Early constriction or expansion of the external elastic membrane area determines the late remodeling response and cumulative lumen loss in transplant vasculopathy: an intravascular ultrasound study with 4-year follow-up

Background: Although sirolimus-eluting stent (SES) has significantly reduced in-stent restenosis, insufficient neointimal coverage may result in adverse outcomes. Intravascular ultrasound (IVUS) guided percutaneous coronary intervention improves the patency of bare-metal stents at follow-up. IVUS guidance at the time of SES implantation may also optimize neointimal coverage following stenting. Methods: We evaluated 55 SES implanted lesions using both angioscopy and IVUS at follow-up (12±7 months). The lesions were divided into two groups: IVUS guided implantation (group I, n=40); angiography alone (group A, n=15). Neointimal coverage was classified into 4 grades by angioscopy: no coverage ( G0 ); struts bulged into the lumen, but were covered and still translucently visible ( G1 ); struts were visible, but not clear ( G2 ); and struts were embedded and invisible ( G3 ). Minimal stent area (MSA), external elastic membrane (EEM), lumen cross-sectional area (CSA) and plaque burden were measured by IVUS at follow up. Both proximal and distal references were used. Stent expansion was assessed by stent expansion index (SEI) = MSA/reference EEM CSA. Results: Lesion and procedural characteristics were similar between the groups both at stent implantation and at follow-up. Although the post-procedural quantitative angiographic data were not different between the groups, distribution of the angioscopic grades of neointimal coverage at follow-up were significantly different (group A = 1.0±0.5 grades versus group I = 1.5±0.6 grades, p=0.01). IVUS measurements at follow up showed larger plaque burden at the proximal reference sites (54±12% versus 46±9%, p=0.02) and smaller SEI (0.35±0.09 versus 0.46±0.10, p=0.001) in group A than in group I. Conclusions: IVUS guidance at the time of SES implantation may modify angioscopic grades of the neointimal coverage, possibly optimizing neointimal coverage and preventing thrombosis.

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Intravascular ultrasound

State of the Art Surgical Coronary Revascularization ◽

10.1093/med/9780198758785.003.0016 ◽

2021 ◽

pp. 60-63

Author(s):

Lorenz Räber

Keyword(s):

Coronary Artery ◽

Intravascular Ultrasound ◽

Coronary Intervention ◽

Elastic Membrane ◽

Arterial Grafts ◽

Anatomical Structures ◽

Percutaneous Coronary ◽

External Elastic Membrane ◽

Artery Disease ◽

Global And Local

Intravascular ultrasound represents the most established, well-validated, and widely used intracoronary imaging technology worldwide and was introduced approximately 25 years ago. Intravascular ultrasound enables the visualization of key anatomical structures of the coronary artery and saphenous or arterial grafts including the lumen, external elastic membrane, and adventitia and thereby provides the basis for the assessment of the degree of coronary artery stenosis, extent of atherosclerosis burden (i.e. global and local disease burden), and plaque composition. All this represents key information to plan and perform percutaneous coronary intervention procedures in native coronary artery disease or graft lesions and to estimate the risk for future cardiovascular events.

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Cellular rejection and rate of progression of transplant vasculopathy: a 3-year serial intravascular ultrasound study

The Journal of Heart and Lung Transplantation ◽

10.1016/s1053-2498(00)00249-7 ◽

2001 ◽

Vol 20 (4) ◽

pp. 393-398 ◽

Cited By ~ 48

Author(s):

Javier Jimenez ◽

Samir R Kapadia ◽

Mohamad H Yamani ◽

Luba Platt ◽

Robert E Hobbs ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Ultrasound Study ◽

Transplant Vasculopathy ◽

Rate Of Progression ◽

Cellular Rejection

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Circulating microRNA-21 as Stable Blood-Based Markers for Patients With ISR After PCI

The Heart Surgery Forum ◽

10.1532/hsf.3245 ◽

2020 ◽

Vol 23 (6) ◽

pp. E756-E762

Author(s):

Xiong Zhang ◽

Xiao-Ping Xiao ◽

Xu- Ai Ren ◽

Wei Xue

Keyword(s):

Coronary Intervention ◽

Elastic Membrane ◽

Circulating Microrna ◽

Membrane Area ◽

Real Time Quantitative Pcr ◽

Stent Restenosis ◽

Plaque Area ◽

Minimal Lumen Area ◽

External Elastic Membrane ◽

Α Level

It recently has been reported that the in-stent restenosis (ISR) of expanded area after percutaneous coronary intervention (PCI) within six months can become a serious postoperative complication. A real-time quantitative PCR was used to analyze the expression of serum miR-21 in 33 ISR and 37 non-ISR patients after PCI. Expression of miR-21 was significantly higher in the ISR group compared with that in the NISR group, and a similar trend also occurred in factor- (TNF-α) level, Interleukin -6 (IL-6) level, and plaque area (PLA). However, a contrary trend occurred in the external elastic membrane area (EEM) and minimal lumen area (MLA). This study suggests that the increased expression of serum miR-21 is related to ISR after PCI, and miR-21 can be a new predictor of ISR.

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Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009452 ◽

2021 ◽

Vol 14 (3) ◽

Cited By ~ 1

Author(s):

Daniel Chamié ◽

J. Ribamar Costa ◽

Lucas P. Damiani ◽

Dimytri Siqueira ◽

Sérgio Braga ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Intravascular Ultrasound ◽

Elastic Membrane ◽

Complication Rates ◽

Percutaneous Coronary Interventions ◽

Optical Coherence ◽

Coronary Interventions ◽

Stent Expansion ◽

Percutaneous Coronary ◽

External Elastic Membrane

Background: Specific algorithms for use of optical coherence tomography (OCT) to guide percutaneous coronary intervention (PCI) are scarce. Also, the relative benefits of intravascular imaging guidance have not been tested against an optimized angiography-guided PCI strategy. In iSIGHT (Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions), we aimed to investigate whether OCT-guided PCI achieves noninferior stent expansion compared with intravascular ultrasound (IVUS) guidance and if both imaging modalities lead to superior stent expansion compared with an optimized angiography-based strategy. Methods: Patients ≥18 years old undergoing PCI for ≥1 lesion in native coronaries of 2.25 to 4.00 mm in diameter were randomized 1:1:1 to OCT-, IVUS-, or angiography-guided PCI. Predetermined guidance protocols were applied in all groups. An external elastic membrane–based protocol was used for stent sizing by OCT and IVUS. The primary end point was noninferiority of stent expansion (minimum stent area ≥90% of the average reference lumen area), measured by post-PCI OCT, in OCT-guided versus IVUS-guided PCI (noninferiority margin, 6.5%). Results: One hundred fifty-one patients (156 lesions) were randomly allocated to OCT (51 lesions [32.7%]), IVUS (52 lesions [33.3%]), or angiography (53 lesions [34.0%]). Stent expansion with OCT guidance (98.01±16.14%) was noninferior to IVUS (91.69±15.75%; 1-sided lower 95% CI, 0.55 mm 2 ; P non-inferiority <0.001) and superior to angiography (90.53±14.84%, P =0.041). IVUS and angiography obtained similar stent expansions ( P =0.921). Stent edge dissection and periprocedural complication rates were not significantly different among the groups. Conclusions: Stent expansion with OCT guidance using a dedicated external elastic membrane–based sizing strategy was noninferior to that achieved with IVUS and superior to an optimized angiographic strategy. Registration: URL: plataformabrasil.saude.gov.br ; Unique identifier: 69968417.8.0000.5462.

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Automatic Segmentation of Coronary Lumen and External Elastic Membrane in Intravascular Ultrasound Images Using 8-layer U-Net

10.21203/rs.3.rs-42239/v3 ◽

2020 ◽

Author(s):

Liang Dong ◽

Wei Lu ◽

Jun Jiang ◽

Ya Zhao ◽

Xiangfen Song ◽

...

Keyword(s):

Coronary Artery ◽

Intravascular Ultrasound ◽

Tissue Characterization ◽

Data Augmentation ◽

Automatic Segmentation ◽

Model Performance ◽

Single Frequency ◽

Elastic Membrane ◽

Ultrasound Images ◽

External Elastic Membrane

Abstract Background: Intravascular ultrasound (IVUS) is the golden standard in accessing the coronary lesions, stenosis, and atherosclerosis plaques. In this paper, a fully-automatic approach by an 8-layer U-Net is developed to segment the coronary artery lumen and the area bounded by external elastic membrane (EEM), i.e. cross section area (EEM-CSA). The database comprises of single-vendor and single-frequency IVUS data. Particularly, the proposed data augmentation of MeshGrid combined with flip and rotation operations is implemented, improving the model performance without pre- or post-processing of the raw IVUS images.Results: The mean intersection of union (mIoU) of 0.937 and 0.804 for the lumen and EEM-CSA respectively were achieved, which exceeded the manual labeling accuracy of the clinician.Conclusion: The accuracy shown by the proposed method is sufficient for subsequent reconstruction of 3D IVUS images, which is essential for doctors’ diagnosis in the tissue characterization of coronary artery walls and plaque compositions, qualitatively and quantitatively.

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Relation between baseline plaque burden and subsequent remodelling of atherosclerotic left main coronary arteries: a serial intravascular ultrasound study with long-term (>=12 months) follow-up

European Heart Journal ◽

10.1093/eurheartj/ehl034 ◽

2006 ◽

Vol 27 (15) ◽

pp. 1778-1784 ◽

Cited By ~ 17

Author(s):

M. Hartmann

Keyword(s):

Intravascular Ultrasound ◽

Coronary Arteries ◽

Plaque Burden ◽

Left Main ◽

Ultrasound Study

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Intimal hyperplasia thickness at follow-up is independent of stent size: A serial intravascular ultrasound study

The American Journal of Cardiology ◽

10.1016/s0002-9149(98)00603-1 ◽

1998 ◽

Vol 82 (10) ◽

pp. 1168-1172 ◽

Cited By ~ 47

Author(s):

Rainer Hoffmann ◽

Gary S. Mintz ◽

Augusto D. Pichard ◽

Kenneth M. Kent ◽

Lowell F. Satler ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Intimal Hyperplasia ◽

Ultrasound Study

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Automatic Segmentation of Coronary Lumen and External Elastic Membrane in Intravascular Ultrasound Images Using 8-layer U-Net

10.21203/rs.3.rs-42239/v5 ◽

2021 ◽

Author(s):

Liang Dong ◽

Wenbing Jiang ◽

Wei Lu ◽

Jun Jiang ◽

Ya Zhao ◽

...

Keyword(s):

Coronary Artery ◽

Intravascular Ultrasound ◽

Tissue Characterization ◽

Data Augmentation ◽

Automatic Segmentation ◽

Model Performance ◽

Single Frequency ◽

Elastic Membrane ◽

Ultrasound Images ◽

External Elastic Membrane

Abstract Background: Intravascular ultrasound (IVUS) is the golden standard in accessing the coronary lesions, stenosis, and atherosclerosis plaques. In this paper, a fully-automatic approach by an 8-layer U-Net is developed to segment the coronary artery lumen and the area bounded by external elastic membrane (EEM), i.e. cross section area (EEM-CSA). The database comprises of single-vendor and single-frequency IVUS data. Particularly, the proposed data augmentation of MeshGrid combined with flip and rotation operations is implemented, improving the model performance without pre- or post-processing of the raw IVUS images.Results: The mean intersection of union (MIoU) of 0.937 and 0.804 for the lumen and EEM-CSA respectively were achieved, which exceeded the manual labeling accuracy of the clinician. Conclusion: The accuracy shown by the proposed method is sufficient for subsequent reconstruction of 3D IVUS images, which is essential for doctors’ diagnosis in the tissue characterization of coronary artery walls and plaque compositions, qualitatively and quantitatively.

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Automatic Segmentation of Coronary Lumen and External Elastic Membrane in Intravascular Ultrasound Images Using 8-layer U-Net

10.21203/rs.3.rs-42239/v2 ◽

2020 ◽

Author(s):

Liang Dong ◽

Wei Lu ◽

Jun Jiang ◽

Ya Zhao ◽

Xiangfen Song ◽

...

Keyword(s):

Coronary Artery ◽

Intravascular Ultrasound ◽

Tissue Characterization ◽

Data Augmentation ◽

Automatic Segmentation ◽

Model Performance ◽

Single Frequency ◽

Elastic Membrane ◽

Ultrasound Images ◽

External Elastic Membrane

Abstract Background: Intravascular ultrasound (IVUS) is the golden standard in accessing the coronary lesions, stenosis, and atherosclerosis plaques. In this paper, a fully-automatic approach by an 8-layer U-Net is developed to segment the coronary artery lumen and the area bounded by external elastic membrane, i.e. EEM cross section area (EEM-CSA). The database comprises of single-vendor and single-frequency IVUS data. Particularly, the proposed data augmentation of MeshGrid combined with flip and rotation operations is implemented, improving the model performance without pre- or post-processing of the raw IVUS images.Results: The mean intersection of union (mIoU) of 0.941 and 0.750 for the lumen and EEM-CSA respectively were achieved, which exceeded the manual labeling accuracy of the clinician. Conclusion: The accuracy shown by the proposed method is sufficient for subsequent reconstruction of 3D IVUS images, which is essential for doctors’ diagnosis in the tissue characterization of coronary artery walls and plaque compositions, qualitatively and quantitatively.

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