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Albaghdadi MS, Ikegami R, Kassab MB, Gardecki JA, Kunio M, Chowdhury MM, Khamis R, Libby P, Tearney GJ, Jaffer FA. Near-Infrared Autofluorescence in Atherosclerosis Associates With Ceroid and Is Generated by Oxidized Lipid-Induced Oxidative Stress. Arterioscler Thromb Vasc Biol 2021; 41:e385-e398. [PMID: 34011166 DOI: 10.1161/atvbaha.120.315612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Mazen S Albaghdadi
- Cardiovascular Research Center, Division of Cardiology (M.S.A., R.I., M.B.K., M.M.C., F.A.J.), Harvard Medical School, Massachusetts General Hospital, Boston.,Division of Cardiology, Department of Medicine, University of Toronto, ON, Canada (M.S.A.)
| | - Ryutaro Ikegami
- Cardiovascular Research Center, Division of Cardiology (M.S.A., R.I., M.B.K., M.M.C., F.A.J.), Harvard Medical School, Massachusetts General Hospital, Boston.,Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan (R.I.)
| | - Mohamad B Kassab
- Cardiovascular Research Center, Division of Cardiology (M.S.A., R.I., M.B.K., M.M.C., F.A.J.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Joseph A Gardecki
- Wellman Center for Photomedicine (J.A.G., G.J.T., F.A.J.), Harvard Medical School, Massachusetts General Hospital, Boston
| | - Mie Kunio
- Canon USA, Inc, Cambridge, MA (M.K.)
| | - Mohammed M Chowdhury
- Cardiovascular Research Center, Division of Cardiology (M.S.A., R.I., M.B.K., M.M.C., F.A.J.), Harvard Medical School, Massachusetts General Hospital, Boston.,Division of Vascular Surgery, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom (M.M.C.)
| | - Ramzi Khamis
- National Heart Lung Institute, Imperial College London, United Kingdom (R.K.)
| | - Peter Libby
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Guillermo J Tearney
- Wellman Center for Photomedicine (J.A.G., G.J.T., F.A.J.), Harvard Medical School, Massachusetts General Hospital, Boston.,Department of Pathology (G.J.T.), Harvard Medical School, Massachusetts General Hospital, Boston.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA (G.J.T.)
| | - Farouc A Jaffer
- Cardiovascular Research Center, Division of Cardiology (M.S.A., R.I., M.B.K., M.M.C., F.A.J.), Harvard Medical School, Massachusetts General Hospital, Boston.,Wellman Center for Photomedicine (J.A.G., G.J.T., F.A.J.), Harvard Medical School, Massachusetts General Hospital, Boston
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Hasan SM, Faluk M, Patel JD, Abdelmaseih R, Patel J. Use of Optical Coherence Tomography in Coronary Artery Disease: Review Article. Curr Probl Cardiol 2020; 46:100597. [PMID: 32448760 DOI: 10.1016/j.cpcardiol.2020.100597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/06/2020] [Indexed: 11/25/2022]
Abstract
Optical coherence tomography is a catheter-based imaging modality in heart catheterizations, which provides a significantly higher resolution of intravascular pathology by means of using light as opposed to ultrasound. The applications of this modality may include a detailed assessment of atherosclerotic plaques, stent evaluation including coverage and restenosis and percutaneous coronary intervention optimization. In this article, we provide a review of current literature highlighting the advantages and disadvantages of the use of optical coherence tomography in the catheterization lab.
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Gao J, Wang YY, Liu Y. Application of virtual histological intravascular ultrasound in plaque composition assessment of saphenous vein graft diseases. Chin Med J (Engl) 2019; 132:957-62. [PMID: 30958438 DOI: 10.1097/CM9.0000000000000183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Saphenous vein grafts disease (SVGD) is a common complication after coronary artery bypass graft (CABG) and normally treated by percutaneous coronary intervention (PCI). The most common complication after SVG-PCI is slow or no-reflow. It is known that the no-reflow phenomenon occurs in up to 15% of the SVG-PCI and is associated with high risk of major adverse cardiac events (MACEs) and mortality, therefore, it is important to investigate the factors that could predict the clinical outcome of PCI for risk stratification and guiding interventions. In recent years, the spectral analysis of intravascular ultrasound (IVUS) radiofrequency data (virtual histology-IVUS [VH-IVUS]) has been used to provide quantitative assessment on both plaque compositions and morphologic characteristics. DATA SOURCES The PubMed, Embase, and Central databases were searched for possible relevant studies published from 1997 to 2018 using the following index keywords: "Coronary artery bypass grafting," "Saphenous venous graft disease," "Virtual histology-intravascular ultrasound," "Virtual histology-intravascular ultrasound," and "Percutaneous coronary intervention." STUDY SELECTION The primary references were Chinese and English articles including original studies and literature reviews, were identified and reviewed to summarize the advances in the application of VH-IVUS techniques in situ vascular and venous graft vascular lesions. RESULTS With different plaque components exhibiting a defined spectrum, VH-IVUS can classify atherosclerotic plaque into four types: fibrous tissue (FT), fibro fatty (FF), necrotic core (NC), and dense calcium (DC). The radiofrequency signal is mathematically transformed into a color-coded representation, including lipid, fibrous tissue, calcification, and necrotic core. Several studies have demonstrated the independent relationship between VH-IVUS-defined plaque classification or plaque composition and MACEs, but a significant association between plaque components and no-reflow after PCI in acute coronary syndrome. In recent years, VH-IVUS are applied to assess the plaque composition of SVGD, based on the similarity of pathophysiological mechanisms between coronary artery disease (CAD) and SVGD, further studies with the larger sample size, the long-term follow-up, multicenter clinical trials may be warranted to investigate the relationship between plaque composition of saphenous vein graft (SVG) by VH-IVUS and clinical outcomes in patients with SVGD undergoing PCI. CONCLUSIONS In degenerative SVG lesions, VH-IVUS found that plaque composition was associated with clinical features, future studies need to explore the relationship between VH-IVUS defined atherosclerotic plaque components and clinical outcomes in SVGD patients undergoing PCI, an innovative prediction tool of clinical outcomes can be created.
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Lee J, Shin EJ, Lee C, Chang JH. Development of Dual-Frequency Oblong-Shaped-Focused Transducers for Intravascular Ultrasound Tissue Harmonic Imaging. IEEE Trans Ultrason Ferroelectr Freq Control 2018; 65:1571-1582. [PMID: 29994203 DOI: 10.1109/tuffc.2018.2844869] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Tissue harmonic imaging (THI), an essential mode of commercial ultrasound imaging scanners, can provide images with high spatial and contrast resolutions. For THI, the frequency spectrum of a transducer is generally divided for the transmission of fundamental signal and the reception of its second harmonic. Therefore, it is difficult to use the THI mode for intravascular ultrasound (IVUS) imaging because typical IVUS transducers have a narrow -6-dB fractional bandwidth of about 50%. Due to its small aperture (about 0.5 mm) and the strength of IVUS being too weak, it is difficult to construct a high-quality tissue harmonic image. In this paper, we report a recently developed dual-frequency oblong-shaped-focused IVUS transducer for high-quality intravascular THI; the transducer consists of three elements arranged side by side in the horizontal (i.e., elevation) direction. The two outer elements with a center frequency of 35 MHz are responsible for ultrasound transmission and the center element has a center frequency of 70 MHz for the reception of the second-harmonic signals. All three elements have a spherical shape with a radius of 3 mm to efficiently generate harmonics in the region of interest. This configuration of the developed IVUS transducer was determined to facilitate high-quality THI, which was based on the results of Field II simulation and finite-element analysis. The images of wires and a tissue-mimicking phantom indicated that the tissue harmonic images produced by the developed transducer have not only a high spatial resolution but also a deep imaging depth, compared to the 35- and 70-MHz fundamental images.
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Lee J, Moon JY, Chang JH. A 35 MHz/105 MHz Dual-Element Focused Transducer for Intravascular Ultrasound Tissue Imaging Using the Third Harmonic. Sensors (Basel) 2018; 18:E2290. [PMID: 30011948 DOI: 10.3390/s18072290] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/21/2022]
Abstract
The superharmonic imaging of tissue has the potential for high spatial and contrast resolutions, compared to the fundamental and second harmonic imaging. For this technique, the spectral bandwidth of an ultrasound transducer is divided for transmission of ultrasound and reception of its superharmonics (i.e., higher than the second harmonic). Due to the spectral division for the transmission and reception, transmitted ultrasound energy is not sufficient to induce superharmonics in media without using contrast agents, and it is difficult that a transducer has a −6 dB fractional bandwidth of higher than 100%. For the superharmonic imaging of tissue, thus, multi-frequency array transducers are the best choice if available; transmit and receive elements are separate and have different center frequencies. However, the construction of a multi-frequency transducer for intravascular ultrasound (IVUS) imaging is particularly demanding because of its small size of less than 1 mm. Here, we report a recently developed dual-element focused IVUS transducer for the third harmonic imaging of tissue, which consists of a 35-MHz element for ultrasound transmission and a 105-MHz element for third harmonic reception. For high quality third harmonic imaging, both elements were fabricated to have the same focus at 2.5 mm. The results of tissue mimicking phantom tests demonstrated that the third harmonic images produced by the developed transducer had higher spatial resolution and deeper imaging depth than the fundamental images.
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Abstract
Intra-Vascular Ultra-Sound (IVUS) and Frequency Domain-Optical Coherence Tomography (FD-OCT), in vivo, intra-vascular, imaging modalities, widely used in the field of coronary disease, have been recently implemented in peripheral endovascular procedures, for procedural assessment, plaque characterization and determination of predictors of treatment outcomes. Their unique characteristics have also been used in order to provide additional features and improve the performance of re-entry devices and atherotomes. Areas covered: Present review focuses on available literature regarding these two promising imaging technologies in the peripheral vasculature, highlighting the added value produced by their use in endovascular therapy, their limitations and their utilization in new endovascular devices. Authors also provide their future perspective and the possible benefits in understanding vascular behavior and lesion characterization in peripheral endovascular interventions. Expert commentary: By providing both quantitative but also qualitative data on vessel and lesion morphology, intravascular imaging modalities offer a valid solution for endovascular treatment evaluation and outcome presentation homogeneity.
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Affiliation(s)
- S Spiliopoulos
- a 2nd Department of Radiology, Division of Interventional Radiology , Attikon University General Hospital , Athens , Greece
| | - P Kitrou
- b Interventional Radiology Department , Patras University Hospital , Patras , Greece
| | - K Katsanos
- b Interventional Radiology Department , Patras University Hospital , Patras , Greece
- c Interventional Radiology Department , Guy's and St Thomas Hospitals, NHS Foundation Trust , London , UK
| | - D Karnabatidis
- b Interventional Radiology Department , Patras University Hospital , Patras , Greece
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Piao Z, Ma T, Li J, Wiedmann MT, Huang S, Yu M, Kirk Shung K, Zhou Q, Kim CS, Chen Z. High speed intravascular photoacoustic imaging with fast optical parametric oscillator laser at 1.7 μm. Appl Phys Lett 2015; 107:083701. [PMID: 26339072 PMCID: PMC4552696 DOI: 10.1063/1.4929584] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/14/2015] [Indexed: 05/19/2023]
Abstract
Intravascular photoacoustic imaging at 1.7 μm spectral band has shown promising capabilities for lipid-rich vulnerable atherosclerotic plaque detection. In this work, we report a high speed catheter-based integrated intravascular photoacoustic/intravascular ultrasound (IVPA/IVUS) imaging system with a 500 Hz optical parametric oscillator laser at 1725 nm. A lipid-mimicking phantom and atherosclerotic rabbit abdominal aorta were imaged at 1 frame per second, which is two orders of magnitude faster than previously reported in IVPA imaging with the same wavelength. Clear photoacoustic signals by the absorption of lipid rich deposition demonstrated the ability of the system for high speed vulnerable atherosclerotic plaques detection.
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Affiliation(s)
| | - Teng Ma
- Department of Biomedical Engineering, NIH Ultrasonic Transducer Resource Center, University of Southern California , Los Angeles, California 90089, USA
| | - Jiawen Li
- Beckman Laser Institute, Department of Biomedical Engineering, University of California , Irvine, Irvine, California 92612, USA
| | - Maximilian T Wiedmann
- Beckman Laser Institute, Department of Biomedical Engineering, University of California , Irvine, Irvine, California 92612, USA
| | - Shenghai Huang
- Beckman Laser Institute, Department of Biomedical Engineering, University of California , Irvine, Irvine, California 92612, USA
| | - Mingyue Yu
- Department of Biomedical Engineering, NIH Ultrasonic Transducer Resource Center, University of Southern California , Los Angeles, California 90089, USA
| | - K Kirk Shung
- Department of Biomedical Engineering, NIH Ultrasonic Transducer Resource Center, University of Southern California , Los Angeles, California 90089, USA
| | - Qifa Zhou
- Department of Biomedical Engineering, NIH Ultrasonic Transducer Resource Center, University of Southern California , Los Angeles, California 90089, USA
| | - Chang-Seok Kim
- Department of Cogno-Mechatronics Engineering, Pusan National University , Busan 609-735, South Korea
| | - Zhongping Chen
- Beckman Laser Institute, Department of Biomedical Engineering, University of California , Irvine, Irvine, California 92612, USA
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Zivelonghi C, Ghione M, Kilickesmez K, Loureiro RE, Foin N, Lindsay A, de Silva R, Ribichini F, Vassanelli C, Di Mario C. Intracoronary optical coherence tomography: a review of clinical applications. J Cardiovasc Med (Hagerstown) 2015; 15:543-53. [PMID: 24922045 DOI: 10.2459/jcm.0000000000000032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Optical coherence tomography (OCT) is a light-based technology that provides very high spatial resolution images. OCT has been initially employed as a research tool to investigate plaque morphology and stent strut coverage. The introduction of frequency domain OCT allowing fast image acquisition during a prolonged contrast injection via the guiding catheter has made OCT applicable for guidance of coronary interventions. In this manuscript, the various applications of OCT are reviewed, from assessment of plaque vulnerability and severity to characteristics of unstable lesions and thrombus burden to stent optimization and evaluation of late results.
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Affiliation(s)
- Carlo Zivelonghi
- aCardiovascular Biomedical Research Unit, Royal Brompton Hospital bImperial College, London, UK cDepartment of Medicine, University of Verona, Verona, Italy
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Conti de Freitas LC, Phelan E, Liu L, Gardecki J, Namati E, Warger WC, Tearney GJ, Randolph GW. Optical coherence tomography imaging during thyroid and parathyroid surgery: a novel system of tissue identification and differentiation to obviate tissue resection and frozen section. Head Neck 2013; 36:1329-34. [PMID: 23956009 DOI: 10.1002/hed.23452] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/13/2013] [Accepted: 08/12/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Optical coherence tomography (OCT) allows tissue histologic-like evaluation, but without tissue fixation or staining. We investigated OCT images from tissues obtained at thyroid and parathyroid surgeries to provide a preliminary assessment as to whether these images contain sufficient information for recognition and differentiation of normal neck tissues. METHODS Normal tissues were obtained from patients undergoing surgical treatment. Two new-generation OCT systems, including optical frequency domain imaging (OFDI) and μOCT, were compared to representative hematoxylin-eosin histology. RESULTS Thyroid, fat, muscle, lymph nodes, and parathyroid tissues were evaluated. Histologic-like microscopic characteristics sufficient for tissue type identification was realized using both systems for all tissue types examined. CONCLUSION This pilot study demonstrated that new-generation OCT systems are capable of recognizing and differentiating neck tissues encountered during thyroid and parathyroid surgeries. Further advances in OCT miniaturization and development of sterile intraoperative probe formats may allow OCT to offer an intraoperative "optical biopsy" without fixation, staining, or tissue resection.
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Affiliation(s)
- Luiz C Conti de Freitas
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Wellman Center of Photomedicine and Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts; Division of Head and Neck Surgery, Department of Ophthalmology, Otolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Ghione M, Kýlýçkesmez K, Zivelonghi C, Estevez Loureiro R, Foin N, Mattesini A, Secco GG, Dall’Ara G, Rama-Merchan JC, de Silva R, Di Mario C. Intracoronary Optical Coherence Tomography: Experience and Indications for Clinical Use. Curr Cardiovasc Imaging Rep 2013. [DOI: 10.1007/s12410-013-9219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rosa GM, Bauckneht M, Masoero G, Mach F, Quercioli A, Seitun S, Balbi M, Brunelli C, Parodi A, Nencioni A, Vuilleumier N, Montecucco F. The vulnerable coronary plaque: update on imaging technologies. Thromb Haemost 2013; 110:706-22. [PMID: 23803753 DOI: 10.1160/th13-02-0121] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/01/2013] [Indexed: 12/21/2022]
Abstract
Several studies have been carried out on vulnerable plaque as the main culprit for ischaemic cardiac events. Historically, the most important diagnostic technique for studying coronary atherosclerotic disease was to determine the residual luminal diameter by angiographic measurement of the stenosis. However, it has become clear that vulnerable plaque rupture as well as thrombosis, rather than stenosis, triggers most acute ischaemic events and that the quantification of risk based merely on severity of the arterial stenosis is not sufficient. In the last decades, substantial progresses have been made on optimisation of techniques detecting the arterial wall morphology, plaque composition and inflammation. To date, the use of a single technique is not recommended to precisely identify the progression of the atherosclerotic process in human beings. In contrast, the integration of data that can be derived from multiple methods might improve our knowledge about plaque destabilisation. The aim of this narrative review is to update evidence on the accuracy of the currently available non-invasive and invasive imaging techniques in identifying components and morphologic characteristics associated with coronary plaque vulnerability.
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Affiliation(s)
- Gian Marco Rosa
- Fabrizio Montecucco, MD, PhD, Division of Cardiology, Faculty of Medicine, Geneva University Hospital, Avenue de la Roseraie 64, 1211 Geneva 4, Switzerland, Tel.: +41 22 372 71 92, Fax: +41 22 382 72 45, E-mail:
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Poon KKC, Incani A, Raffel OC, Walters DL, Jang IK. Optical coherence tomography: research applications, potential clinical utility and future directions. Interv Cardiol 2012. [DOI: 10.2217/ica.12.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Maurovich-Horvat P, Schlett CL, Alkadhi H, Nakano M, Stolzmann P, Vorpahl M, Scheffel H, Tanaka A, Warger WC, Maehara A, Ma S, Kriegel MF, Kaple RK, Seifarth H, Bamberg F, Mintz GS, Tearney GJ, Virmani R, Hoffmann U. Differentiation of early from advanced coronary atherosclerotic lesions: systematic comparison of CT, intravascular US, and optical frequency domain imaging with histopathologic examination in ex vivo human hearts. Radiology 2012; 265:393-401. [PMID: 23012461 DOI: 10.1148/radiol.12111891] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To establish an ex vivo experimental setup for imaging coronary atherosclerosis with coronary computed tomographic (CT) angiography, intravascular ultrasonography (US), and optical frequency domain imaging (OFDI) and to investigate their ability to help differentiate early from advanced coronary plaques. MATERIALS AND METHODS All procedures were performed in accordance with local and federal regulations and the Declaration of Helsinki. Approval of the local Ethics Committee was obtained. Overall, 379 histologic cuts from nine coronary arteries from three donor hearts were acquired, coregistered among modalities, and assessed for the presence and composition of atherosclerotic plaque. To assess the discriminatory capacity of the different modalities in the detection of advanced lesions, c statistic analysis was used. Interobserver agreement was assessed with the Cohen κ statistic. RESULTS Cross sections without plaque at coronary CT angiography and with fibrous plaque at OFDI almost never showed advanced lesions at histopathologic examination (odds ratio [OR]: 0.02 and 0.06, respectively; both P<.0001), while mixed plaque at coronary CT angiography, calcified plaque at intravascular US, and lipid-rich plaque at OFDI were associated with advanced lesions (OR: 2.49, P=.0003; OR: 2.60, P=.002; and OR: 31.2, P<.0001, respectively). OFDI had higher accuracy for discriminating early from advanced lesions than intravascular US and coronary CT angiography (area under the receiver operating characteristic curve: 0.858 [95% confidence interval {CI}: 0.802, 0.913], 0.631 [95% CI: 0.554, 0.709], and 0.679 [95% CI: 0.618, 0.740]; respectively, P<.0001). Interobserver agreement was excellent for OFDI and coronary CT angiography (κ=0.87 and 0.85, respectively) and was good for intravascular US (κ=0.66). CONCLUSION Systematic and standardized comparison between invasive and noninvasive modalities for coronary plaque characterization in ex vivo specimens demonstrated that coronary CT angiography and intravascular US are reasonably associated with plaque composition and lesion grading according to histopathologic findings, while OFDI was strongly associated. These data may help to develop initial concepts of sequential imaging strategies to identify patients with advanced coronary plaques.
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Affiliation(s)
- Pál Maurovich-Horvat
- Cardiac MR PET CT Program of the Department of Radiology, Cardiology Division, and Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA 02114, USA
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Abstract
Optical coherence tomography (OCT) is a novel light-based imaging modality for application in the coronary circulation. Compared to conventional intravascular ultrasound, OCT has a ten-fold higher image resolution. This advantage has seen OCT successfully applied in the assessment of atherosclerotic plaque, stent apposition, and tissue coverage, heralding a new era in intravascular coronary imaging. The present article discusses the diagnostic value of OCT, both in cardiovascular research as well as in potential clinical application.The unparalleled high image resolution and strong contrast between the coronary lumen and the vessel wall structure enable fast and reliable image interpretation. OCT makes it possible to visualize the presence of atherosclerotic plaque in order to characterize the structure and extent of coronary plaque and to quantify lumen dimensions, as well as the extent of lumen narrowing, in unprecedented detail. Based on optical properties, OCT is able to distinguish different tissue types, such as fibrous, lipid-rich, necrotic, or calcified tissue. Furthermore, OCT is able to cover the visualization of a variety of features of atherosclerotic plaques that have been associated with rapid lesion progression and clinical events, such as thin cap fibroatheroma, fibrous cap thickness, dense macrophage infiltration, and thrombus formation. These unique features allow the use of OCT to assess patients with acute coronary syndrome and to study the dynamic nature of coronary atherosclerosis in vivo and over time. This permits new insights into plaque progression, regression, and rupture, as well as the study of effects of therapies aimed at modulating these developments.Today's OCT technology allows high detail resolution as well as fast and safe clinical image acquisition. These unique features have established OCT as the gold standard for the assessment of coronary stents. This technique makes it possible to study stent expansion, peri-procedural vessel trauma, and the interaction of the stent with the vessel wall down to the level of individual stent struts, both acutely as well as in the long term, where it is has proven extremely sensitive to the detection of even minor amounts of tissue coverage. These qualities render OCT indispensable to addressing vexing clinical questions such as the relationship of drug-eluting stent deployment, vascular healing, the true time course of endothelial stent coverage, and late stent thrombosis. This may also better guide the optimal duration of dual anti-platelet therapy that currently remains unclear and relatively empirical.In the future, OCT might emerge, parallel to its undisputed position in research, as the tool of choice in all clinical scenarios where angiography is limited by its nature as a two-dimensional luminogram.
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Affiliation(s)
- E Regar
- Department of Interventional Cardiology, Thorax Center, Erasmus MC, S'-Gravendijkwal 230, Rotterdam, The Netherlands.
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Karnabatidis D, Katsanos K, Paraskevopoulos I, Diamantopoulos A, Spiliopoulos S, Siablis D. Frequency-domain intravascular optical coherence tomography of the femoropopliteal artery. Cardiovasc Intervent Radiol 2011; 34:1172-81. [PMID: 21191586 DOI: 10.1007/s00270-010-0092-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 12/07/2010] [Indexed: 02/08/2023]
Abstract
PURPOSE Optical coherence tomography (OCT) is a catheter-based imaging method that employs near-infrared light to produce high-resolution intravascular images. The authors report the safety and feasibility and illustrate common imaging findings of frequency-domain OCT (FD-OCT) imaging of the femoropopliteal artery in a series of 20 patients who underwent infrainguinal angioplasty. METHODS After crossing the lesion of interest, OCT was performed with a dextrose saline flush technique with simultaneous obstructive manual groin compression. An automatic pullback FD-OCT device was employed (each scan acquiring 54 mm of vessel lumen in 271 consecutive frames). OCT images were acquired before and after balloon dilatation and following provisional stenting if necessary and were evaluated for baseline characteristics of plaque or in-stent restenosis (ISR), vessel wall trauma after angioplasty, presence of thrombus, stent apposition, and tissue prolapse. Imaging follow-up was not included in this study's protocol. RESULTS Twenty-seven obstructive lesions (18 cases of de novo atherosclerosis and 9 of ISR) of the femoropopliteal artery were imaged and 148 acquisitions were analyzed in total. High-resolution intravascular OCT imaging with effective blood clearance was achieved in 93.9%. Failure was mainly attributed to preocclusive proximal lesions and/or collateral flow. Mixed features of lipid pool areas, calcium deposits, necrotic core, and fibrosis were identified in all of the imaged atherosclerotic lesions, whereas ISR was purely fibrotic. After balloon angioplasty, OCT identified extensive intimal tears in all cases and one case of severe dissection that biplane subtraction angiography failed to identify. CONCLUSIONS Infrainguinal frequency-domain optical coherence tomography is safe and feasible and may provide intravascular high-resolution imaging of the femoropopliteal artery during infrainguinal angioplasty procedures.
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Affiliation(s)
- Dimitris Karnabatidis
- Department of Radiology, School of Medicine, Patras University Hospital, Patras 26504, Greece.
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Li X, Villard JW, Ouyang Y, Michalek JE, Jabara R, Sims D, Kemp N, Glynn T, Banas C, Bailey SR, Feldman MD. Safety and efficacy of frequency domain optical coherence tomography in pigs. EUROINTERVENTION 2011; 7:497-504. [PMID: 21764669 DOI: 10.4244/eijv7i4a80] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To determine the safety and efficacy of frequency domain OCT, which can scan at much higher rates and make it possible to avoid an occlusion balloon and image during an angiographic injection through guide catheter. The catheters have diameters ranging from 2.7 to 3.5 Fr. The presence of the imaging catheter increases fluid resistance to the injection of viscous solutions necessary for clearing the blood. METHODS AND RESULTS The Volcano 3.5 Fr frequency domain OCT catheter system was investigated for safety in (a) n=10 porcine studies using acute and 30-day histology, and (b) for efficacy in n=9 in vivo porcine coronary arteries. We found: (a) frequency domain imaging is safe in the porcine model using histology as an endpoint; (b) the addition of a viscous contrast (iodixonal) to saline is superior for lumen clearance compared to saline alone; (c) hand injection, 4 ml/sec, and 6 ml/sec power injection all provided similar vessel wall clearance; (d) the anticipated loss of vessel wall visualisation with left main injection (due to half the injectate in the non-imaged vessel) was not evident in proximal and middle coronary artery OCT catheter positions. CONCLUSIONS Frequency domain OCT is safe and efficacious in the porcine model.
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Affiliation(s)
- Xiankai Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Sánchez-Elvira G, Coma-Canella I, Artaiz M, Páramo JA, Barba J, Calabuig J. Characterization of coronary plaques with combined use of intravascular ultrasound, virtual histology and optical coherence tomography. Heart Int 2011; 5:e12. [PMID: 21977297 PMCID: PMC3184689 DOI: 10.4081/hi.2010.e12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 09/08/2010] [Accepted: 09/09/2010] [Indexed: 01/24/2023] Open
Abstract
According to post-mortem studies, luminal thrombosis occurs from plaque rupture, erosion and calcified nodules. In vivo studies have found thin cap fibroatheroma (TCFA) as the main vulnerable lesion, prone to rupture. Few data about other post-mortem lesions have been reported in vivo. Our main objective is to characterize in vivo the coronary plaques with intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT), in order to detect not only thin cap fibroatheroma (TCFA), but also other possible vulnerable lesions. The secondary objective is to correlate these findings with clinical and analytical data. Twenty-five patients (18 stable) submitted to coronary angiography were included in this pilot study. After angiography, the three vessels were studied (when possible) with IVUS-VH and OCT. Plaque characteristics were correlated with clinical and analytical data. Forty-six lesions were analyzed. IVUS-VH detected significant necrotic core in 15 (3 were definite TCFA). OCT detected TCFA in 10 lesions, erosion in 6, thrombus in 5 and calcified nodule in 8. Possible vulnerable lesion was found in 61% of stable and 57% of unstable patients. Erosions and calcified nodules were only found in stable patients. Those with significant necrotic core had higher body mass index (P=0.016), higher levels of hs-CRP (P=0.019) and triglycerides (P=0.040). The higher the levels of hs-CRP, the larger the size of the necrotic core (r=0.69, P=0.003). Lesions with characteristics of vulnerability were detected by IVUS-VH and OCT in more than 50% of stable and unstable coronary patients. A significant necrotic core was mainly correlated with higher hs-CRP.
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Affiliation(s)
- William M Suh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Kato K, Yasutake M, Yonetsu T, Joong Kim S, Xing L, M Kratlian C, Takano M, Mizuno K, Jang IK. Intracoronary Imaging Modalities for Vulnerable Plaques. J NIPPON MED SCH 2011; 78:340-51. [DOI: 10.1272/jnms.78.340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Koji Kato
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School
| | - Masahiro Yasutake
- Department of Internal Medicine, (Division of Cardiology, Hepatology, Geriatrics and Integrated Medicine), Nippon Medical School
| | - Taishi Yonetsu
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School
| | - Soo Joong Kim
- Department of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea and Cardiology Division, Massachusetts General Hospital and Harvard Medical School
| | - Lei Xing
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School
| | | | - Masamichi Takano
- Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital
| | - Kyoichi Mizuno
- Department of Internal Medicine, (Division of Cardiology, Hepatology, Geriatrics and Integrated Medicine), Nippon Medical School
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School
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Hariri LP, Bouma BE, Waxman S, Shishkov M, Vakoc BJ, Suter MJ, Freilich MI, Oh WY, Rosenberg M, Tearney GJ. An automatic image processing algorithm for initiating and terminating intracoronary
OFDI pullback. Biomed Opt Express 2010; 1:566-573. [PMID: 21258490 PMCID: PMC3017988 DOI: 10.1364/boe.1.000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 07/28/2010] [Accepted: 08/08/2010] [Indexed: 05/30/2023]
Abstract
Intracoronary optical frequency domain imaging (OFDI) provides high resolution, three-dimensional views of coronary artery microstructure, but requires a non-occlusive saline/contrast purge to displace blood for clear artery views. Recent studies utilized manual pullback initiation/termination based on real-time image observation. Automated pullback initiation/termination by real-time OFDI signal analysis would enable more efficient data acquisition. We evaluate the use of simple imaging parameters to automatically and robustly differentiate between diagnostic-quality clear artery wall (CAW) versus blood-obstructed fields (BOF). Algorithms are tested using intracoronary OCT human data retrospectively and intracoronary OFDI swine and human data prospectively. In prospective analysis of OFDI swine data, the sensitivity and specificity of the ratio of second and first moments (contrast parameter) were 99.6% and 97.2%, respectively. In prospective analysis of OFDI clinical data, the contrast parameter yielded 96.0% sensitivity and 94.5% specificity. Accuracy improved further by analyzing sequential frames. These results indicate the algorithm may be utilized with intracoronary OFDI for initiating and terminating automated pullback and digital data recording.
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Affiliation(s)
- Lida P. Hariri
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
| | - Brett E. Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
- MIT-Harvard Division of Health Sciences and Technology, USA
| | - Sergio Waxman
- Department of Cardiology, Lahey Clinic, Burlington, Massachusetts 01803 USA
| | - Milen Shishkov
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
| | - Benjamin J. Vakoc
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
- MIT-Harvard Division of Health Sciences and Technology, USA
| | - Melissa J. Suter
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
| | - Mark I. Freilich
- Department of Cardiology, Lahey Clinic, Burlington, Massachusetts 01803 USA
| | - Wang-Yul Oh
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
| | - Mireille Rosenberg
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
| | - Guillermo J. Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 02114 USA
- MIT-Harvard Division of Health Sciences and Technology, USA
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