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• W813134012 abstract "JACC: CARDIOVASCULAR IMAGING a 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION VOL. 7, NO. 1, 2014 ISSN 1936-878X/$36.00 PUBLISHED BY ELSEVIER INC. iMAIL LETTERS TO THE EDITOR Integrated IVUS-OCT for Real-Time Imaging of Coronary Atherosclerosis Accurate assessment of atherosclerotic plaque characteristics and the subsequent tailoring of optimal therapy holds great promise for preventing acute coronary syndromes (ACS) and life-threatening sequelae (1). Combined use of optical coher- ence tomography (OCT) and intravascular ultrasound (IVUS) was proposed as a potential method for accurate assessment of plaque characteristics and vulnerability (2,3). However, signi- ficant challenges remain in trying to adapt an integrated OCT-IVUS system for clinical applications. We report here a fully integrated intracoronary OCT-IVUS imaging technique to visualize atherosclerotic plaque in living animals and human coronary arteries from cadavers with high resolution and deep penetration capability simultaneously. First, we created lesions, similar to human atherosclerotic plaques, in male New Zealand white rabbits by feeding them a high- cholesterol diet and subjecting them to de-endothelization procedures (4). We imaged plaques in rabbit aortas using the OCT-IVUS system with a 3.4-F integrated catheter (5) and a 10-ml Omnipaque (iohexol, 350 mgI/ml, GE Healthcare, Princeton, New Jersey) injection flushing into the artery at w3 ml/s for blood clearance. A total of 10 volumetric datasets were obtained from 5 rabbits. Ten 2- to 20-mm long aorta segments were imaged at 5 mm/s pull-back speed. A representative OCT-IVUS image pair and corresponding histology of a rabbit abdominal aorta with a thick-cap fibroatheroma is shown in Fig. 1 (row I). IVUS enables the visualization of the layer structure of the artery wall. Intimal thickening and a low-density acoustic signal region (denoted by the arrow in Fig. 1Ia) demonstrate plaque in the IVUS image. However, this image also illustrates the inability of IVUS to determinate the plaque type and the plaque cap boundary. At the same site in the OCT image (Fig. 1Ib), a homogenous boundary and weak signal region under a high signal region indicates that this plaque is a necrotic/lipid plaque with an overlying fibrous cap. In addition, the minimum thickness of the cap can be easily measured to be w200 m m by using OCT, which is indicative of a thick-cap fibroatheroma. The classification of plaque type is validated by the corresponding histology photo (Fig. 1Ic), which shows loose necrotic material. This area is covered by smooth muscle and fibrous proliferations at the luminal surface, which is consistent with a fibrous cap. All IVUS-OCT images of rabbit aortas were matched with histology for correlation of accuracy. Linear regression showed a high correlation between plaque circumfer- ence percent (PCP) (defined as the circumference of lumen in which there is plaque divided by the entire lumen circumference) determined from histological analysis and the estimated PCP of OCT and IVUS (R 2 ¼ 0.955, p < 0.001 between OCT and histology; R 2 ¼ 0.970, p < 0.001 between IVUS and histology). Second, a female Yorkshire white swine was imaged by conventional femoral access and angiography guidance under Downloaded From: http://imaging.onlinejacc.org/ by Pranav Patel on 01/24/2014 the same flushing procedure as in the rabbits. The goal was to test the feasibility of translating this technology into clinical applications (Figs. 1, row II). In the IVUS image (Fig. 1IIa), the 3-layer structure of the swine artery (wall thickness w0.4 mm) is barely visualized with an IVUS axial resolution of 60 m m. In Figure 1IIb, the OCT image differentiates the 3 structural layers of the artery wall. Last, we collected 14 cadaver coronary arteries from 6 pa- tients who died of complications from ACS or were diagnosed with atherosclerotic heart disease. Representative OCT-IVUS image pairs of a fibrous plaque, calcified plaque, and lipid plaque from different cadavers are shown in Figure 1/rows III, IV, and V, respectively. An acoustic shadow in Figure 1IVa shows the location of a calcified plaque. However, it is difficult to classify the plaque morphology in Figure 1IIIa and Figure 1Va by using IVUS imaging because of intrinsically limited resolution and low soft tissue contrast. The OCT im- aging is able to classify plaque morphology by optical scattering contrast of different tissue types. However, with limited penetration depth, the OCT image cannot provide a clear visualization of the media and adventitia layer at this intima- thickening coronary segment. These results clearly demon- strate the complementary nature of OCT and IVUS imaging. A total of 28 OCT-IVUS image pairs, obtained from 14 plaque samples (2 pairs from each sample, pull-back and repull-back), were analyzed for quantitative validation of the technique’s accuracy and reproducibility. Linear regression showed a high accuracy (R 2 ¼ 0.911, p < 0.001 for OCT histology; R 2 ¼ 0.923, p < 0.001 for IVUS histology) and high reproducibility (R 2 ¼ 0.937, p < 0.001 for OCT; R 2 ¼ 0.971, p < 0.001 for IVUS) of PCP measurements. Our fully integrated in vivo imaging system has high reso- lution to identify the thin cap and deep penetration to visualize the necrotic core simultaneously. Such a device may lead to a more accurate assessment of vulnerable plaques and especially thin-cap fibroatheroma. Moreover, most of the current under- standing about ACS has been achieved through static histo- pathology research. This novel, in vivo integrated OCT-IVUS imaging technique is anticipated to improve our understand- ing of the process of this disease through longitudinal in vivo studies. Acknowledgments The authors acknowledge Mr. E. Steward, Ms. T. Burney, Mr. D. Mukai, and Mr. D. Yoon for their assistance during surgical procedures, as well as Ms. L. Liaw and Ms. L. Li for their assistance in histological analyses. The authors also thank in- dividuals who donated their bodies and tissues for the advancement of education and research. Jiawen Li, MS, Xiang Li, PhD, Dilbahar Mohar, MD, Aidan Raney, MD, Joseph Jing, MS, Jun Zhang, PhD, Abbey Johnston, MD, Shanshan Liang, MS, Teng Ma, BS, K. Kirk Shung, PhD, Sari Mahon, PhD, Matthew Brenner, MD, Jagat Narula, MD, Qifa Zhou, PhD, * Pranav M. Patel, MD, y Zhongping Chen, PhD z" @default.
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• W813134012 date "2014-01-10" @default.
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• W813134012 title "Integrated intracoronary optical coherence tomography-ultrasound for in vivo real-time imaging of atherosclerotic plaques" @default.
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