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Blanco PJ, Ziemer PGP, Bulant CA, Ueki Y, Bass R, Räber L, Lemos PA, García-García HM. Fully automated lumen and vessel contour segmentation in intravascular ultrasound datasets. Med Image Anal 2021; 75:102262. [PMID: 34670148 DOI: 10.1016/j.media.2021.102262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Segmentation of lumen and vessel contours in intravascular ultrasound (IVUS) pullbacks is an arduous and time-consuming task, which demands adequately trained human resources. In the present study, we propose a machine learning approach to automatically extract lumen and vessel boundaries from IVUS datasets. The proposed approach relies on the concatenation of a deep neural network to deliver a preliminary segmentation, followed by a Gaussian process (GP) regressor to construct the final lumen and vessel contours. A multi-frame convolutional neural network (MFCNN) exploits adjacency information present in longitudinally neighboring IVUS frames, while the GP regression method filters high-dimensional noise, delivering a consistent representation of the contours. Overall, 160 IVUS pullbacks (63 patients) from the IBIS-4 study (Integrated Biomarkers and Imaging Study-4, Trial NCT00962416), were used in the present work. The MFCNN algorithm was trained with 100 IVUS pullbacks (8427 manually segmented frames), was validated with 30 IVUS pullbacks (2583 manually segmented frames) and was blindly tested with 30 IVUS pullbacks (2425 manually segmented frames). Image and contour metrics were used to characterize model performance by comparing ground truth (GT) and machine learning (ML) contours. Median values (interquartile range, IQR) of the Jaccard index for lumen and vessel were 0.913, [0.882,0.935] and 0.940, [0.917,0.957], respectively. Median values (IQR) of the Hausdorff distance for lumen and vessel were 0.196mm, [0.146,0.275]mm and 0.163mm, [0.122,0.234]mm, respectively. Also, the mean value of lumen area predictions, and limits of agreement were -0.19mm2, [1.1,-1.5]mm2, while the mean value and limits of agreement of plaque burden were 0.0022, [0.082,-0.078]. The results obtained with the model developed in this work allow us to conclude that the proposed machine learning approach delivers accurate segmentations in terms of image metrics, contour metrics and clinically relevant variables, enabling its use in clinical routine by mitigating the costs involved in the manual management of IVUS datasets.
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Affiliation(s)
- Pablo J Blanco
- National Laboratory for Scientific Computing, LNCC/MCTI, Petrópolis, Brazil; National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, Petrópolis, RJ, Brazil.
| | - Paulo G P Ziemer
- National Laboratory for Scientific Computing, LNCC/MCTI, Petrópolis, Brazil; National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, Petrópolis, RJ, Brazil
| | - Carlos A Bulant
- Consejo Nacional de Investigaciones Científicas, CONICET, Argentina; Universidad Nacional del Centro, UNICEN, Tandil, Argentina; National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, Petrópolis, RJ, Brazil
| | - Yasushi Ueki
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ronald Bass
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA; Georgetown University School of Medicine, Washington, DC, USA
| | - Lorenz Räber
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pedro A Lemos
- Hospital Israelita Albert Einstein, São Paulo, Brazil; National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, Petrópolis, RJ, Brazil
| | - Héctor M García-García
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA; Georgetown University School of Medicine, Washington, DC, USA.
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Bajaj R, Huang X, Kilic Y, Ramasamy A, Jain A, Ozkor M, Tufaro V, Safi H, Erdogan E, Serruys PW, Moon J, Pugliese F, Mathur A, Torii R, Baumbach A, Dijkstra J, Zhang Q, Bourantas CV. Advanced deep learning methodology for accurate, real-time segmentation of high-resolution intravascular ultrasound images. Int J Cardiol 2021; 339:185-191. [PMID: 34153412 DOI: 10.1016/j.ijcard.2021.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/10/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study is to develop and validate a deep learning (DL) methodology capable of automated and accurate segmentation of intravascular ultrasound (IVUS) image sequences in real-time. METHODS AND RESULTS IVUS segmentation was performed by two experts who manually annotated the external elastic membrane (EEM) and lumen borders in the end-diastolic frames of 197 IVUS sequences portraying the native coronary arteries of 65 patients. The IVUS sequences of 177 randomly-selected vessels were used to train and optimise a novel DL model for the segmentation of IVUS images. Validation of the developed methodology was performed in 20 vessels using the estimations of two expert analysts as the reference standard. The mean difference for the EEM, lumen and plaque area between the DL-methodology and the analysts was ≤0.23mm2 (standard deviation ≤0.85mm2), while the Hausdorff and mean distance differences for the EEM and lumen borders was ≤0.19 mm (standard deviation≤0.17 mm). The agreement between DL and experts was similar to experts' agreement (Williams Index ranges: 0.754-1.061) with similar results in frames portraying calcific plaques or side branches. CONCLUSIONS The developed DL-methodology appears accurate and capable of segmenting high-resolution real-world IVUS datasets. These features are expected to facilitate its broad adoption and enhance the applications of IVUS in clinical practice and research.
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Affiliation(s)
- Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Xingru Huang
- School of Electronic Engineering and Computer Science, Queen Mary University of London, UK
| | - Yakup Kilic
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Ajay Jain
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mick Ozkor
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Hannah Safi
- Department of Mechanical Engineering, University College London, London, UK
| | - Emrah Erdogan
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Patrick W Serruys
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, UK
| | - James Moon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Jouke Dijkstra
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands
| | - Qianni Zhang
- School of Electronic Engineering and Computer Science, Queen Mary University of London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK; Institute of Cardiovascular Sciences, University College London, London, UK.
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Li YC, Shen TY, Chen CC, Chang WT, Lee PY, Huang CCJ. Automatic Detection of Atherosclerotic Plaque and Calcification From Intravascular Ultrasound Images by Using Deep Convolutional Neural Networks. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:1762-1772. [PMID: 33460377 DOI: 10.1109/tuffc.2021.3052486] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Atherosclerosis is the major cause of cardiovascular diseases (CVDs). Intravascular ultrasound (IVUS) is a common imaging modality for diagnosing CVDs. However, an efficient analyzer for IVUS image segmentation is required for assisting cardiologists. In this study, an end-to-end deep-learning convolutional neural network was developed for automatically detecting media-adventitia borders, luminal regions, and calcified plaque in IVUS images. A total of 713 grayscale IVUS images from 18 patients were used as training data for the proposed deep-learning model. The model is constructed using the three modified U-Nets and combined with the concept of cascaded networks to prevent errors in the detection of calcification owing to the interference of pixels outside the plaque regions. Three loss functions (Dice, Tversky, and focal loss) with various characteristics were tested to determine the best setting for the proposed model. The efficacy of the deep-learning model was evaluated by analyzing precision-recall curve. The average precision (AP), Dice score coefficient, precision, sensitivity, and specificity of the predicted and ground truth results were then compared. All training processes were validated using leave-one-subject-out cross-validation. The experimental results showed that the proposed deep-learning model exhibits high performance in segmenting the media-adventitia layers and luminal regions for all loss functions, with all tested metrics being higher than 0.90. For locating calcified tissues, the best result was obtained when the focal loss function was applied to the proposed model, with an AP of 0.73; however, the prediction efficacy was affected by the proportion of calcified tissues within the plaque region when the focal loss function was employed. Compared with commercial software, the proposed method exhibited high accuracy in segmenting IVUS images in some special cases, such as when shadow artifacts or side vessels surrounded the target vessel.
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Di Mario C, Mattesini A, Waksman R. An amber signal lights up before the red: do not dismiss it. Eur Heart J 2018; 39:303-304. [PMID: 28591767 DOI: 10.1093/eurheartj/ehx292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
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Assessment of Inter-Expert Variability and of an Automated Segmentation Method of 40 and 60 MHz IVUS Images of Coronary Arteries. PLoS One 2017; 12:e0168332. [PMID: 28107355 PMCID: PMC5249211 DOI: 10.1371/journal.pone.0168332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/11/2016] [Indexed: 11/25/2022] Open
Abstract
The objectives were to compare the performance of a segmentation algorithm, based on the minimization of an uncertainty function, to delineate contours of external elastic membrane and lumen of human coronary arteries imaged with 40 and 60 MHz IVUS, and to use values of this function to delineate portions of contours with highest uncertainty. For 8 patients, 40 and 60 MHz IVUS coronary data acquired pre- and post-interventions were used, for a total of 68,516 images. Manual segmentations of contours (on 2312 images) performed by experts at three core laboratories were the gold-standards. Inter-expert variability was highest on contour points with largest values of the uncertainty function (p < 0.001). Inter-expert variability was lower at 60 than 40 MHz for external elastic membrane (p = 0.013) and lumen (p = 0.024). Average differences in plaque (and atheroma) burden between algorithmic contours and experts’ contours were within inter-expert variability (p < 0.001).
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Giavarini A, Kilic ID, Redondo Diéguez A, Longo G, Vandormael I, Pareek N, Kanyal R, De Silva R, Di Mario C. Intracoronary Imaging. Heart 2017; 103:708-725. [DOI: 10.1136/heartjnl-2015-307888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Maso Talou GD, Larrabide I, Blanco PJ, Bezerra CG, Lemos PA, Feijoo RA. Improving Cardiac Phase Extraction in IVUS Studies by Integration of Gating Methods. IEEE Trans Biomed Eng 2015; 62:2867-77. [DOI: 10.1109/tbme.2015.2449232] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Tomkowiak MT, Raval AN, Van Lysel MS, Funk T, Speidel MA. Calibration-free coronary artery measurements for interventional device sizing using inverse geometry x-ray fluoroscopy: in vivo validation. J Med Imaging (Bellingham) 2014; 1. [PMID: 25544948 DOI: 10.1117/1.jmi.1.3.033504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Proper sizing of interventional devices to match coronary vessel dimensions improves procedural efficiency and therapeutic outcomes. We have developed a method that uses an inverse geometry x-ray fluoroscopy system [scanning beam digital x-ray (SBDX)] to automatically determine vessel dimensions from angiograms without the need for magnification calibration or optimal views. For each frame period (1/15th of a second), SBDX acquires a sequence of narrow beam projections and performs digital tomosynthesis at multiple plane positions. A three-dimensional model of the vessel is reconstructed by localizing the depth of the vessel edges from the tomosynthesis images, and the model is used to calculate the length and diameter in units of millimeters. The in vivo algorithm performance was evaluated in a healthy porcine model by comparing end-diastolic length and diameter measurements from SBDX to coronary computed tomography angiography (CCTA) and intravascular ultrasound (IVUS), respectively. The length error was -0.49 ± 1.76 mm(SBDX- CCTA, mean ± 1 SD). The diameter error was 0.07 ± 0.27 mm (SBDX - minimum IVUS diameter, mean ± 1 SD). The in vivo agreement between SBDX-based vessel sizing and gold standard techniques supports the feasibility of calibration-free coronary vessel sizing using inverse geometry x-ray fluoroscopy.
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Affiliation(s)
- Michael T Tomkowiak
- University of Wisconsin-Madison, Department of Medical Physics, 1111 Highland Ave, Madison, Wisconsin 53705, United States
| | - Amish N Raval
- University of Wisconsin-Madison, Department of Medicine, 600 Highland Ave, Madison, Wisconsin 53792, United States
| | - Michael S Van Lysel
- University of Wisconsin-Madison, Department of Medical Physics, 1111 Highland Ave, Madison, Wisconsin 53705, United States ; University of Wisconsin-Madison, Department of Medicine, 600 Highland Ave, Madison, Wisconsin 53792, United States
| | - Tobias Funk
- Triple Ring Technologies, Inc., 39655 Eureka Dr, Newark, California 94560, United States
| | - Michael A Speidel
- University of Wisconsin-Madison, Department of Medical Physics, 1111 Highland Ave, Madison, Wisconsin 53705, United States ; University of Wisconsin-Madison, Department of Medicine, 600 Highland Ave, Madison, Wisconsin 53792, United States
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Tomkowiak MT, Raval AN, Van Lysel MS, Funk T, Speidel MA. Calibration-Free Coronary Artery Measurements for Interventional Device Sizing using Inverse Geometry X-ray Fluoroscopy: In Vivo Validation. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2014; 9033:90332H. [PMID: 24999298 PMCID: PMC4079058 DOI: 10.1117/12.2044078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Proper sizing of interventional devices to match coronary vessel dimensions improves procedural efficiency and therapeutic outcomes. We have developed a novel method using inverse geometry x-ray fluoroscopy to automatically determine vessel dimensions without the need for magnification calibration or optimal views. To validate this method in vivo, we compared results to intravascular ultrasound (IVUS) and coronary computed tomography angiography (CCTA) in a healthy porcine model. Coronary angiography was performed using Scanning-Beam Digital X-ray (SBDX), an inverse geometry fluoroscopy system that performs multiplane digital x-ray tomosynthesis in real time. From a single frame, 3D reconstruction of the arteries was performed by localizing the depth of vessel lumen edges. The 3D model was used to directly calculate length and to determine the best imaging plane to use for diameter measurements, where out-of-plane blur was minimized and the known pixel spacing was used to obtain absolute vessel diameter. End-diastolic length and diameter measurements were compared to measurements from CCTA and IVUS, respectively. For vessel segment lengths measuring 6 mm to 73 mm by CCTA, the SBDX length error was -0.49 ± 1.76 mm (SBDX - CCTA, mean ± 1 SD). For vessel diameters measuring 2.1 mm to 3.6 mm by IVUS, the SBDX diameter error was 0.07 ± 0.27 mm (SBDX - minimum IVUS diameter, mean ± 1 SD). The in vivo agreement between SBDX-based vessel sizing and gold standard techniques supports the feasibility of calibration-free coronary vessel sizing using inverse geometry x-ray fluoroscopy.
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Affiliation(s)
| | - Amish N Raval
- Dept. of Medicine, University of Wisconsin, Madison, WI, USA
| | - Michael S Van Lysel
- Dept. of Medical Physics, University of Wisconsin, Madison, WI, USA ; Dept. of Medicine, University of Wisconsin, Madison, WI, USA
| | - Tobias Funk
- Triple Ring Technologies, Inc, Newark, CA, USA
| | - Michael A Speidel
- Dept. of Medical Physics, University of Wisconsin, Madison, WI, USA ; Dept. of Medicine, University of Wisconsin, Madison, WI, USA
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Segmentation method of intravascular ultrasound images of human coronary arteries. Comput Med Imaging Graph 2014; 38:91-103. [DOI: 10.1016/j.compmedimag.2013.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 09/06/2013] [Accepted: 09/10/2013] [Indexed: 11/22/2022]
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Zheng S, Jianjian W. Compensation of in-plane rigid motion for in vivo intracoronary ultrasound image sequence. Comput Biol Med 2013; 43:1077-85. [DOI: 10.1016/j.compbiomed.2013.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 05/03/2013] [Accepted: 05/06/2013] [Indexed: 11/29/2022]
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Mendizabal-Ruiz EG, Rivera M, Kakadiaris IA. Segmentation of the luminal border in intravascular ultrasound B-mode images using a probabilistic approach. Med Image Anal 2013; 17:649-70. [DOI: 10.1016/j.media.2013.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 01/28/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
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Gao X, Sadowski DC, Mintchev MP. Intraluminal ultrasonic probe for volumetric monitoring of liquid gastroesophageal reflux. Physiol Meas 2012; 33:487-501. [PMID: 22373519 DOI: 10.1088/0967-3334/33/3/487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Methods for volumetric monitoring of liquid gastroesophageal reflux (GER) are still lacking. The aim of this study was to develop an automated intraluminal measurement technique which allows ambulatory volumetric quantification of liquid GER utilizing a minimum-cost intraluminal ultrasonic probe. This probe consists of two 2 MHz ultrasonic crystals longitudinally assembled along a multi-channel intraluminal impedance (MII) catheter. The proposed probe was initially tested with tubular phantoms of different diameters. Measurements of the cross-sectional areas of the phantoms showed high correlation with the actual areas (R(2) = 0.99). Subsequently, two in-vivo human tests were performed. For each human test the catheter assembly was inserted transnasally and the ultrasonic probe was placed in the area of the lower esophageal sphincter. Multiple liquid swallows of different volumes were invoked using electrolyte drinks. Sectional luminal volume (SLV) in the esophagus between the two ultrasonic crystals was obtained. Results of the swallows demonstrated that measured SLVs correlated with the actual swallowed liquid volume. The ultrasonic probe was combined with a MII catheter to discriminate between antegrade and retrograde bolus transit. Increases of SLVs during liquid GER episodes could be utilized to evaluate GER volume in the vicinity of the ultrasonic probe.
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Affiliation(s)
- X Gao
- Department of Electrical and Computer Engineering, University of Calgary, Calgary, Alberta, Canada
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Katouzian A, Angelini ED, Carlier SG, Suri JS, Navab N, Laine AF. A state-of-the-art review on segmentation algorithms in intravascular ultrasound (IVUS) images. ACTA ACUST UNITED AC 2012; 16:823-34. [PMID: 22389156 DOI: 10.1109/titb.2012.2189408] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past two decades, intravascular ultrasound (IVUS) image segmentation has remained a challenge for researchers while the use of this imaging modality is rapidly growing in catheterization procedures and in research studies. IVUS provides cross-sectional grayscale images of the arterial wall and the extent of atherosclerotic plaques with high spatial resolution in real time. In this paper, we review recently developed image processing methods for the detection of media-adventitia and luminal borders in IVUS images acquired with different transducers operating at frequencies ranging from 20 to 45 MHz. We discuss methodological challenges, lack of diversity in reported datasets, and weaknesses of quantification metrics that make IVUS segmentation still an open problem despite all efforts. In conclusion, we call for a common reference database, validation metrics, and ground-truth definition with which new and existing algorithms could be benchmarked.
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Hernàndez-Sabaté A, Gil D, Garcia-Barnés J, Martí E. Image-based cardiac phase retrieval in intravascular ultrasound sequences. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2011; 58:60-72. [PMID: 21244975 DOI: 10.1109/tuffc.2011.1774] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Longitudinal motion during in vivo pullbacks acquisition of intravascular ultrasound (IVUS) sequences is a major artifact for 3-D exploring of coronary arteries. Most current techniques are based on the electrocardiogram (ECG) signal to obtain a gated pullback without longitudinal motion by using specific hardware or the ECG signal itself. We present an image-based approach for cardiac phase retrieval from coronary IVUS sequences without an ECG signal. A signal reflecting cardiac motion is computed by exploring the image intensity local mean evolution. The signal is filtered by a band-pass filter centered at the main cardiac frequency. Phase is retrieved by computing signal extrema. The average frame processing time using our setup is 36 ms. Comparison to manually sampled sequences encourages a deeper study comparing them to ECG signals.
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Affiliation(s)
- Aura Hernàndez-Sabaté
- Computer Vision Center and Department of Computer Science, Universitat Autonoma de Barcelona, Bellaterra, Spain. aura,
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Serruys PW, Heyndrickx GR, Patel J, Cummins PA, Kleijne JA, Clowes AW. Effect of an anti‐PDGF‐β‐receptor‐blocking antibody on restenosis in patients undergoing elective stent placement. ACTA ACUST UNITED AC 2009; 5:214-22. [PMID: 14630567 DOI: 10.1080/14628840310017177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM The aim of the study was to determine whether a single intravenous infusion of 25 mg/kg CDP860, a humanized di-Fab' fragment against PDGF-beta receptor, leads to a reduction of in-stent restenosis. METHODS In this phase II, double-blind, placebo-controlled, multicentre study 145 patients presenting with stable or unstable angina were randomized to a single infusion of placebo or active drug (CDP860) before undergoing stenting. Quantitative angiography and 3D intravascular ultrasound (IVUS) were obtained at baseline and follow-up. Primary endpoint was the IVUS assessment of percentage in-stent volume obstruction. RESULTS At six-month follow-up, the placebo group and CDP860 group did not differ significantly regarding minimal luminal diameter (1.75 +/- 0.68 versus 1.82 +/--0.66 mm), restenosis rate (16.2 versus 14.1%), minimal lumen area (4.71 +/- 1.85 versus 4.41 +/- 1.77 mm(2) ), in-stent neointimal volume (30 +/- 23 versus 31 +/- 31 mm(3)) and in-stent obstruction volume (23.8 +/- 14.4 versus 22.1 +/- 15.3%). Major adverse cardiac events at 210 days were similar in both groups: death 1.5 versus 1.4%, myocardial infarction 5.9 versus 8.1% and target vessel revascularization 16.4 versus 17.6%. CONCLUSION A single intravenous administration of monoclonal antibody against PDGF-beta receptor failed to reduce the amount of neointimal hyperplasia after stent implantation.
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Baldewsing RA, Danilouchkine MG, Mastik F, Schaar JA, Serruys PW, van der Steen AFW. An inverse method for imaging the local elasticity of atherosclerotic coronary plaques. ACTA ACUST UNITED AC 2008; 12:277-89. [PMID: 18693495 DOI: 10.1109/titb.2007.907980] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The rupture of thin-cap fibroatheroma (TCFA) plaques is a major cause of acute coronary events. A TCFA has a trombogenic soft lipid core, shielded from the blood stream by a thin, possibly inflamed, stiff cap. The majority of atherosclerotic plaques resemble a TCFA in terms of overall structural composition, but have a more complex, heterogeneous morphology. An assessment of the material distribution is vital for quantifying the plaque's mechanical stability and for determining the effect of plaque-stabilizing pharmaceutical agents. We describe a new automated inverse elasticity method, intravascular ultrasound (IVUS) modulography, which is capable of reconstructing a heterogeneous Young's modulus distribution. The elastogram (i.e., spatial strain distribution) of the plaque is the input for the method, and is measured using the clinically available technique, IVUS elastography. Our method incorporates a novel divide-and-conquer strategy, allowing the reconstruction of TCFAs as well as heterogeneous plaques with localized regions of soft, weakened tissue. The method was applied to ex vivo elastograms, which were simulated from the cross sections of postmortem human coronary plaques. To demonstrate the clinical feasibility of the method, measured elastograms from human atherosclerotic coronary arteries were analyzed. One elastogram was measured in vitro; the other, in vivo. The method approximated the true Young's modulus distribution of all simulated plaques, while the in vitro reconstruction was in agreement with histology. In conclusion, the IVUS modulography in combination with the IVUS elastography has strong potential to become an all-encompassing modality for detecting plaques, for assessing the information related to their rupture-proneness, and for imaging their heterogeneous elastic material composition.
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Zhang Q, Lu L, Pu L, Zhang R, Shen J, Zhu Z, Hu J, Yang Z, Chen Q, Shen W. Neointimal hyperplasia persists at six months after sirolimus-eluting stent implantation in diabetic porcine. Cardiovasc Diabetol 2007; 6:16. [PMID: 17550588 PMCID: PMC1892541 DOI: 10.1186/1475-2840-6-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Accepted: 06/05/2007] [Indexed: 11/16/2022] Open
Abstract
Background Observational clinical studies have shown that patients with diabetes have less favorable results after percutaneous coronary intervention compared with the non-diabetic counterparts, but its mechanism remains unclear. The aim of this study was to examine the changes of neointimal hyperplasia after sirolimus-eluting stent (SES) implantation in a diabetic porcine model, and to evaluate the impact of aortic inflammation on this proliferative process. Methods Diabetic porcine model was created with an intravenous administration of a single dose of streptozotocin in 15 Chinese Guizhou minipigs (diabetic group); each of them received 2 SES (Firebird, Microport Co, China) implanted into 2 separated major epicardial coronary arteries. Fifteen non-diabetic minipigs with SES implantation served as controls (control group). At 6 months, the degree of neointimal hyperplasia was determined by repeat coronary angiography, intravascular ultrasound (IVUS) and histological examination. Tumor necrosis factor (TNF)-α protein level in the aortic intima was evaluated by Western blotting, and TNF-α, interleukin (IL)-1β and IL-6 mRNA levels were assayed by reverse transcription and polymerase chain reaction. Results The distribution of stented vessels, diameter of reference vessels, and post-procedural minimal lumen diameter were comparable between the two groups. At 6-month follow-up, the degree of in-stent restenosis (40.4 ± 24.0% vs. 20.2 ± 17.7%, p < 0.05), late lumen loss (0.33 ± 0.19 mm vs. 0.10 ± 0.09 mm, p < 0.001) by quantitative angiography, percentage of intimal hyperplasia in the stented area (26.7 ± 19.2% vs. 7.3 ± 6.1%, p < 0.001) by IVUS, and neointimal area (1.59 ± 0.76 mm2 vs. 0.41 ± 0.18 mm2, p < 0.05) by histological examination were significantly exacerbated in the diabetic group than those in the controls. Significant increases in TNF-α protein and TNF-α, IL-1β and IL-6 mRNA levels were observed in aortic intima in the diabetic group. Conclusion Neointimal hyperplasia persisted at least up to 6 months after SES implantation in diabetic porcine, which may be partly related to an exaggerated inflammatory response within the blood vessel wall. Our results provide theoretical support for potential direct beneficial effects of anti-diabetic and anti-inflammation medications in reducing the risk of restenosis after stenting.
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Affiliation(s)
- Qi Zhang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - Lin Lu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - LiJin Pu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - RuiYan Zhang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - Jie Shen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - ZhengBing Zhu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - Jian Hu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - ZhenKun Yang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - QiuJin Chen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - WeiFeng Shen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
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Sirolimus-eluting cobalt alloyed stents in treating patients with coronary artery disease: six-month angiographic and one-year clinical follow-up result A prospective, historically controlled, multi-center clinical study. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200704010-00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gil D, Hernández A, Rodriguez O, Mauri J, Radeva P. Statistical strategy for anisotropic adventitia modelling in IVUS. IEEE TRANSACTIONS ON MEDICAL IMAGING 2006; 25:768-78. [PMID: 16768241 DOI: 10.1109/tmi.2006.874962] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Vessel plaque assessment by analysis of intravascular ultrasound sequences is a useful tool for cardiac disease diagnosis and intervention. Manual detection of luminal (inner) and media-adventitia (external) vessel borders is the main activity of physicians in the process of lumen narrowing (plaque) quantification. Difficult definition of vessel border descriptors, as well as, shades, artifacts, and blurred signal response due to ultrasound physical properties trouble automated adventitia segmentation. In order to efficiently approach such a complex problem, we propose blending advanced anisotropic filtering operators and statistical classification techniques into a vessel border modelling strategy. Our systematic statistical analysis shows that the reported adventitia detection achieves an accuracy in the range of interobserver variability regardless of plaque nature, vessel geometry, and incomplete vessel borders.
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Affiliation(s)
- Debora Gil
- Computer Science Department, Computer Vision Center, Universidad Autonoma de Barcelona, Spain.
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Cardinal MHR, Meunier J, Soulez G, Maurice RL, Therasse E, Cloutier G. Intravascular ultrasound image segmentation: a three-dimensional fast-marching method based on gray level distributions. IEEE TRANSACTIONS ON MEDICAL IMAGING 2006; 25:590-601. [PMID: 16689263 DOI: 10.1109/tmi.2006.872142] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Intravascular ultrasound (IVUS) is a catheter based medical imaging technique particularly useful for studying atherosclerotic disease. It produces cross-sectional images of blood vessels that provide quantitative assessment of the vascular wall, information about the nature of atherosclerotic lesions as well as plaque shape and size. Automatic processing of large IVUS data sets represents an important challenge due to ultrasound speckle, catheter artifacts or calcification shadows. A new three-dimensional (3-D) IVUS segmentation model, that is based on the fast-marching method and uses gray level probability density functions (PDFs) of the vessel wall structures, was developed. The gray level distribution of the whole IVUS pullback was modeled with a mixture of Rayleigh PDFs. With multiple interface fast-marching segmentation, the lumen, intima plus plaque structure, and media layers of the vessel wall were computed simultaneously. The PDF-based fast-marching was applied to 9 in vivo IVUS pullbacks of superficial femoral arteries and to a simulated IVUS pullback. Accurate results were obtained on simulated data with average point to point distances between detected vessel wall borders and ground truth <0.072 mm. On in vivo IVUS, a good overall performance was obtained with average distance between segmentation results and manually traced contours <0.16 mm. Moreover, the worst point to point variation between detected and manually traced contours stayed low with Hausdorff distances <0.40 mm, indicating a good performance in regions lacking information or containing artifacts. In conclusion, segmentation results demonstrated the potential of gray level PDF and fast-marching methods in 3-D IVUS image processing.
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Affiliation(s)
- Marie-Hélène Roy Cardinal
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital's Research Center, 2099 Alexandre de Sève, Montreal, QC H2L 2W5, Canada.
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Guo D, Richardson P. Detection of cardiac cycle from intracoronary ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2006; 32:345-56. [PMID: 16530093 DOI: 10.1016/j.ultrasmedbio.2005.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Revised: 12/01/2005] [Accepted: 12/09/2005] [Indexed: 05/07/2023]
Abstract
In this paper, we describe a method automatically to determine the phase of a cardiac cycle for each video frame of an intravascular ultrasound (IVUS) video recorded in vivo. We first review the principle of IVUS video and demonstrate the general applicability of our method. We show that the pulsating heart leads to phasic changes in image content of an IVUS video. With an image processing method, we can reverse this process and reliably extract the heart-beat phase directly from IVUS video. With the phase information, we demonstrate that we can build 3-D (3D) time-variant shapes and measure lumen volume changes within a cardiac cycle. We may also measure the changes of IVUS imaging probe off-center vector within a cardiac cycle, which serves as an indicator of vessel center-line curvature. The cardiac cycle extraction algorithm requires one scan of the IVUS video frames and takes O(n) time to complete, n being the total number of the video frames. The advantage of this method is that it requires no user interaction and no hardware set-up and can be applied to coronary scans of live beating hearts. The extracted heart-beat rate, compared with clinical recordings, has less than 1% error.
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Schiele TM. Current understanding of coronary in-stent restenosis. Pathophysiology, clinical presentation, diagnostic work-up, and management. ACTA ACUST UNITED AC 2006; 94:772-90. [PMID: 16258781 DOI: 10.1007/s00392-005-0299-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Accepted: 07/18/2005] [Indexed: 12/29/2022]
Abstract
In-stent restenosis is the limiting entity following coronary stent implantation. It is associated with significant morbidity and cost and thus represents a major clinical and economical problem. Worldwide, approximately 250 000 in-stent restenotic lesions per year have to be dealt with. The pathophysiology of instent restenosis is multifactorial and comprises inflammation, smooth muscle cell migration and proliferation and extracellular matrix formation, all mediated by distinct molecular pathways. Instent restenosis has been recognised as very difficult to manage, with a repeat restenosis rate of 50% regardless of the mechanical angioplasty device used. Much more favourable results were reported for the adjunctive irradiation of the in-stent restenotic lesion, with a consistent reduction of the incidence of repeat in-stent restenosis by 50%. Data from the first clinical trials on drug-eluting stents for the treatment of in-stent restenosis have shown very much promise yielding this strategy likely to become the treatment of choice. This review outlines the histological and molecular findings of the pathophysiology, the epidemiology, the predictors and the diagnostic work-up of in-stent restenosis and puts emphasis on the various treatment options for its prevention and therapy.
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Affiliation(s)
- T M Schiele
- Kardiologie, Klinikum der Ludwig-Maximilians-Universität München--Innenstadt, Ziemssenstrasse 1, 80336 München, Germany.
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Baldewsing RA, Mastik F, Schaar JA, Serruys PW, van der Steen AFW. Young's modulus reconstruction of vulnerable atherosclerotic plaque components using deformable curves. ULTRASOUND IN MEDICINE & BIOLOGY 2006; 32:201-10. [PMID: 16464666 DOI: 10.1016/j.ultrasmedbio.2005.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 11/19/2005] [Accepted: 11/25/2005] [Indexed: 05/06/2023]
Abstract
Rupture, with subsequent thrombosis, of thin-cap fibroatheromas (TCFAs) is a major cause of myocardial infarction. A TCFA has two main components: these are a large, soft lipid pool and a thin, stiff fibrous cap covering it. Quantification of their morphology and stiffness is essential for monitoring atherosclerosis and quantifying the effect of plaque-stabilizing pharmaceutical treatment. To accomplish this, we have developed a model-based Young's modulus reconstruction method. From a plaque strain elastogram, measured with an intravascular ultrasound catheter, it reconstructs a Young's modulus image of the plaque. To this end, a minimization algorithm automatically varies the morphology and stiffness parameters of a TCFA computer model, until the corresponding computer-simulated strain elastogram resembles the measured strain elastogram. The morphology parameters of the model are the control-points of two deformable Bézier curves; one curve delineates the distal border of the lipid pool region, the other the distal border of the cap region. These component regions are assumed to be homogeneous and their stiffness is characterized by a Young's modulus. Reconstructions from strain elastograms that were 1. simulated using a histology-derived computer TCFA, 2. measured from a physical phantom with a soft lipid pool, and 3. simulated with a computer TCFA, where the complexity of its plaque component borders was increased, demonstrated the superior reconstruction/delineation behavior of this method, compared with a previously developed circular reconstruction method that used only circles for border delineation. Consequently, this method may become a valuable tool for the quantification of both the morphology and stiffness of vulnerable atherosclerotic plaque components.
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Affiliation(s)
- Radj A Baldewsing
- Biomedical Engineering, Thorax Centre, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
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25
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Identification of Luminal and Medial Adventitial Borders in Intravascular Ultrasound Images Using Level Sets. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/11902140_61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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26
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Serruys PW, Sianos G, Abizaid A, Aoki J, den Heijer P, Bonnier H, Smits P, McClean D, Verheye S, Belardi J, Condado J, Pieper M, Gambone L, Bressers M, Symons J, Sousa E, Litvack F. The effect of variable dose and release kinetics on neointimal hyperplasia using a novel paclitaxel-eluting stent platform: the Paclitaxel In-Stent Controlled Elution Study (PISCES). J Am Coll Cardiol 2005; 46:253-60. [PMID: 16022951 DOI: 10.1016/j.jacc.2005.03.069] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 03/17/2005] [Accepted: 03/29/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of variable dose and release kinetics of paclitaxel on neointimal hyperplasia. BACKGROUND Conventional paclitaxel-eluting stents use a durable polymer coating as a vehicle for drug delivery. The Conor stent (Conor Medsystems, Menlo Park, California) with intra-strut wells and erodable polymer is specifically designed for drug delivery with programmable pharmacokinetics. METHODS Two hundred and forty-four patients with single vessel disease received either a bare metal Conor stent (n = 53) or one of six different release formulations that varied in dose (10 or 30 microg) and elution release kinetics (first order, zero order), direction (abluminal, luminal), and duration (5, 10, and 30 days). End points at six months (bare stent group) and at four months (eluting stent groups) were angiographic late loss and neointimal tissue volume by intravascular ultrasound and the rate of major adverse cardiac events (MACE). RESULTS The lowest in-stent late loss (0.38 mm, p <0.01, and 0.30 mm, p <0.01) and volume obstruction (8%, p <0.01, and 5%, p <0.01) were observed with the 10-microg and 30-microg doses in the 30-day release groups respectively, whereas the highest in-stent late loss (0.88 mm), volume obstruction (26%), and restenosis rate (11.6%) were observed in the bare stent group. The overall MACE rate of the eluting stent group was 8.6%: death 0.5%, myocardial infarction 2.7%, and target lesion revascularization (TLR) 5.3%. Sub-acute thrombosis was 0.5%. The TLR rates in the two 30-day release groups were 0% and 3.4%. CONCLUSIONS This novel eluting stent platform, using an erodable polymer with complete elution of low doses of paclitaxel, is safe. The inhibition of the in-stent neointimal hyperplasia was best in the long release groups.
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Aoki J, Serruys PW, van Beusekom H, Ong ATL, McFadden EP, Sianos G, van der Giessen WJ, Regar E, de Feyter PJ, Davis HR, Rowland S, Kutryk MJB. Endothelial progenitor cell capture by stents coated with antibody against CD34: the HEALING-FIM (Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth-First In Man) Registry. J Am Coll Cardiol 2005; 45:1574-9. [PMID: 15893169 DOI: 10.1016/j.jacc.2005.01.048] [Citation(s) in RCA: 341] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Revised: 01/22/2005] [Accepted: 01/25/2005] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study was designed to evaluate whether rapid endothelialization of stainless steel stents with a functional endothelium prevents stent thrombosis and reduces the restenotic process. BACKGROUND A "pro-healing" approach for prevention of post-stenting restenosis is theoretically favored over the use of cytotoxic or cytostatic local pharmacologic therapies. It is believed that the central role of the vascular endothelium is to maintain quiescence of the underlying media and adventitia. METHODS Sixteen patients with de novo coronary artery disease were successfully treated with implantation of endothelial progenitor cell (EPC) capture stents. RESULTS Complete procedural and angiographic success was achieved in all 16 patients. The nine-month composite major adverse cardiac and cerebrovascular events (MACCE) rate was 6.3% as a result of a symptom-driven target vessel revascularization in a single patient. There were no other MACCE despite only one month of clopidogrel treatment. At six-month follow-up, mean angiographic late luminal loss was 0.63 +/- 0.52 mm, and percent stent volume obstruction by intravascular ultrasound analysis was 27.2 +/- 20.9%. CONCLUSIONS This first human clinical investigation of this technology demonstrates that the EPC capture coronary stent is safe and feasible for the treatment of de novo coronary artery disease. Further developments in this technology are warranted to evaluate the efficacy of this device for the treatment of coronary artery disease.
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Affiliation(s)
- Jiro Aoki
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Bourantas CV, Plissiti ME, Fotiadis DI, Protopappas VC, Mpozios GV, Katsouras CS, Kourtis IC, Rees MR, Michalis LK. In vivovalidation of a novel semi-automated method for border detection in intravascular ultrasound images. Br J Radiol 2005; 78:122-9. [PMID: 15681323 DOI: 10.1259/bjr/30866348] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The aim of this work was to evaluate a new semi-automated intravascular ultrasound (IVUS) border detection method. The method was used to identify the lumen and the external elastic membrane or the borders of stents in 80 IVUS images, randomly selected from 10 consecutive human coronary arteries. These semi-automated results were compared with observations of two experts. Several indices in each case were obtained in order fully to evaluate the method. The time required for identification of the borders was also recorded. The interobserver variability of the method ranged from 1.21% to 5.61%, the correlation coefficient from 0.98 to 0.99, the slope was close to unity (0.94-1.03), the y intercept close to zero and the Williams index value was close to unity (range 0.67-0.91). The time (mean+/-SD) required for the method to identify the borders of the different vessel layers for the whole IVUS sequence was 5.2+/-0.2 min. The results demonstrate that the method is reliable and capable of identifying rapidly and accurately the different vessel layers depicted in IVUS images.
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Affiliation(s)
- C V Bourantas
- Department of Cardiology, Medical School, GR 45110 Ioannina, Greece
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Cardinal MHR, Meunier J, Soulez G, Maurice RL, Thérasse E, Cloutier G. Automatic 3D Segmentation of Intravascular Ultrasound Images Using Region and Contour Information. ACTA ACUST UNITED AC 2005; 8:319-26. [PMID: 16685861 DOI: 10.1007/11566465_40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Intravascular ultrasound (IVUS) produces images of arteries that show the lumen in addition to the layered structure of the vessel wall. A new automatic 3D IVUS fast-marching segmentation model is presented. The method is based on a combination of region and contour information, namely the gray level probability density functions (PDFs) of the vessel structures and the image gradient. Accurate results were obtained on in-vivo and simulated data with average point to point distances between detected vessel wall boundaries and validation contours below 0.105 mm. Moreover, Hausdorff distances (that represent the worst point to point variations) resulted in values below 0.344 mm, which demonstrate the potential of combining region and contour information in a fast-marching scheme for 3D automatic IVUS image processing.
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Brito FS, Rosa WCM, Arruda JA, Tedesco H, Pestana JOM, Lima VC. Efficacy and safety of oral sirolimus to inhibit in-stent intimal hyperplasia. Catheter Cardiovasc Interv 2005; 64:413-8. [PMID: 15789385 DOI: 10.1002/ccd.20332] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sirolimus systemic administration has shown marked inhibition of neointimal hyperplasia (NIH) after balloon angioplasty in porcine models. In this pilot study, we tested the hypothesis that oral sirolimus is safe and effective to inhibit in-stent NIH and therefore to prevent and treat in-stent restenosis (ISR). Twelve patients (18 lesions) with high risk for ISR, including 8 ISR lesions, were admitted. One day before the procedure, patients were given a 15 mg loading dose of oral sirolimus, followed by 5 mg daily for 28 days, with weekly whole blood level measurements. The daily dose was adjusted to keep the concentration at 10-15 ng/ml. Sirolimus was well tolerated by all patients but one, who died at the end of the third week of treatment. The 4- and 8-month follow-up revealed an angiographic late loss of 0.40 +/- 0.24 and 0.67 +/- 0.45 mm (P < 0.01), respectively. At the same time points, the intravascular ultrasound in in-stent relative volumetric obstruction was 14.4% +/- 9.1% and 23.2% +/- 10.1% (P < 0.01), respectively. At 24-month clinical follow-up, adverse events were one (8.3%) death, two (11.1%) target lesion, and four (22.2%) target vessel revascularizations. In conclusion, in this small group of high-risk ISR patients, oral sirolimus inhibited NIH and therefore may be an effective strategy for the prevention and treatment of ISR.
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Affiliation(s)
- Fábio S Brito
- Hospital São Paulo and Hospital do Rim e Hipertensão, Federal University of São Paulo, Brazil
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Jensen LO, Thayssen P, Pedersen KE, Stender S, Haghfelt T. Low variation and high reproducibility in plaque volume with intravascular ultrasound. Int J Cardiol 2004; 97:463-9. [PMID: 15561334 DOI: 10.1016/j.ijcard.2003.10.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2003] [Revised: 09/03/2003] [Accepted: 10/14/2003] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) has several advantages compared to angiography when evaluating coronary atherosclerosis in the vessel wall. METHODS The accuracy, reproducibility, and short-time spontaneous variation in volume of vessel, plaque and lumen were studied by electrocardiographic-gated three-dimensional (3D) IVUS in 20 male patients with ischaemic heart disease (IHD). RESULTS The study lesions were angiographically insignificant, with a length of the analysed segment on 11.4+/-5.9 mm. At baseline the mean minimal lumen diameter was 2.41+/-0.59 mm, minimal lumen area 4.82+/-2.38 mm2, and maximal plaque burden 65.61+/-9.57%. Mean reference diameter was 3.1+/-0.6 mm. No significant changes were observed in volumes of total vessel, lumen or plaque. The coefficient of variation (CV) for two volume measurements at baseline was: vessel 0.8%, plaque 1.3%, and lumen 1.4%. For measurements recorded at baseline and after 12.6+/-1.5 weeks, CV was respectively 3.5%, 3.3% and 6.6%. Reproducibility and interobserver and intraobserver variation showed very high correlations. A linear correlation was present in percent changes over 12.6+/-1.5 weeks between vessel volume and lumen volume (r=0.804; p<0.001) and between percent changes in plaque volume and vessel volume (r=0.581; p=0.007). No correlation was found between changes in plaque volume and lumen volume (r=0.015; p=0.950). CONCLUSION ECG-gated 3D IVUS is a highly reproducible method when applied on coronary artery atherosclerosis. CV for lumen volume over 12.6+/-1.5 weeks is twice that of plaque volume indicating the superiority of the 3D IVUS compared to coronary angiography (CAG).
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Affiliation(s)
- Lisette Okkels Jensen
- Catherization Laboratorium, Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark.
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Sabaté M, Pimentel G, Prieto C, Corral JM, Bañuelos C, Angiolillo DJ, Alfonso F, Hernández-Antolín R, Escaned J, Fantidis P, Fernández C, Fernández-Ortiz A, Moreno R, Macaya C. Intracoronary Brachytherapy After Stenting De Novo Lesions in Diabetic Patients. J Am Coll Cardiol 2004; 44:520-7. [PMID: 15358014 DOI: 10.1016/j.jacc.2004.02.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2003] [Revised: 02/06/2004] [Accepted: 02/10/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We studied the efficacy of intracoronary brachytherapy (ICB) after successful coronary stenting in diabetic patients with de novo lesions. BACKGROUND Intracoronary brachytherapy has proven effective in preventing recurrences in patients with in-stent restenosis. However, the role of ICB for the treatment of de novo coronary stenoses remains controversial. METHODS Ninety-two patients were randomized to either ICB or no radiation after stenting. Primary end points were in-stent mean neointimal area (primary end point of efficacy) and minimal luminal area of the entire vessel segment (primary end point of effectiveness), as assessed by intravascular ultrasound at six-month follow-up. Quantitative coronary angiography analysis was performed at the target, injured, irradiated, and entire vessel segments. RESULTS At follow-up, the in-stent mean neointimal area was 52% smaller in the ICB group (p < 0.0001). However, there was no difference in the minimal luminal area of the vessel segment (4.5 +/- 2.4 mm2 vs. 4.4 +/- 2.1 mm2). Restenosis rates increased progressively by the analyzed segment in the ICB group: target (7.1% vs. 20.9%, p = 0.07), injured (9.5% vs. 20.9%, p = NS), irradiated (14.3% vs. 20.9%, p = NS), and vessel segment (23.8% vs. 25.6%, p = NS). At one year, 1 cardiac death, 6 myocardial infarctions (MIs) (3 due to late stent thrombosis), and 10 target vessel revascularizations (TVRs) (6 due to the edge effect) occurred in the ICB group, whereas in the nonradiation group, there were 11 TVRs and no deaths or MIs. CONCLUSIONS Intracoronary brachytherapy significantly inhibited in-stent neointimal hyperplasia after stenting in diabetic patients. However, clinically this was counteracted by the occurrence of the edge effect and late stent thrombosis.
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Serruys PW, Wijns W, Sianos G, de Scheerder I, van den Heuvel PA, Rutsch W, Glogar HD, Macaya C, Materne PH, Veldhof S, Vonhausen H, Otto-Terlouw PC, van der Giessen WJ. Direct Stenting Versus Direct Stenting Followed by Centered Beta-Radiation With Intravascular Ultrasound-Guided Dosimetry and Long-Term Anti-Platelet Treatment. J Am Coll Cardiol 2004; 44:528-37. [PMID: 15358015 DOI: 10.1016/j.jacc.2004.03.077] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Revised: 03/01/2004] [Accepted: 03/02/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We sought to assess the efficacy of vascular brachytherapy (VBT) combined with stenting for the primary prevention of restenosis. BACKGROUND Intravascular brachytherapy after stent implantation for de novo lesions has been abandoned for the present. We revisited this procedure by optimizing all procedural steps-the use of glycoprotein IIb/IIa blockers, direct stenting, adequate radiation coverage, avoidance of edge damage, source centering, intravascular ultrasound-guided dosimetry, and continuation of a dual anti-platelet regimen for one year. METHODS The Beta-Radiation Investigation with Direct stenting and Galileo in Europe (BRIDGE) study is a multicenter, randomized controlled trial evaluating the long-term efficacy of VBT with P-32 (20 Gy at 1 mm in the coronary wall) after direct stenting. The primary end point was angiographic intra-stent late loss; secondary end points were six months binary restenosis and neo-intimal hyperplasia. Patients (n = 112) with de novo lesions (2.5 to 4.0 mm in diameter up to 15 mm long) were randomized to either VBT or no-VBT. RESULTS At six months, intra-stent loss was 0.43 and 0.84 mm (p < 0.001) in the irradiated and control groups, respectively. Intra-stent neo-intimal volume was reduced from 36 mm3 to 10 mm3. However, in the irradiated group there were six late occlusions as well as eight restenoses outside the stented and peri-stented area at the fall-off dose edges of the irradiated area. Accordingly, the target vessel revascularization and major adverse cardiac and cerebrovascular events rates at one year in the VBT group (20.4% and 25.9%, respectively) were higher than in the control group (12.1% and 17.2%, respectively). CONCLUSIONS Despite the optimization of pre-, peri-, and post-procedural factors and despite the relative efficacy of the brachytherapy for the prevention of the intra-stent neo-intimal hyperplasia, the clinical outcome of the irradiated group was less favorable than that of the control group.
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McLeod AL, Watson RJ, Anderson T, Inglis S, Newby DE, Northridge DB, Uren NG, McDicken WN. Classification of arterial plaque by spectral analysis in remodelled human atherosclerotic coronary arteries. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:155-159. [PMID: 14998667 DOI: 10.1016/j.ultrasmedbio.2003.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2003] [Revised: 09/23/2003] [Accepted: 10/14/2003] [Indexed: 05/24/2023]
Abstract
We aimed to characterise and to identify the predominant plaque type in vivo using unprocessed radiofrequency (RF) intravascular ultrasound (US) backscatter, in remodelled segments of human atherosclerotic coronary arteries. A total of 16 remodelled segments were identified using a 30-MHz intravascular ultrasound (IVUS) scanner in vivo. Of these, 9 segments were classified as positively remodelled (>1.05 of the total vessel area in comparison with the proximal and distal reference segments) and 7 as negatively remodelled (<0.95 of reference segment area). Spectral parameters (maximum power, mean power, minimum power and power at 30 MHz) were determined and plaque type was defined as mixed fibrous, calcified or lipid-rich. Positively remodelled segments had a larger total vessel area (16.5 +/- 1.1 mm2 vs. 8.7 +/- 0.9 mm2, p<0.01) and plaque area (7.3 +/- 1.1 mm2 vs. 4.4 +/- 0.8 mm2, p=0.05) than negatively remodelled segments. Both positively and negatively remodelled segments had a greater percentage of fibrous plaque (p<0.01) than calcified or lipid-rich plaque. Comparing positively and negatively remodelled segments, there was no significant difference between the proportion of fibrous, calcified or lipid-rich plaque. We have been able to characterise and to identify plaque composition in vivo in human atherosclerotic coronary arteries. Our data suggest that remodelled segments are predominantly composed of fibrous plaque, as identified by RF analysis, although plaque composition is similar, irrespective of the remodelling type.
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Affiliation(s)
- Andrew L McLeod
- Department of Cardiology, Lothian University Hospitals NHS Trust, Edinburgh, UK.
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von Birgelen C, Mintz GS, Eggebrecht H, Herrmann J, Jasper M, Brinkhoff J, Neumann T, Böse D, Baumgart D, Schmermund A, Wieneke H, Haude M, Erbel R. Preintervention arterial remodeling affects vessel stretch and plaque extrusion during coronary stent deployment as demonstrated by three-dimensional intravascular ultrasound. Am J Cardiol 2003; 92:130-5. [PMID: 12860212 DOI: 10.1016/s0002-9149(03)00526-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The mechanisms of lumen enlargement during stent implantation may be significantly affected by arterial remodeling. To assess effects of lesion remodeling, we performed 3-dimensional intravascular ultrasound (IVUS) analyses in 55 coronary lesions before and after deployment of balloon-expandable stents. Standard quantitative analysis was performed, and arterial remodeling was assessed by the remodeling index (target site divided by mean of proximal and distal reference segment vessel areas), which classified lesions into group A (remodeling index < or =1, negative or intermediate remodeling, n = 40) or group B (remodeling index >1, positive remodeling, n = 15) lesions. Characteristics of the 55 patients and the interventional procedures were similar in the 2 groups. IVUS demonstrated that stenting resulted in increased lumen and vessel dimensions and in a reduced plaque size (p < or =0.001 each) in both group A and group B lesions. The extent of lumen increase inside the stents was almost identical, but resulted from different mechanisms: (1) vessel stretch was greater in group A (p <0.002 at minimum lumen site); (2) plaque compression (or embolization) tended to be greater in group B (p = 0.05, along entire stented segment); (3) plaque redistribution within the stent was observed in both groups (p <0.005 both); and (4) significant (p <0.01) plaque extrusion into the distal reference segment was found in group B only. Thus, the remodeling pattern of coronary lesions has a significant impact on the mechanisms of lumen enlargement during stent deployment. Lesions with positive remodeling show more plaque extrusion into the distal reference and less stent-induced vessel stretch than those with negative remodeling.
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von Birgelen C, Mintz GS, Böse D, Baumgart D, Haude M, Wieneke H, Neumann T, Brinkhoff J, Jasper M, Erbel R. Impact of moderate lesion calcium on mechanisms of coronary stenting as assessed with three-dimensional intravascular ultrasound in vivo. Am J Cardiol 2003; 92:5-10. [PMID: 12842236 DOI: 10.1016/s0002-9149(03)00455-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Axial plaque redistribution is an important mechanism of lumen enlargement after stenting of noncalcified lesions. To assess effects of lesion calcification on mechanisms of coronary stenting, we analyzed 55 lesions with noncircumferential calcification with 3-dimensional intravascular ultrasound (IVUS) (standard qualitative and quantitative analyses) before and after implantation of balloon-expandable stents. Thirty-two plaques (58%) showed arcs of calcium <120 degrees of vessel circumference (group A), whereas 23 lesions (42%) contained arcs of calcium > or =120 degrees of vessel circumference (group B). In the entire cohort of 55 lesions, as well as groups A and B, which were studied separately, both single-slice IVUS analysis (performed at minimum lumen site before intervention) and mean stented segment IVUS analysis showed an increase in lumen and vessel area and a decrease in plaque area (p <0.001). The magnitude of lumen and vessel increase and of plaque decrease was similar in both groups. Group A lesions showed significant plaque extrusion into the distal reference segment that was not observed in group B (increase in plaque area of 1.3 +/- 1.9 vs 0.1 +/- 2.0 mm(2), p <0.04). Stenting did not alter plaque area of the proximal reference segment in either group. In addition, there was an increase in vessel area of the distal reference of both groups, indicating that stent-induced vessel expansion observed within the lesion also affected the distal reference. Thus, longitudinal plaque redistribution and vessel expansion contribute to increased lumen dimensions during stenting of lesions with varying amounts of calcium; however, marked plaque extrusion was found only in lesions with a calcium arc of <120 degrees.
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Takeda Y, Tsuchikane E, Kobayashi T, Terai K, Kobayashi Y, Nakagawa T, Sakurai M, Awata N, Kobayashi T. Effect of plaque debulking before stent implantation on in-stent neointimal proliferation: a serial 3-dimensional intravascular ultrasound study. Am Heart J 2003; 146:175-82. [PMID: 12851628 DOI: 10.1016/s0002-8703(03)00114-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent intravascular ultrasound (IVUS) studies have suggested that plaque burden has a role in promoting intimal hyperplasia after stenting. We report on volumetric assessments of in-stent neointimal formation with 3-dimensional IVUS analysis, comparing directional coronary atherectomy (DCA) plus stenting (DCA/stenting) to stenting without DCA. METHODS Twenty-four patients (24 lesions) treated with DCA before stenting were matched to 24 patients (24 lesions) receiving stenting without DCA. All stents were a single Multilink stent. In both groups, serial IVUS was performed before and after intervention and during the 6-month follow-up period. The arterial segments that were analyzed with a computer-based contour detection program were the same as the stented segments analyzed on serial studies. These measurements were obtained: (1) lumen volume (LV), (2) stent volume (SV), (3) vessel volume (VV), (4) in-stent neointimal volume (ISV) calculated as SV-LV, and (5) percent in-stent neointimal volume (%ISV) calculated as ([SV-LV]/SV) x 100. RESULTS Baseline characteristics of the 2 groups were similar. After intervention, both groups achieved similar LV (140.0 mm(3) DCA/stenting vs 135.2 mm(3) stenting alone). However, the follow-up ISV and %ISV were significantly smaller in the DCA/stenting group (19.6 +/- 12.2 mm(3) DCA/stenting vs 44.6 +/- 29.5 mm(3) stenting alone; P =.00040; 15.3% +/- 10.6% DCA/stenting vs 31.5% +/- 17.7% stenting alone; P =.00040). Consequently, the DCA/stenting group showed a significantly greater follow-up LV (121.0 +/- 51.5 mm(3) DCA/stenting vs 91.5 +/- 26.7 mm(3) stenting alone; P =.016). CONCLUSIONS Plaque removal with DCA before stenting inhibits in-stent neointimal hyperplasia.
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Affiliation(s)
- Yoshihiro Takeda
- Department of Cardiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Japan.
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Xu HX, Yin XY, Lu MD, Liu GJ, Xu ZF. Estimation of liver tumor volume using a three-dimensional ultrasound volumetric system. ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:839-846. [PMID: 12837499 DOI: 10.1016/s0301-5629(02)00775-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The usefulness of a new three-dimensional ultrasound (3DUS) volumetric system developed recently was validated in volume measurement of liver tumor in the present study. The system was used to estimate the volumes of 22 regular phantoms, 25 irregular phantoms and 37 liver tumors from 33 patients. The results showed that the consumed time of measurement with the system ranged from 1 to 15 min, depending on different rotation angles. The measured volumes at different rotation angles all significantly correlated with the true volumes and there were no significant differences among measured volumes at different angles. The measurement error of 3DUS was 0.3% +/- 3.3% in regular phantoms, -0.4% +/- 3.7% in irregular phantoms and 0.9% +/- 11.3% in liver tumors, respectively, as compared with -5.3 +/- 9.4%, 13.6 +/- 28.0% and 15.3 +/- 37.3% for two-dimensional ultrasound, respectively (all p < 0.05). The volume estimation with 3DUS also had significant intraobserver and interobserver reproducibility both in vitro and in vivo. It can be concluded that the new system that we used can greatly reduce the consumed time and manual labor for volume measurement with high accuracy and reproducibility. 3DUS volumetry using the new system is more acceptable and valuable in clinical practice and is expected to be useful for evaluation of the efficacy of tumor therapy in situ in patients with hepatic tumors.
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Affiliation(s)
- Hui-Xiong Xu
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
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Arruda JA, Costa MA, Brito FS, Tedesco H, Barbosa AHP, Ribeiro EP, Pestana JOM, Lima VC. Effect of systemic immunosuppression on coronary in-stent intimal hyperplasia in renal transplant patients. Am J Cardiol 2003; 91:1363-5. [PMID: 12767437 DOI: 10.1016/s0002-9149(03)00333-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Airton Arruda
- Hospital São Paulo and Hospital do Rim e Hipertensão, Federal University of São Paulo (UNIFESP-EPM), R. Napoleão de Barros 715-Térreo, São Paulo, SP, Brazil 04024-002
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Palmer ND, Lessells A, Northridge DB, Fox KAA. Evaluation of vascular injury following percutaneous transluminal coronary angioplasty: a comparison of the accuracy of two- and three-dimensional intracoronary ultrasound imaging. Coron Artery Dis 2003; 14:255-62. [PMID: 12702930 DOI: 10.1097/01.mca.0000064020.05024.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Following percutaneous transluminal coronary angioplasty (PTCA), the extent of vascular injury is underestimated by angiographic assessment. Conventional intracoronary ultrasound (ICUS) imaging provides additional information with regard to the extent of dissections but requires mental reconstruction of consecutive images. Three-dimensional ICUS reconstruction overcomes this limitation and may provide more accurate assessment of the extent of vascular injury. This study compares conventional two-dimensional ICUS imaging to combined two- and three-dimensional ICUS information in the assessment of vascular injury following PTCA. METHODS Atherosclerotic, human coronary arteries (n=24) were studied in a specially constructed flow system. Balloon dilatation of significant stenoses was performed followed by assessment using two- and three-dimensional ICUS imaging methods. Treated arteries were submitted for histological assessment after pressure fixation. Dissection depth and length measurements were made from obtained images and compared to histomorphometric assessments. RESULTS Of the 20 arterial segments confirmed histologically to contain dissection, 11 (55%) and 18 (90%) were identified by two-dimensional ICUS and combined two- and three-dimensional ICUS respectively. The kappa values for correlation of dissection type were 0.29 (0.23-0.35) and 0.64 (0.57-0.71) respectively indicating better agreement using combined two- and three-dimensional ICUS. Two-dimensional ICUS consistently underestimated dissection length (3.52+/-1.75 mm compared with 6.54+/-2.42 mm, P<0.001) and depth (0.61+/-0.24 mm compared with 0.92+/-0.32 mm, P=0.001). Combined two- and three-dimensional ICUS produced accurate dissection length (6.13+/-2.29 mm compared with 6.54+/-2.42 mm, P=0.09) and depth (0.86+/-0.32 mm compared with 0.92+/-0.32 mm, P=0.28) estimations. CONCLUSION Computerized three-dimensional reconstruction of ICUS images provides improved accuracy compared to conventional ICUS imaging in the detection and quantitation of arterial dissection. This technique would be a useful adjunct to angiography for the precise assessment of vascular injury following PTCA.
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Affiliation(s)
- Nicholas D Palmer
- Departments of Cardiology and Pathology, Western General Hospital, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
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Klingensmith JD, Schoenhagen P, Tajaddini A, Halliburton SS, Tuzcu EM, Nissen SE, Vince DG. Automated three-dimensional assessment of coronary artery anatomy with intravascular ultrasound scanning. Am Heart J 2003; 145:795-805. [PMID: 12766735 DOI: 10.1016/s0002-8703(03)00089-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Angiography allows the definition of advanced, severe stages of coronary artery disease, but early atherosclerotic lesions, which do not lead to luminal stenosis, are not identified reliably. In contrast, intravascular ultrasound scanning allows the precise characterization and quantification of a wide range of atherosclerotic lesions, independent of the severity of luminal stenosis. METHODS Three-dimensional (3-D) reconstruction of entire coronary segments is possible with the integration of sequential 2-dimensional tomographic images and allows volumetric analysis of coronary arteries. RESULTS Automated systems able to recognize lumen and vessel borders and to display 3-D images are becoming available. CONCLUSION These systems have the potential for on-line 3-D image reconstruction for clinical decision-making and fast routine volumetric analysis in research studies. This review describes 3-D intravascular ultrasound scanning acquisition, analysis, and processing, and the associated technical challenges.
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Affiliation(s)
- Jon D Klingensmith
- Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Klingensmith JD, Tuzcu EM, Nissen SE, Vince DG. Validation of an automated system for luminal and medial-adventitial border detection in three-dimensional intravascular ultrasound. Int J Cardiovasc Imaging 2003; 19:93-104. [PMID: 12749389 DOI: 10.1023/a:1022843104297] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The precise tomographic assessment of coronary artery disease by intravascular ultrasound (IVUS) is useful in quantitative studies. Such studies require identification of luminal and medial-adventitial (MA) borders in a sequence of IVUS images. We have developed a three-dimensional (3D) active-surface system for border detection that facilitates the analysis of many images with minimal user interaction. To assess the validity of the technique, luminal and MA borders in 529 end-diastolic images from nine coronary arterial segments (58.8 +/- 14.2 images per patient) were traced manually by four experienced observers. The computer-detected borders were compared with borders determined by the four observers using a modified Williams' index (WI), the ratio of inter-observer variability to computer-observer variability. While manual tracing required 49.2 +/- 12.1 min for analysis, the analysis system identified luminal (R2 = 0.92) and MA borders (R2 = 0.97) in 13.8 +/- 4.0 min, a decrease of 35.4 min (p < 0.000001). The computer minus observer differences in lumen area and MA area were -0.88 +/- 0.90 and -0.07 +/- 0.63 mm2. Therefore, the computer system underestimated both lumen and MA area, but this effect was very small in MA area. The WI values and 95% confidence intervals were 0.98 (0.89,1.06) for luminal border detection and 0.99 (0.95,1.04) for MA border detection. Plaque volume measurements, a common endpoint of clinical trials, also verified the accuracy of the technique (R2 = 0.98). The proposed 3D active-surface border detection system provides a faster and less-tedious alternative to manual tracing for assessment of coronary artery anatomy in vivo.
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Affiliation(s)
- Jon D Klingensmith
- Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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View from the Cath Lab: Topic: Intravascular ultrasound. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2003; 1:57-63. [PMID: 12623416 DOI: 10.1080/acc.1.1.57.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tanabe K, Serruys PW, Grube E, Smits PC, Selbach G, van der Giessen WJ, Staberock M, de Feyter P, Müller R, Regar E, Degertekin M, Ligthart JMR, Disco C, Backx B, Russell ME. TAXUS III Trial: in-stent restenosis treated with stent-based delivery of paclitaxel incorporated in a slow-release polymer formulation. Circulation 2003; 107:559-64. [PMID: 12566366 DOI: 10.1161/01.cir.0000048184.96491.8a] [Citation(s) in RCA: 242] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The first clinical study of paclitaxel-eluting stent for de novo lesions showed promising results. We performed the TAXUS III trial to evaluate the feasibility and safety of paclitaxel-eluting stent for the treatment of in-stent restenosis (ISR). METHODS AND RESULTS The TAXUS III trial was a single-arm, 2-center study that enrolled 28 patients with ISR meeting the criteria of lesion length < or =30 mm, 50% to 99% diameter stenosis, and vessel diameter 3.0 to 3.5 mm. They were treated with one or more TAXUS NIRx paclitaxel-eluting stents. Twenty-five patients completed the angiographic follow-up at 6 months, and 17 of these underwent intravascular ultrasound (IVUS) examination. No subacute stent thrombosis occurred up to 12 months, but there was one late chronic total occlusion, and additional 3 patients showed angiographic restenosis. The mean late loss was 0.54 mm, with neointimal hyperplasia volume of 20.3 mm3. The major adverse cardiac event rate was 29% (8 patients; 1 non-Q-wave myocardial infarction, 1 coronary artery bypass grafting, and 6 target lesion revascularization [TLR]). Of the patients with TLR, 1 had restenosis in a bare stent implanted for edge dissection and 2 had restenosis in a gap between 2 paclitaxel-eluting stents. Two patients without angiographic restenosis underwent TLR as a result of the IVUS assessment at follow-up (1 incomplete apposition and 1 insufficient expansion of the stent). CONCLUSIONS Paclitaxel-eluting stent implantation is considered safe and potentially efficacious in the treatment of ISR. IVUS guidance to ensure good stent deployment with complete coverage of target lesion may reduce reintervention.
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Affiliation(s)
- Kengo Tanabe
- Division of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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Klingensmith JD, Vince DG. B-spline methods for interactive segmentation and modeling of lumen and vessel surfaces in three-dimensional intravascular ultrasound. Comput Med Imaging Graph 2002; 26:429-38. [PMID: 12453506 DOI: 10.1016/s0895-6111(02)00025-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Intravascular ultrasound (IVUS) provides direct depiction of coronary anatomy, including the degree and extent of coronary plaque, useful in quantitative research or clinical studies. These studies require fast and accurate analysis of coronary morphometry in volumetric IVUS images. Semi-automated interaction techniques are important for this task due to limitations of automated processing. We present B-spline-based surface fitting and manipulation methods that provide a foundation for such interaction techniques. They can be integrated easily with previously developed segmentation algorithms to provide a semi-automated segmentation system for identification of luminal and vessel borders in volumetric IVUS images.
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Affiliation(s)
- Jon D Klingensmith
- Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Tanabe K, Serruys PW, Degertekin M, Regar E, van Domburg RT, Sousa JE, Wülfert E, Morice MC. Fate of side branches after coronary arterial sirolimus-eluting stent implantation. Am J Cardiol 2002; 90:937-41. [PMID: 12398958 DOI: 10.1016/s0002-9149(02)02657-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The sirolimus-eluting stent (SES) is emerging as a potential solution for the prevention of restenosis. Although the outcome of side branches after stenting with an uncoated metal stent (UMS) has been reported, the fate of side branches after SES implantation is unknown. Furthermore, the absence of spontaneous recanalization of occluded side branches following intracoronary brachytherapy has been previously described and has been related to a delayed healing process. We assessed the procedural and 6-month follow-up angiograms of 238 patients enrolled in the RAVEL study, a double-blind controlled trial of the SES versus the UMS. Any side branch seen on the preprocedure angiogram and subsequently covered by the stent was evaluated. The side branch Thrombolysis In Myocardial Infarction (TIMI) flow grade was assessed at baseline and at follow-up by 2 observers. One hundred twenty-eight patients with > or =1 side branches were identified (63 patients in the SES group with 118 side branches, 65 patients in the UMS group with 124 side branches). Side branch occlusion occurred after stenting in 12 branches (10%) in the SES group and in 9 branches (7%) in the UMS group (p = NS). Of these occluded branches, spontaneous recanalization was observed in 11 branches (92%) in the SES group and in 6 branches (67%) in the UMS group at follow-up angiography (p = NS). Thus, the fate of side branches after SES implantation is favorable and at least as good as after UMS implantation.
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Serruys PW, Degertekin M, Tanabe K, Abizaid A, Sousa JE, Colombo A, Guagliumi G, Wijns W, Lindeboom WK, Ligthart J, de Feyter PJ, Morice MC. Intravascular ultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) trial. Circulation 2002; 106:798-803. [PMID: 12176950 DOI: 10.1161/01.cir.0000025585.63486.59] [Citation(s) in RCA: 261] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The goal of this intravascular ultrasound investigation was to provide a more detailed morphological analysis of the local biological effects of the implantation of a sirolimus-eluting stent compared with an uncoated stent. METHODS AND RESULTS In the RAVEL trial, 238 patients with single de novo lesions were randomized to receive either an 18-mm sirolimus-eluting stent (Bx VELOCITY stent, Cordis) or an uncoated stent (Bx VELOCITY stent). In a subset of 95 patients (sirolimus-eluting stent=48, uncoated stent=47), motorized intravascular ultrasound pullback (0.5 mm/s) was performed at a 6-month follow-up. Stent volumes, total vessel volumes, and plaque-behind-stent volumes were comparable. However, the difference in neointimal hyperplasia (2+/-5 versus 37+/-28 mm3) and percent of volume obstruction (1+/-3% versus 29+/-20%) at 6 months between the 2 groups was highly significant (P<0.001), emphasizing the nearly complete abolition of the proliferative process inside the drug-eluting stent. Analysis of the proximal and distal edge volumes showed no significant difference between the 2 groups in external elastic membrane or lumen and plaque volume at the proximal and distal edges. There was also no evidence of intrastent thrombosis or persisting dissection at the stent edges. Although there was a higher incidence of incomplete stent apposition in the sirolimus group compared with the uncoated stent group (P<0.05), it was not associated with any adverse clinical events at 1 year. CONCLUSIONS Sirolimus-eluting stents are effective in preventing neointimal hyperplasia without creating edge effect and without affecting the plaque burden behind the struts.
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Stähr P, Voigtländer T, Rupprecht HJ, Aschenbrücker P, Mamtimin H, Brennecke R, Otto M, Fitzgerald PJ, Meyer J. Impact of vessel curvature on the accuracy of three-dimensional intravascular ultrasound: validation by phantoms and coronary segments. J Am Soc Echocardiogr 2002; 15:823-30. [PMID: 12174352 DOI: 10.1067/mje.2002.120700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Three-dimensional intravascular ultrasound (IVUS) is used for volumetric assessment of arteriosclerotic plaque burden and restenotic tissue at follow-up after coronary interventions. However, the accuracy of these measurements, especially in tortuous vessels, is unclear. METHODS A commercially available electrocardiogram (ECG)-gated 3-dimensional-IVUS system was tested in volume-validated straight and curved hydrocolloid phantoms and in volume-validated coronary specimens. Catheter withdrawal (30 MHz, 3.2F) was triggered using standardized ECG source with 0.2-mm step intervals per cardiac cycle simulation. RESULTS On the basis of automated phantom volume measurements, IVUS overestimated true phantom volume (relative error = [measured V - true V]/true V x 100) by a median of 0.9%, 0.25%, and 1.96% for straight, mildly curved, and severely curved segments, respectively. The true volume of the coronary specimens was overestimated by a median of 5.79%. CONCLUSION A median percentage deviation of 3-dimensional-IVUS-measured volumes from the true volumes of less than 10% in phantoms and coronary artery segments can be achieved.
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Affiliation(s)
- Peter Stähr
- Stanford University Medical School, CA 94305, USA
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Koning G, Dijkstra J, von Birgelen C, Tuinenburg JC, Brunette J, Tardif JC, Oemrawsingh PW, Sieling C, Melsa S, Reiber JHC. Advanced contour detection for three-dimensional intracoronary ultrasound: a validation--in vitro and in vivo. Int J Cardiovasc Imaging 2002; 18:235-48. [PMID: 12123316 DOI: 10.1023/a:1015551920382] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Intracoronary ultrasound (ICUS) provides high-resolution transmural images of the arterial wall. By performing a pullback of the ICUS transducer and three-dimensional reconstruction of the images, an advanced assessment of the lumen and vessel wall morphology can be obtained. To reduce the analysis time and the subjectivity of boundary tracing, automated segmentation of the image sequence must be performed. The Quantitative Coronary Ultrasound-Clinical Measurement Solutions (QCU-CMS) (semi)automated analytical software package uses a combination of transversal and longitudinal model- and knowledge-guided contour detection techniques. On multiple longitudinal sections through the pullback stack, the external vessel contours are detected simultaneously, allowing mutual guidance of the detection in difficult areas. Subsequently, luminal contours are detected on these longitudinal sections. Vessel and luminal contour points are transformed to the individual cross-sections, where they guide the vessel and lumen contour detection on these transversal images. The performance of the software was validated stepwise. A set of phantoms was used to determine the systematic and random errors of the contour detection of external vessel and lumen boundaries. Subsequently, the results of the contour detection as obtained in in vivo image sets were compared with expert manual tracing, and finally the contour detection in in vivo image sequences was compared with results obtained from another previously validated ICUS quantification system. The phantom lumen diameters were underestimated by 0.1 mm, equally by the QCU-CMS software and by manual tracing. Comparison of automatically detected contours and expert manual contours, showed that lumen contours correspond very well (systematic and random radius difference: -0.025 +/- 0.067 mm), while automatically detected vessel contours slightly overestimated the expert manual contours (radius difference: 0.061 +/- 0.037 mm). The cross-sectional vessel and lumen areas as detected with our system and with the second computerized system showed a high correlation (r = 0.995 and 0.978, respectively). Thus, use of the new QCU-CMS analytical software is feasible and the validation data suggest its application for the analysis of clinical research.
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Affiliation(s)
- Gerhard Koning
- Department of Radiology, Leiden University Medical Center, The Netherlands.
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Kutryk MJB, Foley DP, van den Brand M, Hamburger JN, van der Giessen WJ, deFeyter PJ, Bruining N, Sabate M, Serruys PW. Local intracoronary administration of antisense oligonucleotide against c-myc for the prevention of in-stent restenosis: results of the randomized investigation by the Thoraxcenter of antisense DNA using local delivery and IVUS after coronary stenting (ITALICS) trial. J Am Coll Cardiol 2002; 39:281-7. [PMID: 11788220 DOI: 10.1016/s0735-1097(01)01741-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study was designed to determine whether antisense oligodeoxynucleotides (ODN) directed against the nuclear proto-oncogene c-myc could inhibit restenosis when given by local delivery immediately after coronary stent implantation. BACKGROUND Failure of conventional pharmacologic therapies to reduce the incidence of coronary restenosis after percutaneous revascularization techniques has prompted interest in the use of agents that target intracellular central regulatory mechanisms. METHODS Eighty-five patients were randomly assigned to receive either 10 mg of phosphorothioate-modified 15-mer antisense ODN or saline vehicle by intracoronary local delivery after coronary stent implantation. The primary end point was percent neointimal volume obstruction measured by computerized analysis of electrocardiogram-gated intravascular ultrasound (IVUS) at six-month follow-up. Secondary end points included clinical outcome and quantitative coronary angiography analysis. RESULTS Analysis of follow-up IVUS data was performed on 77 patients. In-stent volume obstruction was similar between groups (44 +/- 16% and 46 +/- 14%, placebo vs. ODN; p = 0.57; 95% confidence interval: -1.13 to 0.85). Minimum luminal diameter increased from 0.84 +/- 0.36 and 0.90 +/- 0.45 (p = 0.55) to 2.70 +/- 0.37 and 2.80 +/- 0.37 (p = 0.28) after stent implantation, which decreased to 1.50 +/- 0.61 and 1.50 +/- 0.53 (p = 0.98) by six months, yielding similar loss indexes (placebo vs. ODN, respectively). There were no differences in angiographic restenosis rates (38.5 and 34.2%; p = 0.81; placebo vs. ODN) or clinical outcome. CONCLUSIONS Treatment with 10 mg of phosphorothioate-modified ODN directed against c-myc does not reduce neointimal volume obstruction or the angiographic restenosis rate in this patient population.
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Affiliation(s)
- Michael J B Kutryk
- Department of Interventional Cardiology, Thoraxcenter, University Hospital Dijkzigt, Rotterdam, The Netherlands
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