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Tufaro V, Jaffer FA, Serruys PW, Onuma Y, van der Steen AFW, Stone GW, Muller JE, Marcu L, Van Soest G, Courtney BK, Tearney GJ, Bourantas CV. Emerging Hybrid Intracoronary Imaging Technologies and Their Applications in Clinical Practice and Research. JACC Cardiovasc Interv 2024; 17:1963-1979. [PMID: 39260958 DOI: 10.1016/j.jcin.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 09/13/2024]
Abstract
Intravascular ultrasound and optical coherence tomography are used with increasing frequency for the care of coronary patients and in research studies. These imaging tools can identify culprit lesions in acute coronary syndromes, assess coronary stenosis severity, guide percutaneous coronary intervention (PCI), and detect vulnerable plaques and patients. However, they have significant limitations that have stimulated the development of multimodality intracoronary imaging catheters, which provide improvements in assessing vessel wall pathology and guiding PCI. Prototypes combining 2 or even 3 imaging probes with complementary attributes have been developed, and several multimodality systems have already been used in patients, with near-infrared spectroscopy intravascular ultrasound-based studies showing promising results for the identification of high-risk plaques. Moreover, postmortem histology studies have documented that hybrid imaging catheters can enable more accurate characterization of plaque morphology than standalone imaging. This review describes the evolution in the field of hybrid intracoronary imaging; presents the available multimodality catheters; and discusses their potential role in PCI guidance, vulnerable plaque detection, and the assessment of endovascular devices and emerging pharmacotherapies targeting atherosclerosis.
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Affiliation(s)
- Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Farouc A Jaffer
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Gregg W Stone
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, New York, USA
| | - James E Muller
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, California, USA
| | - Gijs Van Soest
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Brian K Courtney
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada; Conavi Medical Inc, Toronto, Ontario, Canada
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard-MIT Health Sciences and Technology, Cambridge, Massachusetts, USA
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
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Bajaj R, Eggermont J, Grainger SJ, Räber L, Parasa R, Khan AHA, Costa C, Erdogan E, Hendricks MJ, Chandrasekharan KH, Andiapen M, Serruys PW, Torii R, Mathur A, Baumbach A, Dijkstra J, Bourantas CV. Machine learning for atherosclerotic tissue component classification in combined near-infrared spectroscopy intravascular ultrasound imaging: Validation against histology. Atherosclerosis 2022; 345:15-25. [DOI: 10.1016/j.atherosclerosis.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/09/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
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3
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Bajaj R, Garcia-Garcia HM, Courtney BK, Ramasamy A, Tufaro V, Erdogan E, Khan AH, Alves N, Rathod KS, Onuma Y, Serruys PW, Mathur A, Baumbach A, Bourantas C. Multi-modality intravascular imaging for guiding coronary intervention and assessing coronary atheroma: the Novasight Hybrid IVUS-OCT system. Minerva Cardiol Angiol 2021; 69:655-670. [PMID: 33703857 DOI: 10.23736/s2724-5683.21.05532-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intravascular imaging has evolved alongside interventional cardiology as an adjunctive tool for assessing plaque pathology and for guiding and optimising percutaneous coronary intervention (PCI) in challenging lesions. The two modalities which have dominated the field are intravascular ultrasound (IVUS), which relies on sound waves and optical coherence tomography (OCT), relying on light waves. These approaches however have limited efficacy in assessing plaque morphology and vulnerability that are essential for guiding PCI in complex lesions and identifying patient at risk that will benefit from emerging therapies targeting plaque evolution. These limitations are complementary and, in this context, it has been recognised and demonstrated in multi-modality studies that the concurrent use of IVUS and OCT can help overcome these deficits enabling a more complete and accurate plaque assessment. The Conavi Novasight Hybrid IVUS-OCT catheter is the first commercially available device that is capable of invasive clinical coronary assessment with simultaneously acquired and co-registered IVUS and OCT imaging. It represents a significant evolution in the field and is expected to have broad application in clinical practice and research. In this review article we present the limitations of standalone intravascular imaging techniques, summarise the data supporting the value of multimodality imaging in clinical practice and research, describe the Novasight Hybrid IVUS-OCT system and highlight the potential utility of this technology in coronary intervention and in the study of atherosclerosis.
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Affiliation(s)
- Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Brian K Courtney
- Sunnybrook Research Institute, Schulich Heart Program, University of Toronto, Toronto, ON, Canada.,Conavi Medical, North York, ON, Canada
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Emrah Erdogan
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ameer H Khan
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Natasha Alves
- Sunnybrook Research Institute, Schulich Heart Program, University of Toronto, Toronto, ON, Canada
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Yoshinobu Onuma
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Patrick W Serruys
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK - .,Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
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Golforoush P, Yellon DM, Davidson SM. Mouse models of atherosclerosis and their suitability for the study of myocardial infarction. Basic Res Cardiol 2020; 115:73. [PMID: 33258000 PMCID: PMC7704510 DOI: 10.1007/s00395-020-00829-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022]
Abstract
Atherosclerotic plaques impair vascular function and can lead to arterial obstruction and tissue ischaemia. Rupture of an atherosclerotic plaque within a coronary artery can result in an acute myocardial infarction, which is responsible for significant morbidity and mortality worldwide. Prompt reperfusion can salvage some of the ischaemic territory, but ischaemia and reperfusion (IR) still causes substantial injury and is, therefore, a therapeutic target for further infarct limitation. Numerous cardioprotective strategies have been identified that can limit IR injury in animal models, but none have yet been translated effectively to patients. This disconnect prompts an urgent re-examination of the experimental models used to study IR. Since coronary atherosclerosis is the most prevalent morbidity in this patient population, and impairs coronary vessel function, it is potentially a major confounder in cardioprotective studies. Surprisingly, most studies suggest that atherosclerosis does not have a major impact on cardioprotection in mouse models. However, a major limitation of atherosclerotic animal models is that the plaques usually manifest in the aorta and proximal great vessels, and rarely in the coronary vessels. In this review, we examine the commonly used mouse models of atherosclerosis and their effect on coronary artery function and infarct size. We conclude that none of the commonly used strains of mice are ideal for this purpose; however, more recently developed mouse models of atherosclerosis fulfil the requirement for coronary artery lesions, plaque rupture and lipoprotein patterns resembling the human profile, and may enable the identification of therapeutic interventions more applicable in the clinical setting.
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MESH Headings
- Animals
- Aortic Diseases/complications
- Aortic Diseases/genetics
- Aortic Diseases/metabolism
- Aortic Diseases/pathology
- Atherosclerosis/complications
- Atherosclerosis/genetics
- Atherosclerosis/metabolism
- Atherosclerosis/pathology
- Coronary Artery Disease/complications
- Coronary Artery Disease/genetics
- Coronary Artery Disease/metabolism
- Coronary Artery Disease/pathology
- Diet, High-Fat
- Disease Models, Animal
- Genetic Predisposition to Disease
- Mice, Knockout, ApoE
- Myocardial Infarction/etiology
- Myocardial Infarction/genetics
- Myocardial Infarction/metabolism
- Myocardial Infarction/pathology
- Myocardium/pathology
- Phenotype
- Plaque, Atherosclerotic
- Receptors, LDL/deficiency
- Receptors, LDL/genetics
- Rupture, Spontaneous
- Scavenger Receptors, Class B/deficiency
- Scavenger Receptors, Class B/genetics
- Species Specificity
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Affiliation(s)
- Pelin Golforoush
- The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK.
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Fedewa R, Puri R, Fleischman E, Lee J, Prabhu D, Wilson DL, Vince DG, Fleischman A. Artificial Intelligence in Intracoronary Imaging. Curr Cardiol Rep 2020; 22:46. [DOI: 10.1007/s11886-020-01299-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Wang D, Xu X, Zhao M, Wang X. Accelerated miniature swine models of advanced atherosclerosis: A review based on morphology. Cardiovasc Pathol 2020; 49:107241. [PMID: 32554057 DOI: 10.1016/j.carpath.2020.107241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/27/2020] [Accepted: 05/06/2020] [Indexed: 12/31/2022] Open
Abstract
In order to accelerate development of atherosclerosis(AS) in miniature swine models, varieties of strategies and methods have been explored. In addition to traditional methods such as high cholesterol feeding and balloon injury, new methods such as familial hypercholesterolemia induced by gene editing and intramural injection have been applied in recent years. Although it has been claimed that these methods have successfully aggravated lesion areas and stenosis, lesion features induced by different strategies have shown heterogeneity in morphology. In addition, time consumption, high cost, and unavailability are problems that restrict application of these AS models. Here, we summarize strategies and methods to accelerate AS models and further analyze their values, advantages, and shortcomings.
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Affiliation(s)
- Dayang Wang
- Cardiovascular Department, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China.
| | - Xiaoqing Xu
- Third Department of Neurology, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China.
| | - Mingjing Zhao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Xian Wang
- Cardiovascular Insititute, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China.
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Lee J, Hwang YN, Kim GY, Kwon JY, Kim SM. Automated classification of dense calcium tissues in gray-scale intravascular ultrasound images using a deep belief network. BMC Med Imaging 2019; 19:103. [PMID: 31888535 PMCID: PMC6937730 DOI: 10.1186/s12880-019-0403-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 12/18/2019] [Indexed: 01/20/2023] Open
Abstract
Background IVUS is widely used to quantitatively assess coronary artery disease. The purpose of this study was to automatically characterize dense calcium (DC) tissue in the gray scale intravascular ultrasound (IVUS) images using the image textural features. Methods A total of 316 Gy-scale IVUS and corresponding virtual histology images from 26 patients with acute coronary syndrome who underwent IVUS along with X-ray angiography between October 2009 to September 2014 were retrospectively acquired and analyzed. One expert performed all procedures and assessed their IVUS scans. After image acquisition, the DC candidate and corresponding acoustic shadow regions were automatically determined. Then, nine image-base feature groups were extracted from the DC candidates. In order to reduce the dimensionalities, principal component analysis (PCA) was performed, and selected feature sets were utilized as an input for a deep belief network. Classification results were validated using 10-fold cross validation. Results The dimensionality of the feature map was efficiently reduced by 50% (from 66 to 33) without any performance decrease using PCA method. Sensitivity, specificity, and accuracy of the proposed method were 92.8 ± 0.1%, 85.1 ± 0.1%, and 88.4 ± 0.1%, respectively (p < 0.05). We found that the window size could largely influence the characterization results, and selected the 5 × 5 size as the best condition. We also validated the performance superiority of the proposed method with traditional classification methods. Conclusions These experimental results suggest that the proposed method has significant clinical applicability for IVUS-based cardiovascular diagnosis.
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Affiliation(s)
- Juhwan Lee
- Department of Biomedical Engineering, Case Western Reserve University, 10900, Euclid Avenue, Cleveland, OH, 44106, USA
| | - Yoo Na Hwang
- Department of Medical Biotechnology, Dongguk University-Bio Medi Campus, (10326) 32, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Ga Young Kim
- Department of Medical Biotechnology, Dongguk University-Bio Medi Campus, (10326) 32, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Ji Yean Kwon
- Department of Medical Devices Industry, Dongguk University-Seoul, (04620) 30, Pildong-ro 1-gil, Jung-gu, Seoul, Republic of Korea
| | - Sung Min Kim
- Department of Medical Biotechnology, Dongguk University-Bio Medi Campus, (10326) 32, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea. .,Department of Medical Devices Industry, Dongguk University-Seoul, (04620) 30, Pildong-ro 1-gil, Jung-gu, Seoul, Republic of Korea.
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Ramasamy A, Serruys PW, Jones DA, Johnson TW, Torii R, Madden SP, Amersey R, Krams R, Baumbach A, Mathur A, Bourantas CV. Reliable in vivo intravascular imaging plaque characterization: A challenge unmet. Am Heart J 2019; 218:20-31. [PMID: 31655414 DOI: 10.1016/j.ahj.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 07/16/2019] [Indexed: 12/11/2022]
Abstract
Intravascular imaging has enabled in vivo assessment of coronary artery pathology and detection of plaque characteristics that are associated with increased vulnerability. Prospective invasive imaging studies of coronary atherosclerosis have demonstrated that invasive imaging modalities can detect lesions that are likely to progress and cause cardiovascular events and provided unique insights about atherosclerotic evolution. However, despite the undoubted value of the existing imaging techniques in clinical and research arenas, all the available modalities have significant limitations in assessing plaque characteristics when compared with histology. Hybrid/multimodality intravascular imaging appears able to overcome some of the limitations of standalone imaging; however, there are only few histology studies that examined their performance in evaluating plaque pathobiology. In this article, we review the evidence about the efficacy of standalone and multi-modality/hybrid intravascular imaging in assessing plaque morphology against histology, highlight the advantages and limitations of the existing imaging techniques and discuss the future potential of emerging imaging modalities in the study of atherosclerosis.
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Affiliation(s)
- Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; School of Medicine and Dentistry, Queen Mary University London, London, UK
| | | | - Ryo Torii
- Department of Mechanical Engineering, University College London, UK
| | - Sean P Madden
- Infraredx Inc., Burlington, MA, United States of America
| | - Rajiv Amersey
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Rob Krams
- School of Engineering and Materials Science, Queen Mary University London, London, UK
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; School of Medicine and Dentistry, Queen Mary University London, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK.
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Kok AM, Molony DS, Timmins LH, Ko YA, Boersma E, Eshtehardi P, Wentzel JJ, Samady H. The influence of multidirectional shear stress on plaque progression and composition changes in human coronary arteries. EUROINTERVENTION 2019; 15:692-699. [DOI: 10.4244/eij-d-18-00529] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Watanabe M, Fukazawa R, Ogawa S, Ohkubo T, Abe M, Hashimoto K, Hashimoto Y, Itoh Y. Virtual histology intravascular ultrasound evaluation of coronary artery lesions within 1 year and more than 10 years after the onset of Kawasaki disease. J Cardiol 2019; 75:171-176. [PMID: 31444141 DOI: 10.1016/j.jjcc.2019.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coronary artery evaluation by virtual histological intravascular ultrasonography (VH-IVUS) late in Kawasaki disease (KD) shows intimal thickening, calcification, fatty components, and necrosis of regressed coronary artery lesions (CALs). However, it is not clear when these VH-IVUS findings start to occur. Therefore, we evaluated coronary arteries using VH-IVUS in patients with early-stage KD and tried to determine whether these atherosclerotic findings on VH-IVUS were different from that in patients with late-stage KD. METHODS Eighteen patients with KD aged between 1 and 32 years who had CALs and underwent cardiac catheterization between January 1, 2008 and December 31, 2014 were included. They were divided into 2 groups-those with the disease for <1 year (group A) and those with it for >10 years (group B). VH-IVUS findings were compared between the groups. The coronary arteries were divided based on coronary angiography findings into normal, regressed (dilated CALs regressed to a normal size), and aneurysmal lesions. The Wilcoxon signed-rank test was used in the statistical analysis. RESULTS In both regressed and aneurysmal lesions, marked intimal proliferation and atherosclerotic findings (fibro-fatty and necrotic core lesions) were observed. In addition, there was no difference in the area percentage of atherosclerosis between the groups. CONCLUSIONS VH-IVUS revealed that atherosclerotic-like findings exist in CALs in patients with KD, even within a year of onset. The findings were almost the same in those with the disease for >10 years. Because there is no histological evidence of atherosclerosis in KD, these VH-IVUS findings may indicate complex histological findings of KD. Nevertheless, early interventions to help reduce the risk factors of atherosclerosis may be required in these patients.
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Affiliation(s)
- Makoto Watanabe
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Ryuji Fukazawa
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
| | - Shunichi Ogawa
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Takashi Ohkubo
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Masanori Abe
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Koji Hashimoto
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | | | - Yasuhiko Itoh
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
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Local intravascular delivery of low-density-lipoprotein cholesterol corresponds with increased intimal thickening in a healthy porcine coronary model. A prelude to development of a model of atherosclerosis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:81-90. [PMID: 31043989 PMCID: PMC6488843 DOI: 10.5114/aic.2019.83774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Preclinical, vascular response studies are limited due to lack of underlying disease. The available cholesterol-diet-based and genetic atherosclerotic models are not satisfactory due to long breeding, unpredictable lesion formation, low plaque volume and degree of stenosis. Aim To evaluate the vascular response to local, intramural delivery of human, highly atherogenic lipids into healthy domestic swine (DS) coronary arteries. Material and methods A total of 24 coronary artery segments of 10 DS were enrolled. Following balloon injury (plain old balloon angioplasty – POBA), segments were assigned to local delivery of 2 ml of human LDL from apheresis (400 mg/dl, n = 9), 0.9% NaCl (control, n = 7) or to POBA alone. The solutions were infused with a modified, triple micro-needle catheter into the vessel wall. After 28 days, optical coherence tomography (OCT), virtual histology IVUS (VH-IVUS) and near-infra-red spectroscopy (NIRS) were performed. Following euthanasia, vessel segments were harvested for pathological evaluation. Results At 28 days the % area stenosis in OCT was highest in the LDL group (23.6 ±13 vs. 10.8 ±7 vs. 8.1 ±7%; p = 0.02). The presence of necrotic core (LDL: 55.5%, control: 37.5% and POBA: 42.8%; p = 0.77) and dense calcium (LDL: 33.3%, control: 28.5%, POBA: 37.5%; p = 0.94) in VH-IVUS were comparable between groups. The lipid core burden index in NIRS was negative in all cases. In pathology, the injury was comparable between groups (LDL: 1.6 ±0.4, control: 1.7 ±0.8, POBA: 1.7; p = 0.8) and specimens showed no signs of necrotic or lipid core. The tissue consisted of smooth muscle cells (SMC)/proteoglycan-rich lesions and inflammatory cells. Conclusions Local delivery of saturated human LDL into the coronary artery wall was feasible and resulted in a higher degree of stenosis caused by intimal thickening. A discrepancy between histopathological findings and virtual histology intravascular ultrasound (VH-IVUS) was also noted.
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12
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Lee J, Chang JH. Dual-Element Intravascular Ultrasound Transducer for Tissue Harmonic Imaging and Frequency Compounding: Development and Imaging Performance Assessment. IEEE Trans Biomed Eng 2019; 66:3146-3155. [PMID: 30835204 DOI: 10.1109/tbme.2019.2901005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE For accurate diagnosis of atherosclerosis, the high spatial and contrast resolutions of intravascular ultrasound (IVUS) images are a key requirement. Increasing the center frequency of IVUS is a simple solution to meet this requirement. However, this leads to a reduction in imaging depth due to the frequency-dependent attenuation of ultrasound. Here, we report a recently developed dual-element IVUS transducer for tissue harmonic imaging (THI) and frequency compounding to increase the spatial and contrast resolutions of IVUS images, while maintaining the imaging depth to assess the overall morphological change of blood vessels. METHODS One 35-MHz element is used for producing general IVUS images and the other 70-MHz element is for receiving the second harmonic signals induced by the 35-MHz ultrasound. The fundamental and second harmonic signals can also be used for frequency compound imaging to further improve contrast resolution. The spatial and contrast resolutions achieved by the developed transducer were evaluated through wire and tissue-mimicking phantom imaging tests. Additionally, the images of a stent deployed in a tissue-mimicking phantom and an excised pig artery were acquired to assess clinical usefulness of the transducer. RESULTS The results demonstrated that the developed IVUS transducer enables us to simultaneously examine the overall morphological change of blood vessels by the 35-MHz ultrasound images and the near vessel layers such as the intima, the media, and the adventitia by either THI or compound images with high spatial and contrast resolutions. In addition, the developed transducer facilitates the simultaneous acquisition of 35- and 70-MHz fundamental images when needed. CONCLUSION The developed dual-element IVUS transducer makes it possible to fully realize the potential benefits of IVUS in the diagnosis of atherosclerosis.
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Bourantas CV, Crake T, Zhang YJ, Ozkor M, Ahmed J, Garcia-Garcia HM, Serruys PW. Intravascular imaging in cardiovascular ageing. Exp Gerontol 2017; 109:31-37. [PMID: 28522312 DOI: 10.1016/j.exger.2017.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/19/2017] [Accepted: 05/14/2017] [Indexed: 11/16/2022]
Abstract
Ageing is related to complex molecular, inflammatory and biochemical changes that affect coronary pathology and often lead to coronary artery disease and cardiovascular events. Intravascular imaging is considered as the ideal technique to study coronary plaque morphology and assess its burden. Over the recent years several studies have been performed that investigated the association between pathophysiological mechanisms that promote vascular ageing and plaque morphology. In addition, several reports have compared plaque pathology in different age groups and a few studies included serial intravascular imaging to assess changes in the atheroma burden and compositional characteristics of the plaque. This review article summarizes the evidence derived from intravascular imaging studies about the implications of vascular ageing on coronary artery morphology and discusses the potential of coronary imaging in assessing atherosclerotic evolution.
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Affiliation(s)
- Christos V Bourantas
- Barts Heart Centre, Barts Health NHS Trust, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK.
| | - Tom Crake
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Yao-Jun Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Mick Ozkor
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Javed Ahmed
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Patrick W Serruys
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
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Lee YT, Laxton V, Lin HY, Chan YWF, Fitzgerald-Smith S, To TLO, Yan BP, Liu T, Tse G. Animal models of atherosclerosis. Biomed Rep 2017; 6:259-266. [PMID: 28451383 PMCID: PMC5403338 DOI: 10.3892/br.2017.843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Atherosclerosis is a significant cause of morbidity and mortality globally. Many animal models have been developed to study atherosclerosis, and permit experimental conditions, diet and environmental risk factors to be carefully controlled. Pathophysiological changes can be produced using genetic or pharmacological means to study the harmful consequences of different interventions. Experiments using such models have elucidated its molecular and pathophysiological mechanisms, and provided platforms for pharmacological development. Different models have their own advantages and disadvantages, and can be used to answer different research questions. In the present review article, different species of atherosclerosis models are outlined, with discussions on the practicality of their use for experimentation.
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Affiliation(s)
- Yee Ting Lee
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Victoria Laxton
- Intensive Care Department, Royal Brompton and Harefield NHS Trust, London SW3 6NP, UK
| | - Hiu Yu Lin
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Yin Wah Fiona Chan
- School of Biological Sciences, University of Cambridge, Cambridge CB2 1AG, UK
| | | | - Tsz Ling Olivia To
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, P.R. China
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Gary Tse
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, P.R. China
- Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China
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15
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Abstract
Coronary artery disease is the result of atherosclerotic changes to the coronary arterial wall, comprising endothelial dysfunction, vascular inflammation and deposition of lipid-rich macrophage foam cells. Certain high-risk atherosclerotic plaques are vulnerable to disruption, leading to rupture, thrombosis and the clinical sequelae of acute coronary syndrome. Though recognised as the gold standard for evaluating the presence, distribution and severity of atherosclerotic lesions, invasive coronary angiography is incapable of identifying non-stenotic, vulnerable plaques that are responsible for adverse cardiovascular events. The recognition of such limitations has impelled the development of intracoronary imaging technologies, including intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy, which enable the detailed evaluation of the coronary wall and atherosclerotic plaques in clinical practice. This review discusses the present status of invasive imaging technologies; summarises up-to-date, evidence-based clinical guidelines; and addresses questions that remain unanswered with regard to the future of intracoronary plaque imaging.
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Affiliation(s)
- Jonathan A Batty
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Shristy Subba
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK.
| | - Peter Luke
- Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Li Wing Chi Gigi
- Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
| | - Hannah Sinclair
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | - Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University, 3rd Floor, William Leech Building, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
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16
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Ogita M, Miyauchi K, Onishi A, Tsuboi S, Wada H, Konishi H, Naito R, Dohi T, Kasai T, Kojima Y, Schwartz RS, Daida H. Development of Accelerated Coronary Atherosclerosis Model Using Low Density Lipoprotein Receptor Knock-Out Swine with Balloon Injury. PLoS One 2016; 11:e0163055. [PMID: 27631974 PMCID: PMC5025170 DOI: 10.1371/journal.pone.0163055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/01/2016] [Indexed: 11/24/2022] Open
Abstract
Background Several animal models have facilitated the evaluation and pathological understanding of atherosclerosis, but a definitive animal model of coronary atherosclerosis is not available. We therefore developed low density lipoprotein receptor knockout (LDLR-KO) pigs with hypercholesterolemia, a model which rapidly developed coronary atherosclerosis following balloon injury. Methods and Results We deleted LDLR exon regions from cultured porcine fetal fibroblasts and cloned LDLR knockout (LDLR-KO) embryos microinjecting fetal fibroblast nuclei into enucleated oocytes. Twelve LDLR-KO pigs were fed a 2.0% cholesterol and 20% fat diet. Baseline serum LDL cholesterol level was 510.0±86.1 mg/dL. Balloon injury was created in 46 coronary segments and necropsy were obtained 2, 4, 8 and 12 weeks later. Coronary artery sections were reviewed to evaluate lesion progression. We found lipid accumulation with foam cells and inflammatory cells beginning four weeks after balloon injury. The mean ratio of macrophages to plaque area was significantly higher in the four- weeks and eight-week animals compared with those at 2-weeks (8.79% ± 5.98% and 17.00% ± 10.38% vs. 1.14% ± 1.88%, P < 0.0001). At 12 weeks the ratio decreased toward the level at 2 week level (4.00% ± 4.56%, P = 0.66 vs. baseline). Advanced coronary atherosclerotic lesions contained lipid pools at eight-weeks with fibrous components beginning at 12 weeks. Conclusions We developed a model of rapid coronary atherosclerosis using LDLR KO pigs with balloon injury. This model may be useful for preclinical evaluation of medication or devices, and may also help investigate mechanisms of plaque progression.
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Affiliation(s)
- Manabu Ogita
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Onishi
- Transgenic Animal Research Center, National Institute of Agrobiological Sciences, Tsukuba, Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirokazu Konishi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko Kojima
- Division of Biomedical Imaging Research, Biomedical Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Robert S Schwartz
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, United States of America
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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17
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Kim JS, Lee SG, Oh J, Park S, Park SI, Hong SY, Kim S, Lee SH, Ko YG, Choi D, Hong MK, Jang Y. Development of Advanced Atherosclerotic Plaque by Injection of Inflammatory Proteins in a Rabbit Iliac Artery Model. Yonsei Med J 2016; 57:1095-105. [PMID: 27401639 PMCID: PMC4960374 DOI: 10.3349/ymj.2016.57.5.1095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/09/2016] [Accepted: 03/03/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Appropriate animal models of atherosclerotic plaque are crucial to investigating the pathophysiology of atherosclerosis, as well as for the evaluation of the efficacy and safety of vascular devices. We aimed to develop a novel animal model that would be suitable for the study of advanced atherosclerotic lesions in vivo. MATERIALS AND METHODS Atherosclerotic plaque was induced in 24 iliac arteries from 12 rabbits by combining a high cholesterol diet, endothelial denudation, and injection into the vessel wall with either saline (n=5), olive oil (n=6), or inflammatory proteins [n=13, high-mobility group protein B1 (HMGB1) n=8 and tumor necrosis factor (TNF)-α n=5] using a Cricket™ Micro-infusion catheter. Optical coherence tomography (OCT) was performed to detect plaque characteristics after 4 weeks, and all tissues were harvested for histological evaluation. RESULTS Advanced plaque was more frequently observed in the group injected with inflammatory proteins. Macrophage infiltration was present to a higher degree in the HMGB1 and TNF-α groups, compared to the oil or saline group (82.1±5.1% and 94.6±2.2% compared to 49.6±14.0% and 46.5±9.6%, p-value<0.001), using RAM11 antibody staining. On OCT, lipid rich plaques were more frequently detected in the inflammatory protein group [saline group: 2/5 (40%), oil group: 3/5 (50%), HMGB1 group: 6/8 (75%), and TNF-α group: 5/5 (100%)]. CONCLUSION These data indicate that this rabbit model of atherosclerotic lesion formation via direct injection of pro-inflammatory proteins into the vessel wall is useful for in vivo studies investigating atherosclerosis.
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Affiliation(s)
- Jung Sun Kim
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seul Gee Lee
- Graduate Program in Science for Aging, Yonsei University, Seoul, Korea
| | - Jaewon Oh
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - Se Il Park
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Yu Hong
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sehoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hak Lee
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Guk Ko
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong Ki Hong
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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18
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Brugaletta S, Giacchi G, Ortega-Paz L, Garcia-Garcia HM, Sabaté M. Stable coronary artery disease. Is it really stable? Lesion morphology interpretation by Grayscale and VH-IVUS in patients with coronary artery disease. ACTA ACUST UNITED AC 2016. [DOI: 10.1002/cce2.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- S. Brugaletta
- Cardiovascular Clinic Institute; Hospital Clinic; University of Barcelona; IDIBAPS, Barcelona Spain
| | - G. Giacchi
- Cardiovascular Clinic Institute; Hospital Clinic; University of Barcelona; IDIBAPS, Barcelona Spain
| | - L. Ortega-Paz
- Cardiovascular Clinic Institute; Hospital Clinic; University of Barcelona; IDIBAPS, Barcelona Spain
| | - H. M. Garcia-Garcia
- MedStar Washington Hospital Center; 110 Irving St., NW, Suite 4B-1 Washington District of Columbia, 20010
| | - M. Sabaté
- Cardiovascular Clinic Institute; Hospital Clinic; University of Barcelona; IDIBAPS, Barcelona Spain
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19
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Lee J, Jang J, Chang JH. Oblong-Shaped Focused Transducers for Intravascular Ultrasound Imaging. IEEE Trans Biomed Eng 2016; 64:671-680. [DOI: 10.1109/tbme.2016.2572182] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Roleder T, Wojakowski W. Intravascular ultrasound, optical coherence tomography and near infrared spectroscopy. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Virtual Histology-Intravascular Ultrasound. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Brown AJ, Costopoulos C, West NEJ. Virtual-histology intravascular ultrasound: justifiable criticism or unfair slander? Interv Cardiol 2015. [DOI: 10.2217/ica.15.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Erlinge D. Near-infrared spectroscopy for intracoronary detection of lipid-rich plaques to understand atherosclerotic plaque biology in man and guide clinical therapy. J Intern Med 2015; 278:110-25. [PMID: 26096457 DOI: 10.1111/joim.12381] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ischaemic heart disease is the leading cause of death worldwide. The common denominator for plaques causing acute coronary syndrome (ACS) is lipid accumulation, either as a lipid core or lipid pools. An intracoronary imaging device to detect lipid-rich plaques (LRPs) could therefore identify most of the plaques causing ACS and sudden death. Near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS) is a promising new intracoronary imaging method that is able to specifically quantify lipid accumulation measured as the lipid core burden index (LCBI). NIRS-IVUS is highly specific for the identification of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) culprit plaques usually in the form of a circular LRP. NIRS-IVUS may assist in defining the aetiology of coronary events. The effect of cholesterol-lowering therapy on the lipid core can be measured in coronary plaques in patients, and NIRS-IVUS may be a useful tool for drug development in phase II studies as a surrogate end-point for future ACS. Plaques with a high LCBI have an increased risk of peri-procedural events. NIRS-IVUS can help to define the diameter and length of stents to avoid procedure-related complications. Increased coronary LCBI predicts a higher risk of future cardiovascular events. Lipid core detection using NIRS may help to identify vulnerable plaques to treat them before they cause ACS or sudden death.
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Affiliation(s)
- D Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
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24
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Costopoulos C, Brown AJ, Teng Z, Hoole SP, West NEJ, Samady H, Bennett MR. Intravascular ultrasound and optical coherence tomography imaging of coronary atherosclerosis. Int J Cardiovasc Imaging 2015; 32:189-200. [DOI: 10.1007/s10554-015-0701-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
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25
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Brugaletta S, Sabaté M. Assessment of plaque composition by intravascular ultrasound and near-infrared spectroscopy: from PROSPECT I to PROSPECT II. Circ J 2014; 78:1531-9. [PMID: 24931516 DOI: 10.1253/circj.cj-14-0496] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Atherosclerosis is the main cause of coronary artery disease (CAD), which is today the leading cause of death worldwide and will continue to be the first in the world in 2030. Vulnerable coronary plaques are usually characterized by a high content of necrotic core, a thin inflamed fibrous cap (intense accumulation of macrophages) and scarce presence of smooth muscle cells. None of these characteristics can be estimated by coronary angiography, which on the contrary underestimates the magnitude of atherosclerotic burden, particularly in earlier stage disease when positive vascular remodeling may allow "normal" lumen caliber despite substantial vascular wall plaque. The recognition of the ubiquity of substantial but non-flow limiting lesions that may be at high risk for subsequent plaque rupture has resulted in a paradigm shift in thinking about the pathophysiology of CAD, with the focus no longer solely on the degree of arterial luminal narrowing. This growing need for more information about coronary atherosclerosis in order to identify patients and lesions at risk for complications during PCI and for future adverse cardiac events has been the primary impetus for the development of novel intracoronary imaging methods able to detect plaque composition, in particular presence of a necrotic core/lipid pool, such as intravascular ultrasound virtual histology and near-infrared spectroscopy. These imaging technologies and their clinical and clinical/research applications are discussed in detail.
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26
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Jansen K, van Soest G, van der Steen AFW. Intravascular photoacoustic imaging: a new tool for vulnerable plaque identification. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1037-48. [PMID: 24631379 DOI: 10.1016/j.ultrasmedbio.2014.01.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 05/13/2023]
Abstract
The vulnerable atherosclerotic plaque is believed to be at the root of the majority of acute coronary events. Even though the exact origins of plaque vulnerability remain elusive, the thin-cap fibroatheroma, characterized by a lipid-rich necrotic core covered by a thin fibrous cap, is considered to be the most prominent type of vulnerable plaque. No clinically available imaging technique can characterize atherosclerotic lesions to the extent needed to determine plaque vulnerability prognostically. Intravascular photoacoustic imaging (IVPA) has the potential to take a significant step in that direction by imaging both plaque structure and composition. IVPA is a natural extension of intravascular ultrasound that adds tissue type specificity to the images. IVPA utilizes the optical contrast provided by the differences in the absorption spectra of plaque components to image composition. Its capability to image lipids in human coronary atherosclerosis has been shown extensively ex vivo and has recently been translated to an in vivo animal model. Other disease markers that have been successfully targeted are calcium and inflammatory markers, such as macrophages and matrix metalloproteinase; the latter two through application of exogenous contrast agents. By simultaneously displaying plaque morphology and composition, IVPA can provide a powerful prognostic marker for disease progression, and as such has the potential to transform the current practice in percutaneous coronary intervention.
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Affiliation(s)
- Krista Jansen
- Department of Biomedical Engineering, Thorax Centre, Erasmus University Medical Center, Rotterdam, The Netherlands; Interuniversity Cardiology Institute of The Netherlands-Netherlands Heart Institute, Utrecht, The Netherlands
| | - Gijs van Soest
- Department of Biomedical Engineering, Thorax Centre, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Antonius F W van der Steen
- Department of Biomedical Engineering, Thorax Centre, Erasmus University Medical Center, Rotterdam, The Netherlands; Interuniversity Cardiology Institute of The Netherlands-Netherlands Heart Institute, Utrecht, The Netherlands; Department of Imaging Science and Technology, Delft University of Technology, Delft, The Netherlands
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27
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Invasive assessment modalities of unprotected left main stenosis. J Saudi Heart Assoc 2014; 27:109-17. [PMID: 25870504 PMCID: PMC4392349 DOI: 10.1016/j.jsha.2014.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 04/19/2014] [Accepted: 04/27/2014] [Indexed: 01/06/2023] Open
Abstract
Among all coronary lesions, the decision-making process for the treatment of unprotected left main (ULM) stem lesions is still challenging. Indeed, the optimal therapeutic strategy for patients with ULM disease remains controversial: coronary artery bypass grafting was established as the gold standard, but it is without doubt that percutaneous coronary intervention (PCI) performed by experienced operators achieves good results at long term follow up, especially in cases where the ostium and/or shaft of ULM are treated. Thanks to the widespread use of invasive assessment of atherothrombotic ULM stenosis, improved selection of PCI cases and techniques of stenting, better outcomes are now possible. This review seeks to define the place of PCI in ULM disease by describing the different modalities of ULM stenosis assessment.
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28
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Jansen K, Wu M, van der Steen AF, van Soest G. Photoacoustic imaging of human coronary atherosclerosis in two spectral bands. PHOTOACOUSTICS 2014; 2:12-20. [PMID: 25302152 PMCID: PMC4182816 DOI: 10.1016/j.pacs.2013.11.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 10/29/2013] [Accepted: 11/16/2013] [Indexed: 05/03/2023]
Abstract
Spectroscopic intravascular photoacoustic imaging (sIVPA) has shown promise to detect and distinguish lipids in atherosclerotic plaques. sIVPA generally utilizes one of the two high absorption bands in the lipid absorption spectrum at 1.2 μm and 1.7 μm. Specific absorption signatures of various lipid compounds within the bands in either wavelength range can potentially be used to differentiate between plaque lipids and peri-adventitial lipids. With the aim to quantify any differences between the two bands, we performed combined sIVPA imaging in both absorption bands on a vessel phantom and an atherosclerotic human coronary artery ex vivo. Lipid detection in a human atherosclerotic lesion with sIVPA required lower pulse energy at 1.7 μm than at 1.2 μm (0.4 mJ versus 1.2 mJ). The imaging depth was twice as large at 1.2 μm compared to 1.7 μm. Adequate differentiation between plaque and peri-adventitial lipids was achieved at 1.2 μm only.
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Affiliation(s)
- Krista Jansen
- Department of Biomedical Engineering, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Interuniversity Cardiology Institute of The Netherlands – Netherlands Heart Institute, P.O. Box 19258, 3501 DG Utrecht, The Netherlands
| | - Min Wu
- Department of Biomedical Engineering, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Antonius F.W. van der Steen
- Department of Biomedical Engineering, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Interuniversity Cardiology Institute of The Netherlands – Netherlands Heart Institute, P.O. Box 19258, 3501 DG Utrecht, The Netherlands
- Department of Imaging Science and Technology, Delft University of Technology, Lorentzweg 1, 2628 CJ Delft, The Netherlands
| | - Gijs van Soest
- Department of Biomedical Engineering, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Corresponding author. Tel.: +31 10 70 44638; fax: +31 10 70 44720.
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29
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Brugaletta S, Cola C, Martin-Yuste V, Vilahur G, Oriol J, Padro T, Guerra JM, Borras R, Badimon L, Sabate M. Qualitative and quantitative accuracy of ultrasound-based virtual histology for detection of necrotic core in human coronary arteries. Int J Cardiovasc Imaging 2014; 30:469-76. [DOI: 10.1007/s10554-014-0372-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/15/2014] [Indexed: 01/15/2023]
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30
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Jansen K, Wu M, van der Steen AFW, van Soest G. Lipid detection in atherosclerotic human coronaries by spectroscopic intravascular photoacoustic imaging. OPTICS EXPRESS 2013; 21:21472-84. [PMID: 24104022 DOI: 10.1364/oe.21.021472] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The presence of lipids in atherosclerotic coronary lesions is an important determinant of their potential to trigger acute coronary events. Spectroscopic intravascular photoacoustic imaging (sIVPA) has the potential to automatically detect lipids in atherosclerotic lesions. For real-time in vivo imaging, limiting the number of excitation wavelengths is crucial. We explored methods for plaque lipid detection using sIVPA, with the aim to minimize the number of laser pulses per image line. A combined intravascular ultrasound (IVUS) and photoacoustic imaging system was used to image a vessel phantom and human coronary arteries ex vivo. We acquired co-registered cross-sectional images at several wavelengths near 1200 nm, a lipid-specific absorption band. Correlating the photoacoustic spectra at 6 or 3 wavelengths from 1185 to 1235 nm with the absorption spectrum of cholesterol and peri-adventitial tissue, we could detect and differentiate the lipids in the atherosclerotic plaque and peri-adventitial lipids, respectively. With two wavelengths, both plaque and peri-adventitial lipids were detected but could not be distinguished.
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31
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Obaid DR, Calvert PA, Gopalan D, Parker RA, Hoole SP, West NEJ, Goddard M, Rudd JHF, Bennett MR. Atherosclerotic plaque composition and classification identified by coronary computed tomography: assessment of computed tomography-generated plaque maps compared with virtual histology intravascular ultrasound and histology. Circ Cardiovasc Imaging 2013; 6:655-64. [PMID: 23960215 DOI: 10.1161/circimaging.112.000250] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Computed tomography (CT) is used routinely for coronary angiography, and higher-risk features of plaques can also be identified. However, the ability of CT to discriminate individual plaque components and classify plaques according to accepted histological definitions is unknown. METHODS AND RESULTS We first determined CT attenuation ranges for individual plaque components using combined in vivo CT coregistered with virtual histology intravascular ultrasound (VH-IVUS) in 108 plaques from 57 patients. Comparison with contrast attenuation created plaque/contrast attenuation ratios that were significantly different for each component. In a separate validation cohort of 47 patients, these Plaque Maps correlated significantly with VH-IVUS-determined plaque component volumes (necrotic core: r=0.41, P=0.002; fibrous plaque: r=0.54, P<0.001; calcified plaque: r=0.59, P<0.001; total plaque: r=0.62, P<0.001). We also assessed VH-IVUS and CT Plaque Maps against coregistered histology in 72 (VH-IVUS) and 87 (CT) segments from 8 postmortem coronary arteries. The diagnostic accuracy of CT to detect calcified plaque (83% versus 92%), necrotic core (80% versus 65%), and fibroatheroma (80% versus 79%) was comparable with VH-IVUS. However, although VH-IVUS could identify thin-cap fibroatheromas (TCFA) with a diagnostic accuracy of between 74% and 82% (depending on the TCFA definition used), the spatial resolution of CT prevented direct identification of TCFA. CONCLUSIONS CT-derived Plaque Maps based on contrast-adjusted attenuation ranges can define individual plaque components with a similar accuracy to VH-IVUS ex vivo. However, coronary CT Plaque Maps could not reliably classify plaques and identify TCFA, such that high-risk plaques may be misclassified or overlooked.
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Affiliation(s)
- Daniel R Obaid
- Division of Cardiovascular Medicine, and Centre for Applied Medical Statistics, University of Cambridge, Cambridge, United Kingdom; and Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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Flamini V, Kerskens C, Simms C, Lally C. Fibre orientation of fresh and frozen porcine aorta determined non-invasively using diffusion tensor imaging. Med Eng Phys 2013; 35:765-76. [DOI: 10.1016/j.medengphy.2012.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 08/07/2012] [Accepted: 08/10/2012] [Indexed: 11/16/2022]
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Kwan AC, Cater G, Vargas J, Bluemke DA. Beyond Coronary Stenosis: Coronary Computed Tomographic Angiography for the Assessment of Atherosclerotic Plaque Burden. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013; 6:89-101. [PMID: 23524381 PMCID: PMC3601491 DOI: 10.1007/s12410-012-9183-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronary computed tomographic angiography (CCTA) is emerging as a key non-invasive method for assessing cardiovascular risk by measurement of coronary stenosis and coronary artery calcium (CAC). New advancements in CCTA technology have led to the ability to directly identify and quantify the so-called "vulnerable" plaques that have features of positive remodeling and low density components. In addition, CCTA presents a new opportunity for noninvasive measurement of total coronary plaque burden that has not previously been available. The use of CCTA needs also to be balanced by its risks and, in particular, the associated radiation exposure. We review current uses of CCTA, CCTA's ability to measure plaque quantity and characteristics, and new developments in risk stratification and CCTA technology. CCTA represents a quickly developing field that will play a growing role in the non-invasive management of cardiovascular disease.
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Affiliation(s)
- Alan C Kwan
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
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Lee CS, Seo YH, Yang DJ, Kim KH, Park HW, Yuk HB, Lee MS, Kim WH, Kwon TG, Bae JH. Positive Vascular Remodeling in Culprit Coronary Lesion is Associated With Plaque Composition: An Intravascular Ultrasound-Virtual Histology Study. Korean Circ J 2012; 42:747-52. [PMID: 23236326 PMCID: PMC3518708 DOI: 10.4070/kcj.2012.42.11.747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/03/2012] [Accepted: 06/04/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between the positive remodeling (PR) of a coronary artery and plaque composition has been studied only in a relatively small number of study population or non-culprit lesion. We evaluated the association between coronary plaque composition and coronary artery remodeling in a relatively large number of culprit lesions. SUBJECTS AND METHODS The study population consisted of 325 consecutive patients with coronary artery disease that underwent intravascular ultrasound-virtual histology examination in a culprit lesion. The remodeling index (RI) was calculated as the lesion external elastic membrane (EEM) area divided by the average reference EEM area. RESULTS The lesions with PR (RI>1.05, n=97, mean RI=1.19±0.12) had a higher fibrous volume/lesion length (3.85±2.12 mm(3)/mm vs. 3.04±1.79 mm(3)/mm, p=0.003) and necrotic core volume/lesion length (1.26±0.89 mm(3)/mm vs. 0.90±0.66 mm(3)/mm, p=0.001) than those with negative remodeling (NR) (RI<0.95, n=132, mean RI=0.82±0.09). At the minimal luminal area site, the lesions with PR had a higher fibrous area (5.81±3.17 mm(2) vs. 3.61±2.30 mm(2), p<0.001), dense calcified area (0.73±0.69 mm(2) vs. 0.46±0.43 mm(2), p=0.001), and necrotic core area (1.93±1.33 mm(2) vs. 1.06±0.91 mm(2), p<0.001) than those with NR. RI showed significant positive correlation with fibrous volume/lesion length (r=0.173, p=0.002), necrotic core volume/lesion length (r=0.188, p=0.001), fibrous area (r=0.347, p<0.001), fibrofatty area (r=0.111, p=0.036), dense calcified area (r=0.239, p<0.001), and necrotic core area (r=0.334, p<0.001). Multivariate analysis showed that the independent factor for PR was the necrotic core volume/lesion length (beta=0.130, 95% confidence interval; 0.002-0.056, p=0.037) over the entire lesion. CONCLUSION This study suggests that PR in a culprit lesion is associated with the necrotic core volume in the entire lesion, which is a characteristic of vulnerable plaque.
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Affiliation(s)
- Chung Seop Lee
- Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea
| | - Young Hoon Seo
- Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea
| | - Dong Ju Yang
- Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea
| | - Ki Hong Kim
- Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea
| | - Hyun Woong Park
- Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea
| | - Hyung Bin Yuk
- Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea
| | - Moo-Sik Lee
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Wan-Ho Kim
- Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea
| | - Taek-Geun Kwon
- Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea
| | - Jang-Ho Bae
- Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea
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Rosenthal A, Jaffer FA, Ntziachristos V. Intravascular multispectral optoacoustic tomography of atherosclerosis: prospects and challenges. IMAGING IN MEDICINE 2012; 4:299-310. [PMID: 23144663 PMCID: PMC3493570 DOI: 10.2217/iim.12.20] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The progression of atherosclerosis involves complex changes in the structure, composition and biology of the artery wall. Currently, only anatomical plaque burden is routinely characterized in living patients, whereas compositional and biological changes are mostly inaccessible. However, anatomical imaging alone has proven to be insufficient for accurate diagnostics of the disease. Multispectral optoacoustic tomography offers complementary data to anatomical methods and is capable of imaging both tissue composition and, via the use of molecular markers, the biological activity therein. In this paper we review recent progress in multispectral optoacoustic tomography imaging of atherosclerosis with specific emphasis on intravascular applications. The potential capabilities of multispectral optoacoustic tomography are compared with those of established intravascular imaging techniques and current challenges on the road towards a clinically viable imaging modality are discussed.
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Affiliation(s)
- Amir Rosenthal
- Institute for Biological & Medical Imaging, Helmholtz Zentrum München & Technische Universität München, Munich, Germany
| | - Farouc A Jaffer
- Cardiovascular Research Center & Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vasilis Ntziachristos
- Institute for Biological & Medical Imaging, Helmholtz Zentrum München & Technische Universität München, Munich, Germany
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Fuster JJ, Castillo AI, Zaragoza C, Ibáñez B, Andrés V. Animal models of atherosclerosis. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2012; 105:1-23. [PMID: 22137427 DOI: 10.1016/b978-0-12-394596-9.00001-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cardiovascular disease is currently the predominant cause of mortality worldwide and its incidence is expected to increase significantly during the next decades owing to the unhealthy effects of modern lifestyle habits (e.g., obesity and lack of physical exercise). Cardiovascular death is frequently associated with acute myocardial infarction or stroke, which are generally the ultimate consequence of an underlying atherosclerotic process. Small and big animal models are valuable tools to understand the molecular mechanisms underlying atherosclerotic plaque formation and progression, as well as the occurrence of associated ischemic events. Moreover, animal models of atherosclerosis are pivotal for testing mechanistic hypothesis and for translational research, including the assessment of dietary and/or pharmacological interventions and the development of imaging technologies and interventional devices. In this chapter, we will describe the most widely used animal models that have permitted major advances in atherosclerosis research and significant improvements in the treatment and diagnosis of atherosclerotic disease.
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Affiliation(s)
- José J Fuster
- Department of Epidemiology, Atherothrombosis and Imaging, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Araki T, Nakamura M, Utsunomiya M, Sugi K. Visualization of coronary plaque in type 2 diabetes mellitus patients using a new 40 MHz intravascular ultrasound imaging system. J Cardiol 2011; 59:42-9. [PMID: 21890326 DOI: 10.1016/j.jjcc.2011.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 07/11/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Previous epidemiological studies demonstrated plaque vulnerability to be high in diabetic patients. iMap-intravascular ultrasound (IVUS) is a recently developed radiofrequency 40 MHz IVUS imaging system for tissue characterization. This study aimed to characterize coronary plaque in target lesions of diabetic patients using iMap-IVUS. METHODS We studied 175 treated vessels in 146 patients with stable angina pectoris and analyzed plaque components of culprit lesions by iMAP-IVUS. Patients were divided into 2 groups: non-diabetic (non-DM: 112 vessels, 93 patients) and diabetic (DM: 63 vessels, 53 patients). RESULTS In gray-scale IVUS 2D analysis, there were no differences in IVUS parameters. In 3D analysis, the DM group tended to have a larger plaque volume (p=0.07) and plaque burden (p=0.10). At minimum lumen sites, the absolute lipidic and necrotic areas (0.84 ± 0.44 mm(2) vs. 0.58 ± 0.41 mm(2), p<0.001, and 2.42 ± 1.65 mm(2) vs. 1.46 ± 1.76 mm(2), p<0.001, respectively) and percent lipidic and necrotic areas were significantly greater in the DM than in the non-DM group (8.39 ± 3.38% vs. 5.25 ± 2.30%, p<0.0001, and 23.65 ± 11.54% vs. 12.99 ± 10.71%, p<0.0001, respectively). In addition, the absolute lipidic and necrotic volumes (11.75 ± 10.59 mm(3) vs. 8.18 ± 6.24 mm(3), p<0.01, and 29.99 ± 28.90 mm(3) vs. 19.44 ± 19.35 mm(3), p<0.01, respectively) and percent lipidic and necrotic volumes were significantly greater in the DM than in the non-DM group (6.27 ± 1.92% vs. 5.13 ± 1.82%, p<0.0001, and 16.54 ± 7.56% vs. 12.08 ± 6.05%, p<0.0001, respectively). CONCLUSION Characterization of coronary plaque by iMAP-IVUS in diabetic patients showed increased lipidic amount and necrotic plaque volume relative to subjects without DM.
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Affiliation(s)
- Tadashi Araki
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515, Japan
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Brugaletta S, Garcia-Garcia HM, Serruys PW, de Boer S, Ligthart J, Gomez-Lara J, Witberg K, Diletti R, Wykrzykowska J, van Geuns RJ, Schultz C, Regar E, Duckers HJ, van Mieghem N, de Jaegere P, Madden SP, Muller JE, van der Steen AF, van der Giessen WJ, Boersma E. NIRS and IVUS for Characterization of Atherosclerosis in Patients Undergoing Coronary Angiography. JACC Cardiovasc Imaging 2011; 4:647-55. [DOI: 10.1016/j.jcmg.2011.03.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 03/07/2011] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
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Garcìa-Garcìa HM, Gogas BD, Serruys PW, Bruining N. IVUS-based imaging modalities for tissue characterization: similarities and differences. Int J Cardiovasc Imaging 2011; 27:215-24. [PMID: 21327914 PMCID: PMC3078312 DOI: 10.1007/s10554-010-9789-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 12/30/2010] [Indexed: 01/08/2023]
Abstract
Gray-scale intravascular ultrasound (IVUS) is the modality that has been established as the golden standard for in vivo imaging of the vessel wall of the coronary arteries. The use of IVUS in clinical practice is an important diagnostic tool used for quantitative assessment of coronary artery disease. This has made IVUS the de-facto invasive imaging method to evaluate new interventional therapies such as new stent designs and for atherosclerosis progression-regression studies. However, the gray-scale representation of the coronary vessel wall and plaque morphology in combination with the limited resolution of the current IVUS catheters makes it difficult, if not impossible, to identify qualitatively (e.g. visually) the plaque morphology similar as that of histopathology, the golden standard to characterize and quantify coronary plaque tissue components. Meanwhile, this limitation has been partially overcome by new innovative IVUS-based post-processing methods such as: virtual histology IVUS (VH-IVUS, Volcano Therapeutics, Rancho Cordova, CA, USA), iMAP-IVUS (Bostoc Scientific, Santa Clara, CA, USA), Integrated Backscatter IVUS (IB-IVUS) and Automated Differential Echogenicity (ADE).
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Affiliation(s)
- Hector M Garcìa-Garcìa
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Room BA-571, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Layland J, Wilson AM, Lim I, Whitbourn RJ. Virtual histology: a window to the heart of atherosclerosis. Heart Lung Circ 2011; 20:615-21. [PMID: 21276753 DOI: 10.1016/j.hlc.2010.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Intravascular ultrasound has done much to improve our understanding of atherosclerosis and the impact of percutaneous intervention on the coronary artery. However, subjectivity in interpreting the acoustic reflection of the ultrasound signal has spawned the development of other progressive technologies. Virtual histology intravascular ultrasound (VHIVUS) utilises the ultrasound backscatter signal in order to colour code plaque into four pre-specified subtypes based on their histological composition. We review the background behind traditional grey scale intravascular ultrasound (IVUS) and examine the current evidence for VHIVUS and its potential for use in clinical interventional practice.
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Affiliation(s)
- J Layland
- Cardiovascular Research Centre, St. Vincent's Hospital, Melbourne, Victoria, Australia.
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The representative porcine model for human cardiovascular disease. J Biomed Biotechnol 2010; 2011:195483. [PMID: 21253493 PMCID: PMC3022214 DOI: 10.1155/2011/195483] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 12/13/2010] [Indexed: 11/18/2022] Open
Abstract
To improve human health, scientific discoveries must be translated into practical applications. Inherent in the development of these technologies is the role of preclinical testing using animal models. Although significant insight into the molecular and cellular basis has come from small animal models, significant differences exist with regard to cardiovascular characteristics between these models and humans. Therefore, large animal models are essential to develop the discoveries from murine models into clinical therapies and interventions.
This paper will provide an overview of the more frequently used large animal models, especially porcine models for preclinical studies.
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Timaran CH, Rosero EB, Martinez AE, Ilarraza A, Modrall JG, Clagett GP. Atherosclerotic plaque composition assessed by virtual histology intravascular ultrasound and cerebral embolization after carotid stenting. J Vasc Surg 2010; 52:1188-94. [DOI: 10.1016/j.jvs.2010.05.101] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/24/2010] [Accepted: 05/25/2010] [Indexed: 10/19/2022]
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The pre-clinical animal model in the translational research of interventional cardiology. JACC Cardiovasc Interv 2010; 2:373-83. [PMID: 19463458 DOI: 10.1016/j.jcin.2009.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 02/19/2009] [Accepted: 03/08/2009] [Indexed: 11/23/2022]
Abstract
Scientific discoveries for improvement of human health must be translated into practical applications. Such discoveries typically begin at "the bench" with basic research, then progress to the clinical level. In particular, in the field of interventional cardiology, percutaneous cardiovascular intervention has rapidly evolved from an experimental procedure to a therapeutic clinical setting. Pre-clinical studies using animal models play a very important role in the evaluation of efficacy and safety of new medical devices before their use in human clinical studies. This review provides an overview of the emerging role, results of pre-clinical studies and development, and evaluation of animal models for percutaneous cardiovascular intervention technologies for patients with symptomatic cardiovascular disease.
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Garcia-Garcia HM, Costa MA, Serruys PW. Imaging of coronary atherosclerosis: intravascular ultrasound. Eur Heart J 2010; 31:2456-69. [DOI: 10.1093/eurheartj/ehq280] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Thim T, Hagensen MK, Wallace-Bradley D, Granada JF, Kaluza GL, Drouet L, Paaske WP, Bøtker HE, Falk E. Unreliable Assessment of Necrotic Core by Virtual Histology Intravascular Ultrasound in Porcine Coronary Artery Disease. Circ Cardiovasc Imaging 2010; 3:384-91. [PMID: 20460496 DOI: 10.1161/circimaging.109.919357] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Troels Thim
- From The Atherosclerosis Research Unit (T.T., M.K.H., E.F.), Department of Cardiology, Aarhus University Hospital, Skejby and; Institute of Clinical Medicine, Aarhus University, Denmark; The Jack H. Skirball Center for Cardiovascular Research (T.T., D.W.-B., J.F.G., G.L.K.), Cardiovascular Research Foundation, New York, NY; Institut des Vaisseaux et du Sang (L.D.), Paris, France; and the Departments of Cardiothoracic and Vascular Surgery (W.P.P.), and Cardiology (H.E.B.), Aarhus University Hospital
| | - Mette Kallestrup Hagensen
- From The Atherosclerosis Research Unit (T.T., M.K.H., E.F.), Department of Cardiology, Aarhus University Hospital, Skejby and; Institute of Clinical Medicine, Aarhus University, Denmark; The Jack H. Skirball Center for Cardiovascular Research (T.T., D.W.-B., J.F.G., G.L.K.), Cardiovascular Research Foundation, New York, NY; Institut des Vaisseaux et du Sang (L.D.), Paris, France; and the Departments of Cardiothoracic and Vascular Surgery (W.P.P.), and Cardiology (H.E.B.), Aarhus University Hospital
| | - David Wallace-Bradley
- From The Atherosclerosis Research Unit (T.T., M.K.H., E.F.), Department of Cardiology, Aarhus University Hospital, Skejby and; Institute of Clinical Medicine, Aarhus University, Denmark; The Jack H. Skirball Center for Cardiovascular Research (T.T., D.W.-B., J.F.G., G.L.K.), Cardiovascular Research Foundation, New York, NY; Institut des Vaisseaux et du Sang (L.D.), Paris, France; and the Departments of Cardiothoracic and Vascular Surgery (W.P.P.), and Cardiology (H.E.B.), Aarhus University Hospital
| | - Juan F. Granada
- From The Atherosclerosis Research Unit (T.T., M.K.H., E.F.), Department of Cardiology, Aarhus University Hospital, Skejby and; Institute of Clinical Medicine, Aarhus University, Denmark; The Jack H. Skirball Center for Cardiovascular Research (T.T., D.W.-B., J.F.G., G.L.K.), Cardiovascular Research Foundation, New York, NY; Institut des Vaisseaux et du Sang (L.D.), Paris, France; and the Departments of Cardiothoracic and Vascular Surgery (W.P.P.), and Cardiology (H.E.B.), Aarhus University Hospital
| | - Greg L. Kaluza
- From The Atherosclerosis Research Unit (T.T., M.K.H., E.F.), Department of Cardiology, Aarhus University Hospital, Skejby and; Institute of Clinical Medicine, Aarhus University, Denmark; The Jack H. Skirball Center for Cardiovascular Research (T.T., D.W.-B., J.F.G., G.L.K.), Cardiovascular Research Foundation, New York, NY; Institut des Vaisseaux et du Sang (L.D.), Paris, France; and the Departments of Cardiothoracic and Vascular Surgery (W.P.P.), and Cardiology (H.E.B.), Aarhus University Hospital
| | - Ludovic Drouet
- From The Atherosclerosis Research Unit (T.T., M.K.H., E.F.), Department of Cardiology, Aarhus University Hospital, Skejby and; Institute of Clinical Medicine, Aarhus University, Denmark; The Jack H. Skirball Center for Cardiovascular Research (T.T., D.W.-B., J.F.G., G.L.K.), Cardiovascular Research Foundation, New York, NY; Institut des Vaisseaux et du Sang (L.D.), Paris, France; and the Departments of Cardiothoracic and Vascular Surgery (W.P.P.), and Cardiology (H.E.B.), Aarhus University Hospital
| | - William P. Paaske
- From The Atherosclerosis Research Unit (T.T., M.K.H., E.F.), Department of Cardiology, Aarhus University Hospital, Skejby and; Institute of Clinical Medicine, Aarhus University, Denmark; The Jack H. Skirball Center for Cardiovascular Research (T.T., D.W.-B., J.F.G., G.L.K.), Cardiovascular Research Foundation, New York, NY; Institut des Vaisseaux et du Sang (L.D.), Paris, France; and the Departments of Cardiothoracic and Vascular Surgery (W.P.P.), and Cardiology (H.E.B.), Aarhus University Hospital
| | - Hans Erik Bøtker
- From The Atherosclerosis Research Unit (T.T., M.K.H., E.F.), Department of Cardiology, Aarhus University Hospital, Skejby and; Institute of Clinical Medicine, Aarhus University, Denmark; The Jack H. Skirball Center for Cardiovascular Research (T.T., D.W.-B., J.F.G., G.L.K.), Cardiovascular Research Foundation, New York, NY; Institut des Vaisseaux et du Sang (L.D.), Paris, France; and the Departments of Cardiothoracic and Vascular Surgery (W.P.P.), and Cardiology (H.E.B.), Aarhus University Hospital
| | - Erling Falk
- From The Atherosclerosis Research Unit (T.T., M.K.H., E.F.), Department of Cardiology, Aarhus University Hospital, Skejby and; Institute of Clinical Medicine, Aarhus University, Denmark; The Jack H. Skirball Center for Cardiovascular Research (T.T., D.W.-B., J.F.G., G.L.K.), Cardiovascular Research Foundation, New York, NY; Institut des Vaisseaux et du Sang (L.D.), Paris, France; and the Departments of Cardiothoracic and Vascular Surgery (W.P.P.), and Cardiology (H.E.B.), Aarhus University Hospital
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Goderie TPM, van Soest G, Garcia-Garcia HM, Gonzalo N, Koljenović S, van Leenders GJLH, Mastik F, Regar E, Oosterhuis JW, Serruys PW, van der Steen AFW. Combined optical coherence tomography and intravascular ultrasound radio frequency data analysis for plaque characterization. Classification accuracy of human coronary plaques in vitro. Int J Cardiovasc Imaging 2010; 26:843-50. [PMID: 20396951 PMCID: PMC2991172 DOI: 10.1007/s10554-010-9631-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 04/05/2010] [Indexed: 11/26/2022]
Abstract
This study was performed to characterize coronary plaque types by optical coherence tomography (OCT) and intravascular ultrasound (IVUS) radiofrequency (RF) data analysis, and to investigate the possibility of error reduction by combining these techniques. Intracoronary imaging methods have greatly enhanced the diagnostic capabilities for the detection of high-risk atherosclerotic plaques. IVUS RF data analysis and OCT are two techniques focusing on plaque morphology and composition. Regions of interest were selected and imaged with OCT and IVUS in 50 sections, from 14 human coronary arteries, sectioned post-mortem from 14 hearts of patients dying of non-cardiovascular causes. Plaques were classified based on IVUS RF data analysis (VH-IVUSTM), OCT and the combination of those. Histology was the benchmark. Imaging with both modalities and coregistered histology was successful in 36 sections. OCT correctly classified 24; VH-IVUS 25, and VH-IVUS/OCT combined, 27 out of 36 cross-sections. Systematic misclassifications in OCT were intimal thickening classified as fibroatheroma in 8 cross-sections. Misclassifications in VH-IVUS were mainly fibroatheroma as intimal thickening in 5 cross-sections. Typical image artifacts were found to affect the interpretation of OCT data, misclassifying intimal thickening as fibroatheroma or thin-cap fibroatheroma. Adding VH-IVUS to OCT reduced the error rate in this study.
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Affiliation(s)
- T. P. M. Goderie
- Thorax Center Biomedical Engineering, Erasmus MC Rotterdam, Ee23.02, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - G. van Soest
- Thorax Center Biomedical Engineering, Erasmus MC Rotterdam, Ee23.02, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - H. M. Garcia-Garcia
- Thorax Center Biomedical Engineering, Erasmus MC Rotterdam, Ee23.02, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - N. Gonzalo
- Thorax Center Biomedical Engineering, Erasmus MC Rotterdam, Ee23.02, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - S. Koljenović
- Department of Pathology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | | | - F. Mastik
- Thorax Center Biomedical Engineering, Erasmus MC Rotterdam, Ee23.02, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - E. Regar
- Thorax Center Biomedical Engineering, Erasmus MC Rotterdam, Ee23.02, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - J. W. Oosterhuis
- Department of Pathology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - P. W. Serruys
- Thorax Center Biomedical Engineering, Erasmus MC Rotterdam, Ee23.02, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - A. F. W. van der Steen
- Thorax Center Biomedical Engineering, Erasmus MC Rotterdam, Ee23.02, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
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48
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Schinkel AFL, Krueger CG, Tellez A, Granada JF, Reed JD, Hall A, Zang W, Owens C, Kaluza GL, Staub D, Coll B, ten Cate FJ, Feinstein SB. Contrast-enhanced ultrasound for imaging vasa vasorum: comparison with histopathology in a swine model of atherosclerosis. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:659-64. [DOI: 10.1093/ejechocard/jeq048] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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49
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Alviar C, Tellez A, Wallace-Bradley D, Lopez-Berestein G, Sanguino A, Schulz D, Builes A, Ballantyne C, Yang CY, Kaluza G, Granada J. Impact of adventitial neovascularisation on atherosclerotic plaque composition and vascular remodelling in a porcine model of coronary atherosclerosis. EUROINTERVENTION 2010. [DOI: 10.4244/eijv5i8a164] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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50
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Leigh Perkins LE. Preclinical Models of Restenosis and Their Application in the Evaluation of Drug-Eluting Stent Systems. Vet Pathol 2010; 47:58-76. [DOI: 10.1177/0300985809352978] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Coronary arterial disease (CAD) is the leading cause of death in the United States, the European Union, and Canada. Percutaneous coronary intervention (PCI) has revolutionized the treatment of CAD, and it is the advent of drug-eluting stent (DES) systems that has effectively allayed much of the challenge of restenosis that has plagued the success of PCI through its 30-year history. However, DES systems have not been a panacea: There yet remain the challenges associated with interventions involving bare metallic stents as well as newly arisen concerns related to the application of DES systems. To effectively address these novel and ongoing issues, animal models are relied on both to project the safety and efficacy of endovascular devices and to provide insight into the pathophysiology underlying the vascular response to injury and mechanisms of restenosis. In this review, preclinical models of restenosis are presented, and their application and limitation in the evaluation of device-based interventional technologies for the treatment of CAD are discussed.
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