1
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Lachmann V, Makimoto H, Kelm M, Bönner F. Aborted sudden cardiac death: ICD or no ICD. Clin Res Cardiol 2017; 106:760-763. [PMID: 28396986 DOI: 10.1007/s00392-017-1110-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Vera Lachmann
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Hisaki Makimoto
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Düsseldorf (CARID), University Düsseldorf, Düsseldorf, Germany
| | - Florian Bönner
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
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2
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Li J, Ma T, Mohar D, Steward E, Yu M, Piao Z, He Y, Shung KK, Zhou Q, Patel PM, Chen Z. Ultrafast optical-ultrasonic system and miniaturized catheter for imaging and characterizing atherosclerotic plaques in vivo. Sci Rep 2015; 5:18406. [PMID: 26678300 PMCID: PMC4683418 DOI: 10.1038/srep18406] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/17/2015] [Indexed: 12/17/2022] Open
Abstract
Atherosclerotic coronary artery disease (CAD) is the number one cause of death worldwide. The majority of CAD-induced deaths are due to the rupture of vulnerable plaques. Accurate assessment of plaques is crucial to optimize treatment and prevent death in patients with CAD. Current diagnostic techniques are often limited by either spatial resolution or penetration depth. Several studies have proved that the combined use of optical and ultrasonic imaging techniques increase diagnostic accuracy of vulnerable plaques. Here, we introduce an ultrafast optical-ultrasonic dual-modality imaging system and flexible miniaturized catheter, which enables the translation of this technology into clinical practice. This system can perform simultaneous optical coherence tomography (OCT)-intravascular ultrasound (IVUS) imaging at 72 frames per second safely in vivo, i.e., visualizing a 72 mm-long artery in 4 seconds. Results obtained in atherosclerotic rabbits in vivo and human coronary artery segments show that this ultrafast technique can rapidly provide volumetric mapping of plaques and clearly identify vulnerable plaques. By providing ultrafast imaging of arteries with high resolution and deep penetration depth simultaneously, this hybrid IVUS-OCT technology opens new and safe opportunities to evaluate in real-time the risk posed by plaques, detect vulnerable plaques, and optimize treatment decisions.
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Affiliation(s)
- Jiawen Li
- Beckman Laser Institute, University of California, Irvine, 1002 Health Sciences Rd. Irvine, CA 92617, USA.,Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, 92697-2700, USA
| | - Teng Ma
- NIH Ultrasonic Transducer Resource Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Dilbahar Mohar
- School of Medicine, University of California, Irvine, 101 The City Drive South, Orange, CA, 92868, USA
| | - Earl Steward
- School of Medicine, University of California, Irvine, 101 The City Drive South, Orange, CA, 92868, USA
| | - Mingyue Yu
- NIH Ultrasonic Transducer Resource Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Zhonglie Piao
- Beckman Laser Institute, University of California, Irvine, 1002 Health Sciences Rd. Irvine, CA 92617, USA
| | - Youmin He
- Beckman Laser Institute, University of California, Irvine, 1002 Health Sciences Rd. Irvine, CA 92617, USA
| | - K Kirk Shung
- NIH Ultrasonic Transducer Resource Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Qifa Zhou
- NIH Ultrasonic Transducer Resource Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Pranav M Patel
- School of Medicine, University of California, Irvine, 101 The City Drive South, Orange, CA, 92868, USA
| | - Zhongping Chen
- Beckman Laser Institute, University of California, Irvine, 1002 Health Sciences Rd. Irvine, CA 92617, USA.,Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, 92697-2700, USA
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3
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Mulder WJM, Jaffer FA, Fayad ZA, Nahrendorf M. Imaging and nanomedicine in inflammatory atherosclerosis. Sci Transl Med 2015; 6:239sr1. [PMID: 24898749 DOI: 10.1126/scitranslmed.3005101] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Bioengineering provides unique opportunities to better understand and manage atherosclerotic disease. The field is entering a new era that merges the latest biological insights into inflammatory disease processes with targeted imaging and nanomedicine. Preclinical cardiovascular molecular imaging allows the in vivo study of targeted nanotherapeutics specifically directed toward immune system components that drive atherosclerotic plaque development and complication. The first multicenter trials highlight the potential contribution of multimodality imaging to more efficient drug development. This review describes how the integration of engineering, nanotechnology, and cardiovascular immunology may yield precision diagnostics and efficient therapeutics for atherosclerosis and its ischemic complications.
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Affiliation(s)
- Willem J M Mulder
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA. Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Farouc A Jaffer
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, MA 02114, USA
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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4
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Sun D, Zheng Y, Yin T, Tang C, Yu Q, Wang G. Coronary drug-eluting stents: From design optimization to newer strategies. J Biomed Mater Res A 2013; 102:1625-40. [DOI: 10.1002/jbm.a.34806] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 04/25/2013] [Accepted: 05/11/2013] [Indexed: 01/25/2023]
Affiliation(s)
- Daming Sun
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University; Chongqing 400044 People's Republic of China
| | - Yiming Zheng
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University; Chongqing 400044 People's Republic of China
| | - Tieying Yin
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University; Chongqing 400044 People's Republic of China
| | - Chaojun Tang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University; Chongqing 400044 People's Republic of China
| | - Qingsong Yu
- Department of Mechanical and Aerospace Engineering; University of Missouri; Columbia Missouri 65211
| | - Guixue Wang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University; Chongqing 400044 People's Republic of China
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5
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Bourantas CV, Onuma Y, Farooq V, Zhang Y, Garcia-Garcia HM, Serruys PW. Bioresorbable scaffolds: Current knowledge, potentialities and limitations experienced during their first clinical applications. Int J Cardiol 2013; 167:11-21. [DOI: 10.1016/j.ijcard.2012.05.093] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/27/2012] [Indexed: 12/21/2022]
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6
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Calvert PA, Bennett MR. Radiofrequency intravascular ultrasound and detection of the vulnerable plaque. Br J Hosp Med (Lond) 2013; 73:682-6. [PMID: 23502196 DOI: 10.12968/hmed.2012.73.12.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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7
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Painting blood vessels and atherosclerotic plaques with an adhesive drug depot. Proc Natl Acad Sci U S A 2012; 109:21444-9. [PMID: 23236189 DOI: 10.1073/pnas.1217972110] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The treatment of diseased vasculature remains challenging, in part because of the difficulty in implanting drug-eluting devices without subjecting vessels to damaging mechanical forces. Implanting materials using adhesive forces could overcome this challenge, but materials have previously not been shown to durably adhere to intact endothelium under blood flow. Marine mussels secrete strong underwater adhesives that have been mimicked in synthetic systems. Here we develop a drug-eluting bioadhesive gel that can be locally and durably glued onto the inside surface of blood vessels. In a mouse model of atherosclerosis, inflamed plaques treated with steroid-eluting adhesive gels had reduced macrophage content and developed protective fibrous caps covering the plaque core. Treatment also lowered plasma cytokine levels and biomarkers of inflammation in the plaque. The drug-eluting devices developed here provide a general strategy for implanting therapeutics in the vasculature using adhesive forces and could potentially be used to stabilize rupture-prone plaques.
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8
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Brugaletta S, Radu MD, Garcia-Garcia HM, Heo JH, Farooq V, Girasis C, van Geuns RJ, Thuesen L, McClean D, Chevalier B, Windecker S, Koolen J, Rapoza R, Miquel-Hebert K, Ormiston J, Serruys PW. Circumferential evaluation of the neointima by optical coherence tomography after ABSORB bioresorbable vascular scaffold implantation: can the scaffold cap the plaque? Atherosclerosis 2012; 221:106-12. [PMID: 22209268 DOI: 10.1016/j.atherosclerosis.2011.12.008] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/03/2011] [Accepted: 12/05/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To quantify the circumferential healing process at 6 and 12 months following scaffold implantation. BACKGROUND The healing process following stent implantation consists of tissue growing on the top of and in the space between each strut. With the ABSORB bioresorbable vascular scaffold (BVS), the outer circumference of the scaffold is detectable by optical coherence tomography (OCT), allowing a more accurate and complete evaluation of the intra-scaffold neointima. METHODS A total of 58 patients (59 lesions), who received an ABSORB BVS 1.1 implantation and a subsequent OCT investigation at 6 (n=28 patients/lesions) or 12 (n=30 patients with 31 lesions) months follow-up were included in the analysis. The thickness of the neointima was calculated circumferentially in the area between the abluminal side of the scaffold and the lumen by means of an automated detection algorithm. The symmetry of the neointima thickness in each cross section was evaluated as the ratio between minimum and maximum thickness. RESULTS The neointima area was not different between 6 and 12 months follow-up (1.57±0.42 mm(2) vs. 1.64±0.77 mm(2); p=0.691). No difference was also found in the mean thickness of the neointima (median [IQR]) between the two follow-up time points (210 μm [180-260]) vs. 220 μm [150-260]; p=0.904). However, the symmetry of the neointima thickness was higher at 12 than at 6 months follow-up (0.23 [0.13-0.28] vs. 0.16 [0.08-0.21], p=0.019). CONCLUSIONS A circumferential evaluation of the healing process following ABSORB implantation is feasible, showing the formation of a neointima layer, that resembles a thick fibrous cap, known for its contribution to plaque stability.
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9
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Obaid DR, Calvert PA, McNab D, West NEJ, Bennett MR. Identification of coronary plaque sub-types using virtual histology intravascular ultrasound is affected by inter-observer variability and differences in plaque definitions. Circ Cardiovasc Imaging 2012; 5:86-93. [PMID: 22109982 DOI: 10.1161/circimaging.111.965442] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies show that virtual histology intravascular ultrasound (VH-IVUS) can identify plaques at high risk of rupture, such as thin-capped fibroatheromata, raising the possibility of immediate targeted intervention. However, plaque classification entails border recognition and subjective assessment of plaque architecture, introducing inter-observer variability without confirmation by core-labs. Furthermore, the accuracy of local versus core-laboratory VH-IVUS plaque classification and effects of different plaque definitions have not been examined. METHODS AND RESULTS Local observers classified 100 VH-IVUS-defined coronary plaques to determine single center inter-observer variability; multi-center variability was determined by comparison with VH-IVUS core-laboratory analysis, and compared with gray-scale IVUS. Frequency of plaque types using different published plaque definitions also was determined. Single-center VH-IVUS inter-observer agreement was strong (kappa=0.86), but lower for thin-capped fibroatheromatas (k=0.59) because of observer judgments on presence and location of confluent necrotic core. Multi-center inter-observer agreement for plaque classification was lower again (k=0.71), particularly for thin-capped fibroatheromatas (k=0.56). Different plaque definitions further reduced VH-IVUS-defined thin-capped fibroatheromata numbers by 44%. The diagnostic accuracy of gray-scale IVUS to identify thin-capped fibroatheromata was poor for both observers (21 and 29% correct), with low inter-observer agreement (k=0.14). CONCLUSIONS VH-IVUS plaque classification, and particularly VH-IVUS-defined thin-capped fibroatheromata identification, varies significantly between local observers, and particularly in comparison with core-laboratory analysis. Differences in VH-IVUS plaque definitions introduce further variability between studies. These factors reduce the use of VH-IVUS plaque classification to guide intervention in a "live" clinical setting, and also affect comparison of diagnostic accuracy and natural history of plaques between studies.
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Affiliation(s)
- Daniel R Obaid
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
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10
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Granada J, Milewski K, Uribe M, Moncada M, Fernandez A, Blanco G, Kaluza G, Wykrzykowska J, Serruys P, Stone G, Delgado J. First clinical evaluation of a luminal self-expanding shield in patients with intermediate coronary lesions. EUROINTERVENTION 2011; 7:780-8. [DOI: 10.4244/eijv7i7a124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Serruys PW, Garcia-Garcia HM, Onuma Y. From metallic cages to transient bioresorbable scaffolds: change in paradigm of coronary revascularization in the upcoming decade? Eur Heart J 2011; 33:16-25b. [PMID: 22041548 DOI: 10.1093/eurheartj/ehr384] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Patrick W Serruys
- Thorax Centrum, Erasmus MC, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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12
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Farooq V, Heo JH, Räber L, Brugaletta S, Radu M, Gogas BD, Diletti R, Onuma Y, Garcia-Garcia HM, Serruys PW. Tools & techniques: risk stratification and diagnostic tools in left main stem intervention. EUROINTERVENTION 2011; 7:747-53. [PMID: 21986332 DOI: 10.4244/eijv7i6a118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Vasim Farooq
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
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13
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Schwarz F, Treitl M, Grimm J, Cyran C, Nikolaou K, Reiser M, Saam T. The relationship between plaque imaging characterization and treatment modality selection. Interv Cardiol 2011. [DOI: 10.2217/ica.11.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Yu SS, Ortega RA, Reagan BW, McPherson JA, Sung HJ, Giorgio TD. Emerging applications of nanotechnology for the diagnosis and management of vulnerable atherosclerotic plaques. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2011; 3:620-46. [PMID: 21834059 DOI: 10.1002/wnan.158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
An estimated 16 million people in the United States have coronary artery disease (CAD), and approximately 325,000 people die annually from cardiac arrest. About two-thirds of unexpected cardiac deaths occur without prior recognition of cardiac disease. A vast majority of these deaths are attributable to the rupture of 'vulnerable atherosclerotic plaques'. Clinically, plaque vulnerability is typically assessed through imaging techniques, and ruptured plaques leading to acute myocardial infarction are treated through angioplasty or stenting. Despite significant advances, it is clear that current imaging methods are insufficiently capable for elucidating plaque composition--which is a key determinant of vulnerability. Further, the exciting improvement in the treatment of CAD afforded by stenting procedures has been buffered by significant undesirable host-implant effects, including restenosis and late thrombosis. Nanotechnology has led to some potential solutions to these problems by yielding constructs that interface with plaque cellular components at an unprecedented size scale. By leveraging the innate ability of macrophages to phagocytose nanoparticles, contrast agents can now be targeted to plaque inflammatory activity. Improvements in nano-patterning procedures have now led to increased ability to regenerate tissue isotropy directly on stents, enabling gradual regeneration of normal, physiologic vascular structures. Advancements in immunoassay technologies promise lower costs for biomarker measurements, and in the near future, may enable the addition of routine blood testing to the clinician's toolbox--decreasing the costs of atherosclerosis-related medical care. These are merely three examples among many stories of how nanotechnology continues to promise advances in the diagnosis and treatment of vulnerable atherosclerotic plaques.
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Affiliation(s)
- Shann S Yu
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
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15
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Vancraeynest D, Pasquet A, Roelants V, Gerber BL, Vanoverschelde JLJ. Imaging the vulnerable plaque. J Am Coll Cardiol 2011; 57:1961-79. [PMID: 21565634 DOI: 10.1016/j.jacc.2011.02.018] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 02/09/2011] [Accepted: 02/15/2011] [Indexed: 12/27/2022]
Abstract
Cardiovascular diseases are still the primary causes of mortality in the United States and in Western Europe. Arterial thrombosis is triggered by a ruptured atherosclerotic plaque and precipitates an acute vascular event, which is responsible for the high mortality rate. These rupture-prone plaques are called "vulnerable plaques." During the past decades, much effort has been put toward accurately detecting the presence of vulnerable plaques with different imaging techniques. In this review, we provide an overview of the currently available invasive and noninvasive imaging modalities used to detect vulnerable plaques. We will discuss the upcoming challenges in translating these techniques into clinical practice and in assigning them their exact place in the decision-making process.
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Affiliation(s)
- David Vancraeynest
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Cliniques, Université Catholique de Louvain, Brussels, Belgium
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In-vivo assessment of the natural history of coronary atherosclerosis: vascular remodeling and endothelial shear stress determine the complexity of atherosclerotic disease progression. Curr Opin Cardiol 2011; 25:627-38. [PMID: 20838338 DOI: 10.1097/hco.0b013e32833f0236] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Atherosclerotic disease progression is determined by localized plaque growth, which is induced by systemic and local hemodynamic factors, and the nature of the wall remodeling response. The purpose of this review is to summarize the processes underlying the heterogeneity of coronary atherosclerosis progression in relation to the local hemodynamic and arterial remodeling environment. RECENT FINDINGS Multiple competing biological processes in the extracellular matrix define the extent of vascular remodeling and disease progression. The remodeling phenomenon is not consistent but is characterized by great phenotypical heterogeneity which reflects the complex effect of systemic, genetic and hemodynamic factors on the arterial wall response to plaque formation and progression. The exaggeration of expansive remodeling (i.e., excessive expansive remodeling) likely contributes to the transformation of an initially favorable action into an excessive course of vessel expansion, continued disease progression and plaque instability. Extremely low endothelial shear stress and excessive expansive remodeling establish a vicious cycle which leads to the formation of severe plaques with high-risk characteristics. SUMMARY The dynamic interplay between the local hemodynamic environment and the wall remodeling behavior determines the complexity of the natural history of atherosclerosis and explains the development of localized plaque vulnerability.
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Sarno G, Garg S, Gomez-Lara J, Garcia Garcia HM, Ligthart J, Bruining N, Onuma Y, Witberg K, van Geuns RJ, de Boer S, Wykrzykowska J, Schultz C, Duckers H, Regar E, de Jaegere P, de Feyter P, van Es GA, Boersma E, van der Giessen W, Serruys PW. Intravascular ultrasound radiofrequency analysis after optimal coronary stenting with initial quantitative coronary angiography guidance: an ATHEROREMO sub-study. EUROINTERVENTION 2011; 6:977-84. [DOI: 10.4244/eijv6i8a169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Morphology of coronary artery lesions assessed by virtual histology intravascular ultrasound tissue characterization and fractional flow reserve. Int J Cardiovasc Imaging 2011; 28:221-8. [PMID: 21336551 DOI: 10.1007/s10554-011-9816-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 01/20/2011] [Indexed: 01/07/2023]
Abstract
Fractional flow reserve (FFR) is an index of the physiological significance of a coronary stenosis. Patients who have lesions with a FFR of >0.80, even optimally treated with medication, have however a MACE rate ranging from 8 to 21%. Coronary plaques at high risk of rupture and clinical events can be also identified by virtual histology intravascular ultrasound (IVUS-VH) as plaques with high amount of necrotic core (NC) abutting the lumen. Aim of this exploratory study was to investigate whether the geometry and composition of lesions with FFR ≤ 0.80 were different from their counterparts. Fifty-five consecutive patients in whom FFR was clinically indicated on a moderate angiographic lesion, received also an imaging investigation on the same lesion with IVUS-VH. Data on plaque geometry and composition was analyzed. Patients were subdivided in two groups according to the value of FFR (> or ≤0.80). Lesions with a FFR ≤ 0.80 (n = 17) showed a slightly larger plaque burden than those with FFR > 0.80 (n = 38) (54.6 ± 0.7% vs. 51.7 ± 0.7% P = 0.1). In addition, they tend to have less content of necrotic core than their counterparts (14.2 ± 8% vs. 19.2 ± 10.2%, P = 0.08). No difference was found in the distribution of NC-rich plaques (fibroatheroma and thin-capped fibroatheroma) between groups (82% in FFR ≤ 0.80 vs. 79% in FFR > 0.80, P = 0.5). Although FFR ≤ 0.80 lesions have larger plaque size, they do not differ in composition from the ones with FFR > 0.80. Further exploration in a large prospective study is needed to study whether the lesions with FFR > 0.80 that are NC rich are the ones associated with the presence of clinical events at follow-up.
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19
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Brugaletta S, Costa JR, Garcia-Garcia HM. Assessment of drug-eluting stents and bioresorbable stents by grayscale IVUS and IVUS-based imaging modalities. Int J Cardiovasc Imaging 2011; 27:239-48. [PMID: 21279692 DOI: 10.1007/s10554-010-9788-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/30/2010] [Indexed: 11/28/2022]
Abstract
Grayscale IVUS and IVUS-based imaging modalities during the last years have become useful in the assessment not only of drug eluting stent, but also of new bioresorbable vascular scaffolds. Although IVUS resolution is not sufficient for determining stent coverage (optical coherence tomography is the gold standard), serial IVUS can measure intimal hyperplasia, assess acute and late incomplete stent apposition, detect the presence and persistence of edge dissections, study edge effects and look for causes of restenosis and thrombosis. In addition other IVUS-based imaging modalities, such as IVUS-VH, iMAP or palpography, can be used to study the serial compositional and mechanical changes of the plaque behind stent struts and also to follow the bioresorption of the new bioresorbable scaffolds, analyzing the backscattering signal coming from the polymeric struts. This review details and evaluates grayscale IVUS and IVUS-based techniques findings in clinical trials, highlighting the usefulness of these imaging modalities in the study of drug eluting stents and bioresorbable vascular scaffold.
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Affiliation(s)
- Salvatore Brugaletta
- Thoraxcenter, Z120, Erasmus MC, Dr Molewaterplein 40, 3015 Rotterdam, The Netherlands
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20
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The year in intracoronary imaging. JACC Cardiovasc Imaging 2010; 3:881-91. [PMID: 20705271 DOI: 10.1016/j.jcmg.2010.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 04/26/2010] [Accepted: 05/13/2010] [Indexed: 11/20/2022]
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Garg S, Serruys PW. Coronary stents: looking forward. J Am Coll Cardiol 2010; 56:S43-78. [PMID: 20797503 DOI: 10.1016/j.jacc.2010.06.008] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 11/24/2022]
Abstract
Despite all the benefits of drug-eluting stents (DES), concerns have been raised over their long-term safety, with particular reference to stent thrombosis. In an effort to address these concerns, newer stents have been developed that include: DES with biodegradable polymers, DES that are polymer free, stents with novel coatings, and completely biodegradable stents. Many of these stents are currently undergoing pre-clinical and clinical trials; however, early results seem promising. This paper reviews the current status of this new technology, together with other new coronary devices such as bifurcation stents and drug-eluting balloons, as efforts continue to design the ideal coronary stent.
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Affiliation(s)
- Scot Garg
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Milewski K, Granada JF. Low-pressure self-expandable luminal shield system: mechanical stabilization of high-risk coronary atherosclerotic lesions. Interv Cardiol 2010. [DOI: 10.2217/ica.10.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Nikolsky E, Danenberg HD, Lotan C, Beyar R. Highlights from the Innovations in Cardiovascular Interventions Meeting: in favor of creativity and ingenuity. Expert Rev Cardiovasc Ther 2010; 8:491-7. [PMID: 20397822 DOI: 10.1586/erc.10.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The annual Innovations in Cardiovascular Interventions Meeting was organized in close collaboration with the Cardiovascular Research Foundation and was co-sponsored by the Society for Coronary Angiography and Interventions. The meeting was co-chaired by Rafael Beyar and Chaim Lotan, and took place in Tel Aviv, Israel, on 6-8 December 2009. It was a continuation of the series of international conferences in interventional cardiology held in Israel since 1995. The meeting is distinctive in that it provides a wide perspective on the innovative technologies and therapies for cardiovascular applications. Unique sessions covering emerging technologies, relationships between academia and industry, as well as regulatory aspects of medical devices provided participants with a wide perspective on current and future technologies. The Innovations in Cardiovascular Interventions Meeting was attended by over 700 participants from over 40 countries, including cardiologists, surgeons, nurses, pharmacists and allied health professionals. The world's leading experts in the field of interventional cardiology, cardiac surgery and radiology presented the latest information on innovative diagnostic and treatment modalities for cardiovascular pathology, and delivered expert lectures and clinical overviews, as well as presentations on the advances and controversies in basic, translational and clinical research. The meeting was accompanied by thematic live cases and a parade of new technology companies. Innovations in Cardiovascular Interventions Meeting 2009 presentations are available to watch and download at www.congress.co.il/ici2009 .
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Affiliation(s)
- Eugenia Nikolsky
- Heart Institute, Cardiovascular Research Unit, Rambam Health Care Campus Technion-Israel Institute of Technology, Haifa, Israel.
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Joner M, Nakazawa G, Bonsignore C, Acampado E, Steigerwald K, Merl S, Vallbracht T, Kolodgie F, Virmani R. Histopathologic evaluation of nitinol self-expanding stents in an animal model of advanced atherosclerotic lesions. EUROINTERVENTION 2010; 5:737-744. [DOI: 10.4244/121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Affiliation(s)
- Pedro R. Moreno
- From the Interventional Cardiology Research, Department of Medicine, Mount Sinai Hospital and Mount Sinai School of Medicine, New York, NY
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Parikh SA, Costa MA. Secondary prevention, the interventional way: prophylactic drug-eluting stents for nonobstructive saphenous vein graft disease. Circulation 2009; 120:1940-2. [PMID: 19884465 DOI: 10.1161/circulationaha.109.903146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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