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Optical Coherence Tomography in Cerebrovascular Disease: Open up New Horizons. Transl Stroke Res 2023; 14:137-145. [PMID: 35445969 DOI: 10.1007/s12975-022-01023-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
Optical coherence tomography (OCT), based on the backscattering or reflection of near-infrared light, enables an ultra-high resolution of up to 10 μm. The successful application of OCT in coronary artery diseases has sparked increasing interest in its implementation in cerebrovascular diseases. OCT has shown promising potential in the atherosclerotic plaque structure characterization, plaque rupture risk stratification, pre-stenting and post-stenting evaluation, and long-term follow-up in extracranial and intracranial atherosclerotic stenosis (ICAS). In hemorrhagic cerebrovascular diseases, OCT plays an important role in the structure evaluation, rupture risk stratification, and healing and occlusion evaluation following initial treatment in intracranial aneurysms (IAs). In this study, we summarized the applications of OCT in the diagnosis, treatment, and follow-up of cerebrovascular diseases, especially in ICAS and IAs. The current limitations and future directions of OCT in the endovascular treatment of cerebrovascular diseases were also discussed.
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The Height and Mobility of Protruding Plaque After Carotid Artery Stenting Are Associated with Postoperative Ischemic Lesions. World Neurosurg 2023; 172:e185-e193. [PMID: 36603647 DOI: 10.1016/j.wneu.2022.12.127] [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: 10/17/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Tissue protrusion (TP) is a possible cause of cerebral infarction after carotid artery stenting (CAS). Using optical frequency domain imaging (OFDI) and angioscopy, we investigated the relationship between the morphological features of TP and postoperative new ischemic lesions on magnetic resonance imaging (MRI)-diffusion weighted imaging (DWI) after CAS. METHODS Fifty patients who underwent CAS and subsequent poststenting intravascular evaluation using both OFDI and angioscopy were included. CAS was performed for proximal protection via the femoral artery approach, and intravascular evaluation with OFDI and angioscopy were performed after stent placement. We compared the background and poststenting intravascular findings between patients with and without postoperative new ischemic lesions on MRI-DWI. RESULTS TP was observed in 42 patients (84%), and postoperative new ischemic lesions on MRI-DWI were observed in 32 patients (64%). The frequency of TP did not differ between the 2 groups, but the height of TP was higher in the DWI-positive group (0.62 mm vs. 0.29 mm, P = 0.0028), and mobile TP was observed only in the DWI-positive group. The height of TP (P = 0.023) was an independent predictor of new periprocedural ischemic brain lesions after CAS, and its cut-off value for mobility was 0.55 mm on the receiver operating characteristic curve (area under the curve, 0.93). CONCLUSIONS The height of TP on OFDI and mobile-TP on angioscopy after CAS were associated with postoperative new ischemic lesions on MRI-DWI. The intravascular evaluation using OFDI and angioscopy could be helpful for a detailed evaluation of TP.
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Optical Coherence Tomography Evaluation of Carotid Artery Stenosis and Stenting in Patients With Previous Cervical Radiotherapy. Front Neurosci 2022; 16:861511. [PMID: 35573285 PMCID: PMC9095735 DOI: 10.3389/fnins.2022.861511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Cervical radiotherapy can lead to accelerated carotid artery stenosis, increased incidence of stroke, and a higher rate of in-stent restenosis in irradiated patients. Our objective was to reveal the morphological characteristics of radiation-induced carotid stenosis (RICS) and the stent–vessel interactions in patients with previous cervical radiotherapy by optical coherence tomography (OCT). Materials and Methods Between November 2017 and March 2019, five patients with a history of cervical radiotherapy were diagnosed with severe carotid artery stenosis and underwent carotid artery stenting (CAS). OCT was conducted before and immediately after the carotid stent implantation. Two patients received OCT evaluation of carotid stenting at 6- or 13-month follow-up. Results The tumor types indicating cervical radiotherapy were nasopharyngeal carcinoma (n = 3), cervical esophageal carcinoma (n = 1), and cervical lymphoma (n = 1). The median interval from the radiotherapy to the diagnosis of RICS was 8 years (range 4–36 years). Lesion characteristics of RICS were detected with heterogeneous signal-rich tissue, dissection, and advanced atherosclerosis upon OCT evaluation. Post-interventional OCT revealed 18.2–57.1% tissue protrusion and 3.3–13.8% stent strut malapposition. Follow-up OCT detected homogeneous signal-rich neointima and signal-poor regions around stent struts. In the patient with high rates of tissue protrusion and stent strut malapposition, the 6-month neointima burden reached 48.9% and microvessels were detected. Conclusion The morphological features of RICS were heterogeneous, including heterogeneous signal-rich tissue, dissection, and advanced atherosclerosis. Stenting was successful in all 5 patients with severe RICS. One patient, with high rates of tissue protrusion and stent strut malapposition immediately after stenting, received in-stent neointimal hyperplasia at a 6-month follow-up.
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Clinical Utility of Intravascular Ultrasound (IVUS) in Carotid Artery Interventions: A Systematic Review and Meta-analysis. J Endovasc Ther 2021; 29:678-691. [PMID: 34955053 DOI: 10.1177/15266028211064824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carotid plaque morphology plays an important role in determining outcome of carotid artery stenting (CAS). Intravascular ultrasound (IVUS) and its extension VH (Virtual Histology)-IVUS evaluate plaque characteristics in real time and guide decision making during stenting. To date, there is no consensus about indications of IVUS and its validated methods. This systematic review and meta-analysis aims to evaluate the clinical utility of IVUS in carotid artery interventions (CAS) and develop a future consensus for research and practice parameters. METHODS A systematic review and meta-analysis was performed of the English literature articles published till February 2021. Studies reporting on IVUS parameters and findings and also its performance compared with other imaging modalities were included in review. Pooled prevalence with 95% confidence intervals (CI) was calculated. The statistical analysis was conducted in R version 3.6.2. RESULTS A total of 2015 patients from 29 studies were included. Proportional meta-analysis was performed on 1566 patients from 11 studies. In 9 studies, stroke/transient ischemic attack (TIA) had a pooled prevalence of 4% (95% CI 3%-5%) while asymptomatic stroke had a pooled prevalence of 46% (95% CI 31%-62%) in 4 studies following IVUS. Two studies reported that IVUS detected more plaque protrusion compared with angiography (n=33/396 vs 11/396). IVUS led to stent type or size change in 8 of 48 cases which were missed on angiography in 3 other studies. Concordance between VH-IVUS and true histology was good at 80% to 85% reported in 2 studies. CONCLUSIONS This systematic review and meta-analysis showed, though IVUS fared better to computed tomography (CT)/magnetic resonance (MR) angiography for better stent selection during CAS, with low to moderate risk of bias in the studies included. However, large scale, preferably randomized controlled studies are needed to predict its role in determining clinical outcome.
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Frequency-Domain Optical Coherence Tomography for Intracranial Atherosclerotic Stenosis: Feasibility, Safety, and Preliminary Experience. Front Neurol 2021; 12:678443. [PMID: 34220686 PMCID: PMC8247572 DOI: 10.3389/fneur.2021.678443] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite advances in non-invasive imaging, the characterization of atherosclerotic plaque remains superior with frequency-domain optical coherence tomography (FD-OCT) in the clinical coronary and experimental cerebrovascular literature. An assessment of the feasibility and safety of FD-OCT for intracranial atherosclerotic stenosis (ICAS) is desirable. Methods: We analyzed a cohort of all consecutive FD-OCT evaluations for ICAS performed at our institution from April 2017 to August 2018 (16 months) in patients who suffered from transient ischemic attack (TIA) or non-disabling stroke despite optimal medical management within 90 days of admission attributable to angiographically verified 70-99% stenosis of an intracranial artery. Results: Thirty-three patients harboring 36 lesions with an average age of (57.6 ± 7.1) years (male sex 27 cases) comprising nine cases of lesions located within the anterior circulation and 24 cases within the posterior circulation were identified. Of the 33 patients with 36 lesions, the FD-OCT imaging catheter detected 35/36 (97%) lesions except in one case in which the FD-OCT catheter failed to navigate excessively tortuous vessels, and FD-OCT images in 27 patients (81.8%) were finally obtained successful, where the target lesion was fully visible, and image quality under at least one pullback was graded 2 or 3. There were no symptomatic complications. Blood flow was the most common artifact encountered (51.9%). Conclusion: FD-OCT is safe and feasible for the assessment of ICAS in the anterior and posterior circulation. The use of diagnostic interferometry will have to be weighed against its cost, and these preliminary findings should be verified by prospective large-scale studies.
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Abstract
Background Stenosis has historically been the major factor used to determine carotid stroke sources. Recent evidence suggests that specific plaque features detected on imaging may be more highly associated with ischemic stroke than stenosis. We sought to determine computed tomography angiography (CTA) imaging features of carotid plaque that optimally discriminate ipsilateral stroke sources. Methods and Results In this institutional review board-approved retrospective cross-sectional study, 494 ipsilateral carotid CTA-brain magnetic resonance imaging pairs were available for analysis after excluding patients with alternative stroke sources. Carotid CTA and clinical markers were recorded, a multivariable Poisson regression model was fitted, and backward elimination was performed with a 2-sided threshold of P<0.10. Discriminatory value was determined using receiver operating characteristic analysis, area under the curve, and bootstrap validation. The final CTA carotid-source stroke prediction model included intraluminal thrombus (prevalence ratio, 2.8 [P<0.001]; 95% CI, 1.6-4.9), maximum soft plaque thickness (prevalence ratio, 1.2 [P<0.001]; 95% CI, 1.1-1.4), and the rim sign (prevalence ratio, 2.0 [P=0.007]; 95% CI, 1.2-3.3). The final discriminatory value (area under the curve=78.3%) was higher than intraluminal thrombus (56.4%, P<0.001), maximum soft plaque thickness (76.4%, P=0.007), or rim sign alone (69.9%, P=0.001). Furthermore, NASCET (North American Symptomatic Carotid Endarterectomy Trial) stenosis categories (cutoffs of 50% and 70%) had lower stroke discrimination (area under the curve=67.4%, P<0.001). Conclusions Optimal discrimination of ipsilateral carotid sources of stroke requires information on intraluminal thrombus, maximum soft plaque thickness, and the rim sign. These results argue against the sole use of carotid stenosis to determine stroke sources on CTA, and instead suggest these alternative markers may better diagnose vulnerable carotid plaque and guide treatment decisions.
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Application of Optical Frequency Domain Imaging to Recanalized Unruptured Internal Carotid Artery Aneurysm Treated by Flow-Diverting Stent-Assisted Coiling. World Neurosurg 2020; 146:1-5. [PMID: 32931994 DOI: 10.1016/j.wneu.2020.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Here we report the application of optical frequency domain imaging (OFDI), a new optical coherence tomography device, for intravascular visualization in the treatment of a recanalized unruptured internal carotid artery aneurysm that was treated initially by stent-assisted coil embolization. CASE DESCRIPTION OFDI revealed malapposition of the stent and lack of neointimal growth at the aneurysm neck, which was treated by deployment of a Pipeline Embolization Device to overlap the stent. An angiogram performed 1 year after the procedure revealed perfect healing of the aneurysm, and OFDI clearly demonstrated good stent apposition and total endothelialization over the aneurysm neck. CONCLUSIONS OFDI/OCT appears to be a useful diagnostic tool for evaluating stent-strut apposition over the vessel wall and the grade of neointimal endothelialization across the neck of the aneurysm in aneurysmal recanalization.
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A Patient with Carotid Mobile Plaques Treated by Carotid Artery Stenting Using a Double-layer Micromesh Stent. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:495-500. [PMID: 37501767 PMCID: PMC10370942 DOI: 10.5797/jnet.cr.2019-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/08/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a case of carotid mobile plaques treated by carotid artery stenting (CAS) using a double-layer micromesh stent (CASPER stent). Case Presentation An 86-year-old male presented with lightheadedness. Carotid artery ultrasound revealed mobile plaques in the right internal carotid artery (ICA). Head and neck MRI demonstrated concomitant left ICA occlusion. We first started medical treatment, but it could not reduce the plaque size. Then, we performed CAS using a CASPER stent in addition to medical treatment. The procedure was finished without complications, and there was no plaque protrusion. The postoperative course was uneventful during 3 years of follow-up. Conclusion A mobile plaque of the carotid artery may be treated less-invasively with a micromesh stent.
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Endovascular optical coherence tomography imaging in cerebrovascular disease. J Clin Neurosci 2020; 80:30-37. [PMID: 33099363 DOI: 10.1016/j.jocn.2020.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Endovascular optical coherence tomography (OCT) is the highest resolution imaging modality currently available with spatial resolution of 10 µm. Although originally developed for interventional cardiology, the ability to visualize the luminal environment and anatomy, along with the stent-vessel interaction could be of great utility for various cerebrovascular diseases, and the adoption of endovascular OCT imaging in the evolving field of interventional neuroradiology seems instinctive. The purpose of this study is to conduct a systematic review of the literature regarding applications of endovascular OCT in the diagnosis and treatment of cerebrovascular diseases. In addition, the authors report their institutional experience with the use of OCT in carotid atherosclerotic disease, cerebral aneurysms, and acute ischemic stroke. A systematic review of the literature was undertaken. Peer-reviewed articles were collected through MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) searches through March 2020. A total of 34 studies with 598 patients were included in the qualitative synthesis. These include 23 studies of carotid atherosclerotic disease, 7 studies of cerebral aneurysms, and 4 studies of non-aneurysmal posterior circulation pathology. OCT imaging was feasible in 94% of patients with 0.6% complication rate. Endovascular OCT appears to be safe and feasible, allowing clinicians to visualize stent-vessel interactions, aneurysmal healing, and vulnerable atherosclerotic plaque features. OCT carries great promise, however additional investigations are needed before any imposing statement can be made about the role of OCT in cerebrovascular imaging.
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What's happening in carotid stent? A case report of prominent plaque protrusion after carotid artery stenting observed on angioscopy. Catheter Cardiovasc Interv 2020; 97:E532-E535. [PMID: 32770728 DOI: 10.1002/ccd.29186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/09/2020] [Accepted: 07/19/2020] [Indexed: 11/10/2022]
Abstract
Thromboembolic complications after carotid artery stenting (CAS) remain an unsolved problem, and several intravascular imaging tools have been proposed to clarify the mechanism of these complications. We report a case of intraprocedural plaque protrusion revealed by angioscopy. A 64-year-old woman underwent CAS for left carotid artery stenosis. After stent placement, optical frequency domain imaging demonstrated some plaque protrusion, and angioscopy showed prominent mobile plaque fragments protruding into the vessel between stent struts and confirmed the coverage of the protruded plaque after the overlapping stent was placed. Compared with other tools, angioscopy more clearly revealed plaque protrusion in the vessel after CAS.
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Abstract
Introduction: Optical Coherence Tomography (OCT) is an intravascular imaging providing high-resolution images of morphological features of arterial wall. Nowadays, OCT is an accepted intravascular modality to study coronary arteries, stent implantation, and vessel injury. In the last decade, an increasing interest have been focused on the application of OCT in carotid arteries.Areas covered: Literature evidence in the application of OCT in carotid arteries still remains debated. So far, OCT has been used as a research tool, aiming to evaluate atherosclerotic plaques' features and stents' behavior after implantation. This paper is intended to summarize clinical evidences and practices in the use of OCT in carotid arteries district and during CAS procedures. Literature review was completed via Pubmed search using Keywords.Expert opinion: CAS is a safe and effective procedure when performed by trained physicians with a tailored approach. In this scenario, ambiguous pictures at ultrasound, angiography, and IVUS might be clarified using OCT.By providing unprecedented microstructural information on atherosclerotic plaques, OCT may identify the features of vulnerable carotid plaque and, by identifying possible defects after stent implantation as malapposition and plaque prolapse, it may help the tailoring approach to CAS.
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Intravascular Imaging for Peripheral Vascular Disease and Endovascular Intervention. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-9526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tissue Protrusion With Attenuation Is Associated With Ischemic Brain Lesions After Carotid Artery Stenting. Stroke 2020; 51:327-330. [DOI: 10.1161/strokeaha.119.026332] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Tissue protrusion between stent struts is frequently observed on optical frequency domain imaging evaluation after carotid artery stenting, but its clinical relevance is unclear. We aimed to investigate the association between the characteristics of tissue protrusion assessed by optical frequency domain imaging and brain lesions identified by diffusion-weighted imaging after carotid artery stenting.
Methods—
Sixty-five consecutive patients who underwent optical frequency domain imaging after protected carotid artery stenting were enrolled in the study. Cross-sectional optical frequency domain images within the stented segments were evaluated at 0.125-mm intervals. Magnetic resonance imaging was performed 1 to 10 days after treatment. The characteristics of tissue protrusion were compared between patients with and without new ipsilateral brain lesions on posttreatment magnetic resonance imaging.
Results—
Tissue protrusion was observed in 62 patients (95%). New brain lesions were observed in 24 patients (37%). In the multivariate analysis, the presence of protrusion with attenuation (odds ratio, 2.94 [95% CI, 1.05–8.68]
P
=0.04) was associated with new brain lesions after carotid artery stenting.
Conclusions—
The presence of protrusion with attenuation assessed by optical frequency domain imaging was associated with ipsilateral brain lesions after carotid artery stenting. Prevention or treatment of protrusions with attenuation may reduce ischemic brain lesions after carotid artery stenting.
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Presence of Plaque Neovascularization on Optical Frequency Domain Imaging Predicts Progression of Carotid Artery Stenosis. World Neurosurg 2019; 127:e330-e336. [DOI: 10.1016/j.wneu.2019.02.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
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Efficacy of post-dilatation during carotid artery stenting for unstable plaque using closed-cell design stent evaluated by optical coherence tomography. J Neuroradiol 2019; 46:384-389. [PMID: 30954551 DOI: 10.1016/j.neurad.2019.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/18/2018] [Accepted: 03/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to use optical coherence tomography (OCT) to evaluate the efficacy of post-dilatation (PD) after stent placement for unstable plaques during carotid artery stenting (CAS) using closed-cell design stent. MATERIALS AND METHODS Twelve unstable carotid plaque lesions diagnosed by magnetic resonance imaging were evaluated by OCT during CAS. Pre-procedural minimum lumen diameter and area were 1.5 ± 0.6 mm and 2.6 ± 1.6 mm2, respectively. The lesion was pre-dilated with balloon catheters (diameter 4.8 ± 0.3 mm), and closed-cell stent was deployed. PD was performed with balloon catheters of the same size as those used for pre-dilatation. Minimum lumen diameter/area and in-stent tissue prolapse volume after stent placement and after PD were calculated by 2-dimensional cross section images. The number of the stent cells showing tissue prolapse and malapposition after stent-placement and after PD were calculated by 3-dimensional analysis. RESULTS Compared to after stent placement, in-stent tissue prolapse volume (0.18 ± 0.10 to 0.22 ± 0.07 mm2/slice, P < 0.01), number of stent cells with any tissue prolapse (12.7 ± 8.2 to 21.0 ± 11.8%, P < 0.001) were significantly increased after PD; stent cells with ≥ 500-µm tissue prolapse (1.6 ± 1.1 to 0.7 ± 0.8%, P < 0.01) and stent malapposition (17.4 ± 7.2 to 14.0 ± 6.3%, P < 0.01) were significantly decreased. CONCLUSIONS PD after carotid stent placement caused increase in in-stent tissue prolapse volume and small tissue prolapse, however, the in-stent large tissue prolapse decreased, as the in-stent tissue prolapse may have been crushed into debris.
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Is optical coherence tomography a coherent strategy for carotid artery stenting? Catheter Cardiovasc Interv 2018; 91:531-532. [PMID: 29460405 DOI: 10.1002/ccd.27533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 11/10/2022]
Abstract
Optical coherence tomography (OCT) is rarely necessary to guide clinical decisions about the appropriateness of carotid revascularization. For carotid artery stenting (CAS), computed tomography angiography is the best imaging tool to assess arch, carotid, and lesion-specific anatomy, including vessel dimensions and calcification. OCT is a coherent strategy after CAS to assess ambiguous angiographic findings and to guide appropriate therapy for dissection, thrombosis, and plaque prolapse.
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Postoperative in-stent protrusion is an important predictor of perioperative ischemic complications after carotid artery stenting. J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2018.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Intravascular imaging has significantly contributed to the advancement of interventional cardiology. Intravascular ultrasound and optical coherence tomography have facilitated decision-making and interventional strategies in management of coronary artery lesions. Yet, applications of these modalities are limited in cerebrovascular practice. With the momentum in advancement of neuroendovascular interventions and techniques for treatment of strokes, cerebrovascular atherosclerotic diseases, aneurysms and vascular malformations, there is a need for the development of high-resolution platforms that can safely be used in cerebrovascular system, and to meet the imaging requirements in the field. In this brief review, we aim to discuss current and emerging intravascular imaging modalities and explore their potentials in field of neuroendovascular surgery.
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Detection of in-stent protrusion (ISP) by intravascular ultrasound during carotid stenting: Usefulness of stent-in-stent placement for ISP. Eur Radiol 2018; 29:77-84. [DOI: 10.1007/s00330-018-5636-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 11/24/2022]
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Abstract
In the past decades, peripheral arteries have represented a model for the comprehension of atherosclerosis as well as for the development of new diagnostic imaging modalities and therapeutic strategies. Peripheral arteries may represent a window to study atherosclerosis. Pathology has prominently contributed to move the clinical and research attention from the arterial lumen stenosis and angiography to morphological and functional imaging techniques. Evidence from large and prospective cohort or randomized controlled studies is still modest. Nevertheless, several emerging imaging investigations represent a potential tool for a comprehensive "in vivo" evaluation of the entire natural history of peripheral atherosclerosis. This constitutes a demanding assignment, as it would be desirable to obtain both single-lesion focused and extensive arterial system views to achieve the most accurate prognostic information. Our narrative review rests upon the fundamental pathological evidence, summarizing the rapidly growing field of imaging of atherosclerosis in peripheral arteries and presenting a selection of both currently available and emerging imaging techniques.
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Optical coherence tomography assessment of newgeneration mesh-covered stents after carotid stenting. EUROINTERVENTION 2017; 13:1347-1354. [DOI: 10.4244/eij-d-16-00866] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Optical coherence tomography guided carotid artery stent procedure: technique and potential applications. Catheter Cardiovasc Interv 2017; 91:521-530. [PMID: 29044926 DOI: 10.1002/ccd.27344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/05/2017] [Accepted: 08/28/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To (1) present a guide on how to perform optical coherence tomography (OCT) in carotid artery stenting (CAS), to (2) highlight several instructive cases illustrating OCT-guidance as an interventional strategy, and to (3) present the largest case-series of OCT-guided CAS performed in North America, demonstrating its feasibility as an imaging modality in this setting. BACKGROUND OCT is an intravascular imaging method that captures images with an axial resolution 10 times higher than intravascular ultrasound. OCT has proven to be a useful modality in coronary angiography and may have similar applications in evaluating carotid atherosclerotic disease. METHODS We compared our experience in CAS utilizing OCT (40 patients) versus that of CAS without OCT guidance (52 patients). RESULTS No strokes or deaths occurred in either group postprocedurally or at 12 months. Fluoroscopy time was reduced in the OCT arm (14 ± 1 vs. 16 ± 1 min). Postprocedural creatinine levels were identical (1 ± 0 mg/dl, P = 0.96). Procedure time (96 ± 8 vs. 80 ± 3 min, P = 0.06) and contrast use (94 ± 4 vs. 83 ± 4 ml, P = 0.05) was slightly elevated in the OCT arm. CONCLUSIONS We established a standardized protocol to consistently obtain OCT images that helped guide interventional decision-making during CAS. OCT imaging in the carotids requires a higher contrast load and prolongs procedure time. However, it can be performed without significant increases in fluoroscopy time or negatively affecting renal function. There were no negative safety signals in this pilot study.
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Japanese Congress of Neurological Surgeons Presidential Address—Treatment of Carotid Artery Stenosis Based on Plaque Imaging. Neurosurgery 2017; 64:129-133. [DOI: 10.1093/neuros/nyx231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/27/2017] [Indexed: 11/12/2022] Open
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Potential of New-Generation Double-Layer Micromesh Stent for Carotid Artery Stenting in Patients with Unstable Plaque: A Preliminary Result Using OFDI Analysis. World Neurosurg 2017; 105:321-326. [DOI: 10.1016/j.wneu.2017.05.171] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 11/18/2022]
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Optical coherence tomography evaluation of tissue prolapse after carotid artery stenting using closed cell design stents for unstable plaque. J Neurointerv Surg 2017; 10:229-234. [PMID: 28360353 DOI: 10.1136/neurintsurg-2017-013004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE During carotid artery stenting (CAS) with the use of closed cell design stents for unstable plaques, tissue prolapse between stent struts was evaluated by optical coherence tomography (OCT). METHODS 14 carotid stenosis lesions diagnosed as unstable plaques by MRI were evaluated by OCT imaging during CAS using closed cell stents. Cross sectional OCT images within the stented segment were evaluated at 1 mm intervals. The slice rate for the presence of tissue prolapse between the struts was calculated. RESULTS No intra-procedural complications occurred. After single stent placement, plaque prolapse was observed in all cases. Slices with any and >500 µm tissue prolapse were seen in 30% and 7.8% of cases, respectively. In 5 of 7 lesions with tissue prolapse >500 µm, additional stents were overlapped. In cases with overlapping stents, slices with any tissue prolapse were significantly decreased from 26% to 16% (p=0.008); in particular, the occurrence of tissue prolapse >500 µm was significantly decreased from 15% to 2.3% (p<0.001). In one case of >500 µm tissue prolapse without an overlapping stent, delayed embolization due to an in-stent thrombus occurred 9 months after the procedure. CONCLUSIONS OCT during CAS using closed cell stent for unstable plaques frequently revealed tissue prolapse between struts. Placement of overlapping stents significantly reduced tissue prolapse, particularly tissue prolapse >500 µm. However, closed cell stents used for unstable plaques may not solve the problem of tissue prolapse.
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Observation of Neointimal Coverage Around the Aneurysm Neck After Stent-Assisted Coil Embolization by Optical Frequency Domain Imaging: Technical Case Report. Oper Neurosurg (Hagerstown) 2016; 13:285-292. [DOI: 10.1093/ons/opw018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 09/19/2016] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE: Stent-assisted coil embolization has been established as a treatment option for wide-necked or complex aneurysms. However, concerns have been raised about the incidence of thromboembolic complications, which is higher for coil embolization without stent assistance. Long-term antiplatelet therapy is necessary to prevent acute or delayed ischemic events potentially associated with incomplete stent apposition after treatment with stent-assisted coil embolization. Optical frequency domain imaging (OFDI) provides excellent-resolution images of intraluminal structures, allowing evaluation of the outcomes of stent-assisted procedures in terms of stent apposition and neointimal coverage. We here describe the novel use of OFDI for the observation of intravascular tissue formation after stent-assisted coil embolization.
CLINICAL PRESENTATION: Two patients were treated with stent-assisted coil embolization for unruptured vertebral artery aneurysm. At the 1- or 2-yr follow-up visit, routine angiography followed by OFDI were performed to evaluate neointimal coverage of the stent strut and stent apposition to the vascular wall. OFDI enabled clear visualization of the vessel wall structures and demonstrated complete coverage of the stent struts as well as full stent wall apposition in 1 patient and incomplete coverage near the aneurism neck as well as mallaposition of some struts in the other patient.
CONCLUSION: OFDI represents a feasible modality for the evaluation of intracranial vasculature and the outcomes of stent-assisted coil embolization in terms of intimal healing of aneurysms, stent-vessel interactions, and neointimal coverage of the stent. Such information is helpful in determining the duration of antiplatelet therapy after stent-assisted coil embolization.
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Optical coherence tomography of traumatic aneurysms of the internal carotid artery: report of 2 cases. J Neurosurg 2015; 124:305-9. [PMID: 26252460 DOI: 10.3171/2015.1.jns142840] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The pathophysiology of extracranial traumatic aneurysm formation has not been fully elucidated. Intraarterial optical coherence tomography (OCT), an imaging modality capable of micrometer cross-sectional resolution, was used to evaluate patients presenting with saccular traumatic aneurysms of the internal carotid artery (ICA). Two consecutive trauma patients diagnosed with saccular traumatic aneurysms of the cervical ICA, per the institutional screening protocol for traumatic cerebrovascular injury, underwent digital subtraction angiography (DSA) with OCT. Optical coherence tomography demonstrated disruption of the intima with preservation and stretching of the more peripheral layers. In 1 patient the traumatic aneurysm was associated with thrombus formation and a separate, more proximal dissection not visible on CT angiography (CTA) or DSA. Imaging with OCT indicates that saccular traumatic aneurysms may develop from disruption of the intima with at least partial preservation of the media and adventitia. This provides in vivo evidence that saccular traumatic aneurysms result from a partial arterial wall tear rather than complete disruption. Interestingly, OCT was also able to detect arterial injury and thrombi not visible on CTA or DSA.
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The basics of intravascular optical coherence tomography. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:74-83. [PMID: 26161097 PMCID: PMC4495121 DOI: 10.5114/pwki.2015.52278] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/12/2015] [Accepted: 05/09/2015] [Indexed: 12/23/2022] Open
Abstract
Optical coherence tomography (OCT) has opened new horizons for intravascular coronary imaging. It utilizes near-infrared light to provide a microscopic insight into the pathology of coronary arteries in vivo. Optical coherence tomography is also capable of identifying the chemical composition of atherosclerotic plaques and detecting traits of their vulnerability. At present it is the only tool to measure the thickness of the fibrous cap covering the lipid core of the atheroma, and thus it is an exceptional modality to detect plaques that are prone to rupture (thin fibrous cap atheromas). Moreover, it facilitates distinguishing between plaque rupture and plaque erosion as a cause of acute intracoronary thrombosis. Optical coherence tomography is applied to guide angioplasties of coronary lesions and to assess outcomes of percutaneous coronary interventions broadly. It identifies stent malapposition, dissections, and thrombosis with unprecedented precision. Furthermore, OCT helps to monitor vessel healing after stenting. It evaluates the coverage of stent struts by the neointima and detects in-stent neoatherosclerosis. With so much potential, new studies are warranted to determine OCT's clinical impact. The following review presents the technical background, basics of OCT image interpretation, and practical tips for adequate OCT imaging, and outlines its established and potential clinical application.
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Correlation of Carotid Intraplaque Hemorrhage and Stroke Using 1.5 T and 3 T MRI. MAGNETIC RESONANCE INSIGHTS 2015; 8:1-8. [PMID: 26056469 PMCID: PMC4454204 DOI: 10.4137/mri.s23560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/06/2015] [Accepted: 04/13/2015] [Indexed: 01/06/2023]
Abstract
Carotid therosclerotic disease causes approximately 25% of the nearly 690,000 ischemic strokes each year in the United States. Current risk stratification based on percent stenosis does not provide specific information on the actual risk of stroke for most individuals. Prospective randomized studies have found only 10 to 12% of asymptomatic patients will have a symptomatic stroke within 5 years. Measurements of percent stenosis do not determine plaque stability or composition. Reports have concluded that cerebral ischemic events associated with carotid plaque are intimately associated with plaque instability. Analysis of retrospective studies has found that plaque composition is important in risk stratification. Only MRI has the ability to identify and measure the detailed components and morphology of carotid plaque and provides more detailed information than other currently available techniques. MRI can accurately detect carotid hemorrhage, and MRI identified carotid hemorrhage correlates with acute stroke.
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In Vivo Characterization of Carotid Neointimal Hyperplasia by use of Optical Coherence Tomography: Before and After Cutting Balloon Angioplasty. J Neuroimaging 2015; 25:1044-6. [PMID: 25702776 DOI: 10.1111/jon.12223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/27/2014] [Indexed: 11/29/2022] Open
Abstract
Optical coherence tomography (OCT) is a modern intravascular imaging modality that has the capability to provide detailed, in vivo characterization of the arterial wall and atherosclerotic plaque. The current understanding of the appearance of atherosclerotic plaque via OCT is largely based on coronary arterial studies where OCT information has been employed to guide therapeutic management and permits the immediate evaluation of percutaneous intervention. The clinical success of OCT in the coronary arteries has laid the foundation for investigation of the carotid artery and thus, stroke risk assessment. We report the novel use of OCT for tissue characterization of severe stenosis subsequent to carotid artery stenting (CAS), both before and after treatment with cutting balloon angioplasty.
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Intraluminal thrombus, intraplaque hemorrhage, plaque thickness, and current smoking optimally predict carotid stroke. Stroke 2014; 46:84-90. [PMID: 25406146 DOI: 10.1161/strokeaha.114.006286] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage (IPH) is associated with acute and future stroke. IPH is also associated with lumen markers of stroke risk including stenosis, plaque thickness, and ulceration. Whether IPH adds further predictive value to these other variables is unknown. The purpose of this study was to determine whether IPH improves carotid-source stroke prediction. METHODS In this retrospective cross-sectional study, patients undergoing stroke workup were imaged with MRI and IPH detection. Seven hundred twenty-six carotid-brain image pairs were analyzed after excluding vessels with noncarotid plaque stroke sources (420) and occlusions (7) or near-occlusions (3). Carotid imaging characteristics were recorded, including percent diameter and mm stenosis, plaque thickness, ulceration, intraluminal thrombus, and IPH. Clinical confounders were recorded, and a multivariable logistic regression model was fitted. Backward elimination was used to determine essential carotid-source stroke predictors with a threshold 2-sided P<0.10. Receiver operating characteristic analysis was performed to determine discriminatory value. RESULTS Significant predictors of carotid-source stroke included intraluminal thrombus (odds ratio=103.6; P<0.001), IPH (odds ratio=25.2; P<0.001), current smoking (odds ratio=2.78; P=0.004), and thickness (odds ratio=1.24; P=0.020). The final model discriminatory value was excellent (area under the curve=0.862). This was significantly higher than the final model without IPH (area under the curve=0.814), or models using only stenosis as a continuous variable (area under the curve=0.770) or cutoffs of 50% and 70% (area under the curve=0.669), P<0.001. CONCLUSIONS After excluding patients with noncarotid plaque stroke sources, optimal discrimination of carotid-source stroke was obtained with intraluminal thrombus, IPH, plaque thickness, and smoking history but not ulceration and stenosis.
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Intravascular Frequency-Domain Optical Coherence Tomography Assessment of Carotid Artery Disease in Symptomatic and Asymptomatic Patients. JACC Cardiovasc Interv 2014; 7:674-84. [DOI: 10.1016/j.jcin.2014.01.163] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 01/09/2014] [Accepted: 01/16/2014] [Indexed: 11/18/2022]
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A case of in-stent neoatherosclerosis 10 years after carotid artery stent implantation: observation with optical coherence tomography and plaque histological findings. Neurol Med Chir (Tokyo) 2013; 54:139-44. [PMID: 24257491 PMCID: PMC4508713 DOI: 10.2176/nmc.cr2013-0063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a patient's case of slow progressive in-stent restenosis 10 years after bare-metal stent implantation to his carotid artery. We treated the patient with an additional stent placement under a distal filter protection device. Optical coherence tomographic assessment and plaque histology during the carotid artery stenting (CAS) revealed atheromatous change at in-stent neointima, which contained lipid-rich plaque and calcification deposits. These findings suggest that in-stent neoatherosclerosis may play an important role in the pathogenesis of very late stent restenosis after CAS.
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Frequency-domain optical coherence tomography assessment of human carotid atherosclerosis using saline flush for blood clearance without balloon occlusion. AJNR Am J Neuroradiol 2013; 34:1414-8. [PMID: 23391841 DOI: 10.3174/ajnr.a3411] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
FD-OCT is a new imaging technique that allows unprecedented in vivo microlevel assessment of human carotid plaque morphologic patterns and stent-vessel interactions. Prior reports describing the use of this technique have used balloon occlusion of the target vessel or iodinated contrast media to facilitate imaging. We report, for the first time, in vivo FD-OCT imaging of human carotid arteries without the use of iodinated contrast material or balloon occlusion techniques.
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New frontiers in the feasibility of optical coherence tomography in carotid arteries. AJNR Am J Neuroradiol 2013; 34:1419-20. [PMID: 23413248 DOI: 10.3174/ajnr.a3445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Optical Coherence Tomography after Carotid Stenting: Rate of Stent Malapposition, Plaque Prolapse and Fibrous Cap Rupture According to Stent Design. Eur J Vasc Endovasc Surg 2013; 45:579-87. [PMID: 23582886 DOI: 10.1016/j.ejvs.2013.03.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 03/07/2013] [Indexed: 11/18/2022]
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Safety and feasibility of intravascular optical coherence tomography using a nonocclusive technique to evaluate carotid plaques before and after stent deployment. J Endovasc Ther 2012; 19:303-11. [PMID: 22788878 DOI: 10.1583/12-3871r.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the safety and feasibility of optical coherence tomography (OCT) in patients with carotid stenosis undergoing carotid artery stenting (CAS). METHODS In a prospective study, 25 consecutive patients (15 men; mean age 74±4 years) undergoing protected CAS were enrolled and underwent high-definition (homoaxial resolution 10 µm) OCT image acquisition before stent deployment, immediately after stent placement, and following postdilation of the stent (3 scans/patient). Pullbacks were started during a nonocclusive flush, mechanically injecting 24 mL of 50% diluted contrast at 6 mL/s to displace blood from the artery. Two independent physicians judged the quality of images on a predefined 1-10 scale. The proportions of specific agreement and kappa values (κ) were calculated. RESULTS No procedural or in-hospital neurological complications occurred (any stroke/death 0%). The technical success of OCT pullbacks was 97.3% (73/75). The total amount of contrast was 86±18 mL/patient. No significant alteration in glomerular filtration rate or any other significant adverse event occurred. The images obtained were of high quality (mean value 8.1 out of 10), with good inter- and intraobserver agreement (κ = 0.81-0.87 and κ = 0.95, respectively). OCT images revealed innovative features such as rupture of the fibrous cap, plaque prolapse, and stent malapposition in a high percentage of the patients (range 24%-100%). CONCLUSION Intravascular OCT during a nonocclusive flush appears to be feasible and safe in carotid arteries. Since some original and unexpected information after CAS has been made available for the first time at such a high definition, future studies with OCT should focus on the interaction between carotid plaque and stent design, which might revolutionize our understanding of the mechanisms of carotid stenting, as well as influence our clinical policies.
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Commentary: intravascular optical coherence tomography: a new, more detailed view of the carotid arteries. J Endovasc Ther 2012; 19:314-5. [PMID: 22788880 DOI: 10.1583/12-3871c2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Intravascular frequency-domain optical coherence tomography assessment of atherosclerosis and stent-vessel interactions in human carotid arteries. AJNR Am J Neuroradiol 2012; 33:1494-501. [PMID: 22422179 DOI: 10.3174/ajnr.a3016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Carotid artery-related stroke is largely an embolic disease that has been correlated with inflammation, plaque rupture, and thrombus formation in "vulnerable" atherosclerotic plaque. Nevertheless, current guidelines for carotid revascularization in asymptomatic patients rely on the calculation of stenosis for risk assessment, a parameter that has been viewed with increasing skepticism. Intravascular OCT is an imaging technique that offers high axial resolution (10 μm), allowing an unprecedented micron-level assessment of human carotid plaque morphology. This observational article reports the first successful use of the newest iteration of this technology, FDOCT without balloon occlusion to assess human carotid artery disease and carotid stent-vessel interaction in vivo. MATERIALS AND METHODS Four patients with asymptomatic carotid artery disease and ambiguous noninvasive and/or angiographic data underwent carotid FDOCT to assess risk and to formulate a treatment strategy. RESULTS Findings include the unexpected demonstration of TCFAs, plaque rupture, thrombus, inflammation, and marked tissue prolapse through stent struts in patients without high-risk factors by conventional criteria, as well as low-risk features in a patient with a high-risk noninvasive study. The procedures were performed without safety issues or special accommodations for vessel occlusion. CONCLUSIONS The present study demonstrates the technical feasibility of FDOCT in cervical carotid arteries. As such, this technology holds the promise of not only clarifying ambiguous data in individual patients but of providing data that might call for a future paradigm shift in the assessment of asymptomatic carotid artery disease.
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