Electrical impedance of layered atherosclerotic plaques on human aortas

Accurate Temperature Reconstruction in Radiofrequency Ablation for Atherosclerotic Plaques Based on Inverse Heat Transfer Analysis

Radio frequency ablation has emerged as a widely accepted treatment for atherosclerotic plaques. However, monitoring the temperature field distribution in the blood vessel wall during this procedure presents challenges. This limitation increases the risk of endothelial cell damage and inflammatory responses, potentially leading to lumen restenosis. The aim of this study is to accurately reconstruct the transient temperature distribution by solving a stochastic heat transfer model with uncertain parameters using an inverse heat transfer algorithm and temperature measurement data. The nonlinear least squares optimization method, Levenberg-Marquardt (LM), was employed to solve the inverse heat transfer problem for parameter estimation. Then, to improve the convergence of the algorithm and reduce the computational resources, a method of parameter sensitivity analysis was proposed to select parameters mainly affecting the temperature field. Furthermore, the robustness and accuracy of the algorithm were verified by introducing random noise to the temperature measurements. Despite the high level of temperature measurement noise (ξ = 5%) and larger initial guess deviation, the parameter estimation results remained closely aligned with the actual values, with an overall ERMS consistently below 0.05. The absolute errors between the reconstruction temperature at the measurement points TC1, TC2, and TC3, and the actual temperature, remained within 0.33 °C, 2.4 °C, and 1.17 °C, respectively. The Levenberg-Marquardt algorithm employed in this study proficiently tackled the ill-posed issue of inversion process and obtained a strong consistency between the reconstructed temperature the actual temperature.

A New Conformal Penetrating Heating Strategy for Atherosclerotic Plaque

(1) Background: A combination of radiofrequency (RF) volumetric heating and convection cooling has been proposed to realize plaque ablation while protecting the endothelial layer. However, the depth of the plaque and the thickness of the endothelial layer vary in different atherosclerotic lesions. Current techniques cannot be used to achieve penetrating heating for atherosclerosis with two targets (the specified protection depth and the ablation depth). (2) Methods: A tissue-mimicking phantom heating experiment simulating atherosclerotic plaque ablation was conducted to investigate the effects of the control parameters, the target temperature (T_target), the cooling water temperature (T_f), and the cooling water velocity (V_f). To further quantitatively analyze and evaluate the ablation depth and the protection depth of the control parameters, a three-dimensional model was established. In addition, a conformal penetrating heating strategy was proposed based on the numerical results. (3) Results: It was found that T_target and T_f were factors that regulated the ablation results, and the temperatures of the plaques varied linearly with T_target or T_f. The simulation results showed that the ablation depth increased with the T_target while the protection depth decreased correspondently. This relationship reversed with the T_f. When the two parameters T_target and T_fwere controlled together, the ablation depth was 0.47 mm-1.43 mm and the protection depth was 0 mm-0.26 mm within 2 min of heating. (4) Conclusions: With the proposed control algorithm, the requirements of both the ablation depth and the endothelium protection depth can be met for most plaques through the simultaneous control of T_target and T_f.

A coupled thermal-electrical-structural model for balloon-based thermoplasty treatment of atherosclerosis

OBJECTIVES

The outcome of balloon-based atherosclerosis thermoplasty is closely related to the temperature/stress distribution during the treatment. For precise prediction of a required thermal lesion in the heterogeneous and thin atherosclerotic vessel, a numerical model incorporating heat-induced tissue expansion or shrinkage and the strain caused by balloon dilation is necessary.

METHODS

A fully coupled thermal-electrical-structural new model was established. The model features a heterogeneous structure including eccentric plaque, healthy artery and surrounding tissue. Tissue expansion/shrinkage and hyperelasticity material model were taken into consideration. Different heating strategies and plaque mechanical properties were investigated. The temperature distribution was compared with the traditional thermal-electrical coupled model. The possibility of thermoplasty treatment using balloons with different sizes was also explored.

RESULTS

The temperature, the electrical intensity and the stress during the thermoplasty were obtained. Lower stress was found in the heating region where tissue shrinkage occurred. The ablation depth was predicted to be ∼0.42 mm larger without coupling the biomechanical influence. The mechanical properties and input condition significantly affect the temperature and stress distribution considering the small dimensions of the tissue. Besides, with a 12.5% reduction of balloon diameter, the largest Von Mises stress decreases by 25.4%.

CONCLUSIONS

It is confirmed that a coupled thermal-electrical-structural model is needed for precise temperature prediction in the balloon-based thermoplasty of the heterogeneous and thin tissue. The model presented may help with future development of optimized treatment planning considering both ablation depth and minimum stress.

Monitoring brain damage using bioimpedance technique in a 3D numerical model of the head

Disturbance in the blood supply to the brain causes a stroke or cerebrovascular accident. This can be due to ischemia caused by blockage (thrombosis, arterial embolism) or a hemorrhage. In this study, the feasibility of basic electrical impedance technique for monitoring such damage was analyzed using a computerized model. Simulations were conducted on a realistic 3D numerical model of the head. Tissues were assumed to act as linear isotropic volume conductors, and the quasi-static approximation was applied. Electrical potentials were calculated by solving Poisson's equation, using the finite volume method and the successive over relaxation method. Left-right asymmetry was calculated for several conductivities and volumes of the damaged region. The results were compared with the left-right asymmetry in a head model with normal brain. A negative asymmetry was revealed for blockage (i.e. the potential amplitude over the ischemic hemisphere was greater than that over the intact hemisphere). In case of hemorrhage, a positive asymmetry was found. Furthermore, correlation was found between the location of the damaged region and the electrodes with significant asymmetry. The 3D numerical simulations revealed that the electrical conductivity and the size of the damaged tissue have an effect on the left-right asymmetry of the surface potential.

Cellular imaging of human atherosclerotic lesions by intravascular electric impedance spectroscopy

Background

Newer techniques are required to identify atherosclerotic lesions that are prone to rupture. Electric impedance spectroscopy (EIS) is able to provide information about the cellular composition of biological tissue. The present study was performed to determine the influence of inflammatory processes in type Va (lipid core, thick fibrous cap) and Vc (abundant fibrous connective tissue while lipid is minimal or even absent) human atherosclerotic lesions on the electrical impedance of these lesions measured by EIS.

Methods and Results

EIS was performed on 1 aortic and 3 femoral human arteries at 25 spots with visually heavy plaque burden. Severely calcified lesions were excluded from analysis. A highly flexible micro-electrode mounted onto a balloon catheter was placed on marked regions to measure impedance values at 100 kHz. After paraffin embedding, visible marked cross sections (n = 21) were processed. Assessment of lesion types was performed by Movats staining. Immunostaining for CD31 (marker of neovascularisation), CD36 (scavenger cells) and MMP-3 (matrix metalloproteinase-3) was performed. The amount of positive cells was assessed semi-quantitatively. 15 type Va lesions and 6 type Vc lesions were identified. Lesions containing abundant CD36-, CD31- and MMP-3-positive staining revealed significantly higher impedance values compared to lesions with marginal or without positive staining (CD36+455±50 Ω vs. CD36- 346±53 Ω, p = 0.001; CD31+436±43 Ω vs. CD31- 340±55 Ω, p = 0.001; MMP-3+ 400±68 Ω vs. MMP-3- 323±33 Ω, p = 0.03).

Conclusions

Atherosclerotic lesions with abundant neovascularisation (CD31), many scavenger receptor class B expressing cells (CD36) or high amount of MMP-3 immunoreactivity reveal significantly higher impedance values compared to lesions with marginal or no detection of immunoreactivity. Findings suggest that inflammatory processes in vulnerable plaques affect the impedance of atherosclerotic lesions and might therefore be detected by EIS.

Bioimpedance technique for monitoring cerebral artery stenosis in a 3D numerical model of the head

Insufficient blood supply to the brain causes a transient ischemic attack (TIA) or a stroke. One of the causes to insufficient blood supply is cerebral artery stenosis. In this study, the feasibility of bioimpedance for monitoring such stenosis was analyzed. Simulations were conducted on a realistic numerical model of the head, focusing on the left middle cerebral artery (LMCA). Tissues were assumed to act as linear isotropic volume conductors, and the quasi-static approximation was applied. Electrical potentials were calculated by solving Poisson's equation, using the finite volume method (FVM) and the successive over relaxation (SOR) method. The best sensitivity found was 0.471 μV/% stenosis, using this electrode configuration: one injector near the left eye and the other injector near the right ear, one measurement position near the left eye and the other one in the right ear, keeping a distance of at least 2.5 cm between measurement and injection positions. The maximal sensitivity achieved in the numerical model under the applied assumptions supports the feasibility of bioimpedance technique for monitoring cerebral artery stenosis. However, according to sensitivity [1/m(4)] maps, calculated for the preferable electrode configurations, the measurements' specificity to the stenosis degree might be inadequate and should be further studied.

Electrochemical impedance spectroscopy to assess vascular oxidative stress

Vascular inflammatory responses are intimately linked with oxidative stress, favoring the development of pre-atherosclerotic lesions. We proposed that oxidized low density lipoprotein (oxLDL) and foam cell infiltrates in the subendothelial layer engendered distinct electrochemical properties that could be measured in terms of the electrochemical impedance spectroscopy (EIS). Concentric bipolar microelectrodes were applied to interrogate EIS of aortas isolated from fat-fed New Zealand White (NZW) rabbits and explants of human aortas. Frequency-dependent EIS measurements were assessed between 10 kHz and 100 kHz, and were significantly elevated in the pre-atherosclerotic lesions in which oxLDL and macrophage infiltrates were prevalent (At 100 kHz: aortic arch lesion=26.7±2.7 kΩ vs. control=15.8±2.4 kΩ; at 10 kHz: lesions=49.2±7.3 kΩ vs. control=27.6±2.7 kΩ, n=10, p<0.001). Similarly, EIS measurements were significantly elevated in the human descending aorta where pre-atherosclerotic lesions or fatty streaks were prominent. EIS measurements remained unchanged in spite of various depths of electrode submersion or orientation of the specimens. Hence, the concentric bipolar microelectrodes provided a reliable means to measure endoluminal electrochemical modifications in regions of pro-inflammatory with high spatial resolution and reproducibility albeit uneven lesion topography and non-uniform current distribution.

Electric impedance spectroscopy of human atherosclerotic lesions

OBJECTIVE

The aim of this in vitro study was to investigate the feasibility of a new highly flexible microelectrode on human tissue and its potential of differentiating atherosclerotic lesions by electric impedance spectroscopy (EIS).

METHODS

Electric impedance measurements (EIM) were performed on 148 spots of 7 aortic and 6 femoral human arteries at 1kHz, 10kHz and 100kHz.

RESULTS

According to the AHA classification 33 (25%) grade I lesions (PI), 34 (26%) grade II (PII), 21 (16%) grade III (PIII), 21 (16%) grade IV (PIV), 13 (10%) grade Va (PVa) and 10 (8%) grade Vb (PVb) could be identified by histology. At 1kHz, 10kHz and 100kHz the mean electric impedance (MEI) of PI, PII, PIII and PIV was statistically not different. At 100kHz the MEI of PVa showed significantly higher values compared to the MEI of PI (455+/-66Omega vs. 375+/-47Omega, p=0.05), PII (455+/-66Omega vs. 358+/-63Omega, p=0.007), PIII (455+/-66Omega vs. 342+/-52Omega, p=0.003), PIV (455+/-66Omega vs. 356+/-41Omegap=0.013) and the MEI of PVb was significantly increased compared to the MEI of PI (698+/-239Omega vs. 375+/-47Omega, p<0.001), PII (698+/-239Omega vs. 358+/-63Omegap<0.001), PIII (698+/-239Omega vs. 342+/-52Omegap<0.001), PIV (698+/-239Omega vs. 356+/-41Omegap<0.001), PVa (698+/-239Omega vs. 455+/-66Omega, p<0.001). Performing ROC analyses for the detection of grouped PVa/PVb lesions, the largest AUC was found at 100kHz with a cut-off value of 441Omega presenting a sensitivity of 74% and a specificity of 94%.

CONCLUSIONS

EIM could be performed on human aortic and femoral tissue. The results show that EIS has the potential to distinguish between different plaque types.

Influence of electrode position on the characterization of artery stenotic plaques by using impedance catheter

Use of balloon impedance catheters (BIC) for the characterization of plaques in vessels can support an optimal medical treatment of plaques. The sensitivity of impedance diagnoses with BIC is related with the distribution of electric fields determined by the electrode configuration. Using the three-dimensional finite element method (FEM) simulation, it was estimated how the relative positions of electrode array to the lipid in the vessel affect on the total impedance magnitude. Further, the short-circuiting effect was investigated with respect to the separation distance on the angular axis between the electrode arrays of angular set. By aid of FEM simulations, it is possible to design the sets of multielectrode arrays which have an optimized resolution for individual vessels.

Intravascular electric impedance spectroscopy of atherosclerotic lesions using a new impedance catheter system

Newer techniques are required to identify atherosclerotic lesions that are prone to rupture. Electric impedance spectroscopy (EIS) can characterize biological tissues by measuring the electrical impedance over a frequency range. We tested a newly designed intravascular impedance catheter (IC) by measuring the impedance of different stages of atherosclerosis induced in an animal rabbit model. Six female New Zealand White rabbits were fed for 17 weeks with a 5% cholesterol-enriched diet to induce early forms of atherosclerotic plaques. All aortas were prepared from the aortic arch to the renal arteries and segments of 5-10 mm were marked by ink spots. A balloon catheter system with an integrated polyimide-based microelectrode structure was introduced into the aorta and the impedance was measured at each spot by using an impedance analyzer. The impedance was measured at frequencies of 1 kHz and 10 kHz and compared with the corresponding histomorphometric data of each aortic segment.Forty-four aortic segments without plaques and 48 segments with evolving atherosclerotic lesions could be exactly matched by the histomorphometric analysis. In normal aortic segments (P0) the change of the magnitude of impedance at 1 kHz and at 10 kHz (|Z|(1 kHz) - |Z|(10 kHz), = ICF) was 208.5 +/- 357.6 Omega. In the area of aortic segments with a plaque smaller than that of the aortic wall diameter (PI), the ICF was 137.7 +/- 192.8 Omega. (P 0 vs. P I; p = 0.52), whereas in aortic segments with plaque formations larger than the aortic wall (PII) the ICF was significantly lower -22.2 +/- 259.9 Omega. (P0 vs. PII; p = 0.002). Intravascular EIS could be successfully performed by using a newly designed microelectrode integrated onto a conventional coronary balloon catheter. In this experimental animal model atherosclerotic aortic lesions showed significantly higher ICF in comparison to the normal aortic tissue.

Design of electrode array for impedance measurement of lesions in arteries

Use of impedance catheters can provide additional information about the composition and the morphology of early plaques in arteries. However, for a correct interpretation of the impedance data recorded inside a vessel, the extra-vessel conditions should not influence the measurement results. In this paper, we estimate the influence of the extra-vessel conditions on the impedance measurement of a vessel wall by using FEM simulation and a two-layer model. Therefore sensitivity fields are simulated. The simulations are validated by experiments and compared to analytical solutions. Further, the influence of the inner radius of a vessel on the measurement result is determined by FEM simulations. From experiments based on the two-layer model, it is found that the apparent resistance depends on the thickness of the first layer and the separation distance of the electrode structure. The measured result corresponds to the results of the FEM simulations, whereas the analytical solution assuming point electrodes is different from the measurement and simulation results. Under the assumption of homogenous and linear volume conductors, the FEM simulated distributions of sensitivity fields are determined. The inner diameter of the artery has no influence on the measurement results. The FEM simulation can support the design of electrode configuration and geometries for impedance catheters.

In vivo intravascular electric impedance spectroscopy using a new catheter with integrated microelectrodes

Interventional techniques are necessary, which allow the characterization of intravascular pathological processes. Electric impedance spectroscopy (EIS) can provide cellular information of biological tissue. We tested the feasibility of intravascular EIS by using a new impedance catheter system with integrated microelectrodes in an experimental animal model. Eighteen stents were implanted into the iliac arteries of female New Zealand White rabbits (n = 11) to induce intimal proliferation. After 14, 28 and 56 days the electric impedance was measured inside and outside of the stented arterial segments by using a balloon catheter with four integrated microelectrodes. The impedance was recorded at a frequency ranging from 1 Hz to 1 MHz. After the measurements, the stents were explanted and histomorphometry was performed. The impedance inside and outside the stent was analysed and compared with the histomorphometric data. Fourteen (n = 6), 28 (n = 5) and 56 (n = 6) days after stent implantation the difference of the electrical impedance between the native and the stented iliac artery segment increased from -924 +/- 715 Ohm to 3689 +/- 1385 Ohm (14 days vs. 28 days; p < 0.05) and 8637 +/- 2881 Ohm (14 days vs. 56 days; p < 0.05), respectively. The increase of the electrical impedance corresponded to an increased neointimal proliferation in the stented arterial segment of 3.6% +/-0.7% after 14 days, 8.4% +/- 4.8% after 28 days (14 days vs. 28 days; p < 0.05) and 10.0% +/- 4.1% after 56 days (14 days vs. 56 days; p < 0.01). Intravascular EIS can be performed by a balloon catheter with integrated microelectrodes and allows the detection of neointimal proliferation after stent implantation.

Four-point electrode measurement of impedance in the vicinity of bovine aorta for quasi-static frequencies

Results are presented here of experimental measurements using a four-point electrode technique to measure the complex impedance of bovine aorta submerged in Ringer's solution. Impedance measurements were taken at 250 microm intervals, ranging from 0 (the electrode directly on the surface of the tissue) to 10 mm. Frequencies ranged from 1 kHz to 10 MHz. Throughout this range, the measured impedance changed by an average of 400% when the electrode was 10 mm from the tissue as compared to when the electrode was in direct contact with the tissue. The change in impedance made it possible to determine when the electrode made contact with the arterial wall.

Simulated characterization of atherosclerotic lesions in the coronary arteries by measurement of bioimpedance

FEM software was used to determine the feasibility of characterizing various types of atherosclerotic lesions in vivo. This was accomplished by simulating two electrodes as being attached to an angioplasty balloon in the coronary artery. The electrodes on the "balloon" touched and measured the simulated complex impedance of type III, IV, and Va and Vb lesions, as defined by the American Heart Association (AHA). Additionally, the effect of changes in morphology on the complex impedance was determined for type Va and Vb lesions. The simulations showed that the layer closest to the electrodes had the most significant effect on the measured complex impedance. As a consequence of these simulations, it appears plausible that electrodes could be placed in vivo to determine the characteristics and type of a given atherosclerotic lesion.

Development of an intravascular impedance catheter for detection of fatty lesions in arteries

Recent studies show that the presence of fatty lesions in the atherosclerotic vessel wall is a risk factor for acute occlusion of blood vessels. Although fat has a high electrical resistivity, existing impedance catheter systems cannot be used for detection of these lesions because artifacts owing to impedance variations in the extravascular surroundings have a major and irretraceable effect on the measurement. Standard algorithms used in attempt to compensate for these artifacts suffer from severe instability problems. We defined design guidelines to be met by a new impedance catheter system in order to make a robust reconstruction algorithm possible and have built an experimental in travascular impedance catheter (IIC) system according to these guidelines, using a normalized differential measurement procedure. With this IIC, we performed experiments on human iliac arteries from the section ward (fixed specimens), showing that plastic models of arterial fatty lesions (8 mm3) can be detected reliably.

Magnetic backprojection imaging of the vascular lumen

Current injected into a phantom model generated a magnetic field which was distorted above a simulated atherosclerotic lesion. The output of a Hall effect magnetic sensor was used in a backprojection to reconstruct the centroid of the simulated blood flow and thus localize the modeled atherosclerotic plaque region.