1
|
Zhuo J, Wang L, Li R, Li Z, Zhang J, Xu Y. Identification of symptomatic carotid artery plaque: a predictive model combining angiography with optical coherence tomography. Front Neurol 2024; 15:1445227. [PMID: 39281411 PMCID: PMC11392725 DOI: 10.3389/fneur.2024.1445227] [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: 06/07/2024] [Accepted: 08/22/2024] [Indexed: 09/18/2024] Open
Abstract
Objective Symptomatic carotid artery disease is indicative of an elevated likelihood of experiencing a subsequent stroke, with the morphology of plaque and its specific features being closely linked to the risk of stroke occurrence. Our study based on the characteristics of carotid plaque assessed by optical coherence tomography (OCT), the plaque morphology evaluated by digital subtraction angiography (DSA) and clinical laboratory indicators were combined, develop a combined predictive model to identify symptomatic carotid plaque. Methods Patients diagnosed with carotid atherosclerotic stenosis who underwent whole-brain DSA and OCT examination at the Affiliated Hospital of Jining Medical University from January 2021 to November 2023 were evaluated. Clinical features, as well as DSA and OCT plaque characteristics, were analyzed for differences between symptomatic and asymptomatic cohorts. An analysis of logistic regression was carried out to identify factors associated with the presence of symptomatic carotid plaque. A multivariate binary logistic regression equation was established with the odds ratio (OR) serving as the risk assessment parameter. The receiver operating characteristic curve was utilized to assess the combined predictive model and independent influencing factors. Results A total of 52 patients were included in the study (symptomatic: 44.2%, asymptomatic: 55.8%). Symptomatic carotid stenosis was significantly linked to four main factors: low-density lipoprotein-cholesterol >3.36 mmol/L [OR, 6.400; 95% confidence interval (CI), 1.067-38.402; p = 0.042], irregular plaque (OR, 6.054; 95% CI, 1.016-36.083; p = 0.048), ruptured plaque (OR, 6.077; 95% CI, 1.046-35.298; p = 0.048), and thrombus (OR, 6.773; 95% CI, 1.194-38.433; p = 0.044). The combined predictive model generated using four indicators showed good discrimination (Area Under Curve, 0.924; 95% CI, 0.815-0. 979). The p value was <0.05 with 78.26% sensitivity and 93.10% specificity. Conclusion OCT is valuable in evaluating the plaque characteristics of carotid atherosclerotic stenosis. The combined predictive model comprising low-density lipoprotein-cholesterol >3.36 mmol/L, irregular plaque, ruptured plaque, and thrombus could help in the detection of symptomatic carotid plaque. Further research conducted on additional independent cohorts is necessary to confirm the clinical significance of the predictive model for symptomatic carotid plaque.
Collapse
Affiliation(s)
- Jun Zhuo
- Medical Engineering and Technology Research Center, School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
- Medical Science and Technology Innovation Center, Institute of Medical Engineering and Interdisciplinary Research, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lin Wang
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ruolin Li
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Zhiyuan Li
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Junhu Zhang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yunjian Xu
- Medical Engineering and Technology Research Center, School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
- Medical Science and Technology Innovation Center, Institute of Medical Engineering and Interdisciplinary Research, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| |
Collapse
|
2
|
Li C, Jia H, Tian J, He C, Lu F, Li K, Gong Y, Hu S, Yu B, Wang Z. Comprehensive Assessment of Coronary Calcification in Intravascular OCT Using a Spatial-Temporal Encoder-Decoder Network. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:857-868. [PMID: 34735339 DOI: 10.1109/tmi.2021.3125061] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Coronary calcification is a strong indicator of coronary artery disease and a key determinant of the outcome of percutaneous coronary intervention. We propose a fully automated method to segment and quantify coronary calcification in intravascular OCT (IVOCT) images based on convolutional neural networks (CNN). All possible calcified plaques were segmented from IVOCT pullbacks using a spatial-temporal encoder-decoder network by exploiting the 3D continuity information of the plaques, which were then screened and classified by a DenseNet network to reduce false positives. A novel data augmentation method based on the IVOCT image acquisition pattern was also proposed to improve the performance and robustness of the segmentation. Clinically relevant metrics including calcification area, depth, angle, thickness, volume, and stent-deployment calcification score, were automatically computed. 13844 IVOCT images with 2627 calcification slices from 45 clinical OCT pullbacks were collected and used to train and test the model. The proposed method performed significantly better than existing state-of-the-art 2D and 3D CNN methods. The data augmentation method improved the Dice similarity coefficient for calcification segmentation from 0.615±0.332 to 0.756±0.222, reaching human-level inter-observer agreement. Our proposed region-based classifier improved image-level calcification classification precision and F1-score from 0.725±0.071 and 0.791±0.041 to 0.964±0.002 and 0.883±0.008, respectively. Bland-Altman analysis showed close agreement between manual and automatic calcification measurements. Our proposed method is valuable for automated assessment of coronary calcification lesions and in-procedure planning of stent deployment.
Collapse
|
3
|
Yang Q, Guo H, Shi X, Xu X, Zha M, Cai H, Yang D, Huang F, Zhang X, Lv Q, Liu R, Liu X. Identification of Symptomatic Carotid Artery Plaque: A Three-Item Scale Combined Angiography With Optical Coherence Tomography. Front Neurosci 2021; 15:792437. [PMID: 34955737 PMCID: PMC8702715 DOI: 10.3389/fnins.2021.792437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/12/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Symptomatic carotid disease conveys a high risk of recurrent stroke. Plaque morphology and specific plaque characteristics are associated with the risk of stroke. This study aimed to evaluate the detailed plaque features by optical coherence tomography (OCT) and develop a simple scale combining clinical indicators, digital subtraction angiography (DSA), and OCT imaging markers to identify symptomatic carotid plaque. Methods: Carotid plaques from consecutive patients who underwent carotid OCT imaging between June 2017 and June 2021 were evaluated. Clinical characteristics, DSA, and OCT data were compared between the symptomatic and asymptomatic groups. Logistic regression was performed to identify the factors associated with symptomatic carotid plaque and to develop a scale. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of the scale. Results: A total of 90 carotid plaques from 90 patients were included (symptomatic 35.6%, asymptomatic 64.4%). Three main factors were found to be associated with symptomatic carotid plaque: high-density lipoprotein cholesterol (HDL-C) <0.925 mmol/L (OR, 4.708; 95% CI, 1.640 to 13.517; P = 0.004), irregular plaque (OR, 4.017; 95% CI, 1.250 to 12.910; P = 0.020), and white thrombus (OR, 4.594; 95% CI, 1.141 to 18.487; P = 0.032). The corresponding score of three items produced a scale with good discrimination (AUC, 0.768; 95% CI, 0.665 to 0.871). The optimal cutoff value of the scale was 1.5 points with 59.4% sensitivity and 84.5% specificity. Conclusion: The three-item scale comprising HDL-C <0.925 mmol/L, angiographical irregular plaque, and white thrombus detected by OCT may provide information to identify symptomatic carotid plaque. Further large-scale studies are required to validate whether the symptomatic carotid plaque scale is clinically valuable in recognizing carotid atherosclerosis in the early stages.
Collapse
Affiliation(s)
- Qingwen Yang
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Hongquan Guo
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Xuan Shi
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaohui Xu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mingming Zha
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Haodi Cai
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Dahong Yang
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Feihong Huang
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Xiaohao Zhang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qiushi Lv
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rui Liu
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
4
|
Kawamori H, Konishi A, Shinke T, Akahori H, Ishihara M, Tsujita H, Otake H, Toba T, Nakano S, Tanimura K, Tsukiyama Y, Nanba I, Kakei Y, Yasuda T, Omori T, Kubo T, Kozuki A, Shite J, Hirata KI. Efficacy of optical frequency domain imaging in detecting peripheral artery disease: the result of a multi-center, open-label, single-arm study. Heart Vessels 2021; 36:818-826. [PMID: 33481085 DOI: 10.1007/s00380-020-01758-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/11/2020] [Indexed: 12/31/2022]
Abstract
Optical frequency domain imaging (OFDI) is a high-resolution intracoronary imaging modality with fast automated longitudinal pullback. We aimed to evaluate the ability of performing OFDI from the superficial femoral artery (SFA) to the below-knee (BK) artery. This clinical trial was a multi-center, single-arm, open-label study. The primary endpoint was to obtain a clear image of the intra-vascular lumen from the SFA to the BK artery, specifically > 270° visualization of the blood vessel lumen with > 16/21 cross sections. The proportion of the clear image (≥ 85%) was regarded as confirmatory of the ability of OFDI to visualize the vessel lumen. Overall, 20 patients were enrolled. The proportion of the primary endpoint was 90% (18/20), and the pre-specified criterion was successfully attained. The proportion of the clear image assessed by the operator was 100% (20/20), and an additional statistical analysis for the proportion of the visualization, > 270°, of the blood vessel lumen revealed a significantly higher cut-off value than that for the pre-specified criterion, 85% (p = 0.0315). There were three adverse events not related to OFDI. OFDI achieved acceptable visualization of the vessel lumen without any adverse event related to it. After regulatory approval based on the present study, OFDI will be available as a new option of endovascular imaging for peripheral artery diseases in daily practiceTrial registration: This study was registered in the Japanese Registry of Clinical Trials (jRCT 2052190025, https://jrct.niph.go.jp/latest-detail/jRCT2052190025 ).
Collapse
Affiliation(s)
- Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Akihide Konishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan. .,Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.,Division of Cardiovascular Medicine, School of Medicine, Showa University, Shinagawa, Japan
| | - Hirokuni Akahori
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroaki Tsujita
- Division of Cardiovascular Medicine, School of Medicine, Showa University, Shinagawa, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shinsuke Nakano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kosuke Tanimura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | - Isao Nanba
- Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yasumasa Kakei
- Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takahiro Yasuda
- Advanced Medical-Engineering Development Center, Kobe University, Kobe, Japan
| | - Takashi Omori
- Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Amane Kozuki
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Junya Shite
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| |
Collapse
|
5
|
Simard T, Motazedian P, Majeed K, Sarathy K, Jung RG, Feder J, Ramirez FD, Di Santo P, Marbach J, Dhaliwal S, Short S, Labinaz A, Schultz C, Russo JJ, So D, Chong AY, Le May M, Hibbert B. Contrast-free optical coherence tomography:Systematic evaluation of non-contrast media for intravascular assessment. PLoS One 2020; 15:e0237588. [PMID: 32817672 PMCID: PMC7446899 DOI: 10.1371/journal.pone.0237588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background Coronary revascularization using imaging guidance is rapidly becoming the standard of care. Intravascular optical coherence tomography uses near-infrared light to obtain high resolution intravascular images. Standard optical coherence tomography imaging technique employs iodinated contrast dye to achieve the required blood clearance during acquisition. We sought to systematically evaluate the technical performance of saline as an alternative to iodinated contrast for intravascular optical coherence tomography assessment. Methods and results We performed bench top optical coherence tomography analysis on nylon tubing with sequential contrast/saline dilutions to empirically derive adjustment coefficients. We then applied these coefficients in vivo in an established rabbit abdominal stenting model with both saline and contrast optical coherence tomography imaging. In this model, we assessed the impact of saline on both quantitative and qualitative vessel assessment. Nylon tubing assessment demonstrated a linear relationship between saline and contrast for both area and diameter. We then derived adjustment coefficients, allowing for accurate calculation of area and diameter when converting saline into both contrast and reference dimensions. In vivo studies confirmed reduced area with saline versus contrast [7.43 (5.67–8.36) mm2 versus 8.2 (6.34–9.39) mm2, p = 0.001] and diameter [3.08 mm versus 3.23 mm, p = 0.001]. Following correction, a strong relationship was achieved in vivo between saline and contrast in both area and diameter without compromising image quality, artefact, or strut assessment. Conclusion Saline generates reduced dimensions compared to contrast during intravascular optical coherence tomography imaging. The relationship across physiologic coronary diameters is linear and can be corrected with high fidelity. Saline does not adversely impact image quality, artefact, or strut assessment.
Collapse
Affiliation(s)
- Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Kiran Sarathy
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard G. Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Feder
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F. Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
- L’Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey Marbach
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shan Dhaliwal
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Spencer Short
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Alisha Labinaz
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Carl Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Juan J. Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Derek So
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aun-Yeong Chong
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michel Le May
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
| |
Collapse
|
6
|
Dubosq M, Gouëffic Y, Duhamel A, Denies F, Dervaux B, Goyault G, Sobocinski J. Optical Coherence Tomography Contribution Assessment in the Revascularization of Long Femoropopliteal Occlusive Lesions (TASC C and D): A Randomized Trial. Ann Vasc Surg 2020; 70:362-369. [PMID: 32634565 DOI: 10.1016/j.avsg.2020.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Endovascular treatment has become the first-line revascularization technique for femoropopliteal lesions. This technique lacks reliable and accurate morphological control of the arterial segment treated. Intraoperative 2-dimensional angiogram consumes iodinated contrast media and increases X-ray exposure; this subsequently provides no 3-dimensional information on the quality of the revascularization completed, what could explain some of the early and late failures of the technique. We evaluated whether intraoperative optical coherence tomography (OCT) control in addition to standard angiogram could improve the primary patency rate at 12 months in comparison to standard angiogram alone in patients with occlusive femoropopliteal lesions. METHODS The tomography by optical coherence in femoral artery trial is a multicentric, prospective, randomized, controlled, and single-blind study including patients with long de novo occlusive femoropopliteal lesions. The randomization will be achieved in 2 balanced groups of patients after crossing successfully the lesion: group 1 with intraoperative OCT control in addition to standard angiogram and group 2 with standard angiogram alone. The randomization will be stratified by center. The protocol has been submitted and approved by a French ethic's committee under reference number CPP2019-12-098. The study has been registered under the reference number NCT04434586 on the Web site of clinicaltrials.gov. RESULTS The primary outcome of the study is the primary patency at 12 months. The number of patients who need to be treated is 166 (83 in each group) considering 5% of no workable data. Symptoms' improvement, target lesion revascularization, target vessel revascularization, quality-of-life questionnaires, cost utility, and cost effectiveness will be analyzed as secondary end-point variables at 12 months. CONCLUSIONS The present study is to evaluate the potential benefit for patients on the result of endovascular revascularization of long occlusive femoropopliteal lesion at 12 months when using intraoperative OCT control.
Collapse
Affiliation(s)
- Maxime Dubosq
- Department of Vascular Surgery, Institut Cœur-Poumon, CHU Lille, Lille, France
| | - Yann Gouëffic
- Vascular Center, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, Metrics: Évaluation des Technologies de santé et des Pratiques Médicales, Lille, France
| | - Fanette Denies
- Univ. Lille, CHU Lille, Metrics: Évaluation des Technologies de santé et des Pratiques Médicales, Lille, France
| | - Benoit Dervaux
- Univ. Lille, CHU Lille, Metrics: Évaluation des Technologies de santé et des Pratiques Médicales, Lille, France
| | - Gilles Goyault
- Department of Vascular and Oncological Interventional Radiology, Institut Cardiovasculaire de Strasbourg (ICS), Clinique Rhena, Strasbourg, France
| | - Jonathan Sobocinski
- Department of Vascular Surgery, Institut Cœur-Poumon, CHU Lille, Lille, France.
| |
Collapse
|
7
|
Pavillard E, Sewall L. A post-market, multi-vessel evaluation of the imaging of peripheral arteries for diagnostic purposeS comparing optical Coherence tomogrApy and iNtravascular ultrasound imaging (SCAN). BMC Med Imaging 2020; 20:18. [PMID: 32059702 PMCID: PMC7023791 DOI: 10.1186/s12880-020-0420-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background Intravascular imaging plays an important part in diagnosis of vascular conditions and providing insight for treatment strategy. Two main imaging modalities are intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The objective of this study was to prove non-inferiority of OCT imaging to IVUS images in matched segments of peripheral vessels in patients with suspected peripheral vascular disease. Methods The SCAN study was a prospective, non-inferiority clinical study of matched IVUS and OCT images collected along defined segments of peripheral vessels from twelve subjects (mean age 68 ± 10.3 years; 10 men) displaying symptoms of vascular disease. Luminal diameters were measured by both imaging systems at the distal, middle, and proximal points of the defined segments. Three blinded interventional radiologists evaluated the quality of both imaging modalities in identifying layered structures (3-point grading), plaque (5-point grading), calcification (5-point grading), stent structure (3-point grading), and artifacts (3-point grading) from 240 randomly ordered images. Mean grading scores and luminal diameters were calculated and analyzed with Student’s t-Test and Mann-Whitney-Wilcoxon testing. Intrareader reproducibility was calculated by intraclass correlation (ICC) analysis. Results The mean scoring of plaque, calcification, and vascular stent struts by the three readers was significant better in terms of image quality for OCT than IVUS (p < 0.001, p = 0.001, p = 0.004, respectively). The mean scores of vessel wall component visibility and artifacts generated by the two imaging systems were not significantly different (p = 0.19, p = 0.07, respectively). Mean vessel luminal diameter and area at three specific locations within the vessels were not significantly different between the two imaging modalities. No patient injury, adverse effect or device malfunction were noted during the study. Conclusions Imaging by OCT provides the physician with better visualization of some vessel and plaque chacteristics, but both IVUS and OCT imaging are safe and effective methods of examining peripheral vessels in order to perform diagnostic assessment of peripheral vessels and provide information necessary for the treatment strategy of peripheral artery disease. Trial registration NCT03480685 registered on 29 March 2018.
Collapse
Affiliation(s)
- Edward Pavillard
- Pennsylvania Vascular Institute, 420 W. Linfield-Trappe Road Suite 3200, Limerick, PA, 19468, USA.
| | - Luke Sewall
- AMITA Health, 911 N. Elm Street Suite 128, Hinsdale, IL, 60521, USA
| |
Collapse
|
8
|
Li Y, Chen J, Chen Z. Multimodal intravascular imaging technology for characterization of atherosclerosis. JOURNAL OF INNOVATIVE OPTICAL HEALTH SCIENCES 2020; 13:2030001. [PMID: 32308744 PMCID: PMC7164814 DOI: 10.1142/s1793545820300013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Early detection of vulnerable plaques is the critical step in the prevention of acute coronary events. Morphology, composition, and mechanical property of a coronary artery have been demonstrated to be the key characteristics for the identification of vulnerable plaques. Several intravascular multimodal imaging technologies providing co-registered simultaneous images have been developed and applied in clinical studies to improve the characterization of atherosclerosis. In this paper, the authors review the present system and probe designs of representative intravascular multimodal techniques. In addition, the scientific innovations, potential limitations, and future directions of these technologies are also discussed.
Collapse
Affiliation(s)
- Yan Li
- Beckman Laser Institute, University of California, Irvine 1002 Health Sciences Road, Irvine, CA 92617 USA
| | - Jason Chen
- Beckman Laser Institute, University of California, Irvine 1002 Health Sciences Road, Irvine, CA 92617 USA
| | - Zhongping Chen
- Department of Biomedical Engineering University of California, Irvine, CA 92697-2700 USA
| |
Collapse
|
9
|
Dubosq M, Patterson BO, Azzaoui R, Mesnard T, De Préville A, Sobocinski J. Protocol Adaptation of Optical Coherence Tomography in Lower Limb Arteries Revascularization. Ann Vasc Surg 2019; 57:257-260. [DOI: 10.1016/j.avsg.2018.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/08/2018] [Accepted: 09/20/2018] [Indexed: 11/30/2022]
|
10
|
Abstract
The rupture of atherosclerotic plaques is the leading cause of death in developed countries. Early identification of vulnerable plaque is the essential step in preventing acute coronary events. Intravascular photoacoustic (IVPA) technology is able to visualize chemical composition of atherosclerotic plaque with high specificity and sensitivity. Integrated with intravascular ultrasound (IVUS) imaging, this multimodal intravascular IVPA/IVUS imaging technology is able to provide both structural and chemical compositions of arterial walls for detecting and characterizing atherosclerotic plaques. In this paper, we present representative multimodal IVPA/IVUS imaging systems and discuss current scientific innovations, potential limitations, and prospective improvements for characterization of coronary atherosclerosis.
Collapse
Affiliation(s)
- Yan Li
- Beckman Laser Institute, University of California, Irvine, 1002 Health Sciences Road, Irvine, CA 92617 USA
| | - Zhongping Chen
- Beckman Laser Institute, University of California, Irvine, 1002 Health Sciences Road, Irvine, CA 92617 USA.,Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92697-2700 USA
| |
Collapse
|
11
|
Pavo N, Samaha E, Sabdyusheva I, von Strandmann RP, Stahnke S, Plass CA, Zlabinger K, Lukovic D, Jambrik Z, Pavo IJ, Bergler-Klein J, Gray WA, Maurer G, Gyöngyösi M. Coating of intravascular balloon with paclitaxel prevents constrictive remodeling of the dilated porcine femoral artery due to inhibition of intimal and media fibrosis. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2016; 27:131. [PMID: 27388164 PMCID: PMC4937086 DOI: 10.1007/s10856-016-5737-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
Here we investigated how a coating of intravascular balloon with paclitaxel (drug-coated balloon; DCB, Freeway™) impacted porcine peripheral artery vascular function and remodeling. Domestic swine (n = 54) underwent percutaneous overstretch balloon dilation of femoral and iliac arteries, controlled by angiography and optical coherence tomography (OCT). Paclitaxel tissue uptake was measured at 1 h and 1, 3, and 9 days post-dilation. At these time-points and at 32 ± 2 days, vascular function of the dilated arteries was assessed using the organ chamber model. Neointimal growth and remodeling indices were determined using OCT and histology at 32 ± 2 days. Intima and media fibrosis were quantified by picrosirius red staining. Post-inflation femoral artery tissue drug levels were 460 ± 214, 136 ± 123, 14 ± 6, and 0.1 ± 0.1 ng/mg at 1 h and 1, 3, and 9 days, respectively. Compared to plain balloon, Freeway™ resulted in a significantly smaller neointimal area (P < 0.05), less tunica intima (8.0 ± 5.4 vs 14.2 ± 4.7 %) and media fibrosis (15.6 ± 7.7 vs 24.5 ± 5.4 %), and less femoral artery constrictive remodeling (remodeling index: 1.08 ± 0.08 vs 0.94 ± 0.08). The DCB was associated with significantly increased vasoconstrictor tone and endothelium-dependent vasodilation impairment shortly after post-overstretch injury. Overall, DCB dilation of peripheral arteries resulted in high drug uptake into arterial tissue. Compared with the plain balloon, the DCB was associated with decreased vessel wall fibrosis after balloon overstretch injury, and reduced degrees of constrictive remodeling and neointimal hyperplasia.
Collapse
Affiliation(s)
- Noemi Pavo
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Eslam Samaha
- Department of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Inna Sabdyusheva
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | | | | | - Christian A Plass
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Katrin Zlabinger
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Dominika Lukovic
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | | | - Imre J Pavo
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Jutta Bergler-Klein
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - William A Gray
- Center for Interventional Vascular Therapy, Columbia-Presbyterian Hospital, New York, NY, USA
| | - Gerald Maurer
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
| |
Collapse
|
12
|
Kendrick DE, Allemang MT, Gosling AF, Nagavalli A, Kim AH, Nishino S, Parikh SA, Bezerra HG, Kashyap VS. Dextran or Saline Can Replace Contrast for Intravascular Optical Coherence Tomography in Lower Extremity Arteries. J Endovasc Ther 2016; 23:723-30. [PMID: 27385151 DOI: 10.1177/1526602816657392] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the hypothesis that alternative flush media could be used for lower extremity optical coherence tomography (OCT) imaging in long lesions that would normally require excessive use of contrast. METHODS The OPTical Imaging Measurement of Intravascular Solution Efficacy (OPTIMISE) trial was a single-center, prospective study (ClinicalTrials.gov identifier NCT01743872) that enrolled 23 patients (mean age 68±11 years; 14 men) undergoing endovascular intervention involving the superficial femoral artery. Four flush media (heparinized saline, dextran, carbon dioxide, and contrast) were used in succession in random order for each image pullback. Quality was defined as ≥270° visualization of vessel wall layers from each axial image. Mean proportions (± standard deviation) of image quality for each flush medium were assessed using 1-way analysis of variance and are reported with the 95% confidence intervals (CI). RESULTS Four OCT catheters failed, leaving 19 patients who completed the OCT imaging protocol; from this cohort, 51 highest quality runs were selected for analysis. Average vessel diameter was 3.99±1.01 mm. OCT imaging allowed 10- to 15-μm resolution of the lumen border, with diminishing quality as vessel diameter increased. Plaque characterization revealed fibrotic lesions. Mean proportions of image quality were dextran 87.2%±12% (95% CI 0.81 to 0.94), heparinized saline 74.3%±24.8% (95% CI 0.66 to 0.93), contrast 70.1%±30.5% (95% CI 0.52 to 0.88), and carbon dioxide 10.0%±10.4% (95% CI 0.00 to 0.26). Dextran, saline, and contrast provided better quality than carbon dioxide (p<0.001). CONCLUSION OCT is feasible in peripheral vessels <5 mm in diameter. Dextran or saline flush media can allow lesion characterization, avoiding iodinated contrast. Carbon dioxide is inadequate for peripheral OCT imaging. Axial imaging may aid in enhancing durability of peripheral endovascular interventions.
Collapse
Affiliation(s)
- Daniel E Kendrick
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Matthew T Allemang
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Andre F Gosling
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Anil Nagavalli
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, USA
| | - Ann H Kim
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Setsu Nishino
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Sahil A Parikh
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Hiram G Bezerra
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Vikram S Kashyap
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| |
Collapse
|
13
|
Schwindt A, Reimers B, Scheinert D, Selmon M, Pigott JP, George JC, Robertson G, Janzer S, McDaniel HB, Shrikhande GV, Torsello G, Schaefers J, Saccà S, Versaci F. Crossing chronic total occlusions with the Ocelot system: the initial European experience. EUROINTERVENTION 2016; 9:854-62. [PMID: 23838387 DOI: 10.4244/eijv9i7a139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to determine the safety, efficacy and feasibility of a new chronic total occlusion (CTO) device using optical coherence tomography (OCT) technology, the Ocelot catheter (Avinger, Inc., Redwood City, CA, USA), for crossing of SFA CTOs following guidewire failure. METHODS AND RESULTS Prospective, multicentre, market preference testing. Thirty-three patients with confirmed CTO (99-100% stenosis by visual estimate) of their superficial femoral artery (SFA) were treated between September 28, 2011, and December 9, 2011, at three European centres. Ocelot crossed 94% (31/33) of CTOs, allowing guidewire placement in the distal true lumen. All (100%) lesions were treated without any major adverse safety events. Procedural time and contrast dose were significantly reduced (p<0.0001) when compared with a similar, non-OCT-guided CTO crossing device (Wildcat catheter; Avinger, Inc.). Overall physician feedback on the catheter performance was positive with an 87% average rating of excellent or good across seven categories. Performance ratings of Ocelot's OCT imaging guidance were consistently positive with an 86% average rating of excellent or good across five OCT categories. CONCLUSIONS The Ocelot catheter combines advanced CTO crossing technology with real-time OCT guidance. When compared with a similar non-OCT-guided catheter, crossing efficacy and safety profile improved. Total procedure time and contrast volumes were significantly reduced. The Ocelot is a safe, efficient and effective tool for crossing CTOs.
Collapse
|
14
|
|
15
|
Abstract
Coronary angiography is the gold standard for the diagnosis of coronary artery disease and guides revascularization strategies. The emergence of new diagnostic modalities has provided clinicians with adjunctive physiologic and image-based data to help formulate treatment strategies. Fractional flow reserve can predict whether percutaneous intervention will benefit a patient. Intravascular ultrasonography and optical coherence tomography are intracoronary imaging modalities that facilitate the anatomic visualization of the vessel lumen and characterize plaques. Near-infrared spectroscopy can characterize plaque composition and potentially provide valuable prognostic information. This article reviews the indications, basic technology, and supporting clinical studies for these modalities.
Collapse
Affiliation(s)
- Elliott M Groves
- Division of Cardiology, Department of Internal Medicine, University of California, 333 City Blvd West, Suite 400, Orange, CA 92868-3298, USA; Department of Biomedical Engineering, University of California, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA
| | - Arnold H Seto
- Division of Cardiology, Department of Internal Medicine, University of California, 333 City Blvd West, Suite 400, Orange, CA 92868-3298, USA; Division of Cardiology, Department of Internal Medicine, Long Beach Veterans Administration Hospital, 5901 East Seventh Street, Long Beach, CA 90822, USA.
| | - Morton J Kern
- Division of Cardiology, Department of Internal Medicine, University of California, 333 City Blvd West, Suite 400, Orange, CA 92868-3298, USA; Division of Cardiology, Department of Internal Medicine, Long Beach Veterans Administration Hospital, 5901 East Seventh Street, Long Beach, CA 90822, USA
| |
Collapse
|
16
|
Gnanadesigan M, van Soest G, White S, Scoltock S, Ughi GJ, Baumbach A, van der Steen AFW, Regar E, Johnson TW. Effect of temperature and fixation on the optical properties of atherosclerotic tissue: a validation study of an ex-vivo whole heart cadaveric model. BIOMEDICAL OPTICS EXPRESS 2014; 5:1038-49. [PMID: 24761287 PMCID: PMC3985992 DOI: 10.1364/boe.5.001038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/24/2014] [Accepted: 02/01/2014] [Indexed: 05/08/2023]
Abstract
Atherosclerotic plaque composition can be imaged using the optical attenuation coefficient derived from intravascular optical coherence tomography (OCT) data. The relation between optical properties and tissue type has been established on autopsy tissues. In this study, we validate an ex-vivo model for the effect of temperature and tissue fixation on optical parameters. We studied the optical attenuation of human coronary arteries at three temperatures, before and after formalin fixation. We developed an en-face longitudinal display of attenuation data of the OCT pullbacks. Using the unfixed, body-temperature condition image as a standard, and after extensive registration with other condition images, we quantify the differences in optical attenuation and the backscattered intensity. The results suggest that tissue fixation and temperature do not introduce systematic errors in studies of arterial optical properties.
Collapse
Affiliation(s)
- Muthukaruppan Gnanadesigan
- Department of Biomedical Engineering, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Biomedical Engineering, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | | | | | - Giovanni J Ughi
- Cardiovascular Diseases, University Hospitals Leuven, & Dept. of Cardiovascular Sciences, KU Leuven, Belgium
| | | | - Antonius FW van der Steen
- Department of Biomedical Engineering, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Imaging Science and Technology, Delft University of Technology, Lorentzweg 1, 2628 CJ Delft, The Netherlands
| | - Evelyn Regar
- Department of Biomedical Engineering, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | | |
Collapse
|
17
|
Prospective Evaluation of Optical Coherence Tomography in Lower Limb Arteries Compared with Intravascular Ultrasound. J Vasc Interv Radiol 2013; 24:1499-508. [DOI: 10.1016/j.jvir.2013.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 11/17/2022] Open
|
18
|
Ughi GJ, Adriaenssens T, Sinnaeve P, Desmet W, D’hooge J. Automated tissue characterization of in vivo atherosclerotic plaques by intravascular optical coherence tomography images. BIOMEDICAL OPTICS EXPRESS 2013; 4:1014-30. [PMID: 23847728 PMCID: PMC3704084 DOI: 10.1364/boe.4.001014] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 05/08/2023]
Abstract
Intravascular optical coherence tomography (IVOCT) is rapidly becoming the method of choice for the in vivo investigation of coronary artery disease. While IVOCT visualizes atherosclerotic plaques with a resolution <20µm, image analysis in terms of tissue composition is currently performed by a time-consuming manual procedure based on the qualitative interpretation of image features. We illustrate an algorithm for the automated and systematic characterization of IVOCT atherosclerotic tissue. The proposed method consists in a supervised classification of image pixels according to textural features combined with the estimated value of the optical attenuation coefficient. IVOCT images of 64 plaques, from 49 in vivo IVOCT data sets, constituted the algorithm's training and testing data sets. Validation was obtained by comparing automated analysis results to the manual assessment of atherosclerotic plaques. An overall pixel-wise accuracy of 81.5% with a classification feasibility of 76.5% and per-class accuracy of 89.5%, 72.1% and 79.5% for fibrotic, calcified and lipid-rich tissue respectively, was found. Moreover, measured optical properties were in agreement with previous results reported in literature. As such, an algorithm for automated tissue characterization was developed and validated using in vivo human data, suggesting that it can be applied to clinical IVOCT data. This might be an important step towards the integration of IVOCT in cardiovascular research and routine clinical practice.
Collapse
|
19
|
Paraskevopoulos I, Spiliopoulos S, Davlouros P, Karnabatidis D, Katsanos K, Alexopoulos D, Siablis D. Evaluation of below-the-knee drug-eluting stents with frequency-domain optical coherence tomography: neointimal hyperplasia and neoatherosclerosis. J Endovasc Ther 2013; 20:80-93. [PMID: 23391087 DOI: 10.1583/12-4091.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To report the use of intravascular frequency-domain optical coherence tomography (FD-OCT) to detect and characterize in-stent neointimal tissue following infrapopliteal drug-eluting stent (DES) placement in patients suffering from critical limb ischemia. METHODS This prospective study included 12 patients (7 men; mean age 72.8±7.2 years) who had previously received 21 infrapopliteal sirolimus- or everolimus-eluting stents. The patients returned for regular angiographic follow-up or presented with clinical relapse of symptoms over a mean follow-up of 13.5±7.3 months (range 6-33), at which time FD-OCT imaging was performed. Study endpoints were technical imaging success, defined as successful FD-OCT acquisition and visualization of the arterial lumen and complete vessel wall, and the detection and characterization of in-stent neointimal hyperplasia according to widely accepted OCT criteria. RESULTS OCT imaging was successfully completed in 19 of the 21 stents. Binary in-stent restenosis (ISR>50%) was detected in 10/19 stents. Percent restenosis was higher after longer follow-up (60.6%±19.8% ≥1 year vs. 35.3%±20.6% <1 year, p=0.03) and in symptomatic vs. asymptomatic patients (61.5%±20.4% vs. 37.2%±19.3%, p=0.04). Neoatherosclerosis findings included lipid-laden neointima (16/19), neointimal neovascularization (13/19), neointimal calcifications (6/19), and thrombus (5/19); no cases of thin-cap fibroatheroma were identified. Neointimal calcifications were more frequent after ≥12 months of follow-up compared to <12 months (46.6% vs. 0%, p=0.02). CONCLUSION FD-OCT of the infrapopliteal arteries following DES placement is safe and feasible and may demonstrate features of developing neointimal neoatherosclerosis. The latter might play a key role as a mechanism of below-the-knee ISR and warrants further investigation.
Collapse
Affiliation(s)
- Ioannis Paraskevopoulos
- Department of Diagnostic and Interventional Radiology, Patras University Hospital, Patras, Greece.
| | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
This article discusses diagnostic imaging techniques used in the evaluation and management of patients with peripheral arterial disease (PAD). Along with a complete vascular examination, noninvasive physiologic testing is used for the initial evaluation of patients with suspected PAD. Duplex ultrasonography provides information on the degree of stenosis or occlusion within a vessel and allows assessment of the vessel wall and plaque morphology. Angiographic imaging techniques should be reserved for determining the optimal endovascular or surgical approach for patients requiring revascularization. Together, all available diagnostic modalities contribute to successful evaluation and management of patients with PAD.
Collapse
Affiliation(s)
- Salman M Azam
- Harrington-McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | | |
Collapse
|
21
|
Kubo T, Xu C, Wang Z, van Ditzhuijzen NS, Bezerra HG. Plaque and thrombus evaluation by optical coherence tomography. Int J Cardiovasc Imaging 2011; 27:289-98. [PMID: 21336556 DOI: 10.1007/s10554-010-9790-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 12/30/2010] [Indexed: 01/08/2023]
Abstract
Intravascular Optical Coherence Tomography has been explored as an imaging tool for vessel wall and thrombus characterization. OCT enables a high resolution arterial wall imaging, and light properties allow tissue characterization. It has been proved one of the most valuable imaging modalities for the evaluation of vulnerable plaque and thrombus. OCT has a unique capacity in volumetric quantification of calcium, and unlike ultrasound, light can easily penetrate calcified plaques. Finally, this review paper will address aspects of the validation method of plaque characterization and potential pitfalls and put in perspective new approaches that may help the evolution of the field.
Collapse
Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | | | | | | | | |
Collapse
|
22
|
van Soest G, Goderie T, Regar E, Koljenović S, van Leenders GLJH, Gonzalo N, van Noorden S, Okamura T, Bouma BE, Tearney GJ, Oosterhuis JW, Serruys PW, van der Steen AFW. Atherosclerotic tissue characterization in vivo by optical coherence tomography attenuation imaging. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:011105. [PMID: 20210431 DOI: 10.1117/1.3280271] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Optical coherence tomography (OCT) is rapidly becoming the method of choice for assessing arterial wall pathology in vivo. Atherosclerotic plaques can be diagnosed with high accuracy, including measurement of the thickness of fibrous caps, enabling an assessment of the risk of rupture. While the OCT image presents morphological information in highly resolved detail, it relies on interpretation of the images by trained readers for the identification of vessel wall components and tissue type. We present a framework to enable systematic and automatic classification of atherosclerotic plaque constituents, based on the optical attenuation coefficient mu(t) of the tissue. OCT images of 65 coronary artery segments in vitro, obtained from 14 vessels harvested at autopsy, are analyzed and correlated with histology. Vessel wall components can be distinguished based on their optical properties: necrotic core and macrophage infiltration exhibit strong attenuation, mu(t)>or=10 mm(-1), while calcific and fibrous tissue have a lower mu(t) approximately 2-5mm(-1). The algorithm is successfully applied to OCT patient data, demonstrating that the analysis can be used in a clinical setting and assist diagnostics of vessel wall pathology.
Collapse
Affiliation(s)
- Gijs van Soest
- Erasmus Medical Center, Thorax Center, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Hetterich H, Redel T, Lauritsch G, Rohkohl C, Rieber J. New X-ray imaging modalities and their integration with intravascular imaging and interventions. Int J Cardiovasc Imaging 2009; 26:797-808. [PMID: 19898992 DOI: 10.1007/s10554-009-9529-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 10/22/2009] [Indexed: 12/17/2022]
Affiliation(s)
- H Hetterich
- Department of Cardiology, Medizinische Poliklinik, University of Munich, Ziemssenstrasse 1, Munich, Germany
| | | | | | | | | |
Collapse
|
24
|
Nienaber CA, Kische S, Skriabina V, Ince H. Noninvasive Imaging Approaches to Evaluate the Patient With Known or Suspected Aortic Disease. Circ Cardiovasc Imaging 2009; 2:499-506. [DOI: 10.1161/circimaging.109.850206] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Christoph A. Nienaber
- From University Hospital Rostock, Department of Cardiology and Angiology, Rostock School of Medicine, Rostock, Germany
| | - Stephan Kische
- From University Hospital Rostock, Department of Cardiology and Angiology, Rostock School of Medicine, Rostock, Germany
| | - Valeria Skriabina
- From University Hospital Rostock, Department of Cardiology and Angiology, Rostock School of Medicine, Rostock, Germany
| | - Hüseyin Ince
- From University Hospital Rostock, Department of Cardiology and Angiology, Rostock School of Medicine, Rostock, Germany
| |
Collapse
|
25
|
Farooq MU, Khasnis A, Majid A, Kassab MY. The role of optical coherence tomography in vascular medicine. Vasc Med 2009; 14:63-71. [PMID: 19144781 DOI: 10.1177/1358863x08095153] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optical coherence tomography (OCT) is an emerging imaging modality that provides high-resolution, microstructural information on atherosclerotic plaques in biological systems. Intracoronary OCT can identify thin-cap fibroatheroma and other vulnerable plaques that may be responsible for acute coronary events. These characteristics make OCT helpful in guiding coronary management and interventions, including stent apposition and early identification of procedure-related complications. OCT is being assessed for its potential role in carotid plaque characterization and in the diagnosis of peripheral arterial atherosclerosis. Its current use in studying carotid and cerebral vasculature and in the diagnosis of peripheral arterial diseases is limited and ill defined, but it is finding increasing application in these areas. Its performance can be further improved by increasing the signal to noise ratio and by using dynamic focus tracking techniques. It can potentially be used to monitor the progression and regression of atherosclerosis in the coronary, cerebral and peripheral vasculature. New indications for its use in vascular medicine are emerging as its technology continues to improve over time.
Collapse
Affiliation(s)
- Muhammad U Farooq
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan 48824, USA
| | | | | | | |
Collapse
|
26
|
Burris NS, Brown EN, Grant M, Kon ZN, Gibber M, Gu J, Schwartz K, Kallam S, Joshi A, Vitali R, Poston RS. Optical coherence tomography imaging as a quality assurance tool for evaluating endoscopic harvest of the radial artery. Ann Thorac Surg 2008; 85:1271-7. [PMID: 18355508 DOI: 10.1016/j.athoracsur.2007.12.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 12/06/2007] [Accepted: 12/10/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Concerns about intimal disruption and spasm have limited enthusiasm for endoscopic radial artery harvest (ERAH), although the risk of these problems after this procedure remains uncertain. Radial artery conduits were screened intraoperatively before and after ERAH vs open harvest using catheter-based high-resolution optical coherence tomography (OCT) imaging. METHODS Twenty-four cadavers and 60 coronary artery bypass graft (CABG) patients scheduled to receive a RA graft underwent OCT imaging before (in situ) and after (ex vivo) open harvest or ERAH. Spasm was quantified by the percentage change in luminal volume between images. Intimal disruption was classified as minor or severe depending on whether the defect was confined to branch ostia or involved the luminal surface. Histology was used to confirm OCT findings. RESULTS Luminal volume significantly declined after harvest in all RAs from CABG patients, but there was no difference between groups: -43% +/- 29% vs -35% +/- 38% change after ERAH (n = 21) vs open harvest (n = 39; p = 0.342). Significantly more intimal injury was noted after ERAH vs open harvest (34/41 vs 9/43, intimal tears/total evaluated RAs, p < 0.0001). Most intimal injury was minor: only 2 tears involved the luminal surface of the RA (both after ERAH). Serial imaging in cadavers revealed that 86% of ostial tears occur in ERAH during the initial blunt dissection step using the endoscope. CONCLUSIONS Although branch injury is a pitfall of ERAH, OCT imaging documented that the quality of RA procured is acceptable and comparable with open harvest. Catheter-based OCT provides an important quality assurance tool for RA harvest.
Collapse
Affiliation(s)
- Nicholas S Burris
- Department of Surgery, University of Maryland, Baltimore, Maryland 21201, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Kim KH, Park BH, Maguluri GN, Lee TW, Rogomentich FJ, Bancu MG, Bouma BE, de Boer JF, Bernstein JJ. Two-axis magnetically-driven MEMS scanning catheter for endoscopic high-speed optical coherence tomography. OPTICS EXPRESS 2007; 15:18130-40. [PMID: 19551111 DOI: 10.1364/oe.15.018130] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
A two-axis scanning catheter was developed for 3D endoscopic imaging with spectral domain optical coherence tomography (SD-OCT). The catheter incorporates a micro-mirror scanner implemented with microelectromechanical systems (MEMS) technology: the micro-mirror is mounted on a two-axis gimbal comprised of folded flexure hinges and is actuated by magnetic field. The scanner can run either statically in both axes or at the resonant frequency (>= 350Hz) for the fast axis. The assembled catheter has an outer diameter of 2.8 mm and a rigid part of 12 mm in length. Its scanning range is +/- 20 in optical angle in both axes with low voltages (1 approximately 3V), resulting in a scannable length of approximately 1 mm at the surface in both axes, even with the small catheter size. The catheter was incorporated with a multi-functional SD-OCT system for 3D endoscopic imaging. Both intensity and polarization-sensitive images could be acquired simultaneously at 18.5K axial scans/s. In vivo 3D images of human fingertips and oral cavity tissue are presented as a demonstration.
Collapse
Affiliation(s)
- Ki Hean Kim
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114 USA
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Meng L, Lv B, Zhang S, Yv B. In vivo optical coherence tomography of experimental thrombosis in a rabbit carotid model. Heart 2007; 94:777-80. [PMID: 17947363 PMCID: PMC2564841 DOI: 10.1136/hrt.2007.117382] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Plaque rupture with subsequent thrombosis is recognised as the underlying pathophysiology of most acute coronary syndromes. Thus, direct thrombus visualisation in vivo may be beneficial for both diagnosis and guidance of therapy. We sought to test the feasibility of imaging acute thrombosis in vivo using optical coherence tomography (OCT) in an experimental thrombosis animal model. Methods and results: Nine male New Zealand White rabbits (weight ≈3.0 kg) were made atherosclerotic with a high-cholesterol diet after injury of the right carotid artery endothelium. Thrombus was then induced with the use of Russell’s viper venom (RVV) and histamine. Subsequently, OCT imaging of the right carotid artery was performed. Histology was performed on arterial regions that were injured by balloon. Six rabbits (67%) developed thrombus. Histological correlation confirmed all thrombi (100%) detected with OCT, with no other thrombi seen in the other regions of the right carotid artery. In the remaining three rabbits, no thrombus was observed by OCT or histology. Conclusion: We demonstrate the feasibility of OCT for the detection of acute thrombosis in vivo using an animal model of atherosclerosis and acute thrombosis. Potential clinical applications include thrombus detection in acute coronary syndromes.
Collapse
Affiliation(s)
- L Meng
- Department of Cardiology, 2nd Affiliated Hospital, HarBin Medical University, HarBin, China, 150086.
| | | | | | | |
Collapse
|
29
|
Brown EN, Burris NS, Gu J, Kon ZN, Laird P, Kallam S, Tang CM, Schmitt JM, Poston RS. Thinking inside the graft: applications of optical coherence tomography in coronary artery bypass grafting. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:051704. [PMID: 17994877 PMCID: PMC2962582 DOI: 10.1117/1.2799521] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Recent advances in catheter-based optical coherence tomography (OCT) have provided the necessary resolution and acquisition speed for high-quality intravascular imaging. Complications associated with clearing blood from the vessel of a living patient have prevented its wider acceptance. We identify a surgical application that takes advantage of the vascular imaging powers of OCT but that circumvents the difficulties. Coronary artery bypass grafting (CABG) is the most commonly performed major surgery in America. A critical determinant of its outcome has been postulated to be injury to the conduit vessel incurred during the harvesting procedure or pathology preexistent in the harvested vessel. As a test of feasibility, intravascular OCT imaging is obtained from the radial arteries (RAs) and/or saphenous veins (SVs) of 35 patients scheduled for CABG. Pathologies detected by OCT are compared to registered histological sections obtained from discarded segments of each graft. OCT reliably detects atherosclerotic lesions in the RAs and discerns plaque morphology as fibrous, fibrocalcific, or fibroatheromatous. OCT is also used to assess intimal trauma and residual thrombi related to endoscopic harvest and the quality of the distal anastomosis. We demonstrate the feasibility of OCT imaging as an intraoperative tool to select conduit vessels for CABG.
Collapse
Affiliation(s)
- Emile N Brown
- University of Maryland, School of Medicine, Department of Cardiac Surgery, 22 South Greene Street N4W94, Baltimore, Maryland 21201, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Evaluation of endovenous radiofrequency ablation and laser therapy with endoluminal optical coherence tomography in an ex vivo model. J Vasc Surg 2007; 45:1047-58. [DOI: 10.1016/j.jvs.2006.12.056] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 12/19/2006] [Indexed: 11/18/2022]
|
31
|
Meissner OA, Schmedt CG, Hunger K, Hetterich H, Sroka R, Rieber J, Babaryka G, Steckmeier BM, Reiser M, Siebert U, Mueller-Lisse U. Endovascular optical coherence tomography ex vivo: venous wall anatomy and tissue alterations after endovenous therapy. Eur Radiol 2007; 17:2384-93. [PMID: 17287969 DOI: 10.1007/s00330-007-0593-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 11/12/2006] [Accepted: 01/11/2007] [Indexed: 11/28/2022]
Abstract
Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-like information of the venous wall. Radiofrequency ablation (RFA) and laser therapy (ELT) are accepted alternatives to surgery. This study evaluated OCT for qualitative assessment of venous wall anatomy and tissue alterations after RFA and ELT in bovine venous specimens. One hundred and thirty-four venous segments were obtained from ten ex-vivo bovine hind limbs. OCT signal characteristics for different wall layers were assessed in 180/216 (83%) quadrants from 54 normal venous cross-sections. Kappa statistics (kappa) were used to calculate intra- and inter-observer agreement. Qualitative changes after RFA (VNUS-Closure) and ELT (diode laser 980 nm, energy densities 15 Joules (J)/cm, 25 J/cm, 35 J/cm) were described in 80 venous cross-sections. Normal veins were characterized by a three-layered appearance. After RFA, loss of three-layered appearance and wall thickening at OCT corresponded with circular destruction of tissue structures at histology. Wall defects after ELT ranged from non-transmural punctiform damage to complete perforation, depending on the energy density applied. Intra- and inter-observer agreement for reading OCT images was very high (0.90 and 0.88, respectively). OCT allows for reproducible evaluation of normal venous wall and alterations after endovenous therapy. OCT could prove to be valuable for optimizing endovenous therapy in vivo.
Collapse
Affiliation(s)
- Oliver A Meissner
- Institute for Clinical Radiology, Ludwig Maximilians University, Ziemssenstr. 1, 80336 Munich, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Burris N, Schwartz K, Tang CM, Jafri MS, Schmitt J, Kwon MH, Toshinaga O, Gu J, Brown J, Brown E, Pierson R, Poston R. Catheter-based infrared light scanner as a tool to assess conduit quality in coronary artery bypass surgery. J Thorac Cardiovasc Surg 2007; 133:419-27. [PMID: 17258576 DOI: 10.1016/j.jtcvs.2006.09.056] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 08/13/2006] [Accepted: 09/07/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Endothelial disruption within saphenous vein and radial artery grafts increases thrombosis risk. However, no clinically applicable method for imaging the intima currently exists. We used a novel infrared imaging technology, optical coherence tomography (OCT; LightLab Imaging, Inc, Westford, Mass), to visualize the intima within harvested conduits. METHODS Conduits were procured endoscopically (37 saphenous vein grafts and 8 radial artery grafts) or with the open technique (9 radial artery grafts) from 50 patients. Surplus segments were analyzed by means of OCT for evidence of preexisting pathology or traumatic injury. Focal plaques in radial artery grafts and the intimal hyperplasia area in saphenous vein grafts were quantified as having an intimal/medial thickness ratio of greater than 0.5. Biopsy specimens were obtained for histologic confirmation and to analyze matrix metalloproteinase 2 levels (saphenous vein grafts) and prostacyclin/nitric oxide metabolites (radial artery grafts). Interobserver kappa coefficients and a Bland-Altman analysis were used to determine the reproducibility and accuracy of OCT interpretations. RESULTS Radial artery imaging revealed plaque in 76%. Endoscopically harvested vessels showed intraluminal clot (38%) and intimal tears ranging from severe (6%) to mild (88%). In saphenous vein grafts intimal thickening was detected in 86% and intraluminal clotting in 68%. The intimal/medial thickness ratio determined by means of OCT correlated directly with matrix metalloproteinase 2 levels (R = 0.6804) in saphenous vein grafts and inversely with metabolites of prostacyclin (R = -0.55) and nitric oxide (R = -0.58) in radial artery grafts. OCT imaging was reproducible (interobserver kappa coefficients of >0.81 for the characterization of plaque types) and showed a strong correlation with histology (R = 0.8, P < .001). CONCLUSIONS OCT imaging provides an accurate, real-time, and reproducible means for assessing saphenous vein graft and radial artery graft bypass conduits. As a quality assurance tool, this technology might afford a more objective basis for conduit selection.
Collapse
Affiliation(s)
- Nicholas Burris
- Department of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, Md 21201, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|