Catheter-based Imaging Research Articles

107 Conventional Catheter-based Angiography Versus Non-invasive Imaging in the Evaluation of Symptomatic Carotid Disease

INTRODUCTION: The indication for invasive treatment of symptomatic carotid disease with CEA or carotid stenting was established based on catheter digitally subtracted imaging (DSA) however operative referral for symptomatic carotid disease is still largely based on non-invasive imaging such as CTA or ultrasound. METHODS: Retrospective analysis all consecutive patients who were referred for evaluation and treatment of symptomatic carotid disease after non-invasive imaging with CTA or ultrasound showed ipsilateral carotid stenosis of >50% or occlusion. Patients were included if they had ipsilateral cerebral or ocular ischemia within two weeks of index event. RESULTS: A total of 280 patients with stenosis >50 and <100% were included. Of those, 53 (19%) were found to have stenosis <50% leading to treatment with best medical therapy instead of intervention. Out of 50 patients with total occlusion, 16 (32%) were found to have a string sign and were treated with stenting. Percent stenosis of 80 or more on non-invasive imaging was more likely to correlate with stenosis of 50% or more on DSA. CONCLUSIONS: In a cohort of two large North American institutions, 19% of patients referred for revascularization of symptomatic carotid disease based on non-invasive imaging were found to have non-significant carotid stenosis and were treated with best medical therapy and 32% of those with suspected occlusion were successfully revascularized. Our findings highlight the importance of catheter cased angiography in the evaluation of carotid disease.

An Unsupervised Deep Learning Framework for Retrospective Gating of Catheter-Based Cardiac Imaging

Motion artifacts are a major challenge in the in vivo application of catheter-based cardiac imaging modalities. Gating is a critical tool for suppressing motion artifacts. Electrocardiogram (ECG) gating requires a trigger device or synchronous ECG recordings for retrospective analysis. Existing retrospective software gating methods extract gating signals through separate steps based on changes in vessel morphology or image features, which require a high computational cost and are prone to error accumulation. In this paper, we report on an end-to-end unsupervised learning framework for retrospective image-based gating (IBG) of catheter-based intracoronary images, named IBG Network. It establishes a direct mapping from a continuously acquired image sequence to a gated subsequence. The network was trained on clinical data sets in an unsupervised manner, addressing the difficulty of obtaining the gold standard in deep learning-based motion suppression techniques. Experimental results of in vivo intravascular ultrasound and optical coherence tomography sequences show that the proposed method has better performance in terms of motion artifact suppression and processing efficiency compared with the state-of-the-art nonlearning signal-based and IBG methods.

In-hospital imaging utilization after elective endovascular brain aneurysm treatment: a surrogate metric for the value of hospitalization.

Despite the adoption of same-day outpatient surgical procedures in some specialties, it remains common practice to admit patients for monitoring after elective endovascular treatment of brain aneurysms to monitor for complications. The necessity of such monitoring has not been fully characterized. Here, the authors reviewed the utilization of imaging during posttreatment hospitalization, a surrogate measure for workup of suspected complications requiring hospital resources, to infer the value of inpatient monitoring after endovascular aneurysm treatment. Clinical and angiographic data from eligible patients were retrospectively assessed for demographic characteristics, imaging indications, timing of imaging, and imaging findings. Patients were included if they underwent elective endovascular brain aneurysm treatment, and patients were excluded if significant intraprocedural complications occurred. The recorded imaging modalities included CT, MRI, catheter-based imaging, and ultrasound; plain radiographs were excluded. Multivariable logistic regression analysis was performed to identify predictors of the need for posttreatment imaging. In total, 1229 elective endovascular procedures for brain aneurysm treatment were included. Patients underwent imaging before discharge in 13.4% (165/1229) of cases, with significant findings in 5.0% (61/1229) of cases. The median (interquartile range) time to first posttreatment imaging was 13.2 (4.2-22.8) hours. The need for imaging during posttreatment hospitalization was positively associated with larger aneurysm size (p < 0.05) and negatively associated with underlying cardiovascular disease (p < 0.05). More than 1 in 8 patients who underwent elective endovascular brain aneurysm treatment required imaging during posttreatment hospitalization, most within the first 24 hours, and 1 in 20 had significant findings. These results suggest the importance of short-term hospitalization after elective endovascular aneurysm treatment.

Atherosclerosis plaque tissue classification using self-attention-based conditional variational auto-encoder generative adversarial network using OCT plaque image.

Adults with coronary artery disease often have atherosclerosis, this is defined as the accumulation of plaquein the tissues of the arterial wall. Cardiologists utilize optical coherence tomography (OCT), a light-based imaging method, to examine the layers of intracoronary tissue alongpathological formations, such as plaque accumulation. Intracoronary cross-sectional images produced by state-of-the-art catheter-based imaging scheme have 10-15 µm high resolution. Nevertheless, interpretation of the obtained images depends on the operator, which takes a lot of time and is exceedingly error-prone from one observer to another. OCT image post-processing that automatically and accurately tags coronary plaques can help the technique become more widely used and lower the diagnostic error rate. To overcome these problems, Atherosclerosis plaque tissue classification using Self-Attention-Based Conditional Variational Auto-Encoder Generative Adversarial Network (APC-OCTPI-SACVAGAN) is proposed which classifies the Atherosclerosis plaque images as Fibro calcific plaque, Fibro atheroma, Thrombus, Fibrous plaque and Micro-vessel. The proposed APC-OCTPI-SACVAGAN technique is executed in MATLAB. The efficiency of proposed APC-OCTPI-SACVAGAN method attains 16.19 %, 17.93 %, 19.81 % and 1.57 % higher accuracy; 16.92 %, 11.54 %, 5.29 % and 1.946 % higher Areaunder curve; and 28.06 %, 25.32 %, 32.19 % and 39.185 % lower computational time comparing to the existing methods respectively.

Utilizing a Functional Lumen Imaging Probe for Evaluation of the Pediatric Airway, A Pilot Study.

Accurate and reproducible measurements of the pediatric airway are critical for diagnostic evaluation and management of subglottic and tracheal stenosis. The endoluminal functional lumen imaging probe (EndoFLIP) is a catheter-based imaging probe which utilizes impedance planimetry to calculate luminal parameters, including cross-sectional area and compliance. Herein, we demonstrate the feasibility of this system for multidimensional evaluation of the pediatric airway. 3D-printed pediatric laryngotracheal models were created based on computed tomography scans, then artificially deformed to simulate both circumferential and posterior subglottic stenosis. Two observers made six measurements of the minimum cross-sectional area (MCSA) and length of stenosis of each model with EndoFLIP. Agreement between observer measurements and model dimensions was evaluated using Lin's concordance correlation coefficient; inter-observer reliability was assessed using intraclass correlation. Four models were created: two without pathology (MCSA: 132.4, 44.3 mm2 ) and two with subglottic stenosis (MCSA: 28.7, 59.7 mm2 , stenotic length 27.8, 24.4 mm). Observer measurements of MCSA and length of stenosis demonstrated high concordance with the models (r = 0.99, 0.95, p < 0.001) with a mean error of 4.5% and 18.2% respectively. There was a low coefficient of variation (0.6%-2.8%) for measurements, indicating high precision. Interrater reliability was high for both MCSA and stenotic length (ICC: 0.99, 0.98). The EndoFLIP system allows for accurate and reproducible measurements of cross-sectional area and stenotic length in pediatric airway models. This method may provide further advantages in the evaluation of airway distensibility, as well as measurements of asymmetric airway pathology. NA Laryngoscope, 134:108-112, 2024.

Abstract 13455: Clinical Outcomes of Intravascular Ultrasound During Percutaneous Coronary Intervention- United States Nation-Wide Analysis 2014 Through 2019

Introduction: Intravascular Ultrasound (IVUS) is a catheter-based real-time imaging procedure that assists in both diagnosis and treatment during Percutaneous Coronary Intervention (PCI). Over the years, IVUS-guided PCI have become more popular. In this study, we aimed to analyze the trends of use of IVUS-guided PCI, adjusted in-hospital mortality, hospital length of stay (LOS) and inpatient cost over the years. Methods: Data were extracted from the National Inpatient Sample (NIS) 2014 through 2019 Database. The NIS was searched for PCI with and without IVUS in adult patients (age ≥ 18) using ICD 9 and 10 codes. Outcomes of interest were utilization rates of IVUS during PCI, trend of adjusted in-hospital mortality, adjusted mean LOS and adjusted mean cost. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. Results: Of 2,871,865 PCIs in 2014 through 2019, 201,075 (7.0%) were coupled with IVUS. The use of IVUS during PCI steadily increased from 6.2% in 2014 to 9.3% in 2019 (trend p&lt;0.001). The adjusted in-hospital mortality and inpatient LOS for PCI with IVUS showed statistically insignificant trend of higher mortality (1.3% in 2014 vs. 1.6% in 2019, trend p=0.053) and shorter LOS (3.2 days in 2014 vs. 3.0 days in 2019, trend p=0.148). The mean adjusted cost steadily increased over the years for patients undergoing PCI with IVUS (24236$ in 2014 vs. 28700$ in 2019, trend p=0.012). Conclusions: There is a steady rise in use of IVUS during PCI. There is a steady hike in hospital costs for PCI with IVUS hospitalizations however in-hospital mortality and LOS remain the same.

Intravascular ultrasound-based decision tree model for the optimal endovascular treatment strategy selection of femoropopliteal artery disease—results from the ONION Study-

BackgroundThe role of catheter-based imaging in peripheral interventions for lower extremity artery disease (LEAD) has increased with percutaneous interventions. To clarify the relation between intravascular ultrasound (IVUS) information and procedure selection strategy for endovascular treatment therapy (EVT) of the femoropopliteal artery in the real-world clinical settings wherein new endovascular technologies (NETs), including drug-coated balloon (DCB), drug-eluting stent (DES), and covered stent-graft (CS). Our retrospective multicenter analysis examined symptomatic 970 patients treated by EVT for de novo femoropopliteal lesions with IVUS guidance. The decision tree analysis was performed retrospectively to determine the association of IVUS and angiography parameters with the strategy selection of endovascular procedures. We divided the study population according to the developed tree, and identified the most popular strategy selection in each subgroup. We finally examined whether the restenosis risk would be different among respective subgroups of the tree.ResultsDuring the study periods, plain old balloon angioplasty, DCB, and bare nitinol stent were most frequently selected (25.3%, 23.9%, and 23.8%, respectively). The drug-eluting stent (DES), covered stent (CS), and spot stent strategies were used in 7.3%, 11.5%, and 8.1%. NETs had the lowest restenosis risk in the overall population. The decision tree had a depth of six branches and divided the patients into 11 subgroups by IVUS and angiography parameters. The restenosis rate was similarly low among these 11 subgroups when the most popular NET in each subgroup was selected (P = 0.94).ConclusionsThe use of IVUS data along with angiography data would standardize the selection of endovascular procedures and can improve patency outcomes if NETs are used properly.

Quantitative endoscopic photoacoustic tomography using a convolutional neural network.

Endoscopic photoacoustic tomography (EPAT) is a catheter-based hybrid imaging modality capable of providing structural and functional information of biological luminal structures, such as coronary arterial vessels and the digestive tract. The recovery of the optical properties of the imaged tissue from acoustic measurements achieved by optical inversion is essential for implementing quantitative EPAT (qEPAT). In this paper, a convolutional neural network (CNN) based on deep gradient descent is developed for qEPAT. The network enables the reconstruction of images representing the spatially varying absorption coefficient in cross-sections of the tubular structures from limited measurement data. The forward operator reflecting the mapping from the absorption coefficient to the optical deposition due to pulsed irradiation is embedded into the network training. The network parameters are optimized layer by layer through the deep gradient descent mechanism using the numerically simulated data. The operation processes of the forward operator and its adjoint operator are separated from the network training. The trained network outputs an image representing the distribution of absorption coefficients by inputting an image that represents the optical deposition. The method has been tested with computer-generated phantoms mimicking coronary arterial vessels containing various tissue types. Results suggest that the structural similarity of the images reconstructed by our method is increased by about 10% in comparison with the non-learning method based on error minimization in the case of the same measuring view.

Intravascular Ultrasound (IVUS) Provides the Filling for the Angiogram's Crust: Benefits of IVUS in Pediatric Interventional Cardiology.

Intravascular ultrasound (IVUS) is a catheter-based imaging modality that generates cross-sectional views of vessel walls and lumens. This technique is used in adult interventional and vascular surgeries to guide the management of coronary artery and peripheral arterial disease. IVUS has been described as superior to angiography in providing data about lesions of interest, including degree of vessel stenosis and stent apposition following intervention. IVUS use to guide transcatheter management of congenital heart disease is limited. We reviewed our experience using IVUS as an adjunctive tool to diagnose lesions and assess intervention in pediatric patients during cardiac catheterization. A retrospective chart review of all pediatric patients who underwent IVUS during cardiac catheterization to evaluate the cross-sectional lumen of non-coronary vessel(s) at Rady Children's Hospital from January 2018 to December 2019 was performed. Median patient age was 637 days (range, 44-4328 days), with mean weight of 12.1 ± 9 kg. Twenty-six vessels were interrogated with IVUS (pulmonary venous stenosis [n = 8], coarctation [n = 5], branch pulmonary artery stenosis [n = 6], systemic shunts and conduits [n = 3], and other peripheral vasculature [n = 4]). IVUS added value in all cases (100%). We found that IVUS guided the intervention in 88% of procedures and defined the endpoint in 62% of transcatheter interventions. There were no IVUS-related complications. IVUS enhanced our diagnostic interpretation and identified occult lesions not visualized by angiography. IVUS was valuable in guiding and defining the endpoints of these interventions.

Optical Coherence Tomography in Cardiac Allograft Vasculopathy: State-of-the-Art Review.

Cardiac allograft vasculopathy (CAV) is a challenging complication of heart transplantation. CAV pathophysiology is incompletely understood, standard screening modalities such as angiography have significant limitations, and currently available therapies have only modest efficacy in preventing progression. Optical coherence tomography is a light-based technique that provides microscopic level catheter-based intravascular imaging and has dramatically expanded our understanding of CAV, demonstrating it to be a complex, heterogeneous, and dynamic process. This review covers characteristics and uses of optical coherence tomography, including vessel characterization, serial use to assess progression of disease, guiding percutaneous intervention, and monitoring response to CAV therapies. We also discuss the potential of optical coherence tomography in providing individualized assessment and enable customized CAV therapies, which may lead to improvements in long-term transplant outcomes.

A deep learning-based model for characterization of atherosclerotic plaque in coronary arteries using optical coherence tomography images.

Coronary artery events are mainly associated with atherosclerosis in adult population, which is recognized as accumulation of plaques in arterial wall tissues. Optical Coherence Tomography (OCT) is a light-based imaging system used in cardiology to analyze intracoronary tissue layers and pathological formations including plaque accumulation. This state-of-the-art catheter-based imaging system provides intracoronary cross-sectional images with high resolution of 10-15µm. But interpretation of the acquired images is operator dependent, which is not only very time-consuming but also highly error prone from one observer to another. An automatic and accurate coronary plaque tagging using OCT image post-processing can contribute to wide adoption of the OCT system and reducing the diagnostic error rate. In this study, we propose a combination of spatial pyramid pooling module with dilated convolutions for semantic segmentation to extract atherosclerotic tissues regardless of their types and training a sparse auto-encoder to reconstruct the input features and enlarge the training data as well as plaque type characterization in OCT images. The results demonstrate high precision of the proposed model with reduced computational complexity, which can be appropriate for real-time analysis of OCT images. At each step of the work, measured accuracy, sensitivity, specificity of more than 93% demonstrate high performance of the model. The main focus of this study is atherosclerotic tissue characterization using OCT imaging. This contributes to wide adoption of the OCT imaging system by providing clinicians with a fully automatic interpretation of various atherosclerotic tissues. Future studies will be focused on analyzing atherosclerotic vulnerable plaques, those coronary plaques which are prone to rupture.

Up around the bend: progress and promise of intravascular imaging in neurointerventional surgery

Endovascular treatment in peripheral and coronary circulations has been greatly advanced with the aid of intravascular imaging such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS).1 2 Studies have...

An iterative gradient convolutional neural network and its application in endoscopic photoacoustic image formation from incomplete acoustic measurement

Endoscopic photoacoustic tomography (EPAT) is a rapidly developing catheter-based imaging technique to provide cross-sectional images of anatomical, functional and molecular data of tubular objects. The scanning geometry of the ultrasonic detector is enclosed in the cavity resulting in highly restricted acquisition of photoacoustically induced acoustic pressures. Thus, data-incompleteness is an important factor that causes degradation of the image quality. This work presents a method to solve the acoustic inverse problem of EPAT from incomplete measurements associated with the image formation process. This method combines the traditional variational iteration with convolutional neural network (CNN), in which the forward operator and adjoint operator of imaging are excluded from the network training and are embedded into each layer of the structural unit. The gradient information is utilized to reduce the influence of incomplete measurements on the image quality. The network is trained unit by unit in an adaptive way to achieve fast convergence. Our numerical results conducted on various data sets showed that the trained network is robust to the sampling rate of the measured data. Also, it is able to provide a generalization that can work across various noise levels in the data. In addition, a robust peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) improvement obtained in the reconstructed images has been demonstrated in comparison with conventional TR reconstruction, CS reconstruction and post-processing by U-net.

Novel Workflow for Conversion of Catheter-based Electroanatomic Mapping to DICOM Imaging for Cardiac Radiation Ablation of Ventricular Tachycardia

A recent clinical trial has demonstrated that Cardiac Radiation Ablation (CRA) has the potential to reduce recurrent Ventricular Tachycardia (VT) that is refractory to drugs and standard catheter ablation. Electroanatomic Mapping (EAM) that would be useful for planning is obtained during catheter ablation, but incompatibility between EAM and DICOM formats required for radiation planning has impeded the use of existing catheter-based mapping to guide CRA and is an important hurdle for the wider adoption of CRA. It was hypothesized that catheter-based EAM could be fused with DICOM imaging for radiation planning, and a process to accomplish this was defined. The raw data export of the CARTO3 EAM system (Version 6.0.45.171, “.mesh” file) was processed with a script to generate 3D VTK files containing X, Y, and Z coordinates obtained during mapping and corresponding impedance, voltage, and other point-based information. The image could then be visualized with standard image processing software (3D Slicer), permitting visualization of the cardiac map and the outlining of a cardiac ablation target on the image surface. This structure was then in turn converted to a DICOM image format and fused with patient thoracic imaging using anatomical landmarks. This process facilitated the fusion of catheter-based EAM and DICOM imaging to inform selection of CRA targets. The workflow was found to be robust and compatible with a second MRI-based VT Ablation planning system, ADAS-VT. The conversion of catheter-based EAM to a DICOM compatible format permits the fusion of images for radiation planning, and an avenue for the wider application of VT CRA. Further improvements in the compatibility of these imaging formats would be expected to improve quality and reproducibility of image fusion.

Fundamentals and role of intravascular ultrasound in percutaneous coronary intervention.

Intravascular ultrasound (IVUS) is a catheter-based invasive imaging modality that has become an essential adjunctive tool to percutaneous coronary intervention (PCI) over the past 20 years. Clinical applications of IVUS in PCI include assessment of lesion severity, characterizing plaque morphology, optimization of acute stent results and clarification of mechanisms of stent failure. Numerous meta-analyses of large observational and randomized studies support the role of IVUS-guided PCI in reducing short and long-term adverse outcomes, including mortality and stent failure, particularly in patients receiving drug-eluting stents (DESs) and in complex lesion subsets. The current review provides a summary of the fundamental aspects and current clinical roles of IVUS in coronary intervention.

The role of intravascular ultrasound in percutaneous coronary intervention of complex coronary lesions.

Intravascular ultrasound (IVUS) is a catheter-based coronary imaging technique. It utilises the emission & subsequent detection of reflected high frequency (30-60 MHz) sound waves to create high resolution, cross-sectional images of the coronary artery. IVUS has been the cornerstone of intracoronary imaging for more than two decades. When compared to the invasive coronary angiogram which studies only the silhouette of the contrast-filled artery lumen, IVUS also crucially images the vessel wall. Because of this capability, IVUS has greatly facilitated understanding of the coronary atherosclerosis process. Such insights from IVUS reveal how commonly and extensively plain angiography underestimates the true extent of coronary plaque, the characteristics of plaques prone to rupture and cause acute coronary syndromes (lipid rich, thin cap atheroma), and a realisation of the widespread occurrence of vessel remodelling in response to atherosclerosis. Similarly, IVUS has historically provided salutary mechanistic insights that have guided many of the incremental advances in the techniques of percutaneous coronary intervention (PCI). Examples include mechanisms of in-stent restenosis, and the importance of high-pressure post-dilatation of stents to ensure adequate stent apposition and thereby reduce the occurrence of stent thrombosis. IVUS also greatly facilitates the choice of correct diameter and length of stent to implant. Overall, a compelling body of evidence indicates that use of intravascular ultrasound in PCI helps to achieve optimal technical results and to mitigate the risk of adverse cardiac events. In this review, the role of intravascular ultrasound as an adjunct to PCI in complex coronary lesions is explored. The complex coronary situations discussed are the left main stem, ostial stenoses, bifurcation stenoses, thrombotic lesions, the chronically occluded coronary artery, and calcified coronary artery disease. By thorough review of the available evidence, we establish that the advantages of IVUS guidance are particularly evident in each of these complex CAD subsets. In particular, some consider the use of IVUS to be almost mandatory in left main PCI. A comparison with other intracoronary imaging techniques is also explored.

Intravascular Polarimetry: Clinical Translation and Future Applications of Catheter-Based Polarization Sensitive Optical Frequency Domain Imaging.

Optical coherence tomography (OCT) and optical frequency domain imaging (OFDI) visualize the coronary artery wall and plaque morphology in great detail. The advent of these high-resolution intracoronary imaging modalities has propelled our understanding of coronary atherosclerosis and provided enhanced guidance for percutaneous coronary intervention. Yet, the lack of contrast between distinct tissue types and plaque compositions impedes further elucidation of the complex mechanisms that contribute to acute coronary syndrome (ACS) and hinders the prospective identification of plaques susceptible to rupture. Intravascular polarimetry with polarization-sensitive OFDI measures polarization properties of the coronary arterial wall using conventional intravascular imaging catheters. The quantitative polarization metrics display notable image contrast between several relevant coronary plaque microstructures that are difficult to identify with conventional OCT and OFDI. Tissues rich in collagen and smooth muscle cells exhibit birefringence, while lipid and macrophages cause depolarization. In this review, we describe the basic principles of intravascular polarimetry, discuss the interpretation of the polarization signatures, and outline promising avenues for future research and clinical implications.

Utility of a new imaging system for displaying complex anatomy during AF ablation with cryoenergy

BackgroundA new catheter-based 3D dielectric imaging modality to guide electrophysiology ablation procedures that does not require contact or X-ray to image and offers new benefits for cryoablation procedures.Case presentationA 51-year-old male with paroxysmal atrial fibrillation was admitted to our hospital for atrial fibrillation ablation that was performed using cryoballoon fourth generation combined with a novel wide-band dielectric imaging system [KODEX-EPD (EPD Solutions, a Philips company)].ConclusionsThis system allowed to visualize left common pulmonary vein before balloon positioning and then confirmed by pulmonary vein angiography.

Role of optical coherence tomography to optimize complex coronary interventions

Optical coherence tomography (OCT) is an innovative catheter-based imaging technology that uses light and fiberoptic to obtain unique details of the coronary arteries and stents on a microscope scale. OCT is an efficient method to rapidly map the extension and type of coronary artery disease with the potential to guide complex percutaneous coronary interventions (PCI). It can reliably detect and quantify atherosclerotic plaque characteristics, differentiate early from late stage of atherosclerotic disease and distinguish atherosclerotic (plaque rupture, erosion, calcified nodule) versus non atherosclerotic causes (spontaneous coronary dissection, intramural hematoma) of acute coronary syndromes. Further, it is very sensitive and accurate in detecting calcium and measuring the most relevant parameters (thickness, proximity to the lumen, circumferential extension) that may impact stent expansion. Based on automatic lumen measures and angiographic co-registration, OCT is used to plan and map the procedural strategy of stent implantation in complex lesion cohorts, with identification of the imaging features that require corrective actions to optimize stent results. OCT is a cardinal tool in patients presenting with stent failure (restenosis and thrombosis) to differentiate mechanical from biological causes with the potential of tailored treatment of the root mechanisms.

Broadband, freeform focusing micro-optics for a side-viewing imaging catheter.

Successful implementation of a catheter-based imaging system relies on the integration of high-performance miniaturized distal end optics. Typically, compensation of chromatic dispersion, as well as astigmatism introduced by the device's sheath, can be addressed only by combining multiple optical elements, adversely impacting size and manufacturability. Here, we present a 300×300×800 μm3 monolithic optic that provides high optical performances over an extended wavelength range (near UV-visible-IR) with minimal chromatic aberrations. The design of the optic, fully optimized using standard optical simulation tools, provides the ability to freely determine aperture and working distance. Manufacturing is cost effective and suited for prototyping and production alike. The experimental characterization of the optic demonstrates a good match with simulation results and performances well suited to both optical coherence tomography and fluorescence imaging, thus paving the way for high-performance multimodal endoscopy systems.