Intravascular ultrasound imaging in the assessment of atherosclerotic plaques in rabbit abdominal aorta: comparison with histologic findings

Intravascular ultrasound allows a hyperplasia diagnosis in vivo in rat as accurate as histomorphometry

OBJECTIVE AND MOTIVATION

Intravascular ultrasound (IVUS) allows in vivo invasive intra-luminal real-time examination of the arterial wall structure. In this study, we aimed to validate for the first time the in vivo IVUS performing as a diagnostic tool by comparison to the well-established histomorphometry approach, in the largely used rat model of carotid angioplasty model that mimics the angioplasty procedure in humans.

METHODS

Atherosclerotic lesions were allowed to develop during four weeks after balloon catheter inflation of the left carotid artery, whereas the intact right carotid artery was used as control. Four weeks after injury, a Boston Scientific 40MHz device to perform IVUS exams in vivo on both carotid arteries. Then, both carotid arteries were examined in vitro by histomorphometry and correlation between IVUS and histomorphometric parameters (plaque plus media cross-sectional areas [CSA] and eccentricity index) were researched.

RESULTS

After ANOVA analysis, comparative statistical analysis showed significant correlations between IVUS and histomorphometry when examining the intact right carotid artery (r=0.662 with p<0.003 for plaque plus media CSA; r=0.774 with p<0.002 for eccentricity index), but also when exploring the injured left carotid artery (r=0.805 with p<0.0001 for plaque plus media CSA; r=0.775 with p<0.002 for eccentricity index).

CONCLUSIONS AND OUTCOME

We report here for the first time the ability of IVUS to study therapeutic vascular effects in vivo in alive rats. This result is of major importance since it will allow this device to be used for restenosis drug testing in rat model of carotid angioplasty.

Imaging of atherosclerosis in WHHL rabbits using high-resolution ultrasound

Watanabe heritable hyperlipidemic (WHHL) rabbits provide an animal model of hypercholesterolemia and atherosclerotic progression. However, a large individual variation in plaque progression rate calls for serial investigations, as do treatment studies. In contrast to histopathology, transthoracic ultrasound imaging of the aortic arch is a noninvasive technique suitable for repeated investigations. We studied 34 WHHL rabbits by both techniques. Ultrasound correctly interpreted plaque morphology compared with histopathology of the same spot (location verified by needle puncture). Intima media thickness (IMT) measured by the two methods agreed well. Ultrasonic values were similar to the histopathologic average circumferential values when these were corrected for postmortem shrinkage. Finally, the transthoracic ultrasound technique demonstrated a significant increase in IMT over a 15-week period (p = 0.0002). We conclude that transthoracic ultrasound of aortic arch IMT in WHHL rabbits is a reliable and feasible technique for studies of plaque progression and the evaluation of interventions.

Effect of Stent Oversizing on In-Stent Stenosis and Lumen Size in Normal Porcine Veins

PURPOSE

To present an in vivo evaluation of the effects of stent oversizing on in-stent stenosis and on actual lumen size in normal veins.

METHODS

Twelve self-expanding stents were implanted in the common iliac veins of 6 minipigs, which were divided in 2 groups for follow-up at 1 and 3 months, respectively. Oversizing ranged from 119.5% to 216% of the original vessel diameter. Intravascular ultrasound (IVUS) was used to measure vessel areas at the stent edges and midpoint. In-stent stenosis and decrease in actual lumen size were evaluated with IVUS immediately after implantation and during follow-up.

RESULTS

There was a very strong positive linear regression between stent oversizing and in-stent stenosis in the 1-month model (r=0.947, p=0.004), in the 3-month model (r=0.931, p=0.007), and in the sum of these 2 groups (r=0.83, p<0.001). Regarding the change in actual lumen size, we found a strong negative linear regression with stent oversizing in the 1-month (r=-0.754, p=0.083) and the 3-month (r=-0.562, p=0.246) groups, but these did not attain statistical significance. However, a strong correlation between stent oversizing and a decrease in lumen size in all samples proved to be statistically significant (r=0.619, p=0.032).

CONCLUSIONS

Stent oversizing was strongly correlated with increased in-stent stenosis and decreased actual lumen size at follow-up in normal non-stenotic porcine veins.

Early endothelial dysfunction in cholesterol-fed rabbits: a non-invasive in vivo ultrasound study

Background

Endothelial function in hypercholesterolemic rabbits is usually evaluated ex vivo on isolated aortic rings. In vivo evaluation requires invasive imaging procedures that cannot be repeated serially.

Aim

We evaluated a non-invasive ultrasound technique to assess early endothelial function in rabbits and compare data with ex vivo measurements.

Methods

Twenty-four rabbits (fed with a cholesterol diet (0.5%) for 2 to 8 weeks) were given progressive infusions of acetylcholine (0.05–0.5 μg/kg/min) and their endothelial function was assessed in vivo by transcutaneous vascular ultrasound of the abdominal aorta. Ex vivo endothelial function was evaluated on isolated aortic rings and compared to in vivo data.

Results

Significant endothelial dysfunction was demonstrated in hypercholesterolemic animals as early as 2 weeks after beginning the cholesterol diet (aortic cross-sectional area variation: -2.9% vs. +4% for controls, p < 0.05). Unexpectedly, response to acetylcholine at 8 weeks was more variable. Endothelial function improved in 5 rabbits while 2 rabbits regained a normal endothelial function. These data corroborated well with ex vivo results.

Conclusion

Endothelial function can be evaluated non-invasively in vivo by transcutaneous vascular ultrasound of the abdominal aorta in the rabbit and results correlate well with ex vivo data.

Endoluminal AAA repair using intravascular ultrasound for graft planning and deployment: a 2-year community-based experience

PURPOSE

To examine the effectiveness of intravascular ultrasound (IVUS) and digital subtraction angiography (DSA) for preoperative planning and intraoperative deployment of stent-grafts to treat abdominal aortic aneurysms.

METHODS

One hundred seventy patients (143 men; mean age 73.6+/-7.2 years, range 51-89) underwent successful DSA and IVUS to determine suitability for stent-graft repair. Patients subsequently received the AneuRx (n=157) or Ancure (n=13) device; intraprocedural IVUS was used to survey the proximal endograft for proper apposition to the aortic wall.

RESULTS

Reliable preoperative IVUS measurements were obtained in all patients. Plaque morphology was assessed in 140 (82.3%) aortic necks; in 36 (25.7%), preoperative IVUS showed high-grade atherosclerotic plaque in the nonaneurysmal abdominal aortic neck. The procedure was successful in 168 (98.8%) cases (1 [0.6%] acute conversion and 1 access failure). There were 2 (1.2%) periprocedural deaths related to bowel ischemia. Four (2.3%) patients developed graft occlusion/kinking and 2 (1.2%) developed renal failure requiring dialysis within 30 days. Multivariate logistic regression analysis revealed that female gender (p=0.0247), a short nonaneurysmal aortic neck (p=0.0185), and presence of high-grade atherosclerotic plaque (p=0.0185) correlated with major acute complications. Over a mean 10.4-month follow-up (range 1-25), 11 patients died of unrelated causes; there was no known AAA rupture or device failure. The Kaplan-Meier estimate of survival at 1 year was 91.0%+/-2.8%. Sixteen (9.4%) patients underwent 17 secondary procedures for endoleak or graft limb occlusion at a mean 5.4 months after stent-graft repair (freedom from secondary intervention at 1 year 86.5%+/-3.2%).

CONCLUSIONS

Our findings suggest that IVUS may identify patients at increased risk of major adverse complications following endovascular repair. The combination of IVUS and DSA for endoluminal stent-graft planning and placement provides excellent short- and mid-term patient outcomes.