Characterization Of Coronary Atherosclerotic Plaques Research Articles

Interscan reproducibility of computed tomography derived coronary plaque volume measurements using a semi-automated analysis software

Abstract Background Coronary computed tomography angiography (CCTA) enables detailed quantification and characterization of coronary atherosclerotic plaque, offering diagnostic and prognostic value. Despite the growing demand for accurate plaque analysis, studies on interscan reproducibility of automated plaque quantification are limited in number and size. Moreover, impact of clinical and technical factors on the reproducibility of plaque assessment tools are scarce. Purpose The objective of this study was to assess the interscan reproducibility of CCTA-derived plaque volume measurements and the implications of clinical and technical characteristics on interscan reproducibility. Methods A total of 101 patients with known coronary artery disease underwent two CCTA scans within hour interval using identical CT acquisition protocol. Coronary plaque volume measurements were quantified on a per-patient level using a contemporary semi-automated plaque analysis software. Results There was no statistically significant difference in median plaque volumes between the first and second scan. The direct correlation was excellent for volumes of non-calcified plaque (NCP), calcified plaque (CP), and total plaque (TP) across all analyses (Pearson’s coefficient 0.96 to 0.99), while moderate for low-density non-calcified plaque (LD-NCP) volumes (Pearson’s coefficient 0.77). Bland Altman analyses demonstrated high interscan agreement with narrow absolute and relative limits of agreement (LoA) across plaque subtypes, except for LD-NCP volumes (Table 1). Interscan reproducibility on CP volumes was affected by CT image quality with narrower LoA in scans with the highest image quality score (p = 0.003), or lowest image reconstructive iteration level (p <0.001). Limits of agreement were significantly narrower for NCP, CP, and TP volumes in lesions located in LAD compared to non-LAD lesions (p <0.001). However, no significant difference in LoA was present when comparing patients according to BMI (<27 and ≥27 kg/m2), heart rate (<65 and ≥65 beats per minute), or Agatston score (<193 and ≥193). Conclusions This comprehensive interscan reproducibility study revealed good agreement in the measurement of plaque subtypes. Adding new insight to existing literature, we have demonstrated that factors such as image quality, image reconstructive algorithms, and lesion location affect the reproducibility of plaque volume measurements. CT-derived plaque quantification using a semi-automated plaque analysis software holds potential for monitoring disease progression or regression in patients with CAD, provided high CCTA image quality.

Interscan reproducibility of computed tomography derived coronary plaque volume measurements

BackgroundCoronary computed tomography angiography (CCTA) enables detailed quantification and characterization of coronary atherosclerotic plaques, offering diagnostic and prognostic value. Interscan reproducibility studies on plaque volume measurements are limited. This study aims to assess the interscan reproducibility of coronary plaque quantification and the implications of clinical and technical characteristics on interscan reproducibility. MethodsCCTA was performed twice in 101 patients with known coronary artery disease at a 1-h interval. The scans were conducted using identical CCTA acquisition protocols. Coronary plaque volumes were quantified using a semi-automated software and performed on a per-lesion, per-vessel, and per-patient level. ResultsMedian plaque volumes were comparable between the first and second CCTA scan. Interscan correlation was high for total plaque (TP), non-calcified plaque (NCP), and calcified plaque (CP) across all analyses (Pearson's coefficient 0.93–0.99), but lower for low-density non-calcified plaque (LD-NCP) volume measurements (Pearson's coefficient 0.74–0.77). Bland-Altman analyses demonstrated higher interscan agreement on a per-patient level compared to on per-vessel and per-lesion level. Interscan reproducibility on CP volumes was affected by CT image quality with narrower LoA in scans with the highest image quality score (p ​= ​0.003), or lowest image reconstructive iteration level (p ​< ​0.001). Limits of agreement were significantly narrower for TP, NCP, and CP volumes in LAD-lesions and vessels compared to non-LAD lesions and vessels (p ​≤ ​0.001). ConclusionOverall reproducibility of repeated CCTA derived plaque measurements by a semi-automated software was modest, and was influenced by image quality, image reconstruction settings, and lesion location.

Recent Trends in Artificial Intelligence-Assisted Coronary Atherosclerotic Plaque Characterization.

Coronary artery disease is a major cause of morbidity and mortality worldwide. Its underlying histopathology is the atherosclerotic plaque, which comprises lipid, fibrous and—when chronic—calcium components. Intravascular ultrasound (IVUS) and intravascular optical coherence tomography (IVOCT) performed during invasive coronary angiography are reference standards for characterizing the atherosclerotic plaque. Fine image spatial resolution attainable with contemporary coronary computed tomographic angiography (CCTA) has enabled noninvasive plaque assessment, including identifying features associated with vulnerable plaques known to presage acute coronary events. Manual interpretation of IVUS, IVOCT and CCTA images demands scarce physician expertise and high time cost. This has motivated recent research into and development of artificial intelligence (AI)-assisted methods for image processing, feature extraction, plaque identification and characterization. We performed parallel searches of the medical and technical literature from 1995 to 2021 focusing respectively on human plaque characterization using various imaging modalities and the use of AI-assisted computer aided diagnosis (CAD) to detect and classify atherosclerotic plaques, including their composition and the presence of high-risk features denoting vulnerable plaques. A total of 122 publications were selected for evaluation and the analysis was summarized in terms of data sources, methods—machine versus deep learning—and performance metrics. Trends in AI-assisted plaque characterization are detailed and prospective research challenges discussed. Future directions for the development of accurate and efficient CAD systems to characterize plaque noninvasively using CCTA are proposed.

In-vivo mechanical characterization of coronary atherosclerotic plaques in living swine using intravascular laser speckle imaging.

The ability to evaluate the viscoelastic properties of coronary arteries is crucial for identifying mechanically unstable atherosclerotic plaques. Here, we demonstrate for the first time in living swine, the capability of intravascular laser speckle imaging (ILSI) to measure an index of coronary plaque viscoelasticity, τ, using a human coronary to swine xenograft model. Cardiac motion effects are evaluated by comparing the EKG-non-gated , and EKG-gated among different plaque types. Results show that both and are significantly lower in necrotic-core plaques compared with stable lesions. Discrete-point pullback measurements demonstrate the capability of ILSI for rapid mechanical characterization of coronary segments under physiological conditions, in-vivo.

Artificial Intelligence in Cardiac CT: Automated Calcium Scoring and Plaque Analysis

To review the current applications of artificial intelligence (AI) for coronary artery calcium scoring (CACS) and plaque analysis with their achievements and potential clinical impacts. Recent advances of AI-based technologies especially deep learning (DL) approaches in medical imaging have achieved substantial progress in automated detection and characterization of coronary atherosclerotic plaques, providing promising results for AI application in diagnosis and management of coronary artery disease. To date, many studies investigated the potential role of DL in CACS and showed promising results for clinical application in a variety of CT examinations, demonstrating excellent agreement compared with manual scoring. DL-based approaches have also provided considerable progress in automated analysis of non-calcified plaque. Many investigations have shown that automated localization and classification of non-calcified plaque and luminal stenosis is feasible in cardiac CT angiography, although still challenging.

Automated classification of coronary plaque calcification in OCT pullbacks with 3D deep neural networks.

.Significance: Detection and characterization of coronary atherosclerotic plaques often need reviews of a large number of optical coherence tomography (OCT) imaging slices to make a clinical decision. However, it is a challenge to manually review all the slices and consider the interrelationship between adjacent slices.Approach: Inspired by the recent success of deep convolutional network on the classification of medical images, we proposed a ResNet-3D network for classification of coronary plaque calcification in OCT pullbacks. The ResNet-3D network was initialized with a trained ResNet-50 network and a three-dimensional convolution filter filled with zeros padding and non-zeros padding with a convolutional filter. To retrain ResNet-50, we used a dataset of OCT images, derived by 18 entire pullbacks from different patients. In addition, we investigated a two-phase training method to address the data imbalance. For an improved performance, we evaluated different input sizes for the ResNet-3D network, such as 3, 5, and 7 OCT slices. Furthermore, we integrated all ResNet-3D results by majority voting.Results: A comparative analysis proved the effectiveness of the proposed ResNet-3D networks against ResNet-2D network in the OCT dataset. The classification performance ( for non-zeros padding and for zeros padding) demonstrated the potential of convolutional neural networks (CNNs) in classifying plaque calcification.Conclusions: This work may provide a foundation for further work in extending the CNN to voxel segmentation, which may lead to a supportive diagnostic tool for assessment of coronary plaque vulnerability.

Comprehensive plaque assessment with serial coronary CT angiography: translation to bedside.

The purpose of this review is to highlight the utility of comprehensive plaque assessment by serial coronary computed tomography angiography (CCTA) to understand atherosclerosis and its effect on cardiovascular risk stratification and management. CCTA is a validated, noninvasive imaging modality for coronary atherosclerotic plaque characterization. Numerous clinical trials have used approach of serial CCTA to demonstrate the potential benefits of multiple treatment strategies to reduce coronary plaque progression and its translation to benefits with cardiovascular outcomes. Serial CCTA trials for cardiovascular therapies combined with clinical outcome studies are providing mechanistic correlations of coronary atherogenesis and cardiovascular risk reduction, thereby establishing a new standard of care in addressing cardiac disease. Advancements in CCTA imaging and plaque analysis continue to expand the potential for CCTA in the evaluation of cardiovascular risk and targeted treatment of CAD.

A three-dimensional quantification of calcified and non-calcified plaques in coronary arteries based on computed tomography coronary angiography images: Comparison with expert's annotations and virtual histology intravascular ultrasound

The detection, quantification and characterization of coronary atherosclerotic plaques has a major effect on the diagnosis and treatment of coronary artery disease (CAD). Different studies have reported and evaluated the noninvasive ability of Computed Tomography Coronary Angiography (CTCA) to identify coronary plaque features. The identification of calcified plaques (CP) and non-calcified plaques (NCP) using CTCA has been extensively studied in cardiovascular research. However, NCP detection remains a challenging problem in CTCA imaging, due to the similar intensity values of NCP compared to the perivascular tissue, which surrounds the vasculature. In this work, we present a novel methodology for the identification of the plaque burden of the coronary artery and the volumetric quantification of CP and NCP utilizing CTCA images and we compare the findings with virtual histology intravascular ultrasound (VH-IVUS) and manual expert's annotations. Bland–Altman analyses were employed to assess the agreement between the presented methodology and VH-IVUS. The assessment of the plaque volume, the lesion length and the plaque area in 18 coronary lesions indicated excellent correlation with VH-IVUS. More specifically, for the CP lesions the correlation of plaque volume, lesion length and plaque area was 0.93, 0.84 and 0.85, respectively, whereas the correlation of plaque volume, lesion length and plaque area for the NCP lesions was 0.92, 0.95 and 0.81, respectively. In addition to this, the segmentation of the lumen, CP and NCP in 1350 CTCA slices indicated that the mean value of DICE coefficient is 0.72, 0.7 and 0.62, whereas the mean HD value is 1.95, 1.74 and 1.95, for the lumen, CP and NCP, respectively.

Coronary Computed Tomography Angiography as a Gatekeeper to Coronary Revascularization: Emphasizing Atherosclerosis Findings Beyond Stenosis.

Coronary computed tomography angiography (CCTA) is the optimal non-invasive test to rule out coronary artery disease (CAD). Decisions to perform coronary revascularization have traditionally been based upon ischemia testing. This review summarizes the latest observations and trials evaluating the suitability of CCTA to select patients for invasive coronary angiography (ICA) and subsequent revascularization. Recent data shows that beyond stenosis, whole-heart quantification and characterization of coronary atherosclerotic plaque improves the estimation of myocardial ischemia. This comprehensive evaluation of the coronary artery tree has greater diagnostic accuracy for invasive fractional flow reserve (FFR) than conventional stress tests. Further, clinical trials have demonstrated that the performance of CCTA in patients with a clinical indication for ICA results in more effective patient care and significantly lower costs. Besides the excellent ability to rule out CAD, recent data shows that quantification and characterization of the coronary artery tree results in high accuracy for ischemia and that CCTA-guided care to select patients for ICA and revascularization is effective. Trials evaluating revascularization based on CCTA findings may be needed.

Coronary vessel intimal sequence extraction based on prior boundary constraints in optical coherence tomography image

Optical coherence tomography (OCT) is a new technique applied in cardiovascular system. It can detect vessel intimal, small structure of plaque surface and discover small lesions with its high axial resolution and quantification character. Especially with the application of OCT in characterization of coronary atherosclerotic plaque, diagnosis and treatment strategy making, optimizing percutaneous coronary intervention therapy and assessment after stent planting make the OCT become an efficient tool for cardiovascular disease diagnosis and treatment. This paper presents a novel coronary vessel intimal sequence extraction method based on prior boundary constraints in OCT image. On the basis of conventional Chan-Vese model, we modified the evolutionary weight function to control the evolutionary rate of boundary by adding local information of boundary curve. At the same time, we added the gradient energy term and intimal boundary constraint term based on priori boundary condition to further control the evolutionary of boundary curve. At last, coronary vessel intimal is extracted in a sequence way. The comparison with vessel intimal, manual segmented by clinical scientists (golden standard), indicates that our coronary vessel intimal extraction method is robust to intimal boundary blur, distortion, guide wire shadow and plaque disturbs. The results of this study can be applied to clinical aid diagnosis and precise diagnosis and treatment.

When should we use contrast material in cardiac MRI?

5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1551-1572.

Non-calcified coronary atherosclerotic plaque characterization by dual energy computed tomography.

Coronary heart disease (CHD) is the most prevalent cause of death worldwide. Atherosclerosis which is the condition of plaque buildup on the inside of the coronary artery wall is the main cause of CHD. Rupture of unstable atherosclerotic coronary plaque is known to be the cause of acute coronary syndrome. Vulnerability of atherosclerotic plaque has been related to a large lipid core covered by a fibrous cap. Non-invasive assessment of plaque characterization is necessary due to prognostic importance of early stage identification. The purpose of this study is to use the additional attenuation data provided by dual energy computed tomography (DECT) for plaque characterization. We propose to train supervised learners on pixel values recorded from DECT monochromatic X-ray and material basis pairs images, for more precise classification of fibrous and lipid plaques. The interaction of the pixel values from different image types is taken into consideration, as single pixel value might not be informative enough to separate fibrous from lipid. Organic phantom plaques scanned in a fabricated beating heart phantom were used as ground truth to train the learners. Our results show that support vector machines, artificial neural networks and random forests provide accurate results both on phantom and patient data.

Relationships between inflammatory mediators and coronary plaque composition in patients with stable angina investigated by ultrasound radiofrequency data analysis

Inflammation has been recognized as a critical process in the progression of coronary atherosclerosis. Virtual Histology-intravascular ultrasound (VH-IVUS) has been reported to be a useful tool for tissue characterization of coronary atherosclerotic plaque. We investigated relationships between plaque composition and inflammation-related factors possibly contributing to atheromatous plaque formation and progression, since these are largely unknown. Using VH-IVUS, we measured plaque volume and composition at the culprit lesions in patients with stable angina undergoing elective percutaneous coronary intervention (n=33, 39 de novo lesions), and then analyzed correlations between plaque components and serum levels of inflammatory factors in both aorta and culprit coronary artery obtained by aspiration using a distal protection device. Linear regression analysis revealed that both aortic and coronary LDL cholesterol levels correlated with %plaque burden along the culprit lesions (r=0.535 and 0.539, respectively), but with none of the plaque components. Of %plaque components, fibro-fatty (FF) correlated positively with both aortic and coronary T cell/B cell ratios (r=0.335 and 0.359, respectively) whereas necrotic core (NC) correlated negatively with both aortic and coronary T cell/B cell ratios (r=-0.373 and -0.483, respectively). These results suggest that LDL cholesterol may be a good marker for total coronary plaque volume whereas the lymphocyte subset of T cell/B cell ratios may be a good marker for plaque composition, especially FF and NC components volume.

Attenuation-based characterization of coronary atherosclerotic plaque: Comparison of dual source and dual energy CT with single-source CT and histopathology

Objective To compare different CT acquisition techniques regarding for attenuation-based characterization of coronary atherosclerotic plaques using histopathology as the standard of reference. Materials and methods In a post mortem study 17 human hearts were studied with dual-source CT (DSCT) and dual energy CT (DECT) mode on a DSCT as well as with 16-slice single-source CT (SSCT). At autopsy, atherosclerotic lesions were cut at 5 μm sections. Histopathologic classification of the plaques according to the American Heart Association (AHA) criteria was performed by two pathologists. Attenuation values of all plaques were measured in DSCT, DECT and SSCT studies, respectively and classified based on attenuation according to modified AHA criteria. Results 58 coronary plaques were identified at autopsy. Regardless of the CT technique only 52/58 plaques were found at CT (sensitivity = 89.6%). There was no significant difference between the mean attenuation values of different plaque types between DSCT, DECT, and SSCT: type IV: 11 HU/8 HU/19 HU; type Va: 44 HU/45 HU/52 HU; type Vb: 1088 HU/966 HU/1079 HU). The sensitivity for correct classification varied depending on the plaque type (type II = 0%, type III = 0%, type IV = 43%, type Va = 58%, Vb = 97%). Conclusion Independent of the used acquisition technique, SSCT, DSCT and DECT show similar results for attenuation-based characterization of atherosclerotic coronary plaques.

Diagnostic accuracy of dual-source computed tomography in the characterization of coronary atherosclerotic plaques: Comparison with intravascular optical coherence tomography

Background Dual-source computed tomography (DSCT) has enabled us to non-invasively visualize coronary artery stenosis, but its ability to characterize coronary atherosclerotic plaques (ASPs) has not been evaluated. Intravascular optical coherence tomography (OCT) provides tissue images of coronary artery wall that are validated by pathohistological studies. We studied the diagnostic accuracy of DSCT in the characterization of coronary ASPs, especially lipid-rich ASP with thin fibrous cap (TCFA), in comparison with OCT. Methods DSCT and OCT were used to image non-stenotic ASPs in non-culprit coronary arteries of 17 acute coronary syndrome (ACS) patients, and 162 coronary regions were enrolled. Results The mean CT values of fibrous ASP, ASP with lipid core, and ASP with calcium deposit were 77.5, 28.9, and 515.9 HU, respectively ( P < 0.0001). ASP with calcium deposit was detected with a sensitivity of 88.9% and a specificity of 98.6%, while ASP with lipid core was detected by DSCT with a relatively low sensitivity of 73.1% and a high specificity of 94.0%. In TCFA, cross-sectional areas of both ASP and lipid core were significantly larger, mean CT value of ASP was significantly lower, and concomitant calcification was more frequently observed compared with lipid-rich ASP with thick fibrous cap (ThCFA). The combination of these CT parameters seems to be a useful index for the differentiation of TCFA from ThCFA. Conclusion DSCT is useful for non-invasive evaluation of calcified and fibro-fatty tissue characters in coronary artery plaque, but it is still not able to differentiate TCFA, one of the features of vulnerable plaque.

The potential of RF backscattered IVUS data and multidetector-row computed tomography images for tissue characterization of human coronary atherosclerotic plaques

The aim is to compare virtual histology which uses spectral analysis of backscattered intravascular ultrasound (VH-IVUS) and multidetector-row computed tomography (MDCT) for the characterization of coronary atherosclerotic plaques obtained by directional coronary atherectomy (DCA). We performed DCA in 15 de novo native coronary stenotic lesions (15 patients) and selected one or two segments within the plaque from each patient (total 29 segments). Then, we evaluated the accuracy of the VH-IVUS findings in 50 sites among the 29 segments compared with the histopathology findings. MDCT was performed in all patients before percutaneous coronary intervention (PCI), and CT density values were measured. VH-IVUS data analysis correlated well with histopathological examination (predictive accuracy: 66.7% for fibrous, 100% for fibro-fatty, 100% for necrotic core, and 100% for dense calcium regions, respectively). In addition, CT density values between fibrous and fibro-fatty plaques classified by histopathology were 100.0 +/- 26.0 HU versus 110.4 +/- 67.9 HU, there were no difference among them (P = 0.594). These findings indicated that the validation of plaque characteristics using VH-IVUS correlates well with histopathology. While tissue characterization using CT density could be difficult to distinguish between fibro-fatty and fibrous tissue.

61: Dual Energy CT for the Characterization of Coronary Atherosclerotic Plaque in Human Coronary Arteries: Initial Experience in a Pressurized Ex-vivo Perfusion Model

61: Dual Energy CT for the Characterization of Coronary Atherosclerotic Plaque in Human Coronary Arteries: Initial Experience in a Pressurized Ex-vivo Perfusion Model

Potential of dual-energy computed tomography to characterize atherosclerotic plaque: ex vivo assessment of human coronary arteries in comparison to histology

Noninvasive characterization of coronary atherosclerotic plaque is limited with current computed tomography (CT) techniques. Dual-energy CT (DECT) has the potential to provide additional attenuation data for better differentiation of plaque components. We attempted to characterize coronary atherosclerotic plaque with DECT. Seven human coronary arteries acquired at autopsy were scanned consecutively at 80 and 140 kVp with CT. Vessels were perfused with saline, and data were acquired before and after contrast agent injection. Lesions were identified, and attenuation measurements were made from CT image quadrants. CT quadrants were classified as densely calcified, fibrocalcific, fibrous, lipid-rich, or normal vessel wall, corresponding to matched histology images. Attenuation values at each peak tube voltage were compared within plaque types for both noncontrast and contrast scans. Further, dual-energy index (DEI) values computed from attenuation were analyzed for classification of plaque. In 14 lesions, a total of 56 quadrants were identified. Histology results classified 8 (14%) as densely calcified, 8 (14%) as fibrocalcific, 9 (16%) as fibrous, 5 (9%) as lipid-rich, and 25 (45%) as normal vessel wall. Calcified lesions attenuated significantly more at 80 kVp in both contrast and noncontrast scans, whereas fibrous plaque attenuated more at 80 kVp only for contrast-enhanced scans. No differences were found for lipid-rich plaques. Using DEI values, only densely calcified plaques could be distinguished from other plaque types except fibrocalcific plaques in contrast images. Only densely calcified and fibrocalcific plaques showed a true change in attenuation at 80 versus 140 kVp. Therefore, calcified plaques could be distinguished from noncalcified plaques with DECT, but further classification of plaque types was not possible.

Optical Coherence Tomography in the Setting of an Acute Anterior Myocardial Infarction

HomeCirculationVol. 116, No. 14Optical Coherence Tomography in the Setting of an Acute Anterior Myocardial Infarction Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBOptical Coherence Tomography in the Setting of an Acute Anterior Myocardial Infarction Ravinay Bhindi, Shahzad M. Munir and Keith M. Channon Ravinay BhindiRavinay Bhindi From the Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. Search for more papers by this author , Shahzad M. MunirShahzad M. Munir From the Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. Search for more papers by this author and Keith M. ChannonKeith M. Channon From the Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. Search for more papers by this author Originally published2 Oct 2007https://doi.org/10.1161/CIRCULATIONAHA.107.722769Circulation. 2007;116:e366–e367An 82-year-old man presented with an acute anterior myocardial infarction and was treated with intravenous reteplase with successful reperfusion. Forty-eight hours later, however, he developed further chest pain and ST-segment elevation. He was referred for salvage percutaneous coronary intervention.The left anterior descending artery was completely occluded proximally (Figure, A) with no detectable collateral flow, and the remainder of the coronary circulation showed diffuse nonsignificant disease. The left anterior descending artery was engaged with a JL4 guide catheter and wired with a Whisper J wire. The lesion was predilated with a 1.5-mm noncompliant balloon that restored flow to the left anterior descending artery and demonstrated a tight culprit lesion in the left anterior descending artery (Figure, B). This was then imaged with optical coherence tomography (OCT), which was facilitated by bolus contrast injection instead of proximal vessel occlusion. Panel C of the Figure demonstrates the composition of the plaque, which was disrupted with fibrocalcific material in the wall and thrombus in the vessel lumen. The lesion was then further dilated with a 2.5/12-mm balloon, stented with a 3.5/12-mm drug-eluting stent, and finally postdilated with a 3.5/9-mm balloon with an excellent angiographic result (Figure, D). OCT was then performed with proximal balloon occlusion at the end of the case, which showed a widely patent vessel, good stent apposition, and no luminal thrombus (Figure, E). Download figureDownload PowerPointA, Coronary angiography demonstrates a totally occluded left anterior descending artery proximally (arrow). B, After predilatation of the left anterior descending artery, the culprit lesion is identified (arrow). C, OCT of the lesion demonstrates a stenosed lumen with a predominantly fibrocalcific plaque (L), which shows evidence of disruption and intraluminal thrombus (arrow). D, Angiographic image after stent deployment (arrow) shows a widely patent vessel. E, OCT after stent deployment demonstrates a widely patent lumen with no intraluminal thrombus and good stent apposition (arrow).OCT is a novel, high-resolution, intravascular imaging modality that provides “optical biopsies” of the vascular wall.1,2 Because blood interferes with the imaging capabilities of the OCT probe, vessel occlusion followed by saline injection is generally performed to permit viewing. An alternative strategy is concurrent imaging during the injection of a contrast bolus to displace blood; this alternative technique was adopted in the present case during the initial sequence of imaging, when blood flow was diminished as a result of the recently ruptured plaque. Adequate images were obtained with no significant delay using this procedure. The present case shows the OCT images of a ruptured plaque detected during salvage percutaneous coronary intervention after an anterior myocardial infarction, which was performed in a hemodynamically stable patient with failed thrombolysis, to characterize the culprit lesion. Such an approach could potentially be used to broaden the application of OCT.DisclosuresNone.FootnotesCorrespondence to Dr Ravinay Bhindi, Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom. E-mail [email protected]References1 Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, Kauffman CR, Shishkov M, Kang DH, Halpern EF, Tearney GJ. Characterization of human atherosclerosis by optical coherence tomography. Circulation. 2002; 106: 1640–1645.LinkGoogle Scholar2 Jang IK, Tearney GJ, MacNeill B, Takano M, Moselewski F, Iftima N, Shishkov M, Houser S, Aretz HT, Halpern EF, Bouma BE. In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation. 2005; 111: 1551–1555.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Lee R, Antoniades C, Adlam D and Channon K (2012) Treatment of recurrent vein graft “stent-in-stent” re-stenosis guided by optical coherence tomography, International Journal of Cardiology, 10.1016/j.ijcard.2011.08.007, 156:1, (e20-e21), Online publication date: 1-Apr-2012. October 2, 2007Vol 116, Issue 14 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.722769PMID: 17909111 Originally publishedOctober 2, 2007 PDF download Advertisement SubjectsCatheter-Based Coronary and Valvular InterventionsImagingMyocardial Infarction

1122 Coronary atherosclerotic plaque characterization with virtual histology: is there a difference according to risk factors and in the group with predominant fibro-lipidic component?

1122 Coronary atherosclerotic plaque characterization with virtual histology: is there a difference according to risk factors and in the group with predominant fibro-lipidic component?