1
|
Razzi F, Regar E, Dijkstra J, Witberg K, Ligthart J, Ramlal S, Stam M, Krabbendam-Peters I, Hoogendoorn A, Duncker D, Van Esch J, Wentzel J, Van Soest G, Van Steijn V, Van Beusekom H. Relation between pre-existing plaque size and neointimal healing in an adult porcine model of familial hypercholesterolemia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2022] Open
Abstract
Abstract
Background
Despite the efficacy of novel drug eluting stents (DES) in preventing restenosis, this complication still occurs, as do neo-atherosclerosis development and poor stent strut coverage that are associated with stent thrombosis. Safety and efficacy of novel coronary stents are preclinically being tested using an established porcine coronary model. However, the use of young healthy animal only allow limited conclusions to be drawn on the long-term effects, as the artieries do not reflect human pathology of advanced atherosclerosis. A key unresolved question is whether and how the presence, size and composition of pre-existing atherosclerotic plaque affect neointimal healing.
Purpose
The objective of this study is to understand the role of atherosclerotic plaque in neointimal response following DES placement in a large animal model of coronary artery disease by using optical coherence tomography (OCT) analysis.
Methods
The study was approved by the animal ethics committee. Familial hypercholesterolemia (FH) swine (n=6 Bretoncelles-Meishan) were given a high fat diet for 12 months to develop atherosclerosis. Stents (n=14) were implanted in n=14 coronary arteries under guidance of OCT with a stent-artery ratio of 1.1:1 at sites of atherosclerotic plaque, and animals were sacrificed after 28 days. Two types of Sirolimus eluting stents with different release profiles were implanted. Serial OCT pullbacks were taken before and after stent placement and after 28 days (follow-up), quantitatively analyzed and compared using dedicated software. The lumen area, stent area, plaque size (calculated as external elastic lamina (EEL) area - lumen area) and neointima (calculated as stent area – lumen area) were evaluated for each frame and averaged per stent. The plaque burden before stent implantation was evaluated at the same site of stent placement using coronary side branches as reference.
Results
The graph shows the association between the pre-existing plaque size before stenting and neointima formation after 28 days. Surprisingly, more pre-existing plaque size resulted in less neointima (P<0.01). There was one outlier, a stent with long dissection and extensive malapposition at baseline which showed an excessive tissue response at follow-up. The response in this animal model shows similarity to human vessel response as both regions with thin neointima formation as well as poor strut coverage were observed for both stent types.
Conclusion
The novel model of adult FH swine shows long-term vessel response to DES, that is similar to human response. This work shows that pre-existing atherosclerotic plaque affects the neointima after DES implantation. This insight highlights the necessity to use relevant disease models for safety and efficacy testing.
Plaque size and neointima relation
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Netherlands Organisation for Health Research and Development (ZonMw)
Collapse
Affiliation(s)
- F Razzi
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - E Regar
- Ludwig-Maximilians University, Munich, Germany
| | - J Dijkstra
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - K Witberg
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - J Ligthart
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - S.A Ramlal
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - M Stam
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | | | - A Hoogendoorn
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D.J Duncker
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - J Van Esch
- TU Delft, Product and Process Engineering, Delft, Netherlands (The)
| | - J.J Wentzel
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - G Van Soest
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - V Van Steijn
- TU Delft, Product and Process Engineering, Delft, Netherlands (The)
| | | |
Collapse
|
2
|
Masdjedi K, Van Zandvoort LJC, Ligthart J, Tovar Forero NM, Lemmert ME, Diletti R, Witberg K, Zijlstra F, Kardys I, Van Mieghem NM, Daemen J. P4198The predictive value of Pd/pa and resting diastolic pressure ratio (DPR) on 1-year adverse cardiovascular event following contemporary percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Masdjedi
- Erasmus Medical Centre, Cardiology, Rotterdam, Netherlands
| | | | - J Ligthart
- Erasmus Medical Centre, Cardiology, Rotterdam, Netherlands
| | | | - M E Lemmert
- Erasmus Medical Centre, Cardiology, Rotterdam, Netherlands
| | - R Diletti
- Erasmus Medical Centre, Cardiology, Rotterdam, Netherlands
| | - K Witberg
- Erasmus Medical Centre, Cardiology, Rotterdam, Netherlands
| | - F Zijlstra
- Erasmus Medical Centre, Cardiology, Rotterdam, Netherlands
| | - I Kardys
- Erasmus Medical Centre, Cardiology, Rotterdam, Netherlands
| | | | - J Daemen
- Erasmus Medical Centre, Cardiology, Rotterdam, Netherlands
| |
Collapse
|
3
|
Karanasos A, Zhang B, Van Der Sijde J, Van Ditzhuijzen N, Witberg K, Ligthart J, Gnanadesigan M, Diletti R, Van Geuns R, Van Soest G, Dijkstra J, Zijlstra F, Regar E. P2336Dynamic changes in non-culprit coronary atherosclerotic lesion morphology: a longitudinal OCT study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2336] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
4
|
Vroegindewey M, Schuurman A, Kardys I, Anroedh S, Oemrawsingh R, Ligthart J, Garcia-Garcia H, Van Geuns R, Regar E, Van Mieghem N, Serruys P, Boersma H, Akkerhuis K. P2362SYNTAX score is positively correlated with intravascular ultrasound and near-infrared spectroscopy for the assessment of atherosclerotic burden in patients with stable coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2362] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
5
|
Brouwer P, Ligthart J, Regar E. P-010 Optical Coherence Tomography (OCT) Before and After Flowdiverter Treatment in Basilar Dolichoectasia. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.46] [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: 11/04/2022]
|
6
|
van Ditzhuijzen NS, Karanasos A, Bruining N, van den Heuvel M, Sorop O, Ligthart J, Witberg K, Garcia-Garcia HM, Zijlstra F, Duncker DJ, van Beusekom HMM, Regar E. The impact of Fourier-Domain optical coherence tomography catheter induced motion artefacts on quantitative measurements of a PLLA-based bioresorbable scaffold. Int J Cardiovasc Imaging 2014; 30:1013-26. [DOI: 10.1007/s10554-014-0447-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 05/09/2014] [Indexed: 11/24/2022]
|
7
|
Diletti R, Karanasos A, Muramatsu T, Nakatani S, Van Mieghem NM, Onuma Y, Nauta ST, Ishibashi Y, Lenzen MJ, Ligthart J, Schultz C, Regar E, de Jaegere PP, Serruys PW, Zijlstra F, van Geuns RJ. Everolimus-eluting bioresorbable vascular scaffolds for treatment of patients presenting with ST-segment elevation myocardial infarction: BVS STEMI first study. Eur Heart J 2014; 35:777-86. [DOI: 10.1093/eurheartj/eht546] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
|
8
|
Van Ditzhuijzen NS, Van Beusekom HMM, Sorop O, Van Den Heuvel M, Ligthart J, Witberg K, Zijlstra F, Duncker DJ, Regar E. Optical coherence tomography analysis of atherosclerosis development in swine fed a high-cholesterol diet. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2404] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
9
|
Karanasos A, Van Geuns RJ, Van Mieghem N, Schultz C, Ligthart J, Witberg K, Diletti R, De Jaegere P, Zijlstra F, Regar E. Bioresorbable vascular scaffold in ST-elevation acute myocardial infarction. A preliminary OCT report. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3946] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
10
|
Van Ditzhuijzen NS, Bruining N, Sorop O, Ligthart J, Witberg K, Duncker DJ, Zijlstra F, Van Beusekom HMM, Regar E. Bioresorbable stents: serial measurements using optical coherence tomography - the impact of respiratory and cardiac movement. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3965] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
Jamil Z, Tearney G, Bruining N, Sihan K, van Soest G, Ligthart J, van Domburg R, Bouma B, Regar E. Interstudy reproducibility of the second generation, Fourier domain optical coherence tomography in patients with coronary artery disease and comparison with intravascular ultrasound: a study applying automated contour detection. Int J Cardiovasc Imaging 2012; 29:39-51. [PMID: 22639296 PMCID: PMC3550705 DOI: 10.1007/s10554-012-0067-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 05/04/2012] [Indexed: 11/28/2022]
Abstract
Recently, Fourier domain OCT (FD-OCT) has been introduced for clinical use. This approach allows in vivo, high resolution (15 micron) imaging with very fast data acquisition, however, it requires brief flushing of the lumen during imaging. The reproducibility of such fast data acquisition under intracoronary flush application is poorly understood. To assess the inter-study variability of FD-OCT and to compare lumen morphometry to the established invasive imaging method, IVUS. 18 consecutive patients with coronary artery disease scheduled for PCI were included. In each target vessel a FD-OCT pullback (MGH system, light source 1,310 nm, 105 fps, pullback speed 20 mm/s) was acquired during brief (3 s) injection of X-ray contrast (flow 3 ml/s) through the guiding catheter. A second pullback was repeated under the same conditions after re-introduction of the FD OCT catheter into the coronary artery. IVUS and OCT imaging was performed in random order. FD-OCT and IVUS pullback data were analyzed using a recently developed software employing semi automated lumen contour and stent strut detection algorithms. Corresponding ROI were matched based on anatomical landmarks such as side branches and/or stent edges. Inter-study variability is presented as the absolute difference between the two pullbacks. FD-OCT showed remarkably good reproducibility. Inter-study variability in native vessels (cohort A) was very low for mean and minimal luminal area (0.10 ± 0.38, 0.19 ± 0.57 mm2, respectively). Likewise inter-study variability was very low in stented coronary segments (cohort B) for mean lumen, mean stent, minimal luminal and minimal stent area (0.06 ± 0.08, 0.07 ± 0.10, 0.04 ± 0.09, 0.04 ± 0.10 mm2, respectively). Comparison to IVUS morphometry revealed no significant differences. The differences between both imaging methods, OCT and IVUS, were very low for mean lumen, mean stent, minimal luminal and minimal stent area (0.10 ± 0.45, 0.10 ± 0.36, 0.26 ± 0.54, 0.05 ± 0.47 mm2, respectively). FD-OCT shows excellent reproducibility and very low inter-study variability in both, native and stented coronary segments. No significant differences in quantitative lumen morphometry were observed between FD-OCT and IVUS. Evaluating these results suggest that FD-OCT is a reliable imaging tool to apply in longitudinal coronary artery disease studies.
Collapse
Affiliation(s)
- Z Jamil
- Thoraxcenter, Bd 585, Erasmus MC, Dr. Molewaterplein 40, 3015-GD, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Papadopoulou SL, Brugaletta S, Garcia-Garcia HM, Rossi A, Girasis C, Dharampal AS, Neefjes LA, Ligthart J, Nieman K, Krestin GP, Serruys PW, de Feyter PJ. Assessment of atherosclerotic plaques at coronary bifurcations with multidetector computed tomography angiography and intravascular ultrasound-virtual histology. Eur Heart J Cardiovasc Imaging 2012; 13:635-42. [DOI: 10.1093/ehjci/jes083] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
13
|
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.
Collapse
Affiliation(s)
- E Regar
- Department of Interventional Cardiology, Thorax Center, Erasmus MC, S'-Gravendijkwal 230, Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|
14
|
Gonzalo N, Serruys PW, Okamura T, Shen ZJ, Onuma Y, Garcia-Garcia HM, Sarno G, Schultz C, van Geuns RJ, Ligthart J, Regar E. Optical coherence tomography assessment of the acute effects of stent implantation on the vessel wall: a systematic quantitative approach. Heart 2009; 95:1913-9. [PMID: 19671534 DOI: 10.1136/hrt.2009.172072] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [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: 12/15/2022] Open
Abstract
OBJECTIVE To observe and characterise vessel injury after stenting using optical coherence tomography (OCT), to propose a systematic OCT classification for periprocedural vessel trauma, to evaluate its frequency in stable versus unstable patients and to assess its clinical impact during the hospitalisation period. SETTING Stenting causes vessel injury. DESIGN AND INTERVENTIONS All consecutive patients in whom OCT was performed after stent implantation were included in the study. Qualitative and quantitative assessment of tissue prolapse, intra-stent dissection and edge dissection were performed. RESULTS Seventy-three patients (80 vessels) were analysed. Tissue prolapse within the stented segment was visible in 78/80 vessels (97.5%). Median number of tissue prolapse sites was 8 (IQR 4-19), mean (SD) area 1.04 (0.9) mm(2). Intra-stent dissection flaps were visible in 69/80 vessels (86.3%) (median number 3 (IQR 1.25-6), maximum flap length 450 (220) microm). Fifty-five out of 80 vessels (68.8%) showed dissection cavities (median number 2 (IQR 0-4.75), maximum depth 340 (170) microm). Edge dissection was visible in 20 vessels (mean (SD) length flap 744 (439) microm). The frequency of tissue prolapse or intra-stent dissection was similar in stable and unstable patients (95.6% vs 100%, p = 0.5 for tissue prolapse; 91.1% vs 82.9%, p = 0.3 for intra-stent dissection). There were no events during the hospitalisation period. CONCLUSIONS OCT allows a detailed visualisation of vessel injury after stent implantation and enables a systematic classification and quantification in vivo. In this study, frequency of tissue prolapse or intra-stent dissections after stenting was high, irrespective of the clinical presentation of the patients, and was not associated with clinical events during hospitalisation.
Collapse
Affiliation(s)
- N Gonzalo
- Thoraxcenter, Erasmus MC, 3015-CE Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Carafa R, Wollgast J, Canuti E, Ligthart J, Dueri S, Hanke G, Eisenreich SJ, Viaroli P, Zaldívar JM. Seasonal variations of selected herbicides and related metabolites in water, sediment, seaweed and clams in the Sacca di Goro coastal lagoon (Northern Adriatic). Chemosphere 2007; 69:1625-37. [PMID: 17610932 DOI: 10.1016/j.chemosphere.2007.05.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 05/10/2007] [Accepted: 05/14/2007] [Indexed: 05/04/2023]
Abstract
This study assesses the status of Sacca di Goro coastal lagoon (Northern Adriatic, Italy) with respect to watershed pollution. Because 80% of its watershed is devoted to agriculture, plant protection products and their metabolites were found in the water column, sediments (the upper 0-15 cm layer), macroalgae (Ulva rigida) and clams (Tapes philippinarum). Five seasonal sampling campaigns were performed from May 2004 to April 2005 and concentrations measured in five stations in the lagoon and six in the watershed. Relatively high concentrations of the s-triazine - terbuthylazine -, urea herbicides - diuron - and alachlor were detected through the year mainly at stations directly influenced by the Po di Volano inflow. The concentrations of products in use follow a clear seasonal pattern with spring peaks. This pattern is also visible in the sediments as well as in biota. Among metabolites, hydroxylated compounds prevailed, often with concentrations greater than those of the parent compounds. For the most part of the year, the concentrations in biota were close to detection limits, with concentration peaks in spring.
Collapse
Affiliation(s)
- R Carafa
- Rural, Water and Ecosystem Resources Unit, Institute for Environment and Sustainability, DG Joint Research Centre, European Commission, Ispra (VA), Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Carafa R, Marinov D, Dueri S, Wollgast J, Ligthart J, Canuti E, Viaroli P, Zaldívar JM. A 3D hydrodynamic fate and transport model for herbicides in Sacca di Goro coastal lagoon (Northern Adriatic). Mar Pollut Bull 2006; 52:1231-48. [PMID: 16643962 DOI: 10.1016/j.marpolbul.2006.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2005] [Revised: 02/02/2006] [Accepted: 02/24/2006] [Indexed: 05/08/2023]
Abstract
Sacca di Goro is a shallow coastal microtidal lagoon with a surface area of 26 km2, and an average depth of about 1.5m. Fresh water pollutant loads from Po River branches and several drainage canals lead to anthropogenic eutrophication, frequent summer anoxia crises and chemical contamination. Such events not only affect the lagoon ecosystem but also cause serious economic losses, the lagoon being the second largest producer of clams in Italy. The present work aims at using a fate model coupled with COHERENS 3D hydrodynamic model to simulate and to explain the spatial distribution and temporal variations of s-triazines herbicides in the Sacca di Goro lagoon. The simulation results of spatial and temporal dynamic behaviour of atrazine, simazine and terbuthylazine have been compared with experimental data obtained during an annual monitoring programme.
Collapse
Affiliation(s)
- R Carafa
- Inland and Marine Waters Unit, Institute for Environment and Sustainability, Joint Research Centre, European Commission, Via E. Fermi 1, TP 272, 21020 Ispra, VA, Italy
| | | | | | | | | | | | | | | |
Collapse
|
17
|
de Feyter PJ, Serruys PW, Nieman K, Mollet N, Cademartiri F, van Geuns RJ, Slager C, van der Steen AFW, Krams R, Schaar JA, Wielopolski P, Pattynama PMT, Arampatzis A, van der Lugt A, Regar E, Ligthart J, Smits P. Imaging of coronary atherosclerosis and identification of the vulnerable plaque. Neth Heart J 2003; 11:347-358. [PMID: 25696244 PMCID: PMC2499949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Identification of the vulnerable plaque responsible for the occurrence of acute coronary syndromes and acute coronary death is a prerequisite for the stabilisation of this vulnerable plaque. Comprehensive coronary atherosclerosis imaging in clinical practice should involve visualisation of the entire coronary artery tree and characterisation of the plaque, including the three-dimensional morphology of the plaque, encroachment of the plaque on the vessel lumen, the major tissue components of the plaque, remodelling of the vessel and presence of inflammation. Obviously, no single diagnostic modality is available that provides such comprehensive imaging and unfortunately no diagnostic tool is available that unequivocally identifies the vulnerable plaque. The objective of this article is to discuss experience with currently available diagnostic modalities for coronary atherosclerosis imaging. In addition, a number of evolving techniques will be briefly discussed.
Collapse
|
18
|
Affiliation(s)
- T Szili-Torok
- Thoraxcentre, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
19
|
Matthys K, Carlier S, Segers P, Ligthart J, Sianos G, Serrano P, Verdonck PR, Serruys PW. In vitro study of FFR, QCA, and IVUS for the assessment of optimal stent deployment. Catheter Cardiovasc Interv 2001; 54:363-75. [PMID: 11747166 DOI: 10.1002/ccd.1301] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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] [Indexed: 11/08/2022]
Abstract
We tested whether fractional flow reserve (FFR) discriminates between suboptimally and optimally deployed stents. Latex tubes (diameter solidus in circle = 4 mm) with diameter stenosis 40% (n = 3), 50% (n = 3) and 60% (n = 3) were tested in a pulsatile flow system, using water. Measurements were done at baseline (n = 9; FFR/QCA) and after suboptimal (SOD; 3-mm balloon at 8 atm) and optimal (OD; 4 mm balloon at 16 atm) deployment of a 35-mm stent (n = 6; FFR/QCA/IVUS). Varying Q from 150 to 50 ml/min increased FFR by 2-7%. Conversely, at 100 ml/min, FFR increased by only 0.8% from SOD to OD (P < 0.05). Extrapolating data to blood flow, the gain in FFR from SOD to OD is less than 5% for Q = 100 ml/min, while FFR may increase by 15-20% by changes in blood flow from 50 to 150 ml/min. We conclude that IVUS and QCA are more appropriate for the assessment of optimal stent deployment.
Collapse
Affiliation(s)
- K Matthys
- Institute Biomedical Technology IBITECH, Hydraulics Laboratory, Ghent University, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
van Der Giessen WJ, Regar E, Harteveld MS, Coen VL, Bhagwandien R, Au A, Levendag PC, Ligthart J, Serruys PW, den Boer A, Verdouw PD, Boersma E, Hu T, van Beusekom HM. "Edge Effect" of (32)p radioactive stents is caused by the combination of chronic stent injury and radioactive dose falloff. Circulation 2001; 104:2236-41. [PMID: 11684637 DOI: 10.1161/hc4301.097873] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radioactive stents have been reported to reduce in-stent neointimal thickening. An unexpected increase in neointimal response was observed, however, at the stent-to-artery transitions, the so-called "edge effect." To investigate the factors involved in this edge effect, we studied stents with 1 radioactive half and 1 regular nonradioactive half, thereby creating a midstent radioactive dose-falloff zone next to a nonradioactive stent-artery transition at one side and a radioactive stent-artery transition at the other side. METHODS AND RESULTS Half-radioactive stents (n=20) and nonradioactive control stents (n=10) were implanted in the coronary arteries of Yucatan micropigs. Animals received aspirin and clopidogrel as antithrombotics. After 4 weeks, a significant midstent stenosis was observed by angiography in the half-radioactive stents. Two animals died suddenly because of coronary occlusion at this mid zone at 8 and 10 weeks. At 12-week follow-up angiography, intravascular ultrasound and histomorphometry showed a significant neointimal thickening at the midstent dose-falloff zone of the half-radioactive stents, but not at the stent-to-artery transitions at both extremities. Such a midstent response (mean angiographic late loss 1.0 mm) was not observed in the nonradioactive stents (mean loss 0.4 to 0.6 mm; P< 0.01). CONCLUSIONS The edge effect of high-dose radioactive stents in porcine coronary arteries is associated with the combination of stent injury and radioactive dose falloff.
Collapse
Affiliation(s)
- W J van Der Giessen
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Regar E, Kozuma K, Ligthart J, Carlier SG, de Vries A, Serruys PW. Coronary stent implantation in a septal perforator artery: case report and review of the literature. Jpn Circ J 2000; 64:802-4. [PMID: 11059626 DOI: 10.1253/jcj.64.802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Septal perforator arteries play an important role in the blood supply of the anterior interventricular septum. Their intramyocardial course makes them inaccessible for coronary bypass revascularization. Although modern catheter-based techniques might be superior to coronary bypass grafting in offering the most complete revascularization in selected patient populations, a systematic review of the literature revealed a paucity of data regarding the outcome of these patients. The present report describes coronary stent implantation in a dominant septal perforator artery and the analysis of the anatomic relationship between the stent and the intraventricular septum using a new imaging technique, catheter-based intracardiac ultrasound.
Collapse
Affiliation(s)
- E Regar
- Thoraxcenter, Dijkzigt Hospital, Erasmus University, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
22
|
Bruining N, Sabate M, de Feyter PJ, Kay IP, Ligthart J, Disco C, Kutryk MJ, Roelandt JR, Serruys PW. Quantitative measurements of in-stent restenosis: A comparison between quantitative coronary ultrasound and quantitative coronary angiography. Catheter Cardiovasc Interv 1999; 48:133-42. [PMID: 10506766 DOI: 10.1002/(sici)1522-726x(199910)48:2<133::aid-ccd3>3.0.co;2-h] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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] [Indexed: 01/27/2023]
Abstract
While quantitative coronary angiography (QCA) remains the standard used to assess new interventional therapies, intracoronary ultrasound (ICUS) is gaining interest. The aim of the study was to determine the relationship between QCA and quantitative coronary ultrasound (QCU) measurements after stenting. Sixty-two consecutive patients with both QCA and QCU analysis after stent implantation were included in the study. The mean luminal diameter (QCU vs. QCA) were 2.74 +/- 0.46 mm and 2.41 +/- 0.49 mm (P < 0.0001), the minimal luminal diameter (MLD) 2.08 +/- 0.44 mm and 1.62 +/- 0.42 mm (P < 0. 0001), and the projected QCU MLD 1.90 +/- 0.42 mm (P < 0.0001 with respect to QCA). Percentage obstruction diameter (QCU vs. QCA) were 41.53% +/- 10.78% and 43.15% +/- 12.72% (P = NS). The stent diameter (QCU vs. QCA) were 3.54 +/- 0.65 mm and 3.80 +/- 0.37 mm (P = 0. 0004). Stent length measured by QCU were longer at 31.11 +/- 13.54 mm against 28.63 +/- 12.75 mm, P < 0.0001 with respect to QCA. In conclusion, while QCA and QCU appear to be comparable tools for measuring corrected stent diameters and stent lengths, smaller luminal diameters were found using QCA. This is of particular relevance to quantitative studies addressing absolute changes in vascular or luminal diameters. Cathet. Cardiovasc. Intervent. 48:133-142, 1999.
Collapse
Affiliation(s)
- N Bruining
- Thoraxcenter, Department of Cardiology, Erasmus Medical Center and Erasmus University, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Carlier SG, Marijnissen JP, Coen VL, Sabate M, van der Giessen WJ, Ligthart J, den Boer A, Levendag PC, Serruys PW. Comparison of brachytherapy strategies based on dose-volume histograms derived from quantitative intravascular ultrasound. Cardiovasc Radiat Med 1999; 1:115-24. [PMID: 11229543 DOI: 10.1016/s1522-1865(99)00003-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We present in this paper the comparison, by simulation, of different treatment strategies based either on beta- or gamma-sources, both with and without a centering device. Ionizing radiation to prevent restenosis is an emerging modality in interventional cardiology. Numerous clinical studies are presently being performed or planned, but there is variability in dose prescription, and both gamma- and beta-emitters are used, leading to a wide range of possible dose distributions over the arterial vessel wall. This paper discusses the potential merits of dose-volume histograms (DVH) based on three-dimensional (3-D) reconstruction of electrocardiogram (ECG)-gated intravascular ultrasound (IVUS) to compare brachytherapy treatment strategies. MATERIALS AND METHODS DVH describe the cumulative distribution of dose over three specific volumes: (1) at the level of the luminal surface, a volume was defined with a thickness of 0.1 mm from the automatically detected contour of the highly echogenic blood-vessel interface; (2) at the level of the IVUS echogenic media-adventitia interface (external elastic lamina [EEL]), an adventitial volume was computed considering a 0.5-mm thickness from EEL; and (3) the volume encompassed between the luminal surface and the EEL (plaque + media). The IVUS data used were recorded in 23 of 31 patients during the Beta Energy Restenosis Trial (BERT) conducted in our institution. RESULTS On average, the minimal dose in 90% of the adventitial volume was 37 +/- 16% of the prescribed dose; the minimal dose in 90% of the plaque + media volume was 58 +/- 24% and of the luminal surface volume was 67 +/- 31%. The minimal dose in the 10% most exposed luminal surface volume was 296 +/- 42%. Simulations of the use of a gamma-emitter and/or a radioactive source train centered in the lumen are reported, with a comparison of the homogeneity of the dose distribution. CONCLUSIONS It is possible to derive DVH from IVUS, to evaluate the dose delivered to different parts of the coronary wall. This process should improve our understanding of the mechanisms of action of brachytherapy.
Collapse
Affiliation(s)
- S G Carlier
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Carlier SG, Marijnissen JP, Coen VL, van der Giessen WJ, Sabate M, Ligthart J, den Boer A, Céspedes IE, Li W, van der Steen AF, Levendag PC, Serruys PW. Guidance of intracoronary radiation therapy based on dose-volume histograms derived from quantitative intravascular ultrasound. IEEE Trans Med Imaging 1998; 17:772-778. [PMID: 9874301 DOI: 10.1109/42.736033] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Application of ionizing radiation to prevent restenosis in atherosclerotic vessels treated by balloon angioplasty is a new treatment under investigation in interventional cardiology and radiology. There is variability in dose prescription, and both gamma- and beta-emitters are used, leading to a wide range of dose distribution over the arterial vessel wall. We present a new modality of dosimetry based on a method that three-dimensional (3-D) image reconstruction of electrocardiogram (ECG)-gated intravascular ultrasound (IVUS) images. Dose volume histograms (DVH) are used to describe the cumulative distribution of dose over two specific volumes: i) at the level of the luminal surface, defined with a thickness of 0.1 mm from the automatically detected contour of the highly echogenic blood-vessel interface, and ii) the adventitia volume is computed considering a 0.5-mm thickness from the echogenic media-adventitia interface. DVH provide a tool for reporting the actual delivered dose at the site believed to be the target: the adventitia, and to detect excessive radiation which could lead to vascular complications. Simulation of a gamma-emitter or of a radioactive source train in the center of the lumen are possible. The data obtained from the first ten patients included in the beta-irradiation trial (BERT 1.5) conducted in our institution are presented, supporting the use of DVH based on quantitative IVUS measurements for optimal dose prescription in vascular interventional radiation therapy.
Collapse
Affiliation(s)
- S G Carlier
- Department of Intervention Cardiology, Thoraxcentre, Erasmus University Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Bruining N, von Birgelen C, de Feyter PJ, Ligthart J, Serruys PW, Roelandt JR. Dynamic imaging of coronary stent structures: an ECG-gated three-dimensional intracoronary ultrasound study in humans. Ultrasound Med Biol 1998; 24:631-637. [PMID: 9695265 DOI: 10.1016/s0301-5629(98)00038-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Three-dimensional (3D) intracoronary ultrasound (ICUS) systems allow dynamic 3D reconstruction of coronary segments after stent deployment, but motion artifacts are frequently present. The use of an electrocardiographic-gated ICUS image acquisition workstation and a dedicated pullback device may overcome this problem. In the present study, we evaluated the potential of dynamic 3D reconstruction of intracoronary stents in 51 patients. Two different types of stent designs were investigated: (1) the Wallstent (mesh type; n = 36) and (2) the Cordis Coronary stent (coil type; n = 15). There was a tendency for imaging of the mesh stent type to be better than imaging of coil type stents (p = 0.06). Differences in the orientation of the stent struts (mesh:longitudinal; coil:transversal) most likely explain this difference. These in vivo observations were tested and confirmed in in vitro experiments. In conclusion, dynamic 3D ICUS reconstruction of the entire stent architecture in vivo was feasible for stents of mesh type, while stents of coil type were incompletely visualized.
Collapse
Affiliation(s)
- N Bruining
- Department of Cardiology, Erasmus University, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
26
|
Bruining N, von Birgelen C, de Feyter PJ, Ligthart J, Li W, Serruys PW, Roelandt JR. ECG-gated versus nongated three-dimensional intracoronary ultrasound analysis: implications for volumetric measurements. Cathet Cardiovasc Diagn 1998; 43:254-60. [PMID: 9535359 DOI: 10.1002/(sici)1097-0304(199803)43:3<254::aid-ccd3>3.0.co;2-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The quantitative analysis of a three-dimensional (3-D) intracoronary ultrasound (ICUS) image data set permits a more comprehensive assessment of coronary arterial segments. The 3-D image sets are generally acquired during continuous motorized pullbacks. However, the cyclic changes of vascular dimensions and the cyclic spatial displacement of the ICUS transducer relative to the vessel wall can result in characteristic image artifacts, which may limit the applicability of quantitative automated analysis systems. This limitation may be overcome by an ECG-gated image acquisition. In the present study we acquired in vivo (1) nongated and (2) ECG-gated 3-D ICUS image sets of 15 human atherosclerotic coronary arteries and performed a computer-assisted contour detection of the lumen and total vessel boundaries. Total vessel and lumen volumes measured significantly larger in the nongated versus ECG-gated end-diastolic image sets (753+/-307 mm3 vs. 705+/-305 mm3; 411+/-154 mm3 vs. 388+/-165 mm3, both: P < 0.05). Both end-diastolic and systolic measurements were available in nine arteries, showing a larger total vessel and lumen volume at systole (664+/-221 mm3 vs. 686+/-227 mm3, P=0.03; 384+/-164 mm3 vs. 393+/-170 mm3, P=0.08). The differences observed may be of particular interest for volumetric ICUS studies, addressing presumably small differences in vessel or lumen dimensions.
Collapse
Affiliation(s)
- N Bruining
- Thoraxcenter, Department of Cardiology, Erasmus Medical Center and Erasmus University, Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Gil R, von Birgelen C, Prati F, Di Mario C, Ligthart J, Serruys PW. Usefulness of three-dimensional reconstruction for interpretation and quantitative analysis of intracoronary ultrasound during stent deployment. Am J Cardiol 1996; 77:761-4. [PMID: 8651131 DOI: 10.1016/s0002-9149(97)89214-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [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] [Indexed: 02/01/2023]
Abstract
We examined 49 coronary stents in 33 patients after angiographically guided optimization of the deployment by intracoronary ultrasound, and compared the findings of a conventional 2-dimensional analysis approach with the results obtained from an automatic lumen recognition provided by a 3-dimensional reconstruction system. The automatic lumen analysis demonstrated that only 15 stents (31%) fulfilled defined ultrasound criteria of adequate stent deployment, and that 5 of these cases were missed by the conventional approach, which systematically overestimated the dimensions of the minimal stent lumen.
Collapse
Affiliation(s)
- R Gil
- Intracoronary Imaging Laboratory and Cardiac Catheterization Laboratory, Thoraxcenter, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
29
|
Camenzind E, Kint PP, Di Mario C, Ligthart J, van der Giessen W, Boersma E, Serruys PW. Intracoronary heparin delivery in humans. Acute feasibility and long-term results. Circulation 1995; 92:2463-72. [PMID: 7586346 DOI: 10.1161/01.cir.92.9.2463] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [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] [Indexed: 01/26/2023]
Abstract
BACKGROUND Inefficacy of systemic drug administration for restenosis prevention may partially relate to insufficient local drug concentration. This study aimed to evaluate the acute feasibility and long-term outcome of using an infusion-perfusion coil balloon, Dispatch. METHODS AND RESULTS In 22 patients after balloon angioplasty, the coil balloon was studied for (1) feasibility of local heparin delivery, (2) symptoms and signs of ischemia during prolonged deployment compared with angioplasty balloon occlusion, (3) coronary pressure and flow distal to the inflated device, and (4) long-term clinical and angiographic results. During prolonged intracoronary deployment of the coil balloon (29 +/- 8 minutes), 5 of 22 patients developed mild chest pain versus 20 of 22 during angioplasty (275 +/- 283 seconds). Neither hemodynamic nor vectorcardiographic signs of ischemia were detected, in contrast to angioplasty balloon occlusion. Baseline flow across the coil balloon was 44 +/- 31 mL/min, increasing by a factor of 1.8 +/- 0.7 during pharmacologically induced hyperemia. A mean volume of 14.2 +/- 6.1 mL containing 1416 +/- 608 IU of heparin was infused locally at a pressure of 122 +/- 54 mm Hg. At 7 +/- 1-month follow-up, 1 asymptomatic patient had died, and of the remaining 21, 17 (81%) were asymptomatic. Angiographic follow-up was obtained in 15 of 21 patients (71%), including all 4 symptomatic patients. Mean minimal luminal diameter after the procedure was 2.16 +/- 0.49 mm and at follow-up, 1.89 +/- 0.45 mm, which corresponds to a restenosis rate (diameter stenosis > or = 50%) of 7% (1/15). CONCLUSIONS Intracoronary use of the coil balloon after balloon angioplasty proved to be feasible and subjectively as well as objectively well tolerated during prolonged deployment by virtue of its perfusion properties. High volumes of heparin solution can be infused locally at very low pressure. No unfavorable clinical or angiographic long-term effects were observed.
Collapse
Affiliation(s)
- E Camenzind
- Cardiac Catheterization Laboratory, University Hospital Dijkzigt, Rotterdam, Netherlands
| | | | | | | | | | | | | |
Collapse
|
30
|
Verburgh CA, Hendriks WD, Ligthart J, Berghout A. [Necrotizing fasciitis caused by Group A beta-hemolytic streptococci]. Ned Tijdschr Geneeskd 1993; 137:607-9. [PMID: 8459860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A case is presented of a 35-year-old man with necrotizing fasciitis caused by group A beta-haemolytic Streptococci, accompanied by severe systemic toxicity, and necessitating amputation of the leg. After prolonged intensive care treatment the patient recovered.
Collapse
Affiliation(s)
- C A Verburgh
- Afd. Inwendige Geneeskunde, Zuiderziekenhuis, Rotterdam
| | | | | | | |
Collapse
|
31
|
Vreugdenhil G, Ligthart J, de Leeuw PW. [Rhabdomyolysis, disseminated intravascular coagulation and multiple organ failure in a patient with cocaine and heroine poisoning]. Ned Tijdschr Geneeskd 1992; 136:1213-5. [PMID: 1614570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 19-year-old female patient with cocaine and heroin intoxication is described in whom several life threatening complications such as hypovolemic shock, cardiopulmonary insufficiency, rhabdomyolysis, diffuse intravascular coagulation and multiple organ failure occurred. The patient survived the intoxication after quick intensive treatment.
Collapse
Affiliation(s)
- G Vreugdenhil
- Zuiderziekenhuis, afd. Interne Geneeskunde, Rotterdam
| | | | | |
Collapse
|