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Mozaffari MH, Lee WS. Freehand 3-D Ultrasound Imaging: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2099-2124. [PMID: 28716431 DOI: 10.1016/j.ultrasmedbio.2017.06.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 05/20/2023]
Abstract
Two-dimensional ultrasound (US) imaging has been successfully used in clinical applications as a low-cost, portable and non-invasive image modality for more than three decades. Recent advances in computer science and technology illustrate the promise of the 3-D US modality as a medical imaging technique that is comparable to other prevalent modalities and that overcomes certain drawbacks of 2-D US. This systematic review covers freehand 3-D US imaging between 1970 and 2017, highlighting the current trends in research fields, the research methods, the main limitations, the leading researchers, standard assessment criteria and clinical applications. Freehand 3-D US systems are more prevalent in the academic environment, whereas in clinical applications and industrial research, most studies have focused on 3-D US transducers and improvement of hardware performance. This topic is still an interesting active area for researchers, and there remain many unsolved problems to be addressed.
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Affiliation(s)
- Mohammad Hamed Mozaffari
- School of Electrical Engineering and Computer Science (EECS), University of Ottawa, Ottawa, Ontario, Canada.
| | - Won-Sook Lee
- School of Electrical Engineering and Computer Science (EECS), University of Ottawa, Ottawa, Ontario, Canada
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Dixon AJ, Kilroy JP, Dhanaliwala AH, Chen JL, Phillips LC, Ragosta M, Klibanov AL, Wamhoff BR, Hossack JA. Microbubble-mediated intravascular ultrasound imaging and drug delivery. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2015; 62:1674-1685. [PMID: 26415129 DOI: 10.1109/tuffc.2015.007143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intravascular ultrasound (IVUS) provides radiation-free, real-time imaging and assessment of atherosclerotic disease in terms of anatomical, functional, and molecular composition. The primary clinical applications of IVUS imaging include assessment of luminal plaque volume and real-time image guidance for stent placement. When paired with microbubble contrast agents, IVUS technology may be extended to provide nonlinear imaging, molecular imaging, and therapeutic delivery modes. In this review, we discuss the development of emerging imaging and therapeutic applications that are enabled by the combination of IVUS imaging technology and microbubble contrast agents.
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Modelling of image-catheter motion for 3-D IVUS. Med Image Anal 2008; 13:91-104. [PMID: 18675579 DOI: 10.1016/j.media.2008.06.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 06/13/2008] [Accepted: 06/19/2008] [Indexed: 11/23/2022]
Abstract
Three-dimensional intravascular ultrasound (IVUS) allows to visualize and obtain volumetric measurements of coronary lesions through an exploration of the cross sections and longitudinal views of arteries. However, the visualization and subsequent morpho-geometric measurements in IVUS longitudinal cuts are subject to distortion caused by periodic image/vessel motion around the IVUS catheter. Usually, to overcome the image motion artifact ECG-gating and image-gated approaches are proposed, leading to slowing the pullback acquisition or disregarding part of IVUS data. In this paper, we argue that the image motion is due to 3-D vessel geometry as well as cardiac dynamics, and propose a dynamic model based on the tracking of an elliptical vessel approximation to recover the rigid transformation and align IVUS images without loosing any IVUS data. We report an extensive validation with synthetic simulated data and in vivo IVUS sequences of 30 patients achieving an average reduction of the image artifact of 97% in synthetic data and 79% in real-data. Our study shows that IVUS alignment improves longitudinal analysis of the IVUS data and is a necessary step towards accurate reconstruction and volumetric measurements of 3-D IVUS.
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Barajas J, Caballero KL, Rodriguez O, Radeva P. Cardiac phase extraction in IVUS sequences using 1-D Gabor filters. ACTA ACUST UNITED AC 2008; 2007:343-6. [PMID: 18001960 DOI: 10.1109/iembs.2007.4352294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A main issue in the automatic analysis of Intravascular Ultrasound (IVUS) images is the presence of periodic changes provoked by heart motion during the cardiac cycle. Although the Electrocardiogram (ECG) signal can be used to gate the sequence, few IVUS systems incorporate the ECG-gating option, and the synchronization between them implies several issues. In this paper, we present a fast and robust method to assign a phase in the cardiac cycle to each image in the sequence directly from in vivo clinical IVUS sequences. It is based on the assumption that the vessel wall is significantly brighter than the blood in each IVUS beam. To guarantee stability in this assumption, we use normalized reconstructed images. Then, the wall boundary is extracted for all the radial beams in the sequence and a matrix with these positions is formed. This matrix is filtered using a bank of 1-D Gabor filters centered at the predominant frequency of a given number of windows in the sequence. After filtering, we combine the responses to obtain a unique phase within the cardiac cycle for each image. For this study, we gate the sequence to make the sequence comparable with other ones of the same patient. The method is tested with 12 pullbacks of real patients and 15 synthetic tests.
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Affiliation(s)
- Joel Barajas
- Computer Vision Center, Autonomous University of Barcelona, Edificio O, Campus UAB, 08193 Bellaterra, Spain.
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6
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Light ED, Smith SW. Two dimensional arrays for real time 3D intravascular ultrasound. ULTRASONIC IMAGING 2004; 26:115-128. [PMID: 15344415 DOI: 10.1177/016173460402600204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We have previously described 2D arrays operating at up to 10.0 MHz consisting of several thousand elements for transthoracic cardiac imaging and over a hundred elements for intracardiac imaging using 7 Fr to 12 Fr catheters. We have begun to explore forward viewing real time 3D phased array intravascular ultrasound, which may require imaging depths of a few centimeters to look down the axis of a vessel to view vulnerable atherosclerotic plaque. We used a noncoaxial based cable technology that allowed 100 signal wires to be placed inside a4.8 French IVUS lumen with an inner diameter of 1.3 mm. We pursued two different fabrication technologies for the building of the transducers. Each transducer was constructed in the forward viewing configuration to allow simultaneous real time B-scans, C-scans and volumetric rendering of vessels and vascular stents distal to the catheter tip. In order to obtain the desired penetration depth, each transducer was constructed to operate at 10.0 MHz. The first method included an ordered array of 11 x 11 = 121 elements. In order to conform to the round aperture of the IVUS lumen, the comers were cut off, resulting in a total of 97 signal channels. Real time images include a 4 mm diameter vessel in a tissue mimicking phantom, an expanded stent and a stent in an excised sheep aorta. The second method is based upon a laser dicing technique that cuts the individual elements in a random pattern. This resulted in 61 signal channels. Real time 3D images of the AIUM test object were made with this transducer.
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Affiliation(s)
- Edward D Light
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
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Klingensmith JD, Schoenhagen P, Tajaddini A, Halliburton SS, Tuzcu EM, Nissen SE, Vince DG. Automated three-dimensional assessment of coronary artery anatomy with intravascular ultrasound scanning. Am Heart J 2003; 145:795-805. [PMID: 12766735 DOI: 10.1016/s0002-8703(03)00089-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Angiography allows the definition of advanced, severe stages of coronary artery disease, but early atherosclerotic lesions, which do not lead to luminal stenosis, are not identified reliably. In contrast, intravascular ultrasound scanning allows the precise characterization and quantification of a wide range of atherosclerotic lesions, independent of the severity of luminal stenosis. METHODS Three-dimensional (3-D) reconstruction of entire coronary segments is possible with the integration of sequential 2-dimensional tomographic images and allows volumetric analysis of coronary arteries. RESULTS Automated systems able to recognize lumen and vessel borders and to display 3-D images are becoming available. CONCLUSION These systems have the potential for on-line 3-D image reconstruction for clinical decision-making and fast routine volumetric analysis in research studies. This review describes 3-D intravascular ultrasound scanning acquisition, analysis, and processing, and the associated technical challenges.
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Affiliation(s)
- Jon D Klingensmith
- Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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De Franco AC, Nissen SE. Coronary intravascular ultrasound: implications for understanding the development and potential regression of atherosclerosis. Am J Cardiol 2001; 88:7M-20M. [PMID: 11705417 DOI: 10.1016/s0002-9149(01)02109-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The incremental value of intravascular ultrasound (IVUS), compared with angiographic analysis of coronary atherosclerosis, originates principally from 2 key features-its tomographic perspective and the ability to image coronary atheroma directly. Whereas angiography depicts the cross-sectional coronary anatomy as a planar silhouette of the lumen, ultrasound directly images the atheroma within the vessel wall, allowing measurement of atheroma size, distribution, and to some extent, composition. Although angiography remains the principal method to assess the extent of coronary atherosclerosis and to guide percutaneous coronary interventions, IVUS is rapidly altering conventional paradigms in the diagnosis and therapy of coronary artery disease. Thus, IVUS has become a vital adjunctive imaging modality for the aggressive coronary interventional cardiologist. As such, ultrasound has earned a role as a viable complementary technique relative to angiography, rather than an alternative to conventional angiographic methods. This article reviews the rationale, technical advantages and limitations, and interpretation of intravascular ultrasonography from the perspective of the general and invasive cardiologist. We emphasize the impact that IVUS studies have had on our understanding of the atherosclerotic coronary artery disease process, because these findings have important implications for all cardiologists. We then review several trials that are currently using intravascular ultrasonography for the study of coronary artery disease regression.
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Affiliation(s)
- A C De Franco
- McLaren Heart and Vascular Center and Cardiac Catheterization Laboratory, McLaren Regional Medical Center, Michigan State University, Flint, Michigan, USA
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al-Khalili F, Svane B, Di Mario C, Prati F, Mallus MT, Rydén L, Schenck-Gustafsson K. Intracoronary ultrasound measurements in women with myocardial infarction without significant coronary lesions. Coron Artery Dis 2000; 11:579-84. [PMID: 11107504 DOI: 10.1097/00019501-200012000-00002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
METHODS Morphologic characteristics of coronary arteries in eight women with myocardial infarction and angiographically normal or not significantly stenosed vessels were investigated with intracoronary ultrasound. The infarct-related vessel was assessed by three-dimensional volumetric analysis and compared with a control vessel from a noninfarcted area. RESULTS Atherosclerosis was found in all infarct-related arteries. The plaques were predominantly soft, eccentric, poorly calcified, and with little lipid pools or none at all. Although the average area and thickness of plaques and cross-sectional narrowing of the infarct-related arteries were greater than those of control arteries, there were no pathognomonic characteristics of plaques in the infarct-related vessels. CONCLUSION The possibility that atherosclerosis is the main etiologic factor for myocardial infarction can not be excluded even for women without an angiographically obvious coronary stenosis in the infarct-related vessels.
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Affiliation(s)
- F al-Khalili
- Department of Cardiology, Karolinska Hospital, Stockholm, Sweden.
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10
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Gatzoulis L, Anderson T, Pye SD, O'Donnell R, McLean CC, McDicken WN. Scanning techniques for three-dimensional forward-viewing intravascular ultrasound imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2000; 26:1461-1474. [PMID: 11179621 DOI: 10.1016/s0301-5629(00)00306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Intravascular ultrasound (US) imaging is a useful tool for assessing arterial disease and aiding treatment procedures. Forward-viewing intravascular US imaging could be of particular use in severely stenosed or totally occluded arteries, where the current side-viewing intravascular US systems are limited by their inability to access the site of interest. In this study, five 3-D forward-viewing intravascular scanning patterns were investigated. The work was carried out using scaled-up vessel phantoms constructed from tissue-mimicking material and a PC-controlled scanning and acquisition system. The scanning patterns were examined and evaluated with regard to the image quality of dense and sparse data sets, the accuracy of quantitative measurements of lumen dimensions and the potential for clinical use. The relative merits and drawbacks of the different patterns are discussed and a preferred scanning pattern is recommended.
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Affiliation(s)
- L Gatzoulis
- Department of Medical Physics and Medical Engineering, University of Edinburgh, Edinburgh, UK
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Cothren RM, Shekhar R, Tuzcu EM, Nissen SE, Cornhill JF, Vince DG. Three-dimensional reconstruction of the coronary artery wall by image fusion of intravascular ultrasound and bi-plane angiography. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 2000; 16:69-85. [PMID: 10928342 DOI: 10.1023/a:1006304419505] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) is becoming increasingly accepted for assessing coronary anatomy. However, its utility in visualizing and quantifying coronary morphology has been limited by its 2D tomographic nature. This study presents a 3D reconstruction technique that accurately preserves 3D geometric information. METHODS AND RESULTS Images obtained from manual IVUS pullbacks and continuous bi-plane angiography were fused, using angiography to reconstruct the transducer trajectory and aid in solving for the correct rotational orientation. A novel 3D active surface method automatically identified the luminal and medial-adventitial borders which, when superimposed on the transducer trajectory, could be surface-rendered for visualization and morphometry. Segmentation agreed well with manual assessment, and 3D luminal shape matched that of angiography when projected to 2D. CONCLUSIONS We conclude that this method provides an accurate reconstruction of the vessel's anatomy, which accounts for the true curvature of the vessel.
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Affiliation(s)
- R M Cothren
- Department of Biomedical Engineering, The Cleveland Clinic Foundation, Ohio 44195, USA
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12
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Di Mario C. Sharp minds and blurred images. Catheter Cardiovasc Interv 1999; 48:251-2. [PMID: 10525221 DOI: 10.1002/(sici)1522-726x(199911)48:3<251::aid-ccd2>3.0.co;2-h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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13
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Ziada KM, Kapadia SR, Tuzcu EM, Nissen SE. The current status of intravascular ultrasound imaging. Curr Probl Cardiol 1999; 24:541-66. [PMID: 10480047 DOI: 10.1016/s0146-2806(99)90016-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- K M Ziada
- Cleveland Clinic Foundation, Intravascular Ultrasound Laboratory, Ohio, USA
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Eccleshall SC, Jordan PJ, Buller NP, Townend JN. In vitro validation of the luminal measurement of a novel catheter based moulding technique. Heart 1999; 81:206-11. [PMID: 9922361 PMCID: PMC1728921 DOI: 10.1136/hrt.81.2.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate a modified angioplasty balloon catheter, which uses a novel balloon polymer to produce luminal moulds. DESIGN The catheter was tested in polyurethane phantoms of diameter 1.5 to 4.0 mm. Inflations were to 1.4 atmospheres for 20 seconds at 37 degrees C. The moulds were viewed by reinflating the balloon to 0. 34 atmospheres and quantified using macrophotography and caliper measurement. RESULTS Evidence of systematic error was found with lumen diameters </= 2.0 mm, accuracy being 0.32 to 0.80 mm and precision 0.23 to 0.24 mm. However, between 2.5 and 4.0 mm the accuracy of measuring luminal diameters was 0.01 mm, the precision 0. 06 mm, and the absolute mean error 0.05 mm. The results for percentage diameter stenosis were -1.15%, 0.86%, and 1.21%, and for lesion length they were 0.20, 0.60, and 0.41 mm, respectively. CONCLUSIONS The prototype catheter shows a high degree of accuracy and precision in phantoms of diameter 2.5 to 4.0 mm-the range within which most interventional work is performed. Further work on this technique as a method of direct three dimensional moulding of the coronary artery lumen is warranted.
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Affiliation(s)
- S C Eccleshall
- Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham B15, UK
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Hoskins PR, Fish PJ, McDicken WN, Moran C. Developments in cardiovascular ultrasound. Part 2: Arterial applications. Med Biol Eng Comput 1998; 36:259-69. [PMID: 9747563 DOI: 10.1007/bf02522469] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many of the changes resulting from arterial disease can be measured, using Doppler ultrasound for measurement of blood velocity and B-scan imaging for measurement of tissue structure and composition. Wall thickness, the degree of arterial narrowing and plaque volume can be measured using B-scan imaging, and 3D ultrasound can be used to improve the accuracy of measurements of plaque volume and for improved visualisation of complex arterial geometries. Measurement of the dynamic properties of the arterial wall permits estimation of wall elasticity and plaque motion. From the Doppler signal, measurements of blood velocity are used to estimate the degree of arterial narrowing and volumetric flow, although measurement errors can be large. Wall shear stress can be estimated by measuring the velocity gradient at the vessel wall. The problems of inadequate spatial resolution and interference from overlying tissue are largely removed when intravascular systems are used, and these have superior capability in the assessment of arterial structure and tissue composition. However, measurement of quantities relating to blood flow is more difficult using the intravascular approach, as the indwelling cather disturbs the blood flow pattern, and currently, assessment of flow and vessel cross-section are not performed at the same site.
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Affiliation(s)
- P R Hoskins
- Department of Medical Physics & Medical Engineering, Royal Infirmary, Edinburgh, UK.
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Vrints CJ, Bosmans J, Claeys MJ, Snoeck JP. User-friendly and low-cost computer system for immediate review, analysis, and reconstruction of intracoronary ultrasound images. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 43:357-62. [PMID: 9535382 DOI: 10.1002/(sici)1097-0304(199803)43:3<357::aid-ccd26>3.0.co;2-h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Rapid review, digital recording, on-line quantification, and three-dimensional reconstruction are all essential in the evaluation of intracoronary ultrasound images during coronary interventions. We describe a low-cost method that offers all these necessary features. The proposed method uses the QuickTime compatible video digitizers of standard multimedia Apple Macintosh or PowerPC desktop computers and the freeware software Object Image 1.60.
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Affiliation(s)
- C J Vrints
- Department of Cardiology, University Hospital of Antwerp, Belgium.
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di Mario C, Reimers B, Almagor Y, Moussa I, Di Francesco L, Ferraro M, Leon MB, Richter K, Colombo A. Procedural and follow up results with a new balloon expandable stent in unselected lesions. HEART (BRITISH CARDIAC SOCIETY) 1998; 79:234-41. [PMID: 9602655 PMCID: PMC1728636 DOI: 10.1136/hrt.79.3.234] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the clinical and angiographic results of the first clinical application of a new balloon expandable stent, the NIR stent, characterised by high longitudinal flexibility and low profile before expansion, and by high radial support and minimal recoil and shortening after expansion. DESIGN Single centre survey of unselected lesions in consecutive patients. SETTING Tertiary referral centre. PATIENTS AND LESIONS: 93 stents of various length (9, 16, and 32 mm) were implanted in 64 lesions in 41 patients. Twenty lesions (31%) were longer than 15 mm, and 17 lesions (27%) were located in vessels with a diameter smaller than 2.5 mm. Extreme tortuosity of the proximal vessel was present in 15 lesions (23%). All patients were treated with aspirin and ticlopidine. All lesions were evaluated before and after treatment by quantitative angiography, and in 47 lesions (75%) the stent expansion was also controlled by intracoronary ultrasound. Clinical follow up was available in all patients and angiographic follow up was performed in 53 lesions (84%), at a mean (SD) interval of 5.4 (1.7) months. RESULTS Deployment of the stent failed in two lesions (3%). Minimum lumen diameter increased from 1.01 (0.54) mm to 2.94 (0.49) mm, and diameter stenosis decreased from 66(15)% to 7(11)%. There was one in-hospital non-Q wave myocardial infarction, one sudden death after 40 days, and 17 target lesion revascularisations (27%). Angiographic restenosis (> or = 50% diameter stenosis) was documented in 19 lesions (36% of all lesions with angiographic follow up), with an average residual diameter stenosis of 43(21)% and minimum lumen diameter of 1.63 (0.74) mm. Restenosis was more common in vessels with a reference diameter < 2.5 mm (45%) and for lesions longer than 15 mm (46%). CONCLUSIONS The NIR stent could be used successfully in most lesions, achieving optimal angiographic results with very few in-hospital or subacute cardiac events. The angiographic restenosis rate and need for target lesion revascularisation remained high in this unfavourable lesion subset, especially in small vessels and long lesions.
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von Birgelen C, Mintz GS, de Vrey EA, Kimura T, Popma JJ, Airiian SG, Leon MB, Nobuyoshi M, Serruys PW, de Feyter PJ. Atherosclerotic coronary lesions with inadequate compensatory enlargement have smaller plaque and vessel volumes: observations with three dimensional intravascular ultrasound in vivo. Heart 1998; 79:137-42. [PMID: 9538305 PMCID: PMC1728616 DOI: 10.1136/hrt.79.2.137] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To compare vessel, lumen, and plaque volumes in atherosclerotic coronary lesions with inadequate compensatory enlargement versus lesions with adequate compensatory enlargement. DESIGN 35 angiographically significant coronary lesions were examined by intravascular ultrasound (IVUS) during motorised transducer pullback. Segments 20 mm in length were analysed using a validated automated three dimensional analysis system. IVUS was used to classify lesions as having inadequate (group I) or adequate (group II) compensatory enlargement. RESULTS There was no significant difference in quantitative angiographic measurements and the IVUS minimum lumen cross sectional area between groups I (n = 15) and II (n = 20). In group I, the vessel cross sectional area was 13.3 (3.0) mm2 at the lesion site and 14.4 (3.6) mm2 at the distal reference (p < 0.01), whereas in group II it was 17.5 (5.6) mm2 at the lesion site and 14.0 (6.0) mm2 at the distal reference (p < 0.001). Vessel and plaque cross sectional areas were significantly smaller in group I than in group II (13.3 (3.0) v 17.5 (5.6) mm2, p < 0.01; and 10.9 (2.8) v 15.2 (4.9) mm2; p < 0.005). Similarly, vessel and plaque volume were smaller in group I (291.0 (61.0) v 353.7 (110.0) mm3, and 177.5 (48.4) v 228.0 (92.8) mm3, p < 0.05 for both). Lumen areas and volumes were similar. CONCLUSIONS In lesions with inadequate compensatory enlargement, both vessel and plaque volume appear to be smaller than in lesions with adequate compensatory enlargement.
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Affiliation(s)
- C von Birgelen
- Thoraxcenter, University Hospital Rotterdam-Dijkzigt, Netherlands
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19
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von Birgelen C, de Vrey EA, Mintz GS, Nicosia A, Bruining N, Li W, Slager CJ, Roelandt JR, Serruys PW, de Feyter PJ. ECG-gated three-dimensional intravascular ultrasound: feasibility and reproducibility of the automated analysis of coronary lumen and atherosclerotic plaque dimensions in humans. Circulation 1997; 96:2944-52. [PMID: 9386161 DOI: 10.1161/01.cir.96.9.2944] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Automated systems for the quantitative analysis of three-dimensional (3D) sets of intravascular ultrasound (IVUS) images have been developed to reduce the time required to perform volumetric analyses; however, 3D image reconstruction by these nongated systems is frequently hampered by cyclic artifacts. METHODS AND RESULTS We used an ECG-gated 3D IVUS image acquisition workstation and a dedicated pullback device in atherosclerotic coronary segments of 30 patients to evaluate (1) the feasibility of this approach of image acquisition, (2) the reproducibility of an automated contour detection algorithm in measuring lumen, external elastic membrane, and plaque+media cross-sectional areas (CSAs) and volumes and the cross-sectional and volumetric plaque+media burden, and (3) the agreement between the automated area measurements and the results of manual tracing. The gated image acquisition took 3.9+/-1.5 minutes. The length of the segments analyzed was 9.6 to 40.0 mm, with 2.3+/-1.5 side branches per segment. The minimum lumen CSA measured 6.4+/-1.7 mm2, and the maximum and average CSA plaque+media burden measured 60.5+/-10.2% and 46.5+/-9.9%, respectively. The automated contour-detection required 34.3+/-7.3 minutes per segment. The differences between these measurements and manual tracing did not exceed 1.6% (SD<6.8%). Intraobserver and interobserver differences in area measurements (n=3421; r=.97 to.99) were <1.6% (SD<7.2%); intraobserver and interobserver differences in volumetric measurements (n=30; r=.99) were <0.4% (SD<3.2%). CONCLUSIONS ECG-gated acquisition of 3D IVUS image sets is feasible and permits the application of automated contour detection to provide reproducible measurements of the lumen and atherosclerotic plaque CSA and volume in a relatively short analysis time.
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Affiliation(s)
- C von Birgelen
- Thoraxcenter, Division of Cardiology, University Hospital Rotterdam-Dijkzigt and Erasmus University, The Netherlands
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Stone GW, Hodgson JM, St Goar FG, Frey A, Mudra H, Sheehan H, Linnemeier TJ. Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing: the CLOUT Pilot Trial. Clinical Outcomes With Ultrasound Trial (CLOUT) Investigators. Circulation 1997; 95:2044-52. [PMID: 9133514 DOI: 10.1161/01.cir.95.8.2044] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Indiscriminate use of balloons larger than the angiographic reference segment lumen results in high rates of ischemic complications after percutaneous transluminal coronary angioplasty (PTCA). We hypothesized that angiographically unsuspected atheromatous remodeling with vessel expansion (the Glagov phenomenon) at and adjacent to PTCA target lesions would safely accommodate oversized balloons in selected patients undergoing PTCA with intravascular ultrasound (IVUS) guidance. METHODS AND RESULTS After angiographically guided PTCA of 104 lesions in 102 patients, IVUS was performed, and if atheromatous remodeling was present, PTCA was repeated with larger balloons sized halfway between the lumen and external elastic membrane. Plaque occupied a mean of 51+/-15% of the angiographically "normal" reference segments. Further balloon upsizing by 0.25 to 1.25 mm was therefore performed in 76 lesions (73%), increasing the nominal balloon-to-artery ratio from 1.12+/-0.15 after standard PTCA to 1.30+/-0.17 after IVUS-guided PTCA (P<.0001). As a result, the angiographic minimal luminal diameter further increased from 1.95+/-0.49 to 2.21+/-0.47 mm, the % diameter stenosis fell from 28+/-15% to 18+/-14%, and the IVUS lumen area rose from 3.16+/-1.04 to 4.52+/-1.14 mm2 (all P<.0001). The incidence of angiographic dissection was not increased after IVUS-guided balloon upsizing (37% versus 40%, P=.67), and major complications occurred in only 2 patients (1.9%). CONCLUSIONS The demonstration by IVUS of atheromatous remodeling permits the safe use of balloons traditionally considered oversized, resulting in significantly improved luminal dimensions without increased rates of dissection or ischemic complications.
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Affiliation(s)
- G W Stone
- Cardiovascular Institute, El Camino Hospital, Mountain View, CA 94040, USA
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21
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von Birgelen C, Di Mario C, Serruys PW. Structural and functional characterization of an intermediate stenosis with intracoronary ultrasound and Doppler: a case of "reverse Glagovian modeling". Am Heart J 1996; 132:694-6. [PMID: 8800046 DOI: 10.1016/s0002-8703(96)90259-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C von Birgelen
- Thoraxcenter, Cardiac Catheterization Laboratory, Erasmua University Rotterdam, The Netherlands
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22
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von Birgelen C, Kutryk MJ, Gil R, Ozaki Y, Di Mario C, Roelandt JR, de Feyter PJ, Serruys PW. Quantification of the minimal luminal cross-sectional area after coronary stenting by two- and three-dimensional intravascular ultrasound versus edge detection and videodensitometry. Am J Cardiol 1996; 78:520-5. [PMID: 8806335 DOI: 10.1016/s0002-9149(96)00356-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The use of 2-dimensional intravascular ultrasound (2-D IVUS) to improve the outcome of coronary stenting has gained clinical acceptance, and recently 3-D IVUS has been introduced to clinical practice. However, there have been no comprehensive studies comparing the measurements of the coronary dimensions after stenting obtained by the different approaches of IVUS and quantitative coronary angiography. We examined the minimal luminal cross-sectional area of 38 stents using 2-D IVUS, 3-D IVUS, and 2 standard methods of quantitative coronary angiography, edge detection (ED) and videodensitometry (VD). Correlations between 2-D IVUS and ED (r = 0.72; p < 0.0001), VD (r = 0.87; p < 0.0001), and 3-D IVUS (r = 0.81; p < 0.0001) were higher than the correlations seen between 3-D IVUS and ED (r = 0.58; p < 0.0005) and VD (r = 0.70; p < 0.0001). The measurements by 2-D and 3-D IVUS (8.32 +/- 2.50 mm2 and 8.05 +/- 2.66 mm2) were larger than the values obtained by the quantitative angiographic techniques ED and VD (7.55 +/- 2.22 mm2 and 7.27 +/- 2.21 mm2). Thus, concordance was seen among all of the 4 techniques, confirming the validity of using IVUS for determination of the minimal luminal cross-sectional area after coronary stenting. A particularly good correlation was found between VD and IVUS, perhaps because measurement of the luminal area is the basic quantification approach of both techniques, whereas the lower correlations of ED with IVUS and VD may be explained by the dependence of ED on the angiographic projections used, which is especially important in eccentric stent configurations.
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Affiliation(s)
- C von Birgelen
- Thoraxcenter, University Hospital Rotterdam-Dijkzigt, Erasmus University Rotterdam, The Netherlands
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23
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von Birgelen C, Di Mario C, Li W, Schuurbiers JC, Slager CJ, de Feyter PJ, Roelandt JR, Serruys PW. Morphometric analysis in three-dimensional intracoronary ultrasound: an in vitro and in vivo study performed with a novel system for the contour detection of lumen and plaque. Am Heart J 1996; 132:516-27. [PMID: 8800020 DOI: 10.1016/s0002-8703(96)90233-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Currently, automated systems for quantitative analysis by intracoronary ultrasound (ICUS) are restricted to the detection of the lumen. The aim of this study was to determine the accuracy and reproducibility of a new semiautomated contour detection method, providing off-line identification of the intimal leading edge and external contour of the vessel in three-dimensional ICUS. The system allows cross-sectional and volumetric quantification of lumen and of plaque. It applies a minimum-cost algorithm and the concept that edge points derived from previously detected longitudinal contours guide and facilitate the contour detection in the cross-sectional images. A tubular phantom with segments of various luminal dimensions was examined in vitro during five catheter pull-backs (1 mm/sec), and subsequently 20 diseased human coronary arteries were studied in vivo with 2.9F 30 MHz mechanical ultrasound catheters (200 images per 20 mm segment). The ICUS measurements of phantom lumen area and volume revealed a high correlation with the true phantom areas and volumes (r = 0.99); relative mean differences were -0.65% to 3.86% for the areas and 0.25% to 1.72% for the volumes of the various segments. Intraob-server and interobserver comparisons showed high correlations (r = 0.95 to 0.98 for area and r = 0.99 for volume) and small mean relative differences (-0.87% to 1.08%), with SD of lumen, plaque, and total vessel measurements not exceeding 7.28%, 10.81%, and 4.44% (area) and 2.66%, 2.81%, and 0.67% (volume), respectively. Thus the proposed analysis system provided accurate measurements of phantom dimensions and can be used to perform highly reproducible area and volume measurements in three-dimensional ICUS in vivo.
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Affiliation(s)
- C von Birgelen
- Thoraxcenter, University Hospital Rotterdam, Dijkzig, Erasmus University, The Netherlands
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24
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von Birgelen C, Gil R, Ruygrok P, Prati F, Di Mario C, van der Giessen WJ, de Feyter PJ, Serruys PW. Optimized expansion of the Wallstent compared with the Palmaz-Schatz stent: on-line observations with two- and three-dimensional intracoronary ultrasound after angiographic guidance. Am Heart J 1996; 131:1067-75. [PMID: 8644583 DOI: 10.1016/s0002-8703(96)90078-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Optimized stent expansion by high-pressure inflations of oversized balloons has initially been derived from experience obtained with the Palmaz-Schatz stent, whereas there is little experience with this strategy in the Wallstent. By using this approach with quantitative coronary angiographic guidance, 20 Wallstents and 20 Palmaz-Schatz stents were implanted in 34 patients and consecutively examined by conventional two-dimensional (2D) intracoronary ultrasound (ICUS) and three-dimensional (3D) ICUS on the basis of the application of a pattern recognition algorithm. Ultrasound criteria of adequate stent expansion were defined as a complete apposition of the stent to the vessel wall, a stent symmetry index (SSI = minimum/maximum lumen diameter) > or = O.7, and a stent-reference lumen area ratio (SRR = Minimum intrastent lumen area/Average of proximal and distal reference lumen area) > or = O.8. In all cases a smooth angiographic lumen and a negative diameter stenosis, on the basis of a distal reference, was achieved. For the Wallstents ICUS showed a higher SSI (2D, 0.95 +/- 0.04 vs 0.85 +/- 0.09; p < 0.001; 3D, 0.90 +/- 0.09 vs 0.82 +/- 0.11, p < 0.05) and a lower SRR (2D, 0.66 +/- 0.12 vs 0.81 +/- 0.13, p < 0.005; 3D, 0.63 +/- 0.14 vs 0.74 +/- 0.15, p < 0.05) than for the Palmaz-Schatz stents. Ninety percent of failure in meeting these criteria resulted from a low SRR. The incidence of incomplete stent apposition (one in both stents) or SSI <0.7 was low and generally associated with an SRR <0.8. The Wallstents met the ICUS criteria less often (2D, 2(1O%) vs 10(50%), p < 0.01; 3D, 3(15%) vs 9(45%), p < 0.05), were significantly longer (35.1 +/- 7.7 mm and 14.3 +/- 3.3 mm, p < 0.0001), and generally demonstrated a larger vessel tapering, measured as proximal minus distal ICUS reference lumen area (1.33 +/- 2.91 mm2 vs 0.44 +/- 1.97 mm(2), not significant). Wallstents meeting the ICUS criteria, however, showed less vessel tapering (0.18 +/- 1.64 mm(2)). Thus optimized stent expansion was followed by excellent angiographic results for both Palmaz-Schatz and Wallstent. Although angiographic results and visual assessment of the ICUS examination suggested a good outcome, few Wallstents met the ICUS criteria in contrast to the Palmaz-Schatz stents. The low value of the SRR in the Wallstents is likely to be caused by vessel tapering, suggesting that this criterion may be unsuitable in assessing the adequacy of the expansion of relatively long stents such as the Wallstent.
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Affiliation(s)
- C von Birgelen
- Thoraxcenter, Division of Cardiology, University Hospital, Erasmus University, Rotterdam, The Netherlands
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Gil R, von Birgelen C, Prati F, Di Mario C, Ligthart J, Serruys PW. Usefulness of three-dimensional reconstruction for interpretation and quantitative analysis of intracoronary ultrasound during stent deployment. Am J Cardiol 1996; 77:761-4. [PMID: 8651131 DOI: 10.1016/s0002-9149(97)89214-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We examined 49 coronary stents in 33 patients after angiographically guided optimization of the deployment by intracoronary ultrasound, and compared the findings of a conventional 2-dimensional analysis approach with the results obtained from an automatic lumen recognition provided by a 3-dimensional reconstruction system. The automatic lumen analysis demonstrated that only 15 stents (31%) fulfilled defined ultrasound criteria of adequate stent deployment, and that 5 of these cases were missed by the conventional approach, which systematically overestimated the dimensions of the minimal stent lumen.
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Affiliation(s)
- R Gil
- Intracoronary Imaging Laboratory and Cardiac Catheterization Laboratory, Thoraxcenter, Rotterdam, The Netherlands
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26
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Prati F, Di Mario C, Gil R, von Birgelen C, Camenzind E, Montauban van Swijndregt WJ, de Feyter PJ, Serruys PW, Roelandt JR. Usefulness of on-line three-dimensional reconstruction of intracoronary ultrasound for guidance of stent deployment. Am J Cardiol 1996; 77:455-61. [PMID: 8629584 DOI: 10.1016/s0002-9149(97)89337-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The additional information provided by automated on-line 3-dimensional (3-D) reconstruction of intracoronary ultrasound (ICUS) was assessed in 42 patients (62 stents) who underwent stent deployment after achieving an optimal quantitative angiographic result. In 10 of 42 patients, 3-D ICUS was also performed before stenting. ICUS images of stents and adjacent reference segments were acquired by using a motorized pullback at a constant speed (1 mm/s) and immediately processed in the catheterization laboratory. Optimal stent expansion was detected by 3-D ICUS in case of complete apposition of stent struts to the vessel wall. Furthermore, an attempt was made to maximize the intrastent lumen area to match lumen area of the reference segment and to cover with stents all the segments with residual significant lesions (plaque burden >50%). Three-dimensional automated reconstruction of ICUS was successful in 8 of 10 patients (80%) before, and in 36 of 42 patients (86%) after stent deployment. In all 8 patients who underwent successful 3-D ICUS assessment before stent implantation, the selection of stent length was facilitated by accurately measuring the lesion length. After stenting, 3-D ICUS modified the management strategy in 21 of 36 patients (58%), triggering additional high-pressure dilatations in 13 patients (36%) and additional stent deployment in 8 (22%). In conclusion, on-line 3-D ICUS facilitates stent selection and strongly modifies the revascularization strategy by accurately detecting stent underexpansion and presence of uncovered lesions.
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Affiliation(s)
- F Prati
- Laboratory of Intracoronary Imaging, Thoraxcenter, Erasmus University, The Netherlands
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von Birgelen C, Slager CJ, Di Mario C, De Feyter PJ, Serruys PW. Volumetric intracoronary ultrasound: A new maximum confidence approach for the quantitative assessment of progression-regression of atherosclerosis? Atherosclerosis 1995. [DOI: 10.1016/0021-9150(95)90078-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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