1
|
Li Z, Tang Z, Wang Y, Liu Z, Wang G, Zhang L, Wu Y, Guo J. Assessment of radial artery atherosclerosis in acute coronary syndrome patients: an in vivo study using optical coherence tomography. BMC Cardiovasc Disord 2022; 22:120. [PMID: 35313827 PMCID: PMC8939080 DOI: 10.1186/s12872-022-02561-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Radial artery (RA) atherosclerosis in acute coronary syndrome (ACS) patients has not been systematically observed in vivo. The study aims to characterize plaque morphology and intimal hyperplasia of the RA in patients with ACS, using optical coherence tomography (OCT). Methods In this retrospective study involving 239 ACS patients underwent RA OCT without guidewire shadow, 3 groups were divided according to the following criteria: radial artery plaque (RAP) group included patients with fibrous, lipid or calcified plaque; patients without RAP were further classified into radial intimal hyperplasia (RIH) group (intima media thickness ratio [IMR] ≥ 1) or normal group (IMR < 1). The presence and characteristics of RAP and its related risk factors were identified. Results The RAP, RIH and normal groups included 76 (31.8%), 69 (28.9%) and 94 (39.3%) patients, respectively. Patients in RAP group were the oldest, compared with those in the RIH and normal groups (p < 0.001), and more frequently had triple vessel disease (p = 0.004). The percentage of plaque rupture (72.4% vs. 56.4%, p = 0.018) and calcification (42.1% vs. 27.6%, p = 0.026) at culprit lesion were significantly higher in patients with RAP than those without RAP. A total of 148 RAP were revealed by OCT, including fibrous (72, 48.6%), lipid (50, 33.8%) and calcified plaques (26, 17.6%). The microvessels were also frequently observed in the RAP group than that in RIH and normal groups (59.2% vs. 8.7% vs. 9.6%, p < 0.001). Multivariate logistic regression analysis showed that age, diabetes, and smoking history (all p < 0.05) were independent risk factors for RAP. Conclusions In terms of insights gained from OCT, RA atherosclerosis is not uncommon in ACS patients by OCT, sharing several morphological characters with early coronary atherosclerosis. Aging, diabetes, and smoking are risk factors for RAP. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02561-5.
Collapse
Affiliation(s)
- Zixuan Li
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhe Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Wang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zijing Liu
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Guozhong Wang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Libin Zhang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yongxia Wu
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jincheng Guo
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
2
|
Sato M, Masuta J, Nishidate I. Differential phase imaging in full-field optical coherence microscopy using a short multimode fiber probe. APPLIED OPTICS 2020; 59:10512-10522. [PMID: 33361986 DOI: 10.1364/ao.405226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/27/2020] [Indexed: 06/12/2023]
Abstract
We demonstrate phase imaging that reduces the common phase noise in full-field optical coherence microscopy using a short multimode fiber (SMMF) probe. Using a cover glass, phase images of the SMMF and sample surfaces were measured simultaneously. Subtracting the phase of the SMMF surface as a reference, the phase drifts in the sample region are reduced. The axial and lateral resolutions were 2.3 µm and <4.4µm, respectively. The standard deviation of the time variation in the phase decreased from 14.3 deg to 9.2 deg and was reduced by 64% when in contact with the polymer film at the SMMF. In quantitative evaluations, the measured phases closely correspond to the phases changed by a piezoelectric device.
Collapse
|
3
|
Pettersen Ø, Pociask E, Malinowski KP, Slezak M, Hegbom K, Wiseth R, Nordhaug DO. Reproducibility of optical coherence tomography in vein grafts used for coronary revascularization. Cardiol J 2018; 27:518-523. [PMID: 30444258 DOI: 10.5603/cj.a2018.0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/11/2018] [Accepted: 09/02/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Optical coherence tomography (OCT) is a high-resolution imaging modality able to provide near-histological images of vessel walls making it possible to distinguish intima and media layers of the vessel wall separately. The use of this imaging technique is increasing while data on the variability and reliability is lacking. The aim of this study was to investigate the reproducibility of frequency-domain OCT in vein grafts used for coronary revascularization. METHODS Five pullbacks were analyzed by the same analyst with a 1-month delay (intraobserver) and by two different analysts (interobserver). Five pairs of pullbacks from the same catheters and vein graft were also analyzed (inter pullback). RESULTS Optical coherence tomography showed low variability in intra- and interobserver analysis with relative differences of mean media and intima thicknesses and areas of less than 5% for most parameters. Relative differences of the same parameters in the inter pullback analysis were in the 5-15% range. Intra- and interobserver reliability was excellent (intraclass correlation coefficient [ICC] > 0.90) for intima thickness and intima, media and intima-media area measurements. Inter pullback reliability was good (ICC: 0.75-0.90) for intima and intima-media area measurements, and moderate to good for mean intima thickness measurements (ICC: 0.79; 0.7338-0.8284). CONCLUSIONS Optical coherence tomography provides good reproducibility for the measurements of parameters relevant for the development of atherosclerosis in vein grafts. CLINICAL TRIAL REGISTRATION ID NCT01834846.
Collapse
Affiliation(s)
- Øystein Pettersen
- Department of Cardiothoracic Surgery, St. Olav's University Hospital, Prinsesse Kristina gate 3, 7030 Trondheim, Norway. .,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway.
| | - Elżbieta Pociask
- Krakow Cardiovascular Research Institute, Krakow, Poland.,AGH University of Science and Technology, Department of Biocybernetics and Biomedical Engineering, Krakow, Poland
| | - Krzysztof P Malinowski
- Krakow Cardiovascular Research Institute, Krakow, Poland.,Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | | | - Knut Hegbom
- Department of Cardiology, St. Olav's Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Rune Wiseth
- Department of Cardiology, St. Olav's Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Dag Ole Nordhaug
- Department of Cardiothoracic Surgery, St. Olav's University Hospital, Prinsesse Kristina gate 3, 7030 Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| |
Collapse
|
4
|
Abstract
We investigated the impact of preoperative ultrasonography of the forearm circulation on radial artery conduit selection. Preoperative ultrasound of the forearm circulation was performed routinely in 536 patients planned for radial artery harvesting. The safety assessment of the harvest included the following algorithm of tests: the ultrasound, the Allen test, and pulse oximetry. The quality criteria that were used to exclude a radial artery from harvesting were small size of the artery, diffuse atherosclerosis, calcifications, and severe neointimal hyperplasia. The overall rejection rate due to safety reasons was 16.4%. Seventy-one (13.2%) radial arteries did not fulfill the conduit quality criteria and consequently these arteries were not harvested. In 13.4% of radial arteries, localized arterial wall disease was found in the distal third of the artery. The distal part of the artery was discarded and the rest was used as a conduit. Our results indicate that the ultrasound provides an accurate preoperative insight into the radial artery morphology, enabling selection of the arteries with favorable morphological features.
Collapse
|
5
|
Gür DÖ, Gür Ö, Gürkan S, Cömez S, Gönültaş A, Yılmaz M. Comparison of endothelial function of coronary artery bypass grafts in diabetic and nondiabetic patients: Which graft offers the best? Anatol J Cardiol 2016; 15:657-62. [PMID: 26301347 PMCID: PMC5336867 DOI: 10.5152/akd.2014.5613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Diabetes associated endothelial dysfunction, which determines both long and short term graft patency, is not uniform in all coronary artery bypass surgery (CABG) grafts. Herein this study, we aimed to investigate the degree of endothelial dysfunction in diabetic radial artery (RA), internal mammarian artery (IMA) and saphenous vein (SV) grafts in vitro tissue bath system. METHODS This is a prospective experimental study. Fifteen diabetic and 15 non-diabetic patients were included to the study. A total number of 96 graft samples were collected; 16 graft samples for each graft type from both diabetic and non-diabetic patients. Arterial grafts were harvested with pedicles and SV grafts were harvested by 'no touch' technique. Vasodilatation response of vascular rings to carbachol, which induces nitric oxide (NO) mediated vasodilatation, was designated as the measure of endothelial function. RESULTS The IMA grafts had the most prominent NO mediated vasodilatation in both diabetic and non-diabetic patients, concluding a better preserved endothelial function than SV and RA. The 'no- touch' SV and RA grafts had similar vasodilatation responses in non-diabetic patients. In diabetic patients, on the other hand, RA grafts exhibited the least vasodilatation response (ie. worst endothelial function), even less vasodilatation than 'no touch' SV grafts (p<0.0001). CONCLUSION Deteriorated function of RA grafts in diabetic patients, even worse than SV grafts made evident by this study, encourages the use of 'no touch' technique as the method of SV harvesting and more meticulous imaging of RA before its use as a graft in diabetic patients.
Collapse
|
6
|
Oldenburg AL, Yu X, Gilliss T, Alabi O, Taylor RM, Troester MA. Inverse-power-law behavior of cellular motility reveals stromal-epithelial cell interactions in 3D co-culture by OCT fluctuation spectroscopy. OPTICA 2015; 2:877-885. [PMID: 26973862 PMCID: PMC4783137 DOI: 10.1364/optica.2.000877] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The progression of breast cancer is known to be affected by stromal cells within the local microenvironment. Here we study the effect of stromal fibroblasts on the in-place motions (motility) of mammary epithelial cells within organoids in 3D co-culture, inferred from the speckle fluctuation spectrum using optical coherence tomography (OCT). In contrast to Brownian motion, mammary cell motions exhibit an inverse power-law fluctuation spectrum. We introduce two complementary metrics for quantifying fluctuation spectra: the power-law exponent and a novel definition of the motility amplitude, both of which are signal- and position-independent. We find that the power-law exponent and motility amplitude are positively (p<0.001) and negatively (p<0.01) correlated with the density of stromal cells in 3D co-culture, respectively. We also show how the hyperspectral data can be visualized using these metrics to observe heterogeneity within organoids. This constitutes a simple and powerful tool for detecting and imaging cellular functional changes with OCT.
Collapse
Affiliation(s)
- Amy L. Oldenburg
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7513
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7295
- Corresponding author:
| | - Xiao Yu
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7513
| | - Thomas Gilliss
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255
| | - Oluwafemi Alabi
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3175
| | - Russell M. Taylor
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3175
| | - Melissa A. Troester
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7295
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435
| |
Collapse
|
7
|
Di Vito L, Porto I, Burzotta F, Trani C, Pirozzolo G, Niccoli G, Leone A, Crea F. Radial artery intima-media ratio predicts presence of coronary thin-cap fibroatheroma: A frequency domain-optical coherence tomography study. Int J Cardiol 2013; 168:1917-22. [DOI: 10.1016/j.ijcard.2012.12.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 11/05/2012] [Accepted: 12/26/2012] [Indexed: 01/19/2023]
|
8
|
Song SW, Sul SY, Lee HJ, Yoo KJ. Comparison of the radial artery and saphenous vein as composite grafts in off-pump coronary artery bypass grafting in elderly patients: a randomized controlled trial. Korean Circ J 2012; 42:107-12. [PMID: 22396698 PMCID: PMC3291720 DOI: 10.4070/kcj.2012.42.2.107] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 09/22/2011] [Accepted: 09/22/2011] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Arterial grafts have a better long-term patency rate than saphenous vein (SV) when used in off-pump coronary artery bypass surgery (OPCAB). However, arterial grafts in elderly patients are often diseased. We sought to compare the early outcomes achieved by using the two different types of composite grafts. Subjects and Methods We conducted a randomized trial to compare radial artery (RA) and SV composite grafts based on the in situ left internal mammary artery in 60 elderly (>70 years old) patients, who were scheduled to undergo OPCAB. Clinical outcomes and 1-year postoperative CT angiography results were compared. The quality of the conduit was evaluated by employing vascular ultrasonography, optical coherence tomography (OCT), and histologic examination. Results No differences in immediate postoperative morbidity and mortality were observed between the two groups. Early postoperative CT angiography revealed a SV patency rate of 100%, which was not different from that of RA composite grafts (99.1%). CT angiography after a year showed an overall patency rate of 96.3%. The overall patency rate of the SV group at 1 year was 94.7%, which was similar to that of the RA group (97.4%). Also, there was no difference in overall survival rate between the two groups. Vascular ultrasonographic images showed strong correlations between OCT and histopathology. Conclusion Our analysis of early outcomes revealed that the SV could be used as an alternative composite graft to the RA in elderly patients. Vascular ultrasonography is an accurate, real-time, and reproducible method for assessing the quality of the RA conduit.
Collapse
Affiliation(s)
- Suk-Won Song
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|
9
|
Liang CP, Wierwille J, Moreira T, Schwartzbauer G, Jafri MS, Tang CM, Chen Y. A forward-imaging needle-type OCT probe for image guided stereotactic procedures. OPTICS EXPRESS 2011; 19:26283-94. [PMID: 22274213 PMCID: PMC3297117 DOI: 10.1364/oe.19.026283] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A forward-imaging needle-type optical coherence tomography (OCT) probe with Doppler OCT (DOCT) capability has the potential to solve critical challenges in interventional procedures. A case in point is stereotactic neurosurgery where probes are advanced into the brain based on predetermined coordinates. Laceration of blood vessels in front of the advancing probe is an unavoidable complication with current methods. Moreover, cerebrospinal fluid (CSF) leakage during surgery can shift the brain rendering the predetermined coordinates unreliable. In order to address these challenges, we developed a forward-imaging OCT probe (740 μm O.D.) using a gradient-index (GRIN) rod lens that can provide real-time imaging feedback for avoiding at-risk vessels (8 frames/s with 1024 A-scans per frame for OCT/DOCT dual imaging) and guiding the instrument to specific targets with 12 μm axial resolution (100 frames/s with 160 A-scans per frame for OCT imaging only). The high signal-to-background characteristic of DOCT provides exceptional sensitivity in detecting and quantifying the blood flow within the sheep brain parenchyma in real time. The OCT/DOCT dual imaging also demonstrated its capability to differentiate the vessel type (artery/vein) on rat's femoral vessels. We also demonstrated in ex vivo human brain that the location of the tip of the OCT probe can be inferred from micro-anatomical landmarks in OCT images. These findings demonstrate the suitability of OCT guidance during stereotactic procedures in the brain and its potential for reducing the risk of cerebral hemorrhage.
Collapse
Affiliation(s)
- Chia-Pin Liang
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742
USA
| | - Jeremiah Wierwille
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742
USA
| | - Thais Moreira
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201
USA
- Research Service, Baltimore VA Medical Center, Baltimore, MD 21201
USA
| | - Gary Schwartzbauer
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201
USA
| | - M. Samir Jafri
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201
USA
- Research Service, Baltimore VA Medical Center, Baltimore, MD 21201
USA
| | - Cha-Min Tang
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201
USA
- Research Service, Baltimore VA Medical Center, Baltimore, MD 21201
USA
| | - Yu Chen
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742
USA
| |
Collapse
|
10
|
Oldenburg AL, Wu G, Spivak D, Tsui F, Wolberg AS, Fischer TH. Imaging and Elastometry of Blood Clots Using Magnetomotive Optical Coherence Tomography and Labeled Platelets. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2011; 18:1100-1109. [PMID: 23833549 PMCID: PMC3700352 DOI: 10.1109/jstqe.2011.2162580] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Improved methods for imaging and assessment of vascular defects are needed for directing treatment of cardiovascular pathologies. In this paper, we employ magnetomotive optical coherence tomography (MMOCT) as a platform both to detect and to measure the elasticity of blood clots. Detection is enabled through the use of rehydrated, lyophilized platelets loaded with superparamagnetic iron oxides (SPIO-RL platelets) that are functional infusion agents that adhere to sites of vascular endothelial damage. Evidence suggests that the sensitivity for detection is improved over threefold by magnetic interactions between SPIOs inside RL platelets. Using the same MMOCT system, we show how elastometry of simulated clots, using resonant acoustic spectroscopy, is correlated with the fibrin content of the clot. Both methods are based upon magnetic actuation and phase-sensitive optical monitoring of nanoscale displacements using MMOCT, underscoring its utility as a broad-based platform to detect and measure the molecular structure and composition of blood clots.
Collapse
Affiliation(s)
- Amy L. Oldenburg
- Department of Physics and Astronomy and the Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255 USA
| | - Gongting Wu
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255 USA
| | - Dmitry Spivak
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255 USA
| | - Frank Tsui
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255 USA
| | - Alisa S. Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7525 USA
| | - Thomas H. Fischer
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7525 USA
| |
Collapse
|
11
|
Endoscopic vein harvesting for coronary artery bypass grafting. Five-year single centre experience. COR ET VASA 2011. [DOI: 10.33678/cor.2011.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Yonetsu T, Kakuta T, Lee T, Takayama K, Kakita K, Iwamoto T, Kawaguchi N, Takahashi K, Yamamoto G, Iesaka Y, Fujiwara H, Isobe M. Assessment of acute injuries and chronic intimal thickening of the radial artery after transradial coronary intervention by optical coherence tomography. Eur Heart J 2010; 31:1608-15. [PMID: 20413398 DOI: 10.1093/eurheartj/ehq102] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Transradial coronary intervention (TRI) introduces a trauma to the radial artery (RA), possibly influencing quality as a bypass conduit if subsequently used. We sought to determine the acute and chronic effects of TRI on the RA by optical coherence tomography (OCT). METHODS AND RESULTS Immediately after TRI completion, 73 RAs in 69 patients were examined. The sheath was pulled back 2 cm distal to the puncture site, and OCT imaging was performed. The acute injuries and intimal thickening were compared between first-TRI RAs and repeat-TRI RAs. Intimal tears were observed in 49 RAs (67.1%) and were more frequent in the distal than in the proximal RA (P = 0.001). Medial dissections were not uncommon (26 RAs, 35.6%). The frequency of acute injury was significantly higher in repeat-TRI RAs (P < 0.001). Intima/medial area, the maximum intimal thickness/medial thickness ratio, and per cent narrowing were all significantly greater in repeat-TRI RAs in the distal and proximal RA. Multivariate analysis revealed that a repeated TRI procedure was the only independent predictor of intimal thickening. CONCLUSION Optical coherence tomography clearly demonstrated significant acute injuries and chronic intimal thickening of RA after TRI. Further study should evaluate the impact of these effects when TRI RAs are subsequently used as conduits, on long-term graft patency and on clinical outcomes after bypass surgery.
Collapse
Affiliation(s)
- Taishi Yonetsu
- Department of Cardiology, Tsuchiura Kyodo Hospital, 11-7, Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Desai PH, Kurian D, Thirumavalavan N, Desai SP, Ziu P, Grant M, White C, Landis RC, Poston RS. A randomized clinical trial investigating the relationship between aprotinin and hypercoagulability in off-pump coronary surgery. Anesth Analg 2009; 109:1387-94. [PMID: 19843776 DOI: 10.1213/ane.0b013e3181b81068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Off-pump coronary artery bypass (OPCAB) surgery is associated with a hypercoagulable state in which the platelet thrombin receptor, protease-activated receptor-1 (PAR-1), helps propagate a thrombin burst within saphenous vein grafts. Aprotinin, used in cardiothoracic surgery mainly for its antifibrinolytic properties, also spares platelet PAR-1 activation due to thrombin. We hypothesized that this PAR-1 antagonistic property provides an antithrombotic benefit during OPCAB surgery. METHODS Patients were randomly assigned to receive saline (n = 38) or a modified full-dose regimen of aprotinin (n = 37) IV during OPCAB surgery. Blood sampled perioperatively from the coronary sinus, skin wounds, and systemic circulation was analyzed to test coagulation and platelet function. Major adverse cardiovascular events were monitored by obtaining troponin I at 24 h (myocardial infarction), predischarge computed tomography angiography (vein graft thrombosis), and by clinical examination for stroke. RESULTS Coronary sinus blood obtained immediately after OPCAB surgery showed significantly less activation in the aprotinin group, as judged by reduced formation of platelet-leukocyte conjugates (P < 0.02) and platelet-derived microparticles (P < 0.05). The aprotinin group showed inhibition of platelet aggregation induced by thrombin (P = 0.007) but not adenosine diphosphate. Thrombin generation, defined by F1.2 levels, was significantly reduced by aprotinin in the coronary sinus but not in skin wound incisions. Major adverse cardiovascular events were significantly reduced in aprotinin-treated patients (5.4% vs 29.7%, P < 0.05). Aprotinin also demonstrated antifibrinolytic properties through diminished red blood cell transfusion (P < 0.04) and reduced blood loss postoperatively (603 +/- 330 vs 810 +/- 415 mL, P < 0.004). CONCLUSION This study demonstrates that aprotinin protects patients undergoing OPCAB surgery from a hypercoagulable state by diminishing thrombin-induced platelet activation and thrombin generation within saphenous vein grafts, while maintaining systemic hemostatic and antifibrinolytic benefits. These results support further investigation of aprotinin and other PAR-1 antagonists in OPCAB surgery.
Collapse
Affiliation(s)
- Pranjal H Desai
- Department of Cardiothoracic Surgery, Boston University and School of Medicine and Boston Medical Centre, Boston, MA 02118, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Brazio PS, Laird PC, Xu C, Gu J, Burris NS, Brown EN, Kon ZN, Poston RS. Harmonic scalpel versus electrocautery for harvest of radial artery conduits: reduced risk of spasm and intimal injury on optical coherence tomography. J Thorac Cardiovasc Surg 2008; 136:1302-8. [PMID: 19026820 DOI: 10.1016/j.jtcvs.2008.05.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Revised: 04/27/2008] [Accepted: 05/25/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Vasospasm is the primary obstacle to widespread adoption of the radial artery as a conduit in coronary artery bypass grafting. We used optical coherence tomography, a catheter-based intravascular imaging modality, to measure the degree of radial artery spasm induced by means of harvest with electrocautery or a harmonic scalpel in patients undergoing coronary artery bypass grafting. METHODS Radial arteries were harvested from 44 consecutive patients with a harmonic scalpel (n = 15) or electrocautery (n = 29). Vessels were imaged before harvesting and after removal from the arm, with saphenous vein tracts serving as internal controls. Optical coherence tomographic findings for the degree of harvesting-induced injury were validated against histologic measures. RESULTS Optical coherence tomographic measures of endovascular dimensions and injury correlated strongly with histologic findings. Mean luminal volume, a measure of vasospasm, decreased significantly less after harvesting with a harmonic scalpel (9% +/- 7%) than with electrocautery (35% +/- 6%, P = .015). Completely intact intima was present in 11 (73%) of 15 radial arteries harvested with a harmonic scalpel (73%) compared with 9 of 29 arteries harvested by means of electrocautery (31%, P = .011). Intraoperative flow measurements and patency rates at 5 days postoperatively were not significantly different among groups. CONCLUSIONS Optical coherence tomography provides a level of speed and accuracy for quantifying endothelial injury and vasospasm that has not been described for any other modality, suggesting potential as an intraoperative quality assurance tool. Our optical coherence tomographic findings suggest that the harmonic scalpel induces less spasm and intimal injury compared with electrocautery.
Collapse
Affiliation(s)
- Philip S Brazio
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Brown EN, Burris NS, Kon ZN, Grant MC, Brazio PS, Xu C, Laird P, Gu J, Kallam S, Desai P, Poston RS. Intraoperative detection of intimal lipid in the radial artery predicts degree of postoperative spasm. Atherosclerosis 2008; 205:466-71. [PMID: 19264305 DOI: 10.1016/j.atherosclerosis.2008.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 12/01/2008] [Accepted: 12/06/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND The radial artery's (RA) tendency to spasm when used as a bypass graft may relate to features of the RA itself. We imaged RA conduits before and after CABG in order to characterize intimal abnormalities that might relate to the risk of spasm. METHODS RA conduits from thirty-two CABG patients were imaged intraoperatively using catheter-based optical coherence tomography (OCT) and again on day 5 using 64-channel MDCT angiography. The change in luminal diameter between timepoints was measured in the proximal, mid and distal RA. "Spasm" was defined as focal or diffuse luminal narrowing to a diameter less than the target coronary. Lipid content in the RA was quantified by the degree of light attenuation on the OCT image. RESULTS Postoperative spasm was diagnosed in 18 of 32 (56%) RA grafts with the distal RA showing the most severe change versus the mid and proximal portions (-24.1+/-43.2% vs. -15.3+/-40.7%, -9.0+/-42.5% change in diameter respectively, p<0.01). The degree of attenuation of the OCT signal produced by the RA was strongly correlated with % diameter change (R=0.64, p=0.0005) and was significantly more pronounced in grafts with spasm versus no spasm (-1.97+/-0.61mm(-1) vs. -0.81+/-0.57mm(-1), p<0.0001). Histology confirmed lipid deposits in areas of RA with strong attenuation. CONCLUSIONS RA conduits otherwise considered acceptable for bypass grafting were often found by OCT imaging to have a substantial amount of lipid, which in turn strongly relates to the risk of postoperative spasm. Screening conduits based on characteristics of intimal quality may improve results following RA grafting.
Collapse
Affiliation(s)
- Emile N Brown
- University of Maryland School of Medicine, Department of Surgery, Baltimore, United States
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
|
17
|
Lin J, Staecker H, Jafri MS. Optical Coherence Tomography Imaging of the Inner Ear: A Feasibility Study with Implications for Cochlear Implantation. Ann Otol Rhinol Laryngol 2008; 117:341-6. [DOI: 10.1177/000348940811700503] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cochlear implantation is now being performed in ears with residual hearing. Those implant recipients who keep residual hearing may benefit from improved pitch resolution through both electrical and acoustic hearing. Preservation of cochlear function after implantation is a challenging task for the surgeon. Current topics of hearing preservation research include electrode design and surgical technique. To maintain hearing, surgeons strive to create a cochleostomy and place the electrode in a minimally traumatic fashion. In this study, we examine a novel catheter-based real-time imaging modality with 10- to 15-μm resolution, optical coherence tomography (OCT), on the inner ear. We demonstrate the capability of OCT to allow visualization of inner ear structures through bone in live mice. We additionally used OCT to image the inner ear in a human temporal bone. Optical coherence tomography was able to delineate soft tissue structures within the cochlea and may be useful as an adjunct to cochlear implantation. Other potential otologic applications of OCT are discussed.
Collapse
|
18
|
Burris NS, Brown EN, Grant M, Kon ZN, Gibber M, Gu J, Schwartz K, Kallam S, Joshi A, Vitali R, Poston RS. Optical coherence tomography imaging as a quality assurance tool for evaluating endoscopic harvest of the radial artery. Ann Thorac Surg 2008; 85:1271-7. [PMID: 18355508 DOI: 10.1016/j.athoracsur.2007.12.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 12/06/2007] [Accepted: 12/10/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Concerns about intimal disruption and spasm have limited enthusiasm for endoscopic radial artery harvest (ERAH), although the risk of these problems after this procedure remains uncertain. Radial artery conduits were screened intraoperatively before and after ERAH vs open harvest using catheter-based high-resolution optical coherence tomography (OCT) imaging. METHODS Twenty-four cadavers and 60 coronary artery bypass graft (CABG) patients scheduled to receive a RA graft underwent OCT imaging before (in situ) and after (ex vivo) open harvest or ERAH. Spasm was quantified by the percentage change in luminal volume between images. Intimal disruption was classified as minor or severe depending on whether the defect was confined to branch ostia or involved the luminal surface. Histology was used to confirm OCT findings. RESULTS Luminal volume significantly declined after harvest in all RAs from CABG patients, but there was no difference between groups: -43% +/- 29% vs -35% +/- 38% change after ERAH (n = 21) vs open harvest (n = 39; p = 0.342). Significantly more intimal injury was noted after ERAH vs open harvest (34/41 vs 9/43, intimal tears/total evaluated RAs, p < 0.0001). Most intimal injury was minor: only 2 tears involved the luminal surface of the RA (both after ERAH). Serial imaging in cadavers revealed that 86% of ostial tears occur in ERAH during the initial blunt dissection step using the endoscope. CONCLUSIONS Although branch injury is a pitfall of ERAH, OCT imaging documented that the quality of RA procured is acceptable and comparable with open harvest. Catheter-based OCT provides an important quality assurance tool for RA harvest.
Collapse
Affiliation(s)
- Nicholas S Burris
- Department of Surgery, University of Maryland, Baltimore, Maryland 21201, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Brown EN, Kon ZN, Tran R, Burris NS, Gu J, Laird P, Brazio PS, Kallam S, Schwartz K, Bechtel L, Joshi A, Zhang S, Poston RS. Strategies to reduce intraluminal clot formation in endoscopically harvested saphenous veins. J Thorac Cardiovasc Surg 2007; 134:1259-65. [PMID: 17976458 DOI: 10.1016/j.jtcvs.2007.07.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 07/10/2007] [Accepted: 07/24/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Residual clot strands within the excised saphenous vein are an increasingly recognized sequela of endoscopic vein harvest. We hypothesized that endoscopic visualization facilitated by sealed carbon dioxide insufflation causes stagnation of blood within the saphenous vein. In the absence of prior heparin administration, this stasis provokes clot formation. METHODS Forty consecutive patients having coronary artery bypass grafting underwent endoscopic vein harvest using sealed (Guidant VasoView, n = 30; Guidant Corp, Minneapolis, Minn) or open (Datascope ClearGlide, n = 10; Datascope Corp, Montvale, NJ) carbon dioxide insufflation followed by ex vivo assessment of intraluminal saphenous vein clot via optical coherence tomography. In the sealed carbon dioxide insufflation groups, clot formation was compared with (preheparinized, n = 20) and without (control, n = 10) heparin administration before endoscopic vein harvest, either at a fixed dose or titrated to an activated clotting time greater than 300 seconds. Risk factors for clot formation were assessed. RESULTS Residual saphenous vein clot was a universal finding in control veins (sealed carbon dioxide insufflation endoscopic vein harvest without preheparinization). At either dose used, heparin given before endoscopic vein harvest significantly decreased saphenous vein clot burden. A similar reduction in clot was observed when using open carbon dioxide insufflation endoscopic vein harvest without preheparinization. Intraoperative blood loss and blood product requirements were similar in all groups. Patient age and preoperative maximum amplitude of the thrombelastography tracing showed a linear correlation with saphenous vein clot volume. CONCLUSION By enabling the quantification of this issue as never before possible, optical coherence tomography screening revealed that intraluminal saphenous vein clot is frequently found after endoscopic vein harvest. Systemic heparinization before harvest or an open carbon dioxide endoscopic vein harvest system are benign changes in practice that can significantly lessen this complication.
Collapse
Affiliation(s)
- Emile N Brown
- Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md 21201, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Brown EN, Burris NS, Gu J, Kon ZN, Laird P, Kallam S, Tang CM, Schmitt JM, Poston RS. Thinking inside the graft: applications of optical coherence tomography in coronary artery bypass grafting. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:051704. [PMID: 17994877 PMCID: PMC2962582 DOI: 10.1117/1.2799521] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Recent advances in catheter-based optical coherence tomography (OCT) have provided the necessary resolution and acquisition speed for high-quality intravascular imaging. Complications associated with clearing blood from the vessel of a living patient have prevented its wider acceptance. We identify a surgical application that takes advantage of the vascular imaging powers of OCT but that circumvents the difficulties. Coronary artery bypass grafting (CABG) is the most commonly performed major surgery in America. A critical determinant of its outcome has been postulated to be injury to the conduit vessel incurred during the harvesting procedure or pathology preexistent in the harvested vessel. As a test of feasibility, intravascular OCT imaging is obtained from the radial arteries (RAs) and/or saphenous veins (SVs) of 35 patients scheduled for CABG. Pathologies detected by OCT are compared to registered histological sections obtained from discarded segments of each graft. OCT reliably detects atherosclerotic lesions in the RAs and discerns plaque morphology as fibrous, fibrocalcific, or fibroatheromatous. OCT is also used to assess intimal trauma and residual thrombi related to endoscopic harvest and the quality of the distal anastomosis. We demonstrate the feasibility of OCT imaging as an intraoperative tool to select conduit vessels for CABG.
Collapse
Affiliation(s)
- Emile N Brown
- University of Maryland, School of Medicine, Department of Cardiac Surgery, 22 South Greene Street N4W94, Baltimore, Maryland 21201, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Kon ZN, White C, Kwon MH, Judy J, Brown EN, Gu J, Burris NS, Laird PC, Brown T, Brazio PS, Gammie J, Brown J, Griffith BP, Poston RS. The role of preexisting pathology in the development of neointimal hyperplasia in coronary artery bypass grafts. J Surg Res 2007; 142:351-6. [PMID: 17631906 PMCID: PMC4146434 DOI: 10.1016/j.jss.2007.03.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 03/15/2007] [Accepted: 03/20/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Saphenous vein grafts (SVG) used for coronary artery bypass surgery (CABG) often develop a gradual luminal narrowing over the first year due to neointimal hyperplasia (NH). Although the basic science of NH is well studied, our clinical understanding of this issue is limited. The purpose of this cohort study was to investigate clinical risk factors for NH by monitoring luminal narrowing within SVG using multichannel CT angiography (CTA). METHODS Thirty patients underwent CABG involving SVG (N = 44) and arterial grafts (N = 36). Patient variables were recorded and the baseline quality of each conduit determined intraoperatively by analyzing surplus segments for intima-media thickness ratio (IMT) by histology and matrix metalloproteinase-2 by enzyme-linked immunosorbent assay. Percent luminal narrowing (%LN) was calculated for each patent graft by comparing the CTA appearance on day 5 to a repeat study at 1 y. RESULTS Compared with arterial grafts, SVG showed significantly higher IMT at baseline (0.9 +/- 0.65 versus 0.22 +/- 0.17, P < 0.0001) and more %LN over the first year (6.9 +/- 7.5 versus 25.3 +/- 13.3% LN, P< 0.0001). Of all of the measured variables, the only significant predictors of %LN included baseline IMT (r = 0.58, P = 0.002) and matrix metalloproteinase-2 levels (r = 0.60, P = 0.002) in SVG. CONCLUSIONS The degree of NH at baseline, a phenomenon exclusive to SVG and not found in arterial grafts, was significantly related to the development of lumen loss in the conduit over the first year after CABG. The study of SVG using serial CTA may provide unique insights into the natural history of SVG remodeling and to identify factors that influence the long-term function of this conduit.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Robert S. Poston
- To whom correspondence and reprint requests should be addressed at Division of Cardiac Surgery, University of Maryland, School of Medicine, N4W94 22 S. Greene St., Baltimore, MD 21201.
| |
Collapse
|