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Yang S, Hu S. Perspectives on endoscopic functional photoacoustic microscopy. APPLIED PHYSICS LETTERS 2024; 125:030502. [PMID: 39022117 PMCID: PMC11251735 DOI: 10.1063/5.0201691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024]
Abstract
Endoscopy, enabling high-resolution imaging of deep tissues and internal organs, plays an important role in basic research and clinical practice. Recent advances in photoacoustic microscopy (PAM), demonstrating excellent capabilities in high-resolution functional imaging, have sparked significant interest in its integration into the field of endoscopy. However, there are challenges in achieving functional PAM in the endoscopic setting. This Perspective article discusses current progress in the development of endoscopic PAM and the challenges related to functional measurements. Then, it points out potential directions to advance endoscopic PAM for functional imaging by leveraging fiber optics, microfabrication, optical engineering, and computational approaches. Finally, it highlights emerging opportunities for functional endoscopic PAM in basic and translational biomedicine.
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Affiliation(s)
- Shuo Yang
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, USA
| | - Song Hu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, USA
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King RM, Peker A, Epshtein M, Arends JM, Brochu AB, Raskett CM, Slazas KJ, Puri AS, Arthur AS, Fiorella D, Gounis MJ, Anagnostakou V. Active drug-coated flow diverter in a preclinical model of intracranial stenting. J Neurointerv Surg 2024; 16:731-736. [PMID: 37399337 DOI: 10.1136/jnis-2023-020391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Flow diverters carry the risk of thromboembolic complications (TEC). We tested a coating with covalently bound heparin that activates antithrombin to address TEC by locally downregulating the coagulation cascade. We hypothesized that the neuroimaging evidence of TEC would be reduced by the coating. METHODS 16 dogs were implanted with overlapping flow diverters in the basilar artery, separated into two groups: heparin-coated (n=9) and uncoated (n=7). Following implantation, high-frequency optical coherence tomography (HF-OCT) was acquired to quantify acute thrombus (AT) formation on the flow diverters. MRI was performed postoperatively and repeated at 1, 2, 3, 4, and 8 weeks, consisting of T1-weighted imaging, time-0f-flight (ToF), diffusion weighted imaging (DWI), susceptibility weighted imaging (SWI), and fluid attenuated inversion recovery (FLAIR) sequences. Neurological examinations were performed throughout the 8-week duration of the study. RESULTS The mean AT volume on coated devices was lower than uncoated (0.014 vs 0.018 mm3); however, this was not significant (P=0.3). The mean number of foci of magnetic susceptibility artifacts (MSAs) on SWI was significantly different between the uncoated and coated groups at the 1-week follow-up (P<0.02), and remained statistically different throughout the duration of the study. The AT volume showed a direct linear correlation with the MSA count and 80% of the variance in the MSA could be explained by the AT volume (P<0.001). Pathological analysis showed evidence of ischemic injury at locations of MSA. CONCLUSIONS Heparin-coated flow diverters significantly reduced the number of new MSAs after 1 week follow-up, showing the potential to reduce TEC.
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Affiliation(s)
- Robert M King
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ahmet Peker
- Radiology, Koç University Hospital, Istanbul, Turkey
| | - Mark Epshtein
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Alice B Brochu
- Research and Development, Stryker Neurovascular, Fremont, California, USA
| | - Christopher M Raskett
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kimiko J Slazas
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Vania Anagnostakou
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Garin D, Cook S, Togni M, Meier P, Wenaweser P, Puricel S, Arroyo D. Experience with a novel high frequency optical coherence tomography device for intracoronary imaging: a case series. Front Cardiovasc Med 2024; 11:1384222. [PMID: 38911518 PMCID: PMC11190299 DOI: 10.3389/fcvm.2024.1384222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Intravascular imaging, especially optical coherence tomography (OCT), has significantly improved percutaneous coronary intervention (PCI), yet its routine clinical application faces challenges. This case series introduces the Gentuity® High-Frequency Optical Coherence Tomography (HF-OCT), a novel device designed to enhance intracoronary imaging with a significantly faster pullback and smaller catheter size, potentially offering enhanced navigability in complex lesions. We aimed to assess the image quality of Gentuity® HF-OCT in complex vessel conditions, as well as presenting a case series to illustrate the application of the device in various clinical scenarios. Methods In this case series, we included all patients who underwent intracoronary HF-OCT imaging at our center. The primary endpoint was image quality assessed by clear image length (CIL). Image quality was assessed in relation to (1) lesion severity assessed by minimum lumen area (MLA); (2) vessel size, differentiating between larger (diameter ≥ 4 mm) and smaller vessel segments; (3) pre- vs. post-PCI conditions, and (4) vessel tortuosity, categorized into none, moderate, and severe. Results Twenty-four HF-OCT runs from 14 patients were included. No significant differences in CIL were observed across lesion severity terciles (p = 0.449), between small and large vessel segments [mean CIL% difference 1.3%; confidence interval (CI), -9.3 to 11.8; p = 0.802], and pre- vs. post-PCI conditions (mean CIL difference -3.9 mm; CI, -14.0 to 6.1; p = 0.373). Vessel tortuosity significantly impacted image quality, with clear reductions in CIL observed in cases of moderate (74.8; CI, 73.5 to 76.0; vs. 63.9; CI, 56.2 to 71.5; p = 0.043) and severe tortuosity (74.8; CI, 73.5 to 76.0; vs. 65.0; CI, 62.1 to 67.9; p = 0.002) compared to vessels with no tortuosity. Overall, the HF-OCT demonstrated excellent catheter deliverability and crossability, with very satisfactory image quality and no significant adverse events. Conclusion The Gentuity® HF-OCT is a new OCT device capable of navigating both small- and large-diameter vessels, with similar image quality, but vessel tortuosity seems to have an impact on image quality. It appears to be as usable as conventional OCT for pre-PCI diagnosis and OCT-guided PCI, potentially bringing additional benefits in terms of deliverability, lesion crossover and ease of use in routine clinical practice.
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Affiliation(s)
| | | | | | | | | | | | - Diego Arroyo
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
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Mansourian E, Pavlin-Premrl D, Friedman J, Jhamb A, Khabaza A, Brooks M, Asadi H, Maingard J. High-frequency optical coherence tomography for endovascular management of cerebral aneurysms. J Med Imaging Radiat Oncol 2024; 68:447-456. [PMID: 38654682 DOI: 10.1111/1754-9485.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
Endovascular management of intracranial aneurysms has become the mainstay of treatment in recent years; however, retreatment rates remain as high as 1 in 5. High-frequency optical coherence tomography (HF-OCT) is an emerging imaging modality for the assessment, treatment and follow-up of cerebral aneurysms. EMBASE and SCOPUS databases were searched for studies relating to the management of intracranial aneurysm with OCT. A combination of keywords were used including 'cerebral aneurysm', 'intracranial aneurysm', 'high-frequency optical coherence tomography', 'optical coherence tomography', and 'optical frequency domain imaging'. There were 23 papers included in this review. For the assessment of intracranial aneurysm, OCT was able to accurately assess aneurysm morphology as well as detailed analysis of arterial wall layers. During IA treatment, OCT was used to assess and troubleshoot stent placement to optimise successful isolation from the circulation. In the follow-up period, endothelial growth patterns were visualised by OCT imaging. OCT shows promise for the treatment of IAs at all stages of management. Due to the novel development of HF-OCT, there is limited longitudinal data in human studies. Further research in this area is required with a focus specifically on long-term treatment outcomes in humans.
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Affiliation(s)
- Elizabeth Mansourian
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Davor Pavlin-Premrl
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Neurointerventional Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Joshua Friedman
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ash Jhamb
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ali Khabaza
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Neurointerventional Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Mark Brooks
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Neurointerventional Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Neurointerventional Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Interventional Neuroradiology Department, Monash Health, Clayton, Victoria, Australia
- School of Medicine, Faculty of Health, Deakin University, Warun Ponds, Victoria, Australia
| | - Julian Maingard
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Neurointerventional Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine, Faculty of Health, Deakin University, Warun Ponds, Victoria, Australia
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Fang R, Zhang P, Zhang T, Kim D, Sun E, Kuranov R, Kweon J, Huang A, Zhang HF. Freeform robotic optical coherence tomography beyond the optical field-of-view limit. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.21.595073. [PMID: 38826217 PMCID: PMC11142137 DOI: 10.1101/2024.05.21.595073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Imaging complex, non-planar anatomies with optical coherence tomography (OCT) is limited by the optical field of view (FOV) in a single volumetric acquisition. Combining linear mechanical translation with OCT extends the FOV but suffers from inflexibility in imaging non-planar anatomies. We report the freeform robotic OCT to fill this gap. To address challenges in volumetric reconstruction associated with the robotic movement accuracy being two orders of magnitudes worse than OCT imaging resolution, we developed a volumetric registration algorithm based on simultaneous localization and mapping (SLAM) to overcome this limitation. We imaged the entire aqueous humor outflow pathway, whose imaging has the potential to customize glaucoma surgeries but is typically constrained by the FOV, circumferentially in mice as a test. We acquired volumetric OCT data at different robotic poses and reconstructed the entire anterior segment of the eye. The reconstructed volumes showed heterogeneous Schlemm's canal (SC) morphology in the reconstructed anterior segment and revealed a segmental nature in the circumferential distribution of collector channels (CC) with spatial features as small as a few micrometers.
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Ma Y, Ji Z, Yang W, Li L, Han L, Liu Y, Guo Y, Dmytriw AA, He C, Li G, Zhang H. Role of optical coherence tomography in pipeline embolization device for the treatment of vertebral-basilar artery dissecting aneurysms. J Neurointerv Surg 2024; 16:308-312. [PMID: 36882320 DOI: 10.1136/jnis-2022-019927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Vertebral-basilar artery dissecting aneurysms (VADAs) are an uncommon phenomenon in all fields of cerebrovascular disease. The flow diverter (FD) can be used as an endoluminal reconstruction device that promotes neointima formation at the aneurysmal neck and preserves the parent artery. To date, imaging examinations such as CT angiography, MR angiography, and DSA are the main methods used to evaluate the vasculature of patients. However, none of these imaging methods can reveal the situation of neointima formation, which is of great importance in evaluating occlusion of VADAs, especially those treated with a FD. METHODS Three patients were included in the study from August 2018 to January 2019. All patients underwent preprocedural, postprocedural, and follow-up evaluations with high resolution MRI, DSA, and optical coherence tomography (OCT), as well as the formation of intima on the surface of the scaffold at the 6 month follow-up. RESULTS Preprocedural, postoperative, and follow-up high resolution MRI, DSA, and OCT of all three cases successfully evaluated occlusion of the VADAs and occurrence of in stent stenosis from different views of intravascular angiography and neointima formation. CONCLUSIONS OCT was feasible and useful to further evaluate VADAs treated with FD from a near pathological perspective, which may contribute toward guiding the duration of antiplatelet medication and early intervention of in stent stenosis.
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Affiliation(s)
- Yongjie Ma
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Zhe Ji
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Wanxin Yang
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Li Li
- Neurosurgery, Harbin Medical University Fourth Hospital, Harbin, China
| | - Liqiang Han
- Software Engineering, Dalian University of Technology, Dalian, Liaoning, China
| | - Yu Liu
- Software Engineering, Dalian University of Technology, Dalian, Liaoning, China
| | - Yuanhao Guo
- Institute of Automation, Chinese Academy of Sciences Institute of Automation, Beijing, China
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Neuroradiology and Neurointervention, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chuan He
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Guilin Li
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Hongqi Zhang
- Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
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Ramezanpour M, Robertson AM, Tobe Y, Jia X, Cebral JR. Phenotyping calcification in vascular tissues using artificial intelligence. ARXIV 2024:arXiv:2401.07825v2. [PMID: 38313202 PMCID: PMC10836085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Vascular calcification is implicated as an important factor in major adverse cardiovascular events (MACE), including heart attack and stroke. A controversy remains over how to integrate the diverse forms of vascular calcification into clinical risk assessment tools. Even the commonly used calcium score for coronary arteries, which assumes risk scales positively with total calcification, has important inconsistencies. Fundamental studies are needed to determine how risk is influenced by the diverse calcification phenotypes. However, studies of these kinds are hindered by the lack of high-throughput, objective, and non-destructive tools for classifying calcification in imaging data sets. Here, we introduce a new classification system for phenotyping calcification along with a semi-automated, non-destructive pipeline that can distinguish these phenotypes in even atherosclerotic tissues. The pipeline includes a deep-learning-based framework for segmenting lipid pools in noisy μ-CT images and an unsupervised clustering framework for categorizing calcification based on size, clustering, and topology. This approach is illustrated for five vascular specimens, providing phenotyping for thousands of calcification particles across as many as 3200 images in less than seven hours. Average Dice Similarity Coefficients of 0.96 and 0.87 could be achieved for tissue and lipid pool, respectively, with training and validation needed on only 13 images despite the high heterogeneity in these tissues. By introducing an efficient and comprehensive approach to phenotyping calcification, this work enables large-scale studies to identify a more reliable indicator of the risk of cardiovascular events, a leading cause of global mortality and morbidity.
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Affiliation(s)
- Mehdi Ramezanpour
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, PA, USA
| | - Anne M. Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, PA, USA
| | - Yasutaka Tobe
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, PA, USA
| | - Xiaowei Jia
- Department of Computer Science, University of Pittsburgh, PA, USA
| | - Juan R. Cebral
- Department of Mechanical Engineering, George Mason University, Fairfax, Virginia, USA
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Shi X, Tao T, Wang Y, Han Y, Xu X, Yin Q, Wang F, Liu R, Liu X. Heavy macrophage infiltration identified by optical coherence tomography relates to plaque rupture. Ann Clin Transl Neurol 2023; 10:2334-2346. [PMID: 37822283 PMCID: PMC10723231 DOI: 10.1002/acn3.51923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE Risk stratification plays a critical role in patients with asymptomatic carotid atherosclerotic stenosis. Heavy macrophage infiltration (HMC) is an important factor of plaque destabilization. However, in vivo imaging technologies and screening criteria for HMC remain limited. We aimed to (i) introduce algorithms for in vivo detection of macrophage infiltrations using optical coherence tomography (OCT) and (ii) to investigate the threshold of HMC and its association with plaque vulnerability. METHODS Ex vivo OCT images were co-registered with histopathology in 282 cross-sectional pairs from 19 carotid endarterectomy specimens. Of these, 197 randomly selected pairs were employed to define the parameters, and the remaining 85 pairs were used to evaluate the accuracy of the OCT-based algorithm in detecting macrophage infiltrations. Clinical analysis included 93 patients receiving carotid OCT evaluation. The prevalence and burden of macrophage infiltration were analyzed. Multivariable and subgroup analysis were performed to investigate the association between HMC and plaque rupture. RESULTS The sensitivity and specificity of algorithm for detecting macrophage infiltration were 88.0% and 74.9%, respectively. Of 93 clinical patients, ruptured plaques exhibited higher prevalence of macrophage infiltration than nonruptured plaques (83.7% [36/43] vs 32.0% [16/50], p < 0.001). HMC was identified when the macrophage index was greater than 60.2 (sensitivity = 74.4%, specificity = 84.0%). Multivariable analysis showed that HMC and multiple calcification were independent risk factors for non-lipid-rich plaque rupture. INTERPRETATION This study provides a novel approach and screening criteria for HMC, which might be valuable for atherosclerotic risk stratification.
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Affiliation(s)
- Xuan Shi
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Tao Tao
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Yi Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Yunfei Han
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xiaohui Xu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Qin Yin
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Fang Wang
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Rui Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xinfeng Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
- Stroke Center and Department of Neurology, First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
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White TG, Santhumayor BA, Turpin J, Shah K, Toscano D, Teron I, Link T, Patsalides A, Woo HH. Flow diverter surface modifications for aneurysm treatment: A review of the mechanisms and data behind existing technologies. Interv Neuroradiol 2023:15910199231207550. [PMID: 37899636 DOI: 10.1177/15910199231207550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Flow diversion (FD) has become a mainstay treatment for large wide-necked aneurysms. Despite excellent safety and efficacy, the risk of thromboembolic complications necessitates the use of dual antiplatelet therapy (DAPT). The use of DAPT makes hemorrhagic complications of stenting carry high morbidity and mortality. Additionally, DAPT usage carries a risk of "nuisance" complications that do not directly impact intracranial circulation but need to be managed nonetheless. To circumvent this issue, the most recent generation of flow diverters have undergone surface modification with various compounds to confer blood compatibility to limit clotting and thrombosis. While these newer generation flow diverters are marketed to enhance ease of deployment, the goal is to eventually facilitate single antiplatelet use with flow diverter treatment. This generation of FDs have potential to expand indications beyond unruptured wide-necked aneurysms to include ruptured intracranial aneurysms without the necessity of DAPT. Currently, no comprehensive review details the molecular mechanisms and pre-clinical and clinical data on these modifications. We seek to fill this gap in the literature by consolidating information on the coating technology for four major FDs currently in clinical use-PipelineTM Flex and Vantage Shield TechnologyTM, FREDTMX, p48/64 hydrophilic coating, and Acandis Dervio® 2heal-to serve as a reference guide in neurointerventional aneurysm treatment. Although the Balt silkTM was one of the first FDs, it is uncoated, thus we will not cover this device in our review. A literature review was performed to obtain information on each coating technology for the major flow diverters currently on the market using international databases (PUBMED, Embase, Medline, Google Scholar). The search criteria used the keywords for each coating technology of interest "phosphorylcholine," "poly 2-methoxyethyl acrylate," "hydrophilic polymer coating," and "fibrin-heparin" Keywords related to the device names "Pipeline Shield," "Pipeline Shield with Flex Technology," "FRED," "FREDX," "p64," "p64-HPC," "Derivo 2heal" were also used. Studies that detailed the mechanism of action of the coating, any pre-clinical studies with surface-modified intravascular devices, and any clinical retrospective series, prospective series, or randomized clinical trials with surface-modified devices for aneurysm treatment were included.
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Affiliation(s)
- Timothy G White
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Brandon A Santhumayor
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Justin Turpin
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Kevin Shah
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Daniel Toscano
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Ina Teron
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Thomas Link
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Athos Patsalides
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Henry H Woo
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
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King RM, Peker A, Anagnostakou V, Raskett CM, Arends JM, Dixit HG, Ughi GJ, Puri AS, Gounis MJ, Shazeeb MS. High-frequency optical coherence tomography predictors of aneurysm occlusion following flow diverter treatment in a preclinical model. J Neurointerv Surg 2023; 15:919-923. [PMID: 36002288 DOI: 10.1136/jnis-2022-019275] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/12/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND High-frequency optical coherence tomography (HF-OCT) is an intravascular imaging method that allows for volumetric imaging of flow diverters in vivo. OBJECTIVE To examine the hypothesis that a threshold for both volume and area of communicating malapposition can be predictive of early aneurysm occlusion. METHODS Fifty-two rabbits underwent elastase aneurysm formation, followed by treatment with a flow diverter. At the time of implant, HF-OCT was acquired to study the rate and degree of communicating malapposition. Treated aneurysms were allowed to heal for either 90 or 180 days and euthanized following catheter angiography. Healing was dichotomized into aneurysm remnant or neck remnant/complete occlusion. Communicating malapposition was measured by HF-OCT using a semi-automatic algorithm able to detect any points where the flow diverter was more than 50 µm from the vessel wall. This was then summed across image slices to either a volume or area. Finally, a subsampled population was used to train a statistical classifier for the larger dataset. RESULTS No difference in occlusion rate was found between device type or follow-up time (p=0.28 and p=0.67, respectively). Both volume and area of malapposition were significantly lower in aneurysms with a good outcome (p<0.001, both). From the statistical model, a volume of less than 0.56 mm3 or a normalized area less than 0.69 as quantified by HF-OCT was predictive of occlusion (p<0.001, each). CONCLUSIONS HF-OCT allows for measurements of both volume and area of malapposition and, from these measurements, an accurate prediction for early aneurysm occlusion can be made.
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Affiliation(s)
- Robert M King
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ahmet Peker
- Department of Radiology, Koc University Hospital, Istanbul, Turkey
| | - Vania Anagnostakou
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christopher M Raskett
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jennifer M Arends
- Research and Development, Stryker Neurovascular, Fremont, California, USA
| | - Harish G Dixit
- Research and Development, Stryker Neurovascular, Fremont, California, USA
| | - Giovanni J Ughi
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Radiology, Image Processing & Analysis Core (iPAC), University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mohammed Salman Shazeeb
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Radiology, Image Processing & Analysis Core (iPAC), University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Forestier G, Cortese J, Bardet SM, Baudouin M, Janot K, Ratsimbazafy V, Perrin ML, Mounier J, Couquet C, Yardin C, Larragneguy Y, Souhaut F, Chauvet R, Belgacem A, Brischoux S, Magne J, Mounayer C, Terro F, Rouchaud A. Comparison of arterial wall integration of different flow diverters in rabbits: The CICAFLOW study. J Neuroradiol 2023:S0150-9861(23)00235-3. [PMID: 37634579 DOI: 10.1016/j.neurad.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND AND PURPOSE New coated flow diverters (FDs) claim antithrombotic properties and increased arterial wall integration. The aim of this study is to compare in vivo endothelial coverage of coated and uncoated FD in the context of different antiplatelet regimens. METHODS Different FDs (Silk Vista - SV, Pipeline with Shield technology - PED shield and Surpass Evolve - SE) were implanted in the aorta of rabbits, all 3 in each animal with 3 different antiplatelet regimens: no antiplatelet therapy, aspirin alone, or aspirin and ticagrelor. Four weeks after FD implantation, angiography, flat-panel CT, and optical coherence tomography (OCT) were performed before harvesting the aorta. Extensive histopathology analyses were performed including environmental scanning electron microscopy (ESEM), multiphoton microscopy (MPM) and histological staining with qualitative and/or quantitative assessment of device coverage. RESULTS All 23 FDs that were implanted remained patent without hyperplasia. Qualitative stent coverage assessment revealed that there were no statistically significant differences between the FD groups (p = 0.19, p = 0.45, p = 0.40, and p = 0.84 for OCT, ESEM, MPM and histology, respectively). Quantitative neointimal measurement of histological sections also showed similar results in all 3 FD groups (p = 0.70). However, there were significant differences between the 3 groups of antiplatelet regimens (p = 0.07) with a higher rate in the no antiplatelet group (p = 0.05 versus aspirin alone and p = 0.03 versus aspirin and ticagrelor). CONCLUSION Our study provides evidence that FD integration into the arterial wall is similar with coated (PED shield) and uncoated devices (SV, SE), regardless of the antiplatelet regimen. FD integration with specific surface coverage should be promoted. TRIAL REGISTRATION APAFIS #2022011215518538.
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Affiliation(s)
- Géraud Forestier
- University Hospital of Limoges, Neuroradiology Department, 2 avenue Martin Luther-King, Dupuytren, Limoges 87042, France; University of Limoges, XLIM UMR CNRS, Limoges 7252, France.
| | - Jonathan Cortese
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France; NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France
| | | | - Maxime Baudouin
- University Hospital of Limoges, Neuroradiology Department, 2 avenue Martin Luther-King, Dupuytren, Limoges 87042, France
| | - Kévin Janot
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France; Regional University Hospital Center Tours, Radiology, Diagnostic and Interventional Neuroradiology, France
| | - Voahirana Ratsimbazafy
- Service de Pharmacie, CHU de Limoges, Limoges, France; Université de Limoges, IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM, UMR, Limoges 1094, France
| | | | - Jérémy Mounier
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | - Claude Couquet
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | - Catherine Yardin
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France; Cytology Department, Dupuytren Limoges University Hospital, France
| | | | - Flavie Souhaut
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | - Romain Chauvet
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | | | - Sonia Brischoux
- Service de pharmacie centrale, CHU Dupuytren, Limoges, France
| | - Julien Magne
- Department of Cardiology and CEBIMER, Limoges University Hospital, France; INSERM U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidémiologie des maladies chroniques en zone tropicale, OmegaHealth, Institut d'Epidémiologie et de Neurologie Tropicale, Limoges, France
| | - Charbel Mounayer
- University Hospital of Limoges, Neuroradiology Department, 2 avenue Martin Luther-King, Dupuytren, Limoges 87042, France; University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | - Faraj Terro
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | - Aymeric Rouchaud
- University Hospital of Limoges, Neuroradiology Department, 2 avenue Martin Luther-King, Dupuytren, Limoges 87042, France; University of Limoges, XLIM UMR CNRS, Limoges 7252, France
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12
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Zoppo CT, Kolstad JW, King RM, Wolfe T, Kraitem A, Vardar Z, Badruddin A, Pereira E, Guerrero BP, Rosqueta AS, Ughi GJ, Gounis MJ, Zaidat OO, Anagnostakou V. A novel intrasaccular aneurysm device with high complete occlusion rate: initial results in a rabbit model. J Neurointerv Surg 2023:jnis-2023-020520. [PMID: 37527927 DOI: 10.1136/jnis-2023-020520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/21/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Intrasaccular flow-disrupting devices are a safe and effective treatment strategy for intracranial aneurysms. We utilized high-frequency optical coherence tomography (HF-OCT) and digital subtraction angiography (DSA) to evaluate SEAL Arc, a new intrasaccular device, and compare the findings with the well-established Woven EndoBridge (WEB) device in an animal model of saccular aneurysms. METHODS In a rabbit model, elastase-induced aneurysms were treated with SEAL Arc (n=11) devices. HF-OCT and DSA were performed after implant and repeated after 12 weeks. Device protrusion and malapposition were assessed at implant time and scored on a binary system. Aneurysm occlusion was assessed at 12 weeks with the WEB Occlusion Scale and dichotomized to complete (A and B) or incomplete (C and D) occlusion. The percentage of neointimal coverage after 12 weeks was quantified using HF-OCT. We compared these data to previously published historical controls treated with the gold-standard WEB device (n=24) in the same model. RESULTS Aneurysm size and device placement were not significantly different between the two groups. Complete occlusion was demonstrated in 80% of the SEAL Arc devices, which compared favorably to the 21% of the aneurysms treated with WEB devices (P=0.002). Neointimal coverage across SEAL Arc devices was 86±15% compared with 49±27% for WEB (P=0.001). Protruding devices had significantly less neointimal coverage (P<0.001) as did incompletely occluded aneurysms (P<0.001). Histologically, all aneurysms treated with SEAL Arc devices were completely healed. CONCLUSION Complete early aneurysm occlusion was frequently observed in the SEAL Arc treated aneurysms, with significant neointimal coverage after 12 weeks.
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Affiliation(s)
- Christopher T Zoppo
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Josephine W Kolstad
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Robert M King
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Thomas Wolfe
- Aurora Neuroscience Innovation Institute, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Afif Kraitem
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Zeynep Vardar
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Aamir Badruddin
- Department of Neurology, Community Hospital, Munster, Indiana, USA
| | - Edgard Pereira
- Vascular and Interventional Radiology, Biscayne Medical Arts Center, Miami, Florida, USA
| | | | - Arturo S Rosqueta
- Research and Development, Galaxy Therapeutics, Milpitas, California, USA
| | - Giovanni J Ughi
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Osama O Zaidat
- Neuroscience, St Vincent Mercy Hospital, Toledo, Ohio, USA
| | - Vania Anagnostakou
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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13
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Bezerra HG, Quimby DL, Matar F, Mohanty BD, Bassily E, Ughi GJ. High-Frequency Optical Coherence Tomography (HF-OCT) for Preintervention Coronary Imaging: A First-in-Human Study. JACC Cardiovasc Imaging 2023; 16:982-984. [PMID: 37407126 DOI: 10.1016/j.jcmg.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 07/07/2023]
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14
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Li Y, Shi Y, Lu Y, Li X, Zhou J, Zadpoor AA, Wang L. Additive manufacturing of vascular stents. Acta Biomater 2023:S1742-7061(23)00338-0. [PMID: 37331614 DOI: 10.1016/j.actbio.2023.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
With the advancement of additive manufacturing (AM), customized vascular stents can now be fabricated to fit the curvatures and sizes of a narrowed or blocked blood vessel, thereby reducing the possibility of thrombosis and restenosis. More importantly, AM enables the design and fabrication of complex and functional stent unit cells that would otherwise be impossible to realize with conventional manufacturing techniques. Additionally, AM makes fast design iterations possible while also shortening the development time of vascular stents. This has led to the emergence of a new treatment paradigm in which custom and on-demand-fabricated stents will be used for just-in-time treatments. This review is focused on the recent advances in AM vascular stents aimed at meeting the mechanical and biological requirements. First, the biomaterials suitable for AM vascular stents are listed and briefly described. Second, we review the AM technologies that have been so far used to fabricate vascular stents as well as the performances they have achieved. Subsequently, the design criteria for the clinical application of AM vascular stents are discussed considering the currently encountered limitations in materials and AM techniques. Finally, the remaining challenges are highlighted and some future research directions are proposed to realize clinically-viable AM vascular stents. STATEMENT OF SIGNIFICANCE: Vascular stents have been widely used for the treatment of vascular disease. The recent progress in additive manufacturing (AM) has provided unprecedented opportunities for revolutionizing traditional vascular stents. In this manuscript, we review the applications of AM to the design and fabrication of vascular stents. This is an interdisciplinary subject area that has not been previously covered in the published review articles. Our objective is to not only present the state-of-the-art of AM biomaterials and technologies but to also critically assess the limitations and challenges that need to be overcome to speed up the clinical adoption of AM vascular stents with both anatomical superiority and mechanical and biological functionalities that exceed those of the currently available mass-produced devices.
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Affiliation(s)
- Yageng Li
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Yixuan Shi
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Yuchen Lu
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Xuan Li
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Jie Zhou
- Department of Biomechanical Engineering, Delft University of Technology, Delft 2628 CD, The Netherlands.
| | - Amir A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology, Delft 2628 CD, The Netherlands.
| | - Luning Wang
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China.
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15
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Optical Coherence Tomography in Cerebrovascular Disease: Open up New Horizons. Transl Stroke Res 2023; 14:137-145. [PMID: 35445969 DOI: 10.1007/s12975-022-01023-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
Optical coherence tomography (OCT), based on the backscattering or reflection of near-infrared light, enables an ultra-high resolution of up to 10 μm. The successful application of OCT in coronary artery diseases has sparked increasing interest in its implementation in cerebrovascular diseases. OCT has shown promising potential in the atherosclerotic plaque structure characterization, plaque rupture risk stratification, pre-stenting and post-stenting evaluation, and long-term follow-up in extracranial and intracranial atherosclerotic stenosis (ICAS). In hemorrhagic cerebrovascular diseases, OCT plays an important role in the structure evaluation, rupture risk stratification, and healing and occlusion evaluation following initial treatment in intracranial aneurysms (IAs). In this study, we summarized the applications of OCT in the diagnosis, treatment, and follow-up of cerebrovascular diseases, especially in ICAS and IAs. The current limitations and future directions of OCT in the endovascular treatment of cerebrovascular diseases were also discussed.
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16
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Soloukey S, Vincent AJPE, Smits M, De Zeeuw CI, Koekkoek SKE, Dirven CMF, Kruizinga P. Functional imaging of the exposed brain. Front Neurosci 2023; 17:1087912. [PMID: 36845427 PMCID: PMC9947297 DOI: 10.3389/fnins.2023.1087912] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
When the brain is exposed, such as after a craniotomy in neurosurgical procedures, we are provided with the unique opportunity for real-time imaging of brain functionality. Real-time functional maps of the exposed brain are vital to ensuring safe and effective navigation during these neurosurgical procedures. However, current neurosurgical practice has yet to fully harness this potential as it pre-dominantly relies on inherently limited techniques such as electrical stimulation to provide functional feedback to guide surgical decision-making. A wealth of especially experimental imaging techniques show unique potential to improve intra-operative decision-making and neurosurgical safety, and as an added bonus, improve our fundamental neuroscientific understanding of human brain function. In this review we compare and contrast close to twenty candidate imaging techniques based on their underlying biological substrate, technical characteristics and ability to meet clinical constraints such as compatibility with surgical workflow. Our review gives insight into the interplay between technical parameters such sampling method, data rate and a technique's real-time imaging potential in the operating room. By the end of the review, the reader will understand why new, real-time volumetric imaging techniques such as functional Ultrasound (fUS) and functional Photoacoustic Computed Tomography (fPACT) hold great clinical potential for procedures in especially highly eloquent areas, despite the higher data rates involved. Finally, we will highlight the neuroscientific perspective on the exposed brain. While different neurosurgical procedures ask for different functional maps to navigate surgical territories, neuroscience potentially benefits from all these maps. In the surgical context we can uniquely combine healthy volunteer studies, lesion studies and even reversible lesion studies in in the same individual. Ultimately, individual cases will build a greater understanding of human brain function in general, which in turn will improve neurosurgeons' future navigational efforts.
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Affiliation(s)
- Sadaf Soloukey
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands,Department of Neurosurgery, Erasmus MC, Rotterdam, Netherlands
| | | | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Chris I. De Zeeuw
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands,Netherlands Institute for Neuroscience, Royal Dutch Academy for Arts and Sciences, Amsterdam, Netherlands
| | | | | | - Pieter Kruizinga
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands,*Correspondence: Pieter Kruizinga,
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17
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Nishi T, Kume T, Yamada R, Koto S, Sasahira Y, Okamoto H, Tamada T, Koyama T, Imai K, Neishi Y, Ughi GJ, Uemura S. Efficacy of a new generation intracoronary optical coherence tomography imaging system with fast pullback. Catheter Cardiovasc Interv 2023; 101:520-527. [PMID: 36740230 DOI: 10.1002/ccd.30573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/16/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We sought to investigate whether a novel, fast-pullback, high-frequency optical coherence tomography (HF-OCT) imaging system enables data acquisition with a reduced amount of contrast agents while retaining the same qualitative and quantitative lesion assessment to conventional OCT. BACKGROUND The increased amount of administered contrast agents is a major concern when performing intracoronary OCT. METHODS The present study is a single-center, prospective, observational study including 10 patients with stable coronary artery disease. A total of 28 individual coronary arteries were assessed by both fast-pullback HF-OCT and by conventional OCT. RESULTS The contrast volume used in each OCT run for the HF-OCT system was significantly lower than for the conventional OCT system (5.0 ± 0.0 mL vs. 7.8 ± 0.7 mL, respectively, with a mean difference of -2.84 [95% confidence interval [CI]: -3.10 to -2.58]). No significant difference was found in the median value of the clear image length between the two OCT systems (74 mm [interquartile range [IQR]; 63, 81], 74 mm [IQR; 71, 75], p = 0.89). Fast-pullback HF-OCT showed comparable measurements to conventional OCT, including minimum lumen area (3.27 ± 1.53 mm2 vs. 3.21 ± 1.53 mm2 , p = 0.27), proximal reference area (7.03 ± 2.28 mm2 vs. 7.03 ± 2.34 mm2 , p = 0.96), and distal reference area (5.93 ± 1.96 mm2 vs. 6.03 ± 2.02 mm2 , p = 0.23). Qualitative OCT findings were comparable between the fast-pullback HF-OCT runs and conventional OCT with respect to identifying lipid-rich plaques, calcifications, layered plaques, macrophages, and cholesterol crystals. CONCLUSION With the fast pullback function of a novel HF-OCT imaging system, we acquired OCT images using a significantly lower amount of contrast volume while retaining a comparable qualitative and quantitative lesion assessment to conventional OCT.
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Affiliation(s)
- Takeshi Nishi
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Ryotaro Yamada
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Satsohi Koto
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshitaka Sasahira
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hiroshi Okamoto
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Tomoko Tamada
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Terumasa Koyama
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Koichiro Imai
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoji Neishi
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Giovanni J Ughi
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Advanced Development Department, Gentuity LLC, Sudbury, Massachusetts, USA
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
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18
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Li D, Tang T, Hu T, Walczak P, Gandhi D, Li S. Application of optical coherence tomography in decision-making of post-thrombectomy adjunctive treatments. J Neurointerv Surg 2022; 15:616-618. [PMID: 35882553 DOI: 10.1136/jnis-2022-019195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/16/2022] [Indexed: 11/04/2022]
Abstract
An adult patient with acute basilar artery occlusion underwent mechanical thrombectomy. After complete reperfusion, a 70% residual stenosis of the proximal basilar artery was observed. Intravascular optical coherence tomography (OCT) identified lipid plaques with an intact fibrous cap and thrombus in the culprit lesion, indicating plaque erosion was the mechanism of in situ thrombosis. Adjunctive antiplatelet therapy rather than rescue interventions was pursued for its beneficial effects in acute coronary syndrome caused by plaque erosion. The patient had a 90-day modified Rankin Scale score of 0. OCT enables precise evaluation of vessel characteristics following thrombectomy, so may improve outcomes through subsequent tailored treatments.
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Affiliation(s)
- Di Li
- Department of Neurointervention, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Tao Tang
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Teng Hu
- Department of Neurointervention, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Piotr Walczak
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dheeraj Gandhi
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shen Li
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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19
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Zeng C, Chen Z, Yang H, Fan Y, Fei L, Chen X, Zhang M. Advanced high resolution three-dimensional imaging to visualize the cerebral neurovascular network in stroke. Int J Biol Sci 2022; 18:552-571. [PMID: 35002509 PMCID: PMC8741851 DOI: 10.7150/ijbs.64373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/28/2021] [Indexed: 11/05/2022] Open
Abstract
As an important method to accurately and timely diagnose stroke and study physiological characteristics and pathological mechanism in it, imaging technology has gone through more than a century of iteration. The interaction of cells densely packed in the brain is three-dimensional (3D), but the flat images brought by traditional visualization methods show only a few cells and ignore connections outside the slices. The increased resolution allows for a more microscopic and underlying view. Today's intuitive 3D imagings of micron or even nanometer scale are showing its essentiality in stroke. In recent years, 3D imaging technology has gained rapid development. With the overhaul of imaging mediums and the innovation of imaging mode, the resolution has been significantly improved, endowing researchers with the capability of holistic observation of a large volume, real-time monitoring of tiny voxels, and quantitative measurement of spatial parameters. In this review, we will summarize the current methods of high-resolution 3D imaging applied in stroke.
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Affiliation(s)
- Chudai Zeng
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China, 410008.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China, 410008
| | - Zhuohui Chen
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China, 410008.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China, 410008
| | - Haojun Yang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China, 410008.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China, 410008
| | - Yishu Fan
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China, 410008.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China, 410008
| | - Lujing Fei
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China, 410008.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China, 410008
| | - Xinghang Chen
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China, 410008.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China, 410008
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China, 410008.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China, 410008
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20
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Baradaran H, Gupta A. Carotid Artery Stiffness: Imaging Techniques and Impact on Cerebrovascular Disease. Front Cardiovasc Med 2022; 9:852173. [PMID: 35369341 PMCID: PMC8964780 DOI: 10.3389/fcvm.2022.852173] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
Arterial stiffness is an important measure of vascular aging and atherosclerosis. Though it is measured in many well-known epidemiologic cohort studies, arterial stiffness is often overlooked in routine clinical practice for a number of reasons including difficulties in measurement, variations in definition, and uncertainties surrounding treatment. Central arterial stiffness, a surrogate for aortic stiffness, is the most commonly measured marker of arterial stiffness. In addition to central stiffness, there are also a number of ultrasound based techniques to measure local vascular stiffness, including carotid stiffness. There is evidence that both local carotid stiffness and central arterial stiffness measures are associated with multiple cerebrovascular processes, including stroke and cognitive dysfunction. Mechanistic explanations supporting this association include increased flow load experienced by the cerebral microvasculature leading to cerebral parenchymal damage. In this article, we review definitions of carotid artery stiffness measures and pathophysiologic mechanisms underpinning its association with plaque development and downstream cerebral pathology. We will review the evidence surrounding the association of carotid stiffness measures with downstream manifestations including stroke, cerebral small vessel disease detected on brain MR such as white matter hyperintensities and covert brain infarctions, brain atrophy, and cognitive dysfunction. With consistent definitions, measurement methods, and further scientific support, carotid stiffness may have potential as an imaging-based risk factor for stroke and cognitive decline.
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Affiliation(s)
- Hediyeh Baradaran
- Department of Radiology, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Hediyeh Baradaran
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
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21
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Anagnostakou V, Epshtein M, Ughi GJ, King RM, Valavanis A, Puri AS, Gounis MJ. Transvascular in vivo microscopy of the subarachnoid space. J Neurointerv Surg 2022; 14:neurintsurg-2021-018544. [PMID: 35115394 DOI: 10.1136/neurintsurg-2021-018544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/19/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The micro-architectonics of the subarachnoid space (SAS) remain partially understood and largely ignored, likely the result of the inability to image these structures in vivo. We explored transvascular imaging with high-frequency optical coherence tomography (HF-OCT) to interrogate the SAS. METHODS In vivo HF-OCT was performed in 10 dogs in both the posterior and anterior cerebral circulations. The conduit vessels used were the basilar, anterior spinal, and middle and anterior cerebral arteries through which the perivascular SAS was imaged. The HF-OCT imaging probe was introduced via a microcatheter and images were acquired using a contrast injection (3.5 mL/s) for blood clearance. Segmentation and three-dimensional rendering of HF-OCT images were performed to study the different configurations and porosity of the subarachnoid trabeculae (SAT) as a function of location. RESULTS Of 13 acquisitions, three were excluded due to suboptimal image quality. Analysis of 15 locations from seven animals was performed showing six distinct configurations of arachnoid structures in the posterior circulation and middle cerebral artery, ranging from minimal presence of SAT to dense networks and membranes. Different locations showed predilection for specific arachnoid morphologies. At the basilar bifurcation, a thick, fenestrated membrane had a unique morphology. SAT average thickness was 100 µm and did not vary significantly based on location. Similarly, the porosity of the SAT averaged 91% and showed low variability. CONCLUSION We have demonstrated the feasibility to image the structures of the SAS with transvascular HF-OCT. Future studies are planned to further map the SAT to increase our understanding of their function and possible impact on neurovascular pathologies.
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Affiliation(s)
- Vania Anagnostakou
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mark Epshtein
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Giovanni J Ughi
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Research and Development, Gentuity LLC, Sudbury, MA, USA
| | - Robert M King
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Antonios Valavanis
- Clinical Neuroscience Center, University Hospital Zurich Department of Neuroradiology, Zurich, ZH, Switzerland
| | - Ajit S Puri
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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22
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Portable, handheld, and affordable blood perfusion imager for screening of subsurface cancer in resource-limited settings. Proc Natl Acad Sci U S A 2022; 119:2026201119. [PMID: 34983869 PMCID: PMC8764675 DOI: 10.1073/pnas.2026201119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 12/11/2022] Open
Abstract
Existing procedures of screening subsurface cancers are either prohibitively resource-intensive and expensive or are unable to provide direct quantitative estimates of the relevant physiological parameters for accurate classification accommodating interpatient variabilities and overlapping clinical manifestations. Here, we introduce a handheld and inexpensive blood perfusion imager that provides a noninvasive in situ screening approach for distinguishing precancer, cancer, and normal scenarios by precise quantitative estimation of the localized blood circulation in the tissue over an unrestricted region of interest without any unwarranted noise in the data, augmented by machine learning–based classification. Clinical trials in minimally resourced settings have established the efficacy of the method in differentiating cancerous and precancerous stages of suspected oral abnormalities, as verified by gold-standard biopsy reports. Precise information on localized variations in blood circulation holds the key for noninvasive diagnostics and therapeutic assessment of various forms of cancer. While thermal imaging by itself may provide significant insights on the combined implications of the relevant physiological parameters, viz. local blood perfusion and metabolic balance due to active tumors as well as the ambient conditions, knowledge of the tissue surface temperature alone may be somewhat inadequate in distinguishing between some ambiguous manifestations of precancer and cancerous lesions, resulting in compromise of the selectivity in detection. This, along with the lack of availability of a user-friendly and inexpensive portable device for thermal-image acquisition, blood perfusion mapping, and data integration acts as a deterrent against the emergence of an inexpensive, contact-free, and accurate in situ screening and diagnostic approach for cancer detection and management. Circumventing these constraints, here we report a portable noninvasive blood perfusion imager augmented with machine learning–based quantitative analytics for screening precancerous and cancerous traits in oral lesions, by probing the localized alterations in microcirculation. With a proven overall sensitivity >96.66% and specificity of 100% as compared to gold-standard biopsy-based tests, the method successfully classified oral cancer and precancer in a resource-limited clinical setting in a double-blinded patient trial and exhibited favorable predictive capabilities considering other complementary modes of medical image analysis as well. The method holds further potential to achieve contrast-free, accurate, and low-cost diagnosis of abnormal microvascular physiology and other clinically vulnerable conditions, when interpreted along with complementary clinically evidenced decision-making perspectives.
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Gounis MJ, Steinman DA. Up around the bend: progress and promise of intravascular imaging in neurointerventional surgery. J Neurointerv Surg 2021; 13:495-496. [PMID: 33986130 DOI: 10.1136/neurintsurg-2021-017707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Matthew J Gounis
- Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - David A Steinman
- Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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24
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Li L, Yongjie M, Dmytriw AA, Jian R, Hongqi Z. Evaluation of Vessel Wall Apposition for Stent-Assisted Coiling in Treatment of Vertebral Artery Aneurysms Using Optical Coherence Tomography. Clin Neuroradiol 2021; 32:565-570. [PMID: 34427701 DOI: 10.1007/s00062-021-01070-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/15/2021] [Indexed: 01/02/2023]
Affiliation(s)
- Li Li
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, No. 45 Changchun Street, Xicheng District, 100053, Beijing, China
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ma Yongjie
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, No. 45 Changchun Street, Xicheng District, 100053, Beijing, China
| | - Adam A Dmytriw
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ren Jian
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, No. 45 Changchun Street, Xicheng District, 100053, Beijing, China
| | - Zhang Hongqi
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, No. 45 Changchun Street, Xicheng District, 100053, Beijing, China.
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25
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Vardar Z, King RM, Kraitem A, Langan ET, Peterson LM, Duncan BH, Raskett CM, Anagnostakou V, Gounis MJ, Puri AS, Ughi GJ. High-resolution image-guided WEB aneurysm embolization by high-frequency optical coherence tomography. J Neurointerv Surg 2021; 13:669-673. [PMID: 32989033 PMCID: PMC8205185 DOI: 10.1136/neurintsurg-2020-016447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND High-frequency optical coherence tomography (HF-OCT) is an intra-vascular imaging technique capable of assessing device-vessel interactions at spatial resolution approaching 10 µm. We tested the hypothesis that adequately deployed Woven EndoBridge (WEB) devices as visualized by HF-OCT lead to higher aneurysm occlusion rates. METHODS In a leporine model, elastase-induced aneurysms (n=24) were treated with the WEB device. HF-OCT and digital subtraction angiography (DSA) were performed following WEB deployment and repeated at 4, 8, and 12 weeks. Protrusion (0-present, 1-absent) and malapposition (0-malapposed, 1-neck apposition >50%) were binary coded. A device was considered 'adequately deployed' by HF-OCT and DSA if apposed and non-protruding. Aneurysm healing on DSA was reported using the 4-point WEB occlusion score: A or B grades were considered positive outcome. Neointimal coverage was quantified on HF-OCT images at 12 weeks and compared with scanning electron microscopy (SEM). RESULTS Adequate deployment on HF-OCT correlated with positive outcome (P=0.007), but no statistically significant relationship was found between good outcome and adequate deployment on DSA (P=0.289). Absence of protrusion on HF-OCT correlated with a positive outcome (P=0.006); however, malapposition alone had no significant relationship (P=0.19). HF-OCT showed a strong correlation with SEM for the assessment of areas of neointimal tissue (R²=0.96; P<0.001). More neointimal coverage of 78%±32% was found on 'adequate deployment' cases versus 31%±24% for the 'inadequate deployment' cases (P=0.001). CONCLUSION HF-OCT visualizes features that can determine adequate device deployment to prognosticate early aneurysm occlusion following WEB implantation and can be used to longitudinally monitor aneurysm healing progression.
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Affiliation(s)
- Zeynep Vardar
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Robert M King
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Afif Kraitem
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Erin T Langan
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | | | - Christopher M Raskett
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Vania Anagnostakou
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Giovanni J Ughi
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Research and Development, Gentuity, Sudbury, Massachusetts, USA
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Afsharan H, Hackmann MJ, Wang Q, Navaeipour F, Jayasree SVK, Zawadzki RJ, Silva D, Joo C, Cense B. Polarization properties of retinal blood vessel walls measured with polarization sensitive optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2021; 12:4340-4362. [PMID: 34457418 PMCID: PMC8367251 DOI: 10.1364/boe.426079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 05/08/2023]
Abstract
A new method based on polarization-sensitive optical coherence tomography (PS-OCT) is introduced to determine the polarization properties of human retinal vessel walls, in vivo. Measurements were obtained near the optic nerve head of three healthy human subjects. The double pass phase retardation per unit depth (DPPR/UD), which is proportional to the birefringence, is higher in artery walls, presumably because of the presence of muscle tissue. Measurements in surrounding retinal nerve fiber layer tissue yielded lower DPPR/UD values, suggesting that the retinal vessel wall tissue near the optic nerve is not covered by retinal nerve fiber layer tissue (0.43°/µm vs. 0.77°/µm, respectively). Measurements were obtained from multiple artery-vein pairs, to quantify the different polarization properties. Measurements were taken along a section of the vessel wall, with changes in DPPR/UD up to 15%, while the vessel wall thickness remained relatively constant. A stationary scan pattern was applied to determine the influence of involuntary eye motion on the measurement, which was significant. Measurements were also analyzed by two examiners, with high inter-observer agreement. The measurement repeatability was determined with measurements that were acquired during multiple visits. An improvement in accuracy can be achieved with an ultra-broad-bandwidth PS-OCT system since it will provide more data points in-depth, which reduces the influence of discretization and helps to facilitate better fitting of the birefringence data.
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Affiliation(s)
- Hadi Afsharan
- Optical+Biomedical Engineering Laboratory, Department of Electrical, Electronic and Computer Engineering, The University of Western Australia, Perth WA 6009, Australia
| | - Michael J. Hackmann
- Optical+Biomedical Engineering Laboratory, Department of Electrical, Electronic and Computer Engineering, The University of Western Australia, Perth WA 6009, Australia
- School of Human Sciences, The University of Western Australia, Crawley 6009, WA, Australia
| | - Qiang Wang
- Optical+Biomedical Engineering Laboratory, Department of Electrical, Electronic and Computer Engineering, The University of Western Australia, Perth WA 6009, Australia
| | - Farzaneh Navaeipour
- Department of Physics, Engineering Physics and Astronomy, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Stephy Vijaya Kumar Jayasree
- Department of Physics, School of Physics, Mathematics and Computing, The University of Western Australia, Perth WA 6009, Australia
| | - Robert J. Zawadzki
- Department of Ophthalmology and Vision Science, University of California Davis, Sacramento, CA 95817, USA
| | - Dilusha Silva
- Microelectronics Research Group, Department of Electrical, Electronic and Computer Engineering, The University of Western Australia, Perth WA 6009, Australia
| | - Chulmin Joo
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Barry Cense
- Optical+Biomedical Engineering Laboratory, Department of Electrical, Electronic and Computer Engineering, The University of Western Australia, Perth WA 6009, Australia
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul 03722, Republic of Korea
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27
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Anagnostakou V, Ughi GJ, Puri AS, Gounis MJ. Optical Coherence Tomography for Neurovascular Disorders. Neuroscience 2021; 474:134-144. [PMID: 34126186 DOI: 10.1016/j.neuroscience.2021.06.008] [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: 10/21/2020] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
Diagnosis of cerebrovascular disease includes vascular neuroimaging techniques such as computed tomography (CT) angiography, magnetic resonance (MR) angiography (with or without use of contrast agents) and catheter digital subtraction angiography (DSA). These techniques provide mostly information about the vessel lumen. Vessel wall imaging with MR seeks to characterize cerebrovascular pathology, but with resolution that is often insufficient for small lesions. Intravascular imaging techniques such as ultrasound and optical coherence tomography (OCT), used for over a decade in the peripheral circulation, is not amendable to routine deployment in the intracranial circulation due to vessel caliber and tortuosity. However, advances in OCT technology including the probe profile, stiffness and unique distal rotation solution, holds the promise for eventual translation of OCT into the clinical arena. As such, it is apropos to review this technology and present the rationale for utilization of OCT in the cerebrovasculature.
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Affiliation(s)
- Vania Anagnostakou
- University of Massachusetts Medical School, Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States
| | - Giovanni J Ughi
- University of Massachusetts Medical School, Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States
| | - Ajit S Puri
- University of Massachusetts Medical School, Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States
| | - Matthew J Gounis
- University of Massachusetts Medical School, Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States.
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28
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Pasarikovski CR, Ku JC, Ramjist J, Dobashi Y, Priola SM, da Costa L, Kumar A, Yang VXD. Minimally invasive intrathecal spinal cord imaging with optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210036R. [PMID: 33988003 PMCID: PMC8118064 DOI: 10.1117/1.jbo.26.5.056002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
SIGNIFICANCE Imaging of the spinal cord is challenging due to the surrounding bony anatomy, physiologic motion, and the small diameter of the spinal cord. This precludes the use of non-invasive imaging techniques in assessing structural changes related to trauma and evaluating residual function. AIM The purpose of our research was to apply endovascular technology and techniques and construct a preclinical animal model of intrathecal spinal cord imaging using optical coherence tomography (OCT). APPROACH Five animals (2 Yorkshire Swine and 3 New Zealand Rabbits) were utilized. Intrathecal access was gained using a 16-guage Tuohy, and an OCT catheter was advanced under roadmap technique into the cervical canal. The OCT catheter has a motorized pullback, and a total length of 54 mm of the spinal canal is imaged. RESULTS Image acquisition was successful for all animals. There were no instances of difficult catheter navigation, enabling OCT imaging rostrally to C2. The thecal sac provided excellent thoroughfare for the OCT catheter. The clear cerebrospinal fluid also provided an excellent medium for image acquisition, with no detectable artifact from the contents of the cerebrospinal fluid. The anatomical space of the spinal canal could be readily appreciated including: dural lining of the thecal sac, epidural veins, pial lining of the spinal cord, arachnoid bands, dentate ligaments, and nerve rootlets/roots. CONCLUSION Minimally invasive intrathecal imaging using endovascular OCT was feasible in this preclinical animal study. The repurposing of an endovascular device for spinal imaging comes with limitations, and a spine-specific device is necessary.
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Affiliation(s)
| | - Jerry C. Ku
- University of Toronto, Division of Neurosurgery, Department of Surgery, Toronto, Ontario, Canada
| | - Joel Ramjist
- University of Toronto, Sunnybrook Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Yuta Dobashi
- University of Toronto, Sunnybrook Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Stefano M. Priola
- Health Sciences North, Division of Neurosurgery, Department of Surgery, Sudbury, Ontario, Canada
| | - Leodante da Costa
- University of Toronto, Sunnybrook Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Ashish Kumar
- University of Toronto, Sunnybrook Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Victor X. D. Yang
- University of Toronto, Sunnybrook Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
- University of Toronto, Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada
- University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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29
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The association between hemodynamics and wall characteristics in human intracranial aneurysms: a review. Neurosurg Rev 2021; 45:49-61. [PMID: 33913050 DOI: 10.1007/s10143-021-01554-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/02/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
Hemodynamics plays a key role in the natural history of intracranial aneurysms (IAs). However, studies exploring the association between aneurysmal hemodynamics and the biological and mechanical characteristics of the IA wall in humans are sparse. In this review, we survey the current body of literature, summarize the studies' methodologies and findings, and assess the degree of consensus among them. We used PubMed to perform a systematic review of studies that explored the association between hemodynamics and human IA wall features using different sources. We identified 28 publications characterizing aneurysmal flow and the IA wall: 4 using resected tissues, 17 using intraoperative images, and 7 using vessel wall magnetic resonance imaging (MRI). Based on correlation to IA tissue, higher flow conditions, such as high wall shear stress (WSS) with complex pattern and elevated pressure, were associated with degenerated walls and collagens with unphysiological orientation and faster synthesis. MRI studies strongly supported that low flow, characterized by low WSS and high blood residence time, was associated with thicker walls and post-contrast enhancement. While significant discrepancies were found among those utilized intraoperative images, they generally supported that thicker walls coexist at regions with prolonged residence time and that thinner regions are mainly exposed to higher pressure with complex WSS patterns. The current body of literature supports a theory of two general hemodynamic-biologic mechanisms for IA development. One, where low flow conditions are associated with thickening and atherosclerotic-like remodeling, and the other where high and impinging flow conditions are related to wall degeneration, thinning, and collagen remodeling.
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30
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Sun XM, Luo JQ, Xiao ZW, Gu QY, Lan LC, Zhang HQ, Zhang GP. Investigations on the potential of optical coherence tomography as an imaging tool for eustachian tube. Sci Rep 2021; 11:8072. [PMID: 33850252 PMCID: PMC8044113 DOI: 10.1038/s41598-021-87637-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/01/2021] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to explore the feasibility of eustachian tube optical coherence tomography (ET-OCT) for imaging the pharyngeal region of the eustachian tube (ET). Ten subjects with ear complaints underwent ET-OCT guided by nasal endoscopy, and ET-OCT examination was performed on both sides of each subject's ETs. The process and resulting images were analysed. Ten subjects ranging from 21 to 73 years old (45 ± 14.77) were enrolled in this study. Eighteen ET-OCT imaging examinations were completed. The mean duration of each examination was 2.80 ± 1.62 min (ranging from 2 to 7 min). There were no adverse events or complications. In some subjects, the ET-OCT images clearly presented the microstructures of the ET wall, including the lumen, mucosa, submucosa, cartilage and plica. However, in some subjects, it showed different characteristics, such as an unclear hierarchy and secretions in the lumen. ET-OCT may help to distinguish the structural composition of the ET and elucidate related pathophysiological mechanisms. It is a valuable imaging tool suited for the ET, with potential diagnostic value in determining the morphology of the lumen, intraluminal mucosa and submucosal tissue in the pharyngeal region of the ET.
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Affiliation(s)
- Xiao-Mei Sun
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Jia-Qi Luo
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Zhi-Wen Xiao
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Qing-Yu Gu
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Lin-Chan Lan
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Hui-Qing Zhang
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Guan-Ping Zhang
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
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31
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Zhu D, Blondel W, Qu J, Wang X, Yang S. Preface to the special issue on "Biomedical Optics". FRONTIERS OF OPTOELECTRONICS 2020; 13:305-306. [PMID: 36641570 PMCID: PMC9743943 DOI: 10.1007/s12200-020-1132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Indexed: 06/17/2023]
Affiliation(s)
- Dan Zhu
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074 China
| | - Walter Blondel
- Université de Lorraine, CNRS, CRAN UMR 7039, Nancy, 54000 France
| | - Junle Qu
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen, 518060 China
| | - Xueding Wang
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109-0553 USA
| | - Sihua Yang
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631 China
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32
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Feng Y, Wu T, Wang T, Li Y, Li M, Li L, Yang B, Bai X, Zhang X, Wang Y, Gao P, Chen Y, Ma Y, Jiao L. Correlation between intracranial vertebral artery stenosis diameter measured by digital subtraction angiography and cross-sectional area measured by optical coherence tomography. J Neurointerv Surg 2020; 13:1002-1006. [DOI: 10.1136/neurintsurg-2020-016835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 11/04/2022]
Abstract
BackgroundIntracranial vertebral artery (V4 segment) stenosis quantification traditionally uses the narrowest stenosis diameter. However, the stenotic V4 lumen is commonly irregularly shaped. Optical coherence tomography (OCT) allows a more precise calculation of V4 geometry. We compared the narrowest diameter stenosis (DS), measured by digital subtraction angiography (DSA), with the area stenosis (AS), measured by OCT. We hypothesized that DS is the gold standard for measuring the degree of stenosis.MethodsFive neuroradiologists evaluated 49 stenosed V4 segments in a blinded protocol. V4 stenosis was measured in millimeters on DSA at its narrowest diameter. OCT was used to estimate the cross-sectional luminal area. We also used automated software to measure DS. Three different angles (anterior, lateral, and oblique views) were used for calculations, and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Warfarin–Aspirin Symptomatic Intracranial Disease (WASID) methods were used in all measurements. Spearman’s R values were calculated. Non-linear regression analysis was performed between the DS and AS, with statistically different correlations.ResultsA high correlation was observed between the WASID and NASCET methods to measure DS with observer measurement and automated software. A good correlation was found between DS measured by observers and AS measured by OCT. Non-linear regression analysis showed that only observer measurement using the oblique view and the WASID method could attain statistically significant differences, but it was weak (r=0.389).ConclusionMeasurement of the narrowest diameter was not a reliable predictor of the cross-sectional area of V4 stenosis. Larger studies are therefore needed to develop a new evaluation system based on V4 stenosis.
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Pasarikovski CR, Ku JC, Priola SM, da Costa L, Yang VXD. Endovascular optical coherence tomography imaging in cerebrovascular disease. J Clin Neurosci 2020; 80:30-37. [PMID: 33099363 DOI: 10.1016/j.jocn.2020.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Endovascular optical coherence tomography (OCT) is the highest resolution imaging modality currently available with spatial resolution of 10 µm. Although originally developed for interventional cardiology, the ability to visualize the luminal environment and anatomy, along with the stent-vessel interaction could be of great utility for various cerebrovascular diseases, and the adoption of endovascular OCT imaging in the evolving field of interventional neuroradiology seems instinctive. The purpose of this study is to conduct a systematic review of the literature regarding applications of endovascular OCT in the diagnosis and treatment of cerebrovascular diseases. In addition, the authors report their institutional experience with the use of OCT in carotid atherosclerotic disease, cerebral aneurysms, and acute ischemic stroke. A systematic review of the literature was undertaken. Peer-reviewed articles were collected through MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) searches through March 2020. A total of 34 studies with 598 patients were included in the qualitative synthesis. These include 23 studies of carotid atherosclerotic disease, 7 studies of cerebral aneurysms, and 4 studies of non-aneurysmal posterior circulation pathology. OCT imaging was feasible in 94% of patients with 0.6% complication rate. Endovascular OCT appears to be safe and feasible, allowing clinicians to visualize stent-vessel interactions, aneurysmal healing, and vulnerable atherosclerotic plaque features. OCT carries great promise, however additional investigations are needed before any imposing statement can be made about the role of OCT in cerebrovascular imaging.
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Affiliation(s)
| | - Jerry C Ku
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Stefano M Priola
- Division of Neurosurgery, Department of Surgery, Health Sciences North, Sudbury, Ontario, Canada; Norther Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Leodante da Costa
- Division of Neurosurgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Victor X D Yang
- Division of Neurosurgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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