151
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Kim BK, Kim JS, Hong MK. Optical Coherence Tomography in Assessing Plaque Characteristics. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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152
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Herrero-Garibi J, Cruz-González I, Parejo-Díaz P, Jang IK. Tomografía de coherencia óptica: situación actual en el diagnóstico intravascular. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70207-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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153
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Akasaka T, Kubo T, Mizukoshi M, Tanaka A, Kitabata H, Tanimoto T, Imanishi T. Pathophysiology of acute coronary syndrome assessed by optical coherence tomography. J Cardiol 2010; 56:8-14. [DOI: 10.1016/j.jjcc.2010.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 05/07/2010] [Indexed: 11/29/2022]
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154
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Kitabata H, Tanaka A, Kubo T, Takarada S, Kashiwagi M, Tsujioka H, Ikejima H, Kuroi A, Kataiwa H, Ishibashi K, Komukai K, Tanimoto T, Ino Y, Hirata K, Nakamura N, Mizukoshi M, Imanishi T, Akasaka T. Relation of microchannel structure identified by optical coherence tomography to plaque vulnerability in patients with coronary artery disease. Am J Cardiol 2010; 105:1673-8. [PMID: 20538113 DOI: 10.1016/j.amjcard.2010.01.346] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 01/29/2010] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
Abstract
Increased neovascularization in atherosclerotic plaques is associated with plaque vulnerability. The high resolution of optical coherence tomography (OCT) might provide a chance to directly visualize plaque neovascularization in vivo. The aim of the present study was to investigate the relation between microchannels in culprit plaques identified by OCT and plaque vulnerability in patients with coronary artery disease. A total of 63 consecutive patients with coronary artery disease who had undergone both OCT and intravascular ultrasound before any interventions to examine culprit lesion morphologies were enrolled. Microchannel was defined as a no-signal tubuloluminal structure on the cross-sectional optical coherence tomographic image. Microchannels were found in 24 (38%) of the 63 patients. The patients were divided into 2 groups according to the presence or absence of microchannels. The frequency of plaque rupture tended to be greater in the microchannel group (50% vs 28%, p = 0.11). The thickness of the fibrous cap (median 60 vs 100 microm, p = 0.001) was significantly less in the patients with microchannels, and significant differences were found in the frequency of thin-cap fibroatheroma (54% vs 21%, p = 0.012) and positive remodeling (67% vs 36%, p = 0.02) between the 2 groups. The high-sensitivity C-reactive protein levels in the microchannel group was significantly greater than those in the no-microchannel group (median 0.27 vs 0.13 mg/dl, p = 0.015). Moreover, increased microchannel counts were associated with greater high-sensitivity C-reactive protein levels (p = 0.01). In conclusion, a significant relation was found between the presence of microchannels in plaques identified by OCT and plaque vulnerability in patients with coronary artery disease.
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155
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Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography. JACC Cardiovasc Imaging 2010; 2:1412-9. [PMID: 20083077 DOI: 10.1016/j.jcmg.2009.09.012] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 09/28/2009] [Accepted: 09/29/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate whether multidetector computed tomography (MDCT) can noninvasively help assess thin-cap fibroatheroma (TCFA). BACKGROUND Plaque rupture and thrombus formation play key roles in the onset of acute coronary syndrome. TCFA is recognized as a precursor lesion for plaque rupture, and MDCT angiography can potentially help identify plaques prone to rupture. METHODS We enrolled 105 patients with coronary artery disease (acute coronary syndromes, n = 31; stable angina pectoris, n = 74). Culprit lesions were assessed by both MDCT and optical coherence tomography (OCT). Patients were divided into a TCFA and a non-TCFA group according to OCT findings; clinical and MDCT observations were compared for 2 groups. RESULTS There were no differences in patients' characteristics between the 2 groups. OCT revealed 25 TCFAs at the culprit site in 105 patients. Acute coronary syndrome was more frequent in the TCFA group than in the non-TCFA group (52% vs. 23%, p = 0.01). High-sensitive C-reactive protein was higher in the TCFA group (0.32 +/- 0.32 mg/dl vs. 0.17 +/- 0.16 mg/dl, p < 0.001). Positive remodeling identified by MDCT was observed more frequently in the TCFA group than in the non-TCFA group (76% vs. 31%, p < 0.001). Computed tomography attenuation value of the culprit plaque in the TCFA group was lower than that in the non-TCFA group (35.1 +/- 32.3 HU vs. 62.0 +/- 33.6 HU, p < 0.001). The frequency of ring-like enhancement in the TCFA group was higher than in the non-TCFA group (44% vs. 4%, p < 0.0001). The sensitivity, specificity, positive predictive value, and negative predictive value of ring-like enhancement for detecting TCFA are 44%, 96%, 79%, and 85%, respectively. By stepwise regression, the ring-like enhancement, high-sensitive C-reactive protein, and diagnosis of acute events were associated with the presence of TCFA at the culprit site. CONCLUSIONS MDCT can identify differences in plaque morphologies between TCFA and non-TCFA. From our results, MDCT may provide for the noninvasive assessment of vulnerable plaque.
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156
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Yamamoto M, Takano M, Murakami D, Inami T, Kobayashi N, Shirakabe A, Inami S, Okamatsu K, Ohba T, Aoki S, Seino Y, Mizuno K. Impact of small thrombus formation in restenotic bare-metal stent lesions associated with acute coronary syndrome: identification by optical coherence tomography. Int J Cardiol 2010; 149:169-173. [PMID: 20071041 DOI: 10.1016/j.ijcard.2009.12.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Revised: 11/29/2009] [Accepted: 12/19/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although in-stent restenosis (ISR) after bare-metal stent (BMS) implantation is considered to be clinically benign, ISR is often associated with adverse complications, such as acute coronary syndrome (ACS). The frequency, type, and location of thrombi in ISR lesions and their clinical presentation have not yet been precisely validated. METHODS Thirty angiographic ISR lesions occurring within 3 to 8 months after stenting were evaluated by optical coherence tomography (OCT). A thrombus was defined as a mass protruding into the lumen with an irregular surface, and its type was divided into red or white. The maximum size of a thrombus and the longitudinal distance from the thrombus to the narrowest lumen were measured. RESULTS A thrombus was identified in 2 patients by angiography and in 10 patients by OCT (7% vs. 33%; P=0.01). OCT showed that 9 patients had white thrombus and another patient had both types of thrombi. ACS relevant to ISR was seen in 6 patients, and the frequency of ACS was significantly higher in patients with thrombus than in those without thrombus [50% (5/10) vs. 5% (1/20); P=0.003]. The maximum size of the thrombus was 412 ± 220 µm in height, 424 ± 251 µm in width, and the longitudinal distance between the thrombus and the minimum lumen area was 0.3 ± 0.7 mm. CONCLUSIONS One third of ISR lesions following BMS deployment dominantly contained a white thrombus, and half of them were associated with ACS. A small thrombus formation adjacent to the narrowest lumen in an ISR lesion may therefore contribute to the clinical presentation of ACS.
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Affiliation(s)
- Masanori Yamamoto
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Masamichi Takano
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
| | - Daisuke Murakami
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Toru Inami
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Nobuaki Kobayashi
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Akihiro Shirakabe
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | | | - Kentaro Okamatsu
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Takayoshi Ohba
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Satoshi Aoki
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Yoshihiko Seino
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Kyoichi Mizuno
- Division of Cardiology, Nippon Medical School, Tokyo, Japan
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157
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van Soest G, Goderie T, Regar E, Koljenović S, van Leenders GLJH, Gonzalo N, van Noorden S, Okamura T, Bouma BE, Tearney GJ, Oosterhuis JW, Serruys PW, van der Steen AFW. Atherosclerotic tissue characterization in vivo by optical coherence tomography attenuation imaging. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:011105. [PMID: 20210431 DOI: 10.1117/1.3280271] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Optical coherence tomography (OCT) is rapidly becoming the method of choice for assessing arterial wall pathology in vivo. Atherosclerotic plaques can be diagnosed with high accuracy, including measurement of the thickness of fibrous caps, enabling an assessment of the risk of rupture. While the OCT image presents morphological information in highly resolved detail, it relies on interpretation of the images by trained readers for the identification of vessel wall components and tissue type. We present a framework to enable systematic and automatic classification of atherosclerotic plaque constituents, based on the optical attenuation coefficient mu(t) of the tissue. OCT images of 65 coronary artery segments in vitro, obtained from 14 vessels harvested at autopsy, are analyzed and correlated with histology. Vessel wall components can be distinguished based on their optical properties: necrotic core and macrophage infiltration exhibit strong attenuation, mu(t)>or=10 mm(-1), while calcific and fibrous tissue have a lower mu(t) approximately 2-5mm(-1). The algorithm is successfully applied to OCT patient data, demonstrating that the analysis can be used in a clinical setting and assist diagnostics of vessel wall pathology.
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Affiliation(s)
- Gijs van Soest
- Erasmus Medical Center, Thorax Center, Rotterdam, The Netherlands.
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158
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Optical coherence tomography imaging: current status and future perspectives. Cardiovasc Interv Ther 2009; 25:2-10. [DOI: 10.1007/s12928-009-0006-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Indexed: 10/20/2022]
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159
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Ikejima H, Imanishi T, Tsujioka H, Kashiwagi M, Kuroi A, Tanimoto T, Kitabata H, Ishibashi K, Komukai K, Takeshita T, Akasaka T. Upregulation of fractalkine and its receptor, CX3CR1, is associated with coronary plaque rupture in patients with unstable angina pectoris. Circ J 2009; 74:337-45. [PMID: 20019415 DOI: 10.1253/circj.cj-09-0484] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent studies suggest that fractalkine (FKN or CX3CL1) and its cognate receptor, CX3CR1, play a role in atherogenesis, so the relationship between coronary plaque rupture, as observed by preintervention optical coherence tomography, and plasma levels of FKN and CX3CR1 was investigated in this study. METHODS AND RESULTS The study population consisted of 46 patients with unstable angina pectoris (UAP), 30 patients with stable angina pectoris, and 25 healthy controls. The UAP patients underwent a preintervention optical coherence tomography study, which revealed that the number of patients with and without plaque rupture at the culprit site was 27 (rupture group) and 19 (non-rupture group), respectively. Plasma levels of soluble FKN (sFKN) and CX3CR1 were measured by enzyme-linked immunosorbent assay and flow cytometry, respectively. The plasma levels of sFKN were significantly increased in UAP patients with plaque rupture compared with patients in the other groups. Multiple logistic regression analysis showed that CD14(+)CD16(+)CX3CR1(+) monocytes and CD3(+)CX3CR1(+) lymphocytes were independent predictors of the presence of ruptured plaque. CONCLUSIONS Increases in the FKN level and the number of CX3CR1-expressing mononuclear cells might contribute to coronary plaque rupture.
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Affiliation(s)
- Hideyuki Ikejima
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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160
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Brott BC. Late Vascular Healing Response to Stents. J Am Coll Cardiol 2009; 55:33-4. [DOI: 10.1016/j.jacc.2009.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 08/18/2009] [Indexed: 10/20/2022]
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161
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Prati F, Regar E, Mintz GS, Arbustini E, Di Mario C, Jang IK, Akasaka T, Costa M, Guagliumi G, Grube E, Ozaki Y, Pinto F, Serruys PWJ. Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 2009; 31:401-15. [PMID: 19892716 DOI: 10.1093/eurheartj/ehp433] [Citation(s) in RCA: 615] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Optical coherence tomography (OCT) is a novel intravascular imaging modality, based on infrared light emission, that enables a high resolution arterial wall imaging, in the range of 10-20 microns. This feature of OCT allows the visualization of specific components of the atherosclerotic plaques. The aim of the present Expert Review Document is to address the methodology, terminology and clinical applications of OCT for qualitative and quantitative assessment of coronary arteries and atherosclerosis.
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Affiliation(s)
- Francesco Prati
- Interventional Cardiology, San Giovanni Hospital, Via dell'Amba Aradam 8, 00184 Rome, Italy.
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162
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Affiliation(s)
- Akiko Maehara
- From the Cardiovascular Research Foundation, Columbia University Medical Center (A.M., G.S.M.), New York, NY; and MedStar Research Institute, Washington Hospital Center (N.J.W.), Washington, DC
| | - Gary S. Mintz
- From the Cardiovascular Research Foundation, Columbia University Medical Center (A.M., G.S.M.), New York, NY; and MedStar Research Institute, Washington Hospital Center (N.J.W.), Washington, DC
| | - Neil J. Weissman
- From the Cardiovascular Research Foundation, Columbia University Medical Center (A.M., G.S.M.), New York, NY; and MedStar Research Institute, Washington Hospital Center (N.J.W.), Washington, DC
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163
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Morikawa Y, Uemura S, Ishigami KI, Soeda T, Okayama S, Takemoto Y, Onoue K, Somekawa S, Nishida T, Takeda Y, Kawata H, Horii M, Saito Y. Morphological features of coronary arteries in patients with coronary spastic angina: assessment with intracoronary optical coherence tomography. Int J Cardiol 2009; 146:334-40. [PMID: 19716193 DOI: 10.1016/j.ijcard.2009.07.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 07/02/2009] [Accepted: 07/19/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary spasm (CS) plays an important role in the pathogenesis of many types of ischemic heart disease, but morphological appearance of non-stenotic coronary segments with CS is not fully understood. We evaluate the morphological characteristics of coronary arteries in patients with coronary spastic angina (CSA) using intravascular optical coherence tomography (OCT). METHODS We evaluated 37 patients with resting chest pain whose coronary angiograms did not reveal significant stenosis. These patients underwent an acetylcholine (ACh) provocation test. OCT was performed after complete dilatation of coronary arteries, and additionally during ACh-induced CS in four patients. RESULTS Based on the ACh test, 23 patients were diagnosed as having CSA, and the remaining 14 patients without CS were referred to as CS-negative. OCT study revealed that coronary segments with ACh-induced CS had homogeneous intimal thickening, and quantitative analysis showed that CS-positive segments had a significantly greater intima area as compared with corresponding CS-negative segments without lipid or calcium content. By contrast, CS-positive segments had a significantly smaller intima area as compared with CS-negative segments with lipid or calcium deposit. During ACh-induced CS, lumen and total vascular areas were significantly decreased, whereas intima area did not change in comparison with complete vasodilatation. The luminal surface of the intima formed a markedly wavy configuration during CS. CONCLUSIONS Coronary artery segments involved in CS are characterized by diffuse intimal thickening without lipid or calcium content. High-resolution coronary OCT imaging could make it possible to analyze the vascular pathophysiology in patients with CS.
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Affiliation(s)
- Yoshinobu Morikawa
- First Department of Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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164
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Takano M, Mizuno K, Kim S, Jang IK. Optical coherence tomography. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0032-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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165
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Villard JW, Paranjape AS, Victor DA, Feldman MD. Applications of optical coherence tomography in cardiovascular medicine, Part 2. J Nucl Cardiol 2009; 16:620-39. [PMID: 19479314 PMCID: PMC4352576 DOI: 10.1007/s12350-009-9100-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 05/06/2009] [Indexed: 02/07/2023]
Affiliation(s)
- Joseph W Villard
- Division of Cardiology, University of Texas Health Science Center in San Antonio and the South Texas Veterans Affairs Health System, Mail Code 7872, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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166
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Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Tanimoto T, Kuroi A, Tsujioka H, Ikejima H, Komukai K, Kataiwa H, Okouchi K, Kashiwaghi M, Ishibashi K, Matsumoto H, Takemoto K, Nakamura N, Hirata K, Mizukoshi M, Akasaka T. Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study. Eur Heart J 2009; 30:1348-55. [DOI: 10.1093/eurheartj/ehp122] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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167
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Low A, Kawase Y, Chan YH, Tearney G, Bouma B, Jang IK. In vivo characterisation of coronary plaques with conventional grey-scale intravascular ultrasound: correlation with optical coherence tomography. EUROINTERVENTION 2009; 4:626-32. [DOI: 10.4244/eijv4i5a105] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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168
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Ishigami KI, Uemura S, Morikawa Y, Soeda T, Okayama S, Nishida T, Takemoto Y, Onoue K, Somekawa S, Takeda Y, Kawata H, Horii M, Saito Y. Long-Term Follow-up of Neointimal Coverage of Sirolimus-Eluting Stents. Circ J 2009; 73:2300-7. [DOI: 10.1253/circj.cj-08-1116] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Shiro Uemura
- First Department of Medicine, Nara Medical University
| | | | | | | | - Taku Nishida
- First Department of Medicine, Nara Medical University
| | | | - Kenji Onoue
- First Department of Medicine, Nara Medical University
| | | | - Yukiji Takeda
- First Department of Medicine, Nara Medical University
| | | | - Manabu Horii
- First Department of Medicine, Nara Medical University
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169
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Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Matsumoto H, Arita Y, Ookochi K, Kuroi A, Kataiwa H, Tanimoto T, Ikejima H, Takarada S, Kubo T, Hirata K, Nakamura N, Mizukoshi M, Imanishi T, Akasaka T. Relationship Between Coronary Arterial Remodeling, Fibrous Cap Thickness and High-Sensitivity C-Reactive Protein Levels in Patients With Acute Coronary Syndrome. Circ J 2009; 73:1291-5. [DOI: 10.1253/circj.cj-08-0968] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Hiroto Tsujioka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Matsumoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yu Arita
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Keishi Ookochi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hideaki Kataiwa
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hideyuki Ikejima
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Shigeho Takarada
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Kumiko Hirata
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Nobuo Nakamura
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Masato Mizukoshi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Toshio Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
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170
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Kume T, Okura H, Yamada R, Kawamoto T, Watanabe N, Neishi Y, Sadahira Y, Akasaka T, Yoshida K. Frequency and Spatial Distribution of Thin-Cap Fibroatheroma Assessed by 3-Vessel Intravascular Ultrasound and Optical Coherence Tomography An Ex Vivo Validation and an Initial In Vivo Feasibility Study. Circ J 2009; 73:1086-91. [DOI: 10.1253/circj.cj-08-0733] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | | | | | | | | | - Yoji Neishi
- Department of Cardiology, Kawasaki Medical School
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171
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Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Tanimoto T, Kuroi A, Tsujioka H, Ikejima H, Ueno S, Kataiwa H, Okouchi K, Kashiwaghi M, Matsumoto H, Takemoto K, Nakamura N, Hirata K, Mizukoshi M, Akasaka T. Morphology of Exertion-Triggered Plaque Rupture in Patients With Acute Coronary Syndrome. Circulation 2008; 118:2368-73. [DOI: 10.1161/circulationaha.108.782540] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Plaque rupture and secondary thrombus formation play key roles in the onset of acute coronary syndrome (ACS). One pathological study suggested that the morphologies of plaque rupture differed between rest-onset and exertion-triggered rupture in men who experienced sudden death. The aim of the present study was to use optical coherence tomography to investigate the relationship in patients with ACS between the morphology of a ruptured plaque and the patient’s activity at the onset of ACS.
Methods and Results—
The study population was drawn from 43 consecutive ACS patients (with or without ST-segment elevation) who underwent optical coherence tomography and presented with a ruptured plaque at the culprit site. Patients were divided into a rest group and an exertion group on the basis of their activities at the onset of ACS. The thickness of the broken fibrous cap correlated positively with activity at the onset of ACS. The culprit plaque ruptured at the shoulder more frequently in the exertion group than in the rest group (rest 57% versus exertion 93%,
P
=0.014). The thickness of the broken fibrous cap in the exertion group was significantly higher than in the rest-onset group (rest onset: 50 μm [interquartile median 15 μm]; exertion: 90 μm [interquartile median 65 μm],
P
<0.01).
Conclusions—
The morphologies of exertion-triggered and rest-onset ruptured plaques differ in ACS patients. Our data suggest that a thin-cap fibroatheroma is a lesion predisposed to rupture both at rest and during the patient’s day-to day activity, and some plaque rupture may occur in thick fibrous caps depending on exertion levels.
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Affiliation(s)
- Atsushi Tanaka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshio Imanishi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shigeho Takarada
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroto Tsujioka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hideyuki Ikejima
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Satoshi Ueno
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hideaki Kataiwa
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Keishi Okouchi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manabu Kashiwaghi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Matsumoto
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazushi Takemoto
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Nobuo Nakamura
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kumiko Hirata
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masato Mizukoshi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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172
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Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Kataiwa H, Kuroi A, Tsujioka H, Tanimoto T, Nakamura N, Mizukoshi M, Hirata K, Akasaka T. Distribution and frequency of thin-capped fibroatheromas and ruptured plaques in the entire culprit coronary artery in patients with acute coronary syndrome as determined by optical coherence tomography. Am J Cardiol 2008; 102:975-9. [PMID: 18929696 DOI: 10.1016/j.amjcard.2008.05.062] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 05/27/2008] [Accepted: 05/27/2008] [Indexed: 10/21/2022]
Abstract
The aim of this study was to investigate the distribution and frequency of thin-capped fibroatheromas (TCFAs) within the entire length of culprit coronary arteries in patients with acute coronary syndrome. Our population was drawn from 43 consecutive patients with acute coronary syndrome (with or without ST-segment elevation) who underwent optical coherence tomography to visualize the entire culprit coronary artery using a nonocclusive optical coherence tomographic technique. Patients were categorized divided into a TCFA group or a no-TCFA group on the basis of the optical coherence tomographic findings. There were no differences in baseline characteristics or angiographic findings between the 2 groups. High-sensitive C-reactive protein in the TCFA group was significantly higher than in the no-TCFA group (median 3.3 mg/L, interquartile 3.1, vs 1.7 mg/L, interquartile 2.2, p = 0.03). Plaque rupture was found in 28 patients (65%) and multiple plaque ruptures in 5 patients (12%). Optical coherence tomogram revealed 21 TCFAs in 18 patients (42%). Multiple TCFAs were found in the same vessel in 3 patients (7%). The distribution of TCFAs in the right coronary arteries of our subject population was relatively even (proximal 2 [12%], mid 5 [29%], distal 3 [18%], p = 0.42), whereas TCFAs in the left anterior descending artery were common in proximal sites (proximal 6 [27%], mid 2 [9%], distal 0, p = 0.018). In conclusion, the use of optical coherence tomography to look for TCFAs and identify their distribution when combined with C-reactive protein may contribute to forming a strategy for preventing impending coronary events.
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Kume T, Okura H, Kawamoto T, Akasaka T, Toyota E, Watanabe N, Neishi Y, Sadahira Y, Yoshida K. Fibrin Clot Visualized by Optical Coherence Tomography. Circulation 2008; 118:426-7. [DOI: 10.1161/circulationaha.107.749564] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Teruyoshi Kume
- From the Department of Cardiology (T. Kume, H.O., T. Kawamoto, E.T., N.W., Y.N., K.Y.) and Department of Pathology (Y.S.), Kawasaki Medical School, Kurashiki, Japan; and Department of Cardiology, Wakayama Medical University, Wakayama, Japan (T.A.)
| | - Hiroyuki Okura
- From the Department of Cardiology (T. Kume, H.O., T. Kawamoto, E.T., N.W., Y.N., K.Y.) and Department of Pathology (Y.S.), Kawasaki Medical School, Kurashiki, Japan; and Department of Cardiology, Wakayama Medical University, Wakayama, Japan (T.A.)
| | - Takahiro Kawamoto
- From the Department of Cardiology (T. Kume, H.O., T. Kawamoto, E.T., N.W., Y.N., K.Y.) and Department of Pathology (Y.S.), Kawasaki Medical School, Kurashiki, Japan; and Department of Cardiology, Wakayama Medical University, Wakayama, Japan (T.A.)
| | - Takashi Akasaka
- From the Department of Cardiology (T. Kume, H.O., T. Kawamoto, E.T., N.W., Y.N., K.Y.) and Department of Pathology (Y.S.), Kawasaki Medical School, Kurashiki, Japan; and Department of Cardiology, Wakayama Medical University, Wakayama, Japan (T.A.)
| | - Eiji Toyota
- From the Department of Cardiology (T. Kume, H.O., T. Kawamoto, E.T., N.W., Y.N., K.Y.) and Department of Pathology (Y.S.), Kawasaki Medical School, Kurashiki, Japan; and Department of Cardiology, Wakayama Medical University, Wakayama, Japan (T.A.)
| | - Nozomi Watanabe
- From the Department of Cardiology (T. Kume, H.O., T. Kawamoto, E.T., N.W., Y.N., K.Y.) and Department of Pathology (Y.S.), Kawasaki Medical School, Kurashiki, Japan; and Department of Cardiology, Wakayama Medical University, Wakayama, Japan (T.A.)
| | - Yoji Neishi
- From the Department of Cardiology (T. Kume, H.O., T. Kawamoto, E.T., N.W., Y.N., K.Y.) and Department of Pathology (Y.S.), Kawasaki Medical School, Kurashiki, Japan; and Department of Cardiology, Wakayama Medical University, Wakayama, Japan (T.A.)
| | - Yoshito Sadahira
- From the Department of Cardiology (T. Kume, H.O., T. Kawamoto, E.T., N.W., Y.N., K.Y.) and Department of Pathology (Y.S.), Kawasaki Medical School, Kurashiki, Japan; and Department of Cardiology, Wakayama Medical University, Wakayama, Japan (T.A.)
| | - Kiyoshi Yoshida
- From the Department of Cardiology (T. Kume, H.O., T. Kawamoto, E.T., N.W., Y.N., K.Y.) and Department of Pathology (Y.S.), Kawasaki Medical School, Kurashiki, Japan; and Department of Cardiology, Wakayama Medical University, Wakayama, Japan (T.A.)
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174
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Unal G, Slabaugh G, Kakadiaris IA, Tannenbaum A. Introduction to the special section on computer vision for intravascular and intracardiac imaging. IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE : A PUBLICATION OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY 2008; 12:273-6. [PMID: 18693494 PMCID: PMC3646520 DOI: 10.1109/titb.2008.920458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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175
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Kaple RK, Maehara A, Mintz GS. Characteristics of high-risk atherosclerotic plaque using intravascular ultrasound-derived virtual histology. ACTA ACUST UNITED AC 2008; 2:565-76. [DOI: 10.1517/17530059.2.5.565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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176
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Kume T, Okura H, Kawamoto T, Akasaka T, Toyota E, Watanabe N, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K. Relationship between coronary remodeling and plaque characterization in patients without clinical evidence of coronary artery disease. Atherosclerosis 2008; 197:799-805. [PMID: 17822707 DOI: 10.1016/j.atherosclerosis.2007.07.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 07/24/2007] [Accepted: 07/26/2007] [Indexed: 11/28/2022]
Abstract
AIMS The objectives of this study were: (1) to evaluate the relationship between coronary arterial remodeling assessed by intravascular ultrasound (IVUS) and plaque morphology assessed by histological examination in patients without clinical evidence of coronary artery disease and (2) to compare plaque morphology between histological examination and optical coherence tomography (OCT). METHODS Coronary segments (n=98) were harvested from the heart of 34 patients who died without clinical evidence of coronary artery disease. The segments with remodeling were assessed by IVUS and compared with corresponding OCT and histological images. RESULTS The fibrofatty plaque area was larger in lesions with expansive remodeling (ER) than in lesions with intermediate/constrictive remodeling (IR/CR) (p<0.01). Incidence of lipid containing plaque with the thickness of the fibrous cap smaller than 200 microm tended to be higher in ER than in IR/CR (34% versus 13%, p=0.10). OCT assessment of lipid containing plaque with thinner fibrous cap was achieved with 92% sensitivity and 75% specificity. CONCLUSIONS The fibrofatty plaque area was larger in lesions with ER than IR/CR even in patients without clinical evidence of coronary artery disease. The current capabilities of OCT are well suited for evaluation of lipid containing plaques with thinner fibrous cap.
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Affiliation(s)
- Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
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177
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Seo YS, Kim JS, Lee JM, Son JY, Kim KJ, Kim W, Kim JS, Ko YG, Choi D, Jang Y. A Newly Developed Stent Thrombus Related to Optical Coherence Tomography. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.12.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yong-Sung Seo
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Sun Kim
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Myung Lee
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Young Son
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Joon Kim
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kim
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
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178
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Hellings WE, Peeters W, Moll FL, Pasterkamp G. From vulnerable plaque to vulnerable patient: the search for biomarkers of plaque destabilization. Trends Cardiovasc Med 2007; 17:162-71. [PMID: 17574124 DOI: 10.1016/j.tcm.2007.03.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There is a strong need for biomarkers to identify patients at risk for future cardiovascular events related with progressive atherosclerotic disease. Ideally, increasing knowledge of the mechanisms of atherosclerotic plaque destabilization should be translated in clinical practice. Currently, the following commonly followed strategies can be identified with the objective to detect either the local vulnerable plaque that is prone to rupture and gives rise to a thrombotic occlusion, or the systemic vulnerable patient, who has a high probability to suffer from an adverse clinical event. On the one hand, studies are ongoing to determine local atherosclerotic plaque characteristics to predict future local plaque rupture and subsequent vascular thrombosis. Newly developed imaging modalities are being developed and validated to detect these plaques in vivo. On the other hand, systemic approaches are pursued to discover serum biomarkers that are applicable to define patients at risk for future cardiovascular events. We propose a third original approach that is optional but yet unexplored, that is, to use local plaque characteristics as a biomarker not just for local plaque destabilization but for future cardiovascular events due to plaque progression in any vascular system. This review aims to provide an overview of the current standings of the identification of the vulnerable plaque and the vulnerable patient.
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Affiliation(s)
- Willem E Hellings
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, The Netherlands
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179
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Brezinski ME. Applications of optical coherence tomography to cardiac and musculoskeletal diseases: bench to bedside? JOURNAL OF BIOMEDICAL OPTICS 2007; 12:051705. [PMID: 17994878 DOI: 10.1117/1.2795689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Selected historical aspects of the transition of optical coherence tomography (OCT) research from the bench to bedside are focused on. The primary function of the National Institutes of Health (NIH) is to improve the diagnosis and treatment of human pathologies. Therefore, research funded by the NIH should have a direct envisioned pathway for transitioning bench work to the bedside. Ultimately, to be successful, this work must be accepted by physicians and by the general science community. This typically requires robustly validated hypothesis-driven research. Work that is not appropriately compared to the current gold standard or does not address a specific pathology is unlikely to achieve widespread acceptance. I outline OCT research in the musculoskeletal and cardiovascular systems, examining the rapid transition from bench to bedside and look at initial validated hypothesis-driven research data that suggested clinical utility, which drove technology development toward specific clinical scenarios. I also consider the time of initial funding compared to when it was applied in patients with clinical pathologies. Finally, ongoing bench work being performed in parallel with clinical studies is examined. The specific applications examined here are identifying unstable coronary plaque and the early detection of osteoarthritis, the former was brought to the bedside primarily through a commercial route while the latter through NIH-funded research.
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Affiliation(s)
- Mark E Brezinski
- Brigham and Women's Hospital, Department of Orthopedic Surgery, 75 Francis Street and Harvard Medical School, Boston, Massachusetts 02115, USA.
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180
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Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, Tanimoto T, Matsuo Y, Masho T, Kitabata H, Tsuda K, Tomobuchi Y, Akasaka T. Assessment of Culprit Lesion Morphology in Acute Myocardial Infarction. J Am Coll Cardiol 2007; 50:933-9. [PMID: 17765119 DOI: 10.1016/j.jacc.2007.04.082] [Citation(s) in RCA: 613] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 04/12/2007] [Accepted: 04/17/2007] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of the present study was to evaluate the ability of optical coherence tomography (OCT) for assessment of the culprit lesion morphology in acute myocardial infarction (AMI) in comparison with intravascular ultrasound (IVUS) and coronary angioscopy (CAS). BACKGROUND Optical coherence tomography is a new intravascular imaging method with a high resolution of approximately 10 microm. This may allow us to assess the vulnerable plaques in detail in vivo. METHODS We enrolled 30 patients with AMI, and analyzed the culprit lesion by OCT, CAS, and IVUS. RESULTS The average duration from the onset of symptom to OCT imaging was 3.8 +/- 1.0 h. The incidence of plaque rupture observed by OCT was 73%, and it was significantly higher than that by CAS (47%, p = 0.035) and IVUS (40%, p = 0.009). Furthermore, OCT (23%) was superior to CAS (3%, p = 0.022) and IVUS (0%, p = 0.005) in the detection of fibrous cap erosion. The intracoronary thrombus was observed in all cases by OCT and CAS, but it was identified in 33% by IVUS (vs. OCT, p < 0.001). Only OCT could estimate the fibrous cap thickness, and it was 49 +/- 21 microm. The incidence of thin cap fibroatheroma (TCFA) was 83% in this population by OCT. CONCLUSIONS Optical coherence tomography is a feasible imaging modality in patients with AMI and allows us to identify not only plaque rupture, but also fibrous cap erosion, intracoronary thrombus, and TCFA in vivo more frequently compared with conventional imaging techniques.
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Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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181
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Hernández Antolín RA, Fernández-Vázquez F, Moreu Burgo J, López Palop R. [Interventional cardiology 2006]. Rev Esp Cardiol 2007; 60 Suppl 1:19-32. [PMID: 17352853 DOI: 10.1157/13099710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The range of applications of percutaneous coronary intervention (PCI) continues to expand and a growing number of patients are being treated, including those with extensive cardiovascular disease, more serious comorbid conditions, and more complex lesions. Even so, the success rate is high, serious complications are rare in stable patients, and the restenosis rate has been dramatically reduced by drug-eluting stents. Nevertheless, percutaneous techniques still have major limitations restricting their use in some type of lesions, such as bifurcations and total occlusions, and their role in relation to surgical revascularization has not yet been well defined in the treatment of the left main coronary artery or multivessel disease. The development of novel types of coated stent with better mechanical characteristics and a lower risk of occlusion will further expand the ambit of PCI. The role of PCI in the management of acute coronary syndromes is already well defined, and has increased the preference for an invasive rather than a conservative approach in high-risk patients without ST elevation and the preference for primary angioplasty rather than thrombolysis in those with ST elevation. The development and implementation of integrated coronary syndrome treatment networks will enable human and material resources to be used efficiently, and will guarantee rapid access to high-quality PCI for those who need it. The potential usefulness of combining cellular therapy with interventional procedures in the treatment of acute myocardial infarction has still to be determined. At present, there is extensive research into noncoronary interventions, which, in the not too distant future, could provide percutaneous treatment for the many elderly patients with severe aortic stenosis who are not currently eligible for surgery.
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182
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Burris N, Schwartz K, Tang CM, Jafri MS, Schmitt J, Kwon MH, Toshinaga O, Gu J, Brown J, Brown E, Pierson R, Poston R. Catheter-based infrared light scanner as a tool to assess conduit quality in coronary artery bypass surgery. J Thorac Cardiovasc Surg 2007; 133:419-27. [PMID: 17258576 DOI: 10.1016/j.jtcvs.2006.09.056] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 08/13/2006] [Accepted: 09/07/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Endothelial disruption within saphenous vein and radial artery grafts increases thrombosis risk. However, no clinically applicable method for imaging the intima currently exists. We used a novel infrared imaging technology, optical coherence tomography (OCT; LightLab Imaging, Inc, Westford, Mass), to visualize the intima within harvested conduits. METHODS Conduits were procured endoscopically (37 saphenous vein grafts and 8 radial artery grafts) or with the open technique (9 radial artery grafts) from 50 patients. Surplus segments were analyzed by means of OCT for evidence of preexisting pathology or traumatic injury. Focal plaques in radial artery grafts and the intimal hyperplasia area in saphenous vein grafts were quantified as having an intimal/medial thickness ratio of greater than 0.5. Biopsy specimens were obtained for histologic confirmation and to analyze matrix metalloproteinase 2 levels (saphenous vein grafts) and prostacyclin/nitric oxide metabolites (radial artery grafts). Interobserver kappa coefficients and a Bland-Altman analysis were used to determine the reproducibility and accuracy of OCT interpretations. RESULTS Radial artery imaging revealed plaque in 76%. Endoscopically harvested vessels showed intraluminal clot (38%) and intimal tears ranging from severe (6%) to mild (88%). In saphenous vein grafts intimal thickening was detected in 86% and intraluminal clotting in 68%. The intimal/medial thickness ratio determined by means of OCT correlated directly with matrix metalloproteinase 2 levels (R = 0.6804) in saphenous vein grafts and inversely with metabolites of prostacyclin (R = -0.55) and nitric oxide (R = -0.58) in radial artery grafts. OCT imaging was reproducible (interobserver kappa coefficients of >0.81 for the characterization of plaque types) and showed a strong correlation with histology (R = 0.8, P < .001). CONCLUSIONS OCT imaging provides an accurate, real-time, and reproducible means for assessing saphenous vein graft and radial artery graft bypass conduits. As a quality assurance tool, this technology might afford a more objective basis for conduit selection.
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Affiliation(s)
- Nicholas Burris
- Department of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, Md 21201, USA
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183
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Abstract
Rupture of vulnerable plaque (VP) is responsible for most coronary events. Optical coherence tomography (OCT) is a high-resolution imaging method that allows excellent characterization of atherosclerotic plaque. While this technique is limited by the need to interrupt blood flow and a shallow depth of penetration, its resolution is an order of magnitude greater than possible with intravascular ultrasound (IVUS), and it has demonstrated better sensitivity and specificity for accurately determining plaque composition. Early in vitro and in vivo experiences have affirmed the excellent quality of these images making it an attractive technology for the analysis of VP. Its high resolution likely renders it the best imaging modality currently available for the evaluation of proper stent deployment and of intracoronary pathology in the setting of percutaneous coronary interventions (PCI). Our institution is currently involved in a multicenter trial to evaluate the effectiveness of OCT when compared to IVUS in this setting. Ongoing technological improvements aim to permit rapid scanning which should alleviate its current major limitation of needing to scan in a blood-free space. OCT is a promising new technology in the evaluation of atherosclerotic plaque and coronary microstructure.
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Affiliation(s)
- Tina L Pinto
- Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA
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Kume T, Akasaka T, Kawamoto T, Okura H, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K. Measurement of the thickness of the fibrous cap by optical coherence tomography. Am Heart J 2006; 152:755.e1-4. [PMID: 16996853 DOI: 10.1016/j.ahj.2006.06.030] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Accepted: 06/06/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Identification of the fibrous cap is important because its thickness is a major determinant of plaque vulnerability in lipid-rich plaque. Thus, a high-resolution imaging technique may be a promising method for the identification of the fibrous cap within lipid-rich plaque. The purpose of this study was to investigate the feasibility of using optical coherence tomography (OCT) to measure the thickness of the fibrous cap within lipid-rich plaque. METHODS AND RESULTS We examined 35 lipid-rich plaques from 102 coronary arterial segments of 38 human cadavers (22 men and 16 women; mean ages, 74 +/- 7 years). Optical coherence tomography and corresponding histological images were digitized for measurement of the thickness of fibrous cap, and the results between OCT and histological examination were compared. There was good correlation of the thickness of the fibrous cap between OCT and histological examination (y = 0.97x + 28.49; r = 0.90; P < .001). A Bland-Altman test showed good agreement of the thickness of the fibrous cap between OCT and histological examination (mean difference, -24 +/- 44 microm). CONCLUSIONS Optical coherence tomography provides an accurate representation of the thickness of the fibrous cap and may prove useful in assessing plaque vulnerability in lipid-rich plaque.
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Affiliation(s)
- Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, Kurashiki 701-0192, Japan.
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