scholarly journals High frequency optical coherence tomography assessment of homogenous neck coverage by intrasaccular devices predicts successful aneurysm occlusion

2019 ◽  
Vol 11 (11) ◽  
pp. 1150-1154 ◽  
Author(s):  
Robert M King ◽  
Miklos Marosfoi ◽  
Jildaz Caroff ◽  
Giovanni J Ughi ◽  
Dale M Groth ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
High Frequency ◽  
Thrombus Formation ◽  
Optical Coherence ◽  
Aneurysm Neck ◽  
Coverage Gap ◽  
Aneurysm Embolization ◽  
Aneurysm Occlusion ◽  
Automated Image Processing

BackgroundHigh frequency optical coherence tomography (HF-OCT) is a novel intravascular imaging technology developed for use in the cerebral vasculature. We hypothesize that HF-OCT characterization of intrasaccular device neck coverage can prognosticate exclusion of the aneurysm from the circulation.MethodsBifurcation and sidewall aneurysms were made in six dogs. Seven aneurysms were treated with next generation intrasaccular devices (NGID) and four with traditional platinum coils. HF-OCT was performed to interrogate gaps in the neck coverage, coil herniation, or acute thrombus formation. Animals were re-imaged at 7, 30, 90, and 180 days following aneurysm embolization. An automated image processing method segmented the devices at the neck of the aneurysm and quantified neck coverage. The largest coverage gap was used to predict aneurysm occlusion at 180 days.ResultsNo difference was found in occlusion rates between the coil and NGID groups (P=0.45). Successful segmentation of the NGID construct was achieved in all cases. A coverage gap >1 mm2 was found to predict failed aneurysm occlusion (P=0.047). This threshold was able to predict all cases of failed occlusion. The average number of devices needed to treat the aneurysm was lower in the NGID group (1.9 vs 6.75, P=0.009). HF-OCT showed strong agreement with scanning electron microscopy (bias 0.0024 mm2 (95% CI −0.0279, 0.0327)).ConclusionsHF-OCT enables precise and accurate measurement of coverage gaps at the neck of aneurysms treated with intrasaccular devices in vivo. We provide in vivo evidence that uniform aneurysm neck coverage by intrasaccular devices is critical for aneurysm occlusion.

Abstract WP1: High-Frequency Optical Coherence Tomography for Cerebrovascular Disease

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ajit S Puri ◽  
Giovanni Ughi ◽  
Robert M King ◽  
Matthew Gounis
Keyword(s):  
Optical Coherence Tomography ◽  
Cerebrovascular Disease ◽  
High Frequency ◽  
Ex Vivo ◽  
Thrombus Formation ◽  
Image Resolution ◽  
Patient Specific ◽  
Optical Coherence

Introduction: Optical coherence tomography (OCT) has played an important role in the diagnosis and treatment guidance in coronary artery disease. However, existing OCT systems are not suitable for routine neurovascular applications due to the size and tortuosity of the arteries. Hypothesis: We seek to demonstrate a prototype high-frequency OCT (HF-OCT) capable of high-resolution imaging in simulated cerebrovascular anatomy. Methods: A low-profile HF-OCT system was constructed with an image resolution approaching 10μm. Using an in vitro, patient-specific model of the circle of Willis with circulating porcine blood, we characterized the delivery of the device and ability to image in a tortuous path. Also, human cadaver intracranial atherosclerosis plaques were imaged with HF-OCT and assessed by an expert imager. Finally, neurovascular devices were implanted in 8 pigs (Fig 1) and HF-OCT imaging was compared with gold-standard DSA and CT. Results: In the phantom, optimal blood clearance was achieved through an intermediate catheter (5 Fr Navien) with infusion of contrast at 5 ml/s in the internal carotid and basilar artery, and 3 ml/sec in the MCA. The in vivo study demonstrated that both malapposition of devices or thrombus formation along the device surface could be reliably diagnosed among 3 reviewers (Fleiss’s kappa of 0.87 and 0.9, respectively). This agreement was superior to DSA and CT. Imaging in tortuous swine brachial showed in all cases imaging free of artifacts, uniform illumination and ability to visualize vessel wall layers. Plaque types including ‘lipid pools’, fibrotic, and calcific tissue from cadaver specimens of ICAD could be adequately depicted by HF-OCT. Conclusion: In vitro, in vivo and ex vivo characterization of a novel HF-OCT device has shown it is capable of imaging in the tortuous intracranial vascular anatomy. This technology has to potential to aid in the diagnosis of cerebrovascular disease and guide optimal endovascular treatment.

High-resolution image-guided WEB aneurysm embolization by high-frequency optical coherence tomography

2020 ◽  
pp. neurintsurg-2020-016447
Author(s):  
Zeynep Vardar ◽  
Robert M King ◽  
Afif Kraitem ◽  
Erin T Langan ◽  
Lindsy M Peterson ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Significant Relationship ◽  
High Frequency ◽  
Positive Outcome ◽  
Optical Coherence ◽  
Aneurysm Embolization ◽  
Aneurysm Occlusion ◽  
Neointimal Coverage ◽  
Woven Endobridge ◽  
Web Device

BackgroundHigh-frequency optical coherence tomography (HF-OCT) is an intra-vascular imaging technique capable of assessing device-vessel interactions at spatial resolution approaching 10 µm. We tested the hypothesis that adequately deployed Woven EndoBridge (WEB) devices as visualized by HF-OCT lead to higher aneurysm occlusion rates.MethodsIn a leporine model, elastase-induced aneurysms (n=24) were treated with the WEB device. HF-OCT and digital subtraction angiography (DSA) were performed following WEB deployment and repeated at 4, 8, and 12 weeks. Protrusion (0-present, 1-absent) and malapposition (0-malapposed, 1-neck apposition >50%) were binary coded. A device was considered ‘adequately deployed’ by HF-OCT and DSA if apposed and non-protruding. Aneurysm healing on DSA was reported using the 4-point WEB occlusion score: A or B grades were considered positive outcome. Neointimal coverage was quantified on HF-OCT images at 12 weeks and compared with scanning electron microscopy (SEM).ResultsAdequate deployment on HF-OCT correlated with positive outcome (P=0.007), but no statistically significant relationship was found between good outcome and adequate deployment on DSA (P=0.289). Absence of protrusion on HF-OCT correlated with a positive outcome (P=0.006); however, malapposition alone had no significant relationship (P=0.19). HF-OCT showed a strong correlation with SEM for the assessment of areas of neointimal tissue (R²=0.96; P<0.001). More neointimal coverage of 78%±32% was found on ‘adequate deployment’ cases versus 31%±24% for the ‘inadequate deployment’ cases (P=0.001).ConclusionHF-OCT visualizes features that can determine adequate device deployment to prognosticate early aneurysm occlusion following WEB implantation and can be used to longitudinally monitor aneurysm healing progression.

scholarly journals Comparison of optical coherence tomography and high frequency ultrasound imaging in mice for the assessment of skin morphology and intradermal volumes

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kornelia Schuetzenberger ◽  
Martin Pfister ◽  
Alina Messner ◽  
Vanessa Froehlich ◽  
Gerhard Garhoefer ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
High Frequency ◽  
Ex Vivo ◽  
Clinical Settings ◽  
Optical Coherence ◽  
High Frequency Ultrasound ◽  
Skin Morphology ◽  
Frequency Ultrasound ◽  
Good Agreement

Abstract Optical coherence tomography (OCT) and high-frequency ultrasound (HFUS), two established imaging modalities in the field of dermatology, were evaluated and compared regarding their applicability for visualization of skin tissue morphology and quantification of murine intradermal structures. The accuracy and reproducibility of both methods were assessed ex vivo and in vivo using a standardized model for intradermal volumes based on injected soft tissue fillers. OCT revealed greater detail in skin morphology, allowing for detection of single layers due to the superior resolution. Volumetric data measured by OCT (7.9 ± 0.3 μl) and HFUS (7.7 ± 0.5 μl) were in good agreement and revealed a high accuracy when compared to the injected volume of 7.98 ± 0.8 µl. In vivo, OCT provided a higher precision (relative SD: 26% OCT vs. 42% HFUS) for the quantification of intradermal structures, whereas HFUS offered increased penetration depth enabling the visualization of deeper structures. A combination of both imaging technologies might be valuable for tumor assessments or other dermal pathologies in clinical settings.

scholarly journals O-029 Acute Thrombus Formation on Flow Diverters Imaged In Vivo Using Optical Coherence Tomography

2016 ◽  
Vol 8 (Suppl 1) ◽  
pp. A19.2-A20
Author(s):  
M Marosfoi ◽  
E Langan ◽  
S Vedantham ◽  
F Clarençon ◽  
R King ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Thrombus Formation ◽  
Optical Coherence ◽  
Flow Diverters

scholarly journals Focal Geometry and Characteristics of Erosion-Prone Coronary Plaques in vivo Angiography and Optical Coherence Tomography Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Muhua Cao ◽  
Tianyu Wu ◽  
Jiawei Zhao ◽  
Zhuo Du ◽  
Zhuozhong Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Optical Coherence Tomography ◽  
Thrombus Formation ◽  
Multivariable Analysis ◽  
Coronary Risk Factors ◽  
Coronary Ostium ◽  
Optical Coherence ◽  
Luminal Narrowing ◽  
Minimal Lumen Area

Objective: This study compared focal geometry and characteristics of culprit plaque erosion (PE) vs. non-culprit plaques in ST-segment elevated myocardial infarction (STEMI) patients in whom optical coherence tomography (OCT) identified PE as the cause of the acute event.Background: Culprit PE is a distinct clinical entity with specific coronary risk factors and its own tailored management strategy. However, not all plaques develop erosion resulting in occlusive thrombus formation.Methods: Between January 2017 and July 2019, there were 484 STEMI patients in whom OCT at the time of primary percutaneous intervention identified culprit lesion PE to be the cause of the event; 484 culprit PE were compared to 1,132 non-culprit plaques within 1,196 imaged vessels.Results: Culprit PE were highly populated at “hot spots” within the proximal 40 mm in the left anterior descending artery (LAD) and tended to cluster proximal to a nearby bifurcation mainly in the LAD. Minimal lumen area (MLA) &lt;2.51 mm2 and AS (area stenosis) &gt;64.02% discriminated culprit PE from non-culprit plaques. In the multivariable analysis, focal geometry (LAD location, distance from coronary ostium &lt;40 mm, and location proximal to a nearby bifurcation), luminal narrowing (MLA &lt;2.51 mm2, AS &gt; 64.02%), and TCFA phenotype were independent predictors of culprit PE overall. Cholesterol crystals were predictive of culprit PE with underlying LRP morphology while the absence of calcification and microchannels were risk factors for culprit PE with an underlying non-LRP. Similarities and differences in predictors of culprit PE were found between males and females; distance from coronary ostium &lt;40 mm, MLA &lt;2.51 mm2, TCFA, and less spotty calcium were risk factors of culprit PE in males, but not in females while smaller RVD was associated with culprit PE only in females.Conclusions: Irrespective of underlying lesion substrates and patient risk factors, there are lesion-specific and OCT-identifiable predictors of developing culprit PE in erosion-prone vulnerable patients.

scholarly journals Longitudinal Monitoring of Flow-Diverting Stent Tissue Coverage After Implant in a Bifurcation Model Using Neurovascular High-Frequency Optical Coherence Tomography

Neurosurgery ◽  
2020 ◽  
Author(s):  
Jildaz Caroff ◽  
Robert M King ◽  
Giovanni J Ughi ◽  
Miklos Marosfoi ◽  
Erin T Langan ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
High Frequency ◽  
Imaging Modality ◽  
Rabbit Model ◽  
Flow Diverter ◽  
Tissue Growth ◽  
Data Sets ◽  
Optical Coherence ◽  
Cross Sectional

Abstract BACKGROUND Tissue growth over covered branches is a leading cause of delayed thrombotic complications after flow-diverter stenting (FDS). Due to insufficient resolution, no imaging modality is clinically available to monitor this phenomenon. OBJECTIVE To evaluate high-frequency optical coherence tomography (HF-OCT), a novel intravascular imaging modality designed for the cerebrovascular anatomy with a resolution approaching 10 microns, to monitor tissue growth over FDS in an arterial bifurcation model. METHODS FDS were deployed in a rabbit model (n = 6), covering the aortic bifurcation. The animals were divided in different groups, receiving dual antiplatelet therapy (DAPT) (n = 4), aspirin only (n = 1), and no treatment (n = 1). HF-OCT data were obtained in vivo at 3 different time points in each animal. For each cross-sectional image, metal and tissue coverage of the jailed ostium was quantified. Scanning electron microscopy images of harvested arteries were subsequently obtained. RESULTS Good quality HF-OCT data sets were successfully acquired at implant and follow-up. A median value of 41 (range 21-55) cross-sectional images were analyzed per ostium for each time point. Between 0 and 30 d after implant, HF-OCT analysis showed a significantly higher ostium coverage when DAPT was not given. After 30 d, similar growth rates were found in the DAPT and in the aspirin group. At 60 d, a coverage of 90% was reached in all groups. CONCLUSION HF-OCT enables an accurate visualization of tissue growth over time on FDS struts. The use of FDS in bifurcation locations may induce a drastic reduction of the jailed-branch ostium area.

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