultrasound (IVUS) is more sensitive than angiography. IVUS provides not only accurate information on lumen size, but also quantification of intimal thickening, vessel wall morphology, and composition. IVUS has evolved as a valuable adjunct to angiography and the optimal diagnostic tool for early detection. Noninvasive testing such as dobutamine stress echocardiography and nuclear stress test have shown considerable accuracy in diagnosing significant CAV. Computed tomographic imaging and cardiac magnetic resonance imaging are promising new modalities but require further study. This article reviews the diagnostic methods that are currently available.
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Abstract
It is now well recognized that the atherosclerotic plaques responsible for thrombus formation are not necessarily those that impinge most on the lumen of the vessel. Nevertheless, clinical investigations for atherosclerosis still focus on quantifying the degree of stenosis caused by plaques. Many of the features associated with a high-risk plaque, including a thin fibrous cap, large necrotic core, macrophage infiltration, neovascularization, and intraplaque hemorrhage, can now be probed by novel imaging techniques. Each technique has its own strengths and drawbacks. In this article, we review the various imaging modalities used for the evaluation and quantification of atherosclerosis.
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Affiliation(s)
- D.R.J. Owen
- Department of Experimental Medicine and Toxicology, Imperial College London, Hammersmith Hospital, London W12 0NN, United Kingdom;
- Clinical Imaging Center, GlaxoSmithKline, London W12 0NN, United Kingdom
| | - A.C. Lindsay
- Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - R.P. Choudhury
- Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Z.A. Fayad
- Imaging Science Laboratories, Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, New York 10029;
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Yamada R, Okura H, Kume T, Neishi Y, Kawamoto T, Miyamoto Y, Imai K, Saito K, Tsuchiya T, Hayashida A, Yoshida K. Target Lesion Thin-Cap Fibroatheroma Defined by Virtual Histology Intravascular Ultrasound Affects Microvascular Injury During Percutaneous Coronary Intervention in Patients With Angina Pectoris. Circ J 2010; 74:1658-62. [DOI: 10.1253/circj.cj-09-0992] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Teruyoshi Kume
- Division of Cardiovascular Medicine, Stanford University
| | - Yoji Neishi
- Division of Cardiology, Kawasaki Medical School
| | | | | | | | - Ken Saito
- Division of Cardiology, Kawasaki Medical School
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Saad M, Toelg R, Khattab A, Kassner G, Abdel-Wahab M, Richardt G. Determination of haemodynamic significance of intermediate coronary lesions using three-dimensional coronary reconstruction. EUROINTERVENTION 2009; 5:573-9. [DOI: 10.4244/eijv5i5a93] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Knollmann FD, Wieltsch A, Peters S, Mahlke A, Niederberger S, Kertesz T. Flat panel volume computed tomography of the coronary arteries. Acad Radiol 2009; 16:1251-62. [PMID: 19608434 DOI: 10.1016/j.acra.2009.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 05/17/2009] [Accepted: 05/18/2009] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Multidetector-row computed tomography (MDCT) has evolved into a sensitive diagnostic tool for the noninvasive detection of coronary artery stenosis, but remains limited by spatial resolution. Flat panel volume computed tomography (fpVCT) offers a higher spatial resolution. In a postmortem investigation of autopsy specimens, the accuracies of fpVCT for measuring the severity of coronary artery stenosis and the size of atherosclerotic plaque components were determined. METHODS AND MATERIALS In 25 autopsy cases, hearts were isolated, the left anterior descending coronary arteries filled with contrast agent, and depicted with a prototype fpVCT unit with a slice thickness of 0.25 mm. Transections of the left anterior descending coronary arteries were reconstructed and compared with histopathologic sections using light microscopy. RESULTS FpVCT measurements of luminal stenosis (r = 0.81), total plaque area (r = 0.88), calcified plaque area (r = 0.92), noncalcified plaque area (r = 0.83), and lipid core size (r = 0.67; P < .02) correlated well with histopathology (P < .0001). The limits of agreement for measuring any plaque component were three times smaller than those reported for MDCT. CONCLUSIONS Postmortem coronary fpVCT provides an accurate and reproducible method for the quantitative assessment of both luminal stenosis and atherosclerotic plaque size. Because of its high spatial resolution, the method should be sufficiently accurate to reliably detect the lipid pools of vulnerable plaques.
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Affiliation(s)
- Friedrich D Knollmann
- Department of Radiology, University of Pittsburgh Medical Center, UPMC Presbyterian, Suite E-177, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA.
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Duivenvoorden R, de Groot E, Stroes ES, Kastelein JJ. Surrogate markers in clinical trials—Challenges and opportunities. Atherosclerosis 2009; 206:8-16. [DOI: 10.1016/j.atherosclerosis.2008.12.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 12/08/2008] [Indexed: 01/08/2023]
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Lavi S, Bae JH, Rihal CS, Prasad A, Barsness GW, Lennon RJ, Holmes DR, Lerman A. Segmental coronary endothelial dysfunction in patients with minimal atherosclerosis is associated with necrotic core plaques. Heart 2009; 95:1525-30. [PMID: 19497916 DOI: 10.1136/hrt.2009.166017] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND/OBJECTIVE Endothelial dysfunction and atherosclerosis are systemic disorders, but are often characterised by segmental involvement and complications. A potential mechanism for local involvement early in the disease process may be related to plaque composition. This study was designed to test the hypothesis that in patients with minimal coronary atherosclerosis, coronary artery segments with abnormal endothelial function have specific plaque characteristics. METHODS Intravascular ultrasound (IVUS) images were obtained from 30 patients who underwent coronary endothelial function assessment. Spectral analysis of the IVUS radiofrequency data was used for assessment of plaque composition. IVUS findings of the coronary sections were compared according to the corresponding endothelial response to acetylcholine. RESULTS Sections with a decrease epicardial coronary arterial diameter in response to acetylcholine had smaller baseline lumen (7.5 (2.4) mm(2) vs 8.8 (3.3) mm(2), p = 0.006) but larger plaque burden (37.1% (9.4%) vs 31% (7%), p = 0.003) than sections with normal endothelial response. Sections with endothelial dysfunction had larger necrotic core plaques: 0.13 (0.03-0.33) mm(2) vs 0.0 (0.0-0.07), p<0.001 and more dense calcium: 0.03 (IQR 0.0-0.13) mm(2) vs 0.0 (0.0-0.10) mm(2), p<0.01), than those with normal endothelial response. Only necrotic core area was associated with endothelial dysfunction (p<0.001) after adjusting for other measures. CONCLUSIONS This study suggests that local coronary endothelial dysfunction in patients with minimal coronary atherosclerosis is associated with plaque characteristics that are typical of vulnerable plaques.
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Affiliation(s)
- S Lavi
- Division of Cardiovascular Diseases and the Center for Coronary Physiology and Imaging, Mayo Clinic, Rochester, MN 55905, USA
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Kassab GS, Choy JS, Svendsen M, Sinha AK, Alloosh M, Sturek M, Huo Y, Sandusky GE, Hermiller J. A novel system for the reconstruction of a coronary artery lumen profile in real time: a preclinical validation. Am J Physiol Heart Circ Physiol 2009; 297:H485-92. [PMID: 19465543 DOI: 10.1152/ajpheart.01224.2008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Accurate sizing of vessel diameter is important for understanding the physiology of blood vessels as well as the treatment of coronary and peripheral artery disease. The objective of this study was to validate a novel catheter-based system [the LumenRECON (LR) system] for the real-time reconstruction of lumen cross-sectional area (CSA) along the length of a vessel segment. A total of 22 swine (20 Yorkshire and 2 atherosclerotic Ossabaw swine) were used to evaluate the accuracy, reproducibility, and safety of the system compared with intravascular ultrasound (IVUS). The CSA of the right coronary artery, left anterior descending coronary artery, and left circumflex artery were determined by IVUS and the LR system over a 3- to 4-cm segment in 12 Yorkshire and 2 atherosclerotic Ossabaw swine and 2 postmortem atherosclerotic human hearts. In eight chronic animals, the effect of the LR catheter on the vessel wall was evaluated at 1 day and 2 wk (4 animals each) after the intervention. A Bland-Altman plot of the LR and IVUS data showed a mean difference between the two measurements of 0.055 mm in diameter, which was not statistically significant from zero, indicating a lack of bias in the comparison of the LR system with IVUS. The root mean square error of the two measurements was 10.2% of the mean IVUS diameter. The repeatability of the LR system was assessed using duplicate measurements. The mean of the difference between the two measurements was nearly zero, and the repeatability coefficient was within 4.5% of the mean of the two measurements. No injury or intimal hyperplasia was found acutely or chronically after the use of the LR system. This study establishes the accuracy, reproducibility, and safety of a nonimaging 2.7-Fr catheter for lumen sizing of coronary arteries. The system provides a continuous quantitative axial profile of the mean vessel lumen in real time and may have significant utility in vascular research and clinically in the catheterization laboratory.
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Affiliation(s)
- Ghassan S Kassab
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN 46202, USA.
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Low A, Kawase Y, Chan YH, Tearney G, Bouma B, Jang IK. In vivo characterisation of coronary plaques with conventional grey-scale intravascular ultrasound: correlation with optical coherence tomography. EUROINTERVENTION 2009; 4:626-32. [DOI: 10.4244/eijv4i5a105] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Alfonso F, Goncalves M, Goicolea J, Hernandez R, Segovia J, Rodriguez P, Fernandez-Ortiz A, Najar S, Bañuelos C, Macaya C. Feasibility of intravascular ultrasound studies: predictors of imaging success before coronary interventions. Clin Cardiol 2009; 20:1010-6. [PMID: 9422839 PMCID: PMC6655976 DOI: 10.1002/clc.4960201207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intravascular ultrasound (IVUS) is currently used to study lesions during transcatheter coronary therapy. However, before dilation some lesions cannot be reached or crossed with the imaging catheter. HYPOTHESIS This study seeks to elucidate which factors determine the feasibility of IVUS examination before coronary interventions. METHODS Accordingly, 100 consecutive patients undergoing IVUS examination before coronary angioplasty were prospectively studied. The clinical and angiographic characteristics of 77 patients with a successful IVUS study (Group A) were compared with those of 23 patients in whom IVUS was attempted but the target lesion could not be interrogated (Group B). The echogenic characteristics of the target lesion [before (n = 77) or after intervention (in 18 patients in Group B)] were also studied. RESULTS Patients in Group B were significantly older (62 +/- 7 vs. 57 +/- 10 years, p < 0.05) and more frequently had stable angina [8 (35%) vs. 9 (11%), p < 0.05]. The distribution of lesions within the coronary tree and angiographic lesion characteristics including length, eccentricity, calcification, bend location, and the American College of Cardiology/American Heart Association classification were similar in both groups. However, proximal tortuosities (> 45 degrees at end diastole) were more frequently found in Group B [20 (87%) vs. 47 (61%), p < 0.05]. In addition, by quantitative angiography, patients in Group B had smaller arteries (reference diameter 2.8 +/- 0.4 vs. 3.1 +/- 0.4 mm, p < 0.05) and more severe lesions (minimal lumen diameter 0.46 +/- 0.24 vs. 0.65 +/- 0.34 mm, p < 0.05). On IVUS, calcified lesions were more frequently visualized in Group B (61 vs. 38%, p < 0.05). On multivariate analysis, catheter size, baseline minimal lumen diameter, angiographic proximal tortuosities, and lesion calcification on imaging were independent predictors of the feasibility of IVUS studies. CONCLUSIONS Unsuccessful IVUS studies before intervention occur more frequently (1) in vessels with proximal tortuosities or severe lumen narrowing, (2) in lesions that are calcified on IVUS, and (3) when large imaging catheters are used.
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Affiliation(s)
- F Alfonso
- Cardiopulmonary Department, Hospital Universitario San Carlos, Madrid, Spain
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Arterial Tissue in Health and Disease: Experimental Data, Collagen-Based Modeling and Simulation, Including Aortic Dissection. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/978-3-211-95875-9_4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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