TCT-359: Images of Human Coronary Atherosclerosis From a Hybrid Intravascular Ultrasound and Optical Coherence Tomography Catheter

This chapter discusses the progression from the use of angiography to identify and characterize coronary atherosclerosis to novel intracoronary imaging techniques, which has enabled a greater appreciation of plaque composition in the pathogenesis of coronary artery disease. With particular focus on intravascular ultrasound and optical coherence tomography, the chapter highlights the different strengths and weaknesses of each technique, and potential future developments.

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Intravascular ultrasound and optical coherence tomography imaging of coronary atherosclerosis

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-015-0701-3 ◽

2015 ◽

Vol 32 (1) ◽

pp. 189-200 ◽

Cited By ~ 12

Author(s):

Charis Costopoulos ◽

Adam J. Brown ◽

Zhongzhao Teng ◽

Stephen P. Hoole ◽

Nick E. J. West ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Intravascular Ultrasound ◽

Coronary Atherosclerosis ◽

Optical Coherence ◽

Tomography Imaging ◽

Optical Coherence Tomography Imaging

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Abstract 9601: Early Coronary Atherosclerotic Morphology in Pseudoxanthoma Elasticum: Images From Intravascular Ultrasound and Optical Coherence Tomography

Circulation ◽

10.1161/circ.130.suppl_2.9601 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Hayato Tada ◽

Masa-aki Kawashiri ◽

Akihiko Hodatsu ◽

Chiaki Nakanishi ◽

Tetsuo Konno ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Intravascular Ultrasound ◽

Coronary Atherosclerosis ◽

Early Stage ◽

Morphological Changes ◽

Systemic Disease ◽

Elastic Fiber ◽

Pseudoxanthoma Elasticum ◽

Optical Coherence ◽

Internal Elastic Lamina

Background: Pseudoxanthoma elasticum (PXE) is an inherited systemic disease of connective tissue primarily affecting the skin, retina, and cardiovascular system. It is characterized pathologically by fragmentation and calcification of elastic fiber. However, few data exist regarding the pathogenesis of the coronary atherosclerosis due to the rarity of this disease. The aim of the present study was to assess the early atherosclerotic morphology in PXE using intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Methods: We assessed detailed morphological changes of the coronary arterial wall by IVUS and OCT of the two PXE cases (73 yr male and 69 yr female), both of whom were without any evidence of coronary risk factor. Distal portion of the left anterior descending artery, that was not evident of plaques by angiography, was evaluated using commercially available IVUS system and OCT system. Results: Using IVUS modality, an additional high-gain layer without acoustic shadow, which was located in the intima-media complex, was detected. This additional layer represented several tissue characteristics including fibrosis, dense fibrosis, and calcification using integrated backscatter-IVUS. The OCT image revealed this abnormal layer as heterogeneous shaggy intima without thickness, suggesting the presence of calcified fragmented internal elastic lamina. Conclusions: We report the first IVUS and OCT findings in the coronary artery in patients with PXE. These images suggest that the unique morphology found in those subjects represent a preclinical, early stage of coronary atherosclerosis in PXE.

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Virtual histology intravascular ultrasound and optical coherence tomography in percutaneous coronary intervention

Oxford Textbook of Interventional Cardiology ◽

10.1093/med/9780199569083.003.011 ◽

2010 ◽

pp. 174-182

Author(s):

Ravinay Bhindi ◽

Keith M. Channon

Keyword(s):

Optical Coherence Tomography ◽

Intravascular Ultrasound ◽

Coronary Atherosclerosis ◽

Experimental Studies ◽

Coronary Plaque ◽

Optical Coherence ◽

Plaque Composition ◽

Virtual Histology ◽

Luminal Stenosis ◽

Artery Disease

The inadequacies of angiography to identify and characterize coronary atherosclerosis were not fully appreciated until pathologic studies revealed that coronary atherosclerosis in patients with fatal myocardial infarction was typically diffuse and in many cases was accompanied by positive remodelling, without luminal stenosis. Pathologic studies also identified the critical pathophysiogical role of plaque rupture in coronary thrombosis, and the appreciation that plaque biology and composition, rather than luminal stenosis alone, were more critical determinants of plaque behaviour. Clinical and experimental studies have shown that the vulnerable plaque, prone to rupture, is characterized by a large lipid core rich in inflammatory cells, a thin fibrous cap, and by positive remodelling. The development of novel intracoronary imaging techniques has enabled a greater appreciation of plaque composition in the pathogenesis of coronary artery disease in living patients. In particular, advances in intravascular ultrasound (IVUS) to provide ‘virtual histology’ of coronary plaque components, and optical coherence tomography (OCT) to define plaque composition in exquisite detail have provided new insights into the relationships between coronary plaque, the risk of clinical events, and the response of the vessel wall to percutaneous intervention.

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Hybrid intravascular ultrasound and optical coherence tomography catheter for imaging of coronary atherosclerosis

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.24295 ◽

2012 ◽

Vol 81 (3) ◽

pp. 494-507 ◽

Cited By ~ 47

Author(s):

Brian H. Li ◽

Annie S.O. Leung ◽

Alan Soong ◽

Chelsea E. Munding ◽

Hyunggyun Lee ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Intravascular Ultrasound ◽

Coronary Atherosclerosis ◽

Optical Coherence

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Choice of Intracoronary Imaging: When to Use Intravascular Ultrasound or Optical Coherence Tomography

Interventional Cardiology Review ◽

10.15420/icr.2016.11.01.11 ◽

2016 ◽

Vol 11 (1) ◽

pp. 11

Author(s):

Sudheer Koganti ◽

◽

Tushar Kotecha ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Coronary Angiography ◽

Intravascular Ultrasound ◽

Coronary Stenosis ◽

Coronary Intervention ◽

Vessel Diameter ◽

Drug Eluting Stent ◽

Optical Coherence ◽

Disease Extent ◽

Intracoronary Imaging

Intracoronary imaging has the capability of accurately measuring vessel and stenosis dimensions, assessing vessel integrity, characterising lesion morphology and guiding optimal percutaneous coronary intervention (PCI). Coronary angiography used to detect and assess coronary stenosis severity has limitations. The 2D nature of fluoroscopic imaging provides lumen profile only and the assessment of coronary stenosis by visual estimation is subjective and prone to error. Performing PCI based on coronary angiography alone is inadequate for determining key metrics of the vessel such as dimension, extent of disease, and plaque distribution and composition. The advent of intracoronary imaging has offset the limitations of angiography and has shifted the paradigm to allow a detailed, objective appreciation of disease extent and morphology, vessel diameter, stent size and deployment and healing after PCI. It has become an essential tool in complex PCI, including rotational atherectomy, in follow-up of novel drug-eluting stent platforms and understanding the pathophysiology of stent failure after PCI (e.g. following stent thrombosis or in-stent restenosis). In this review we look at the two currently available and commonly used intracoronary imaging tools – intravascular ultrasound and optical coherence tomography – and the merits of each.

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