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Intravascular Imaging Modalities (OCT and IVUS)
Published in Vikram S. Kashyap, Matthew Janko, Justin A. Smith, Endovascular Tools & Techniques Made Easy, 2020
Elder Iarossi Zago, Gabriel Tensol Rodriguez Pereira, Hiram Bezerra
Although catheter-based angiography is the method used by most endovascular interventionalists to assess the severity and morphology of vascular lesions and guide treatment, it has many known limitations. Primarily, these images are lumenograms, depicting a two-dimensional projection of a contrast-filled lumen, with little information about the vessel wall and the vessel's inherent three-dimensional characteristics. Intravascular imaging—intravascular ultrasound (IVUS) and optical coherence tomography (OCT)—includes imaging modalities that utilize catheter-mounted probes to provide an axial cross-sectional image of a vessel to address the limitations of conventional angiography in imaging and interventions (1–4).
OCT assessment out of the coronary arteries
Published in Hiram G. Bezerra, Guilherme F. Attizzani, Marco A. Costa, OCT Made Easy, 2017
Jun Li, Daniel Kendrick, Vikram S. Kashyap, Sahil A. Parikh
Peripheral arterial disease (PAD) affects 20% of the population over the age of 65.1–3 The presence of PAD not only serves as an important surrogate for the development of coronary artery disease, but also can have a profound effect on the quality of life in patients with claudication. Dr. Thomas Fogarty and Dr. Charles Dotter independently introduced endovascular therapies in the peripheral vasculature in the 1960s with the use of balloon catheter angioplasty.4–8 Endovascular techniques are now widely used by vascular surgeons, interventional cardiologists, and interventional radiologists in the peripheral vasculature. Although conventional angiography provides information in the two-dimensional plane of the vessel outline and luminal dimension, it lacks detail regarding lesion morphology and vessel wall characteristics. Intravascular imaging serves as a useful adjunct to traditional angiography in the characterization and treatment of vascular disease.
Bioresorbable scaffolds in diffuse disease
Published in Yoshinobu Onuma, Patrick W.J.C. Serruys, Bioresorbable Scaffolds, 2017
Neil Ruparelia, Hiroyoshi Kawamoto, Antonio Colombo
As previously mentioned, the use of intravascular imaging (e.g., intravascular ultrasound or optical coherence tomography) is invaluable in treating long segments of disease. Due to current device design, appreciation of plaque composition (e.g., the presence of calcium) and measurement of the reference vessel diameter is essential prior to BRS implantation (Figure 7.4.3). This enables appropriate vessel preparation and BRS sizing considering the limited potential of upsizing following implantation due to the risk of strut fracture. Finally, to allow adequate expansion and stent apposition, postimplantation intravascular imaging is mandatory to ensure optimal results and the best clinical outcomes. Appropriate postdilatation will facilitate embedment of the struts into the vessel wall partially counteracting the impact of greater strut thickness.
Coronary atherosclerotic plaque progression: contributing factors in statin-treated patients
Published in Expert Review of Cardiovascular Therapy, 2020
Donald Clark, Rishi Puri, Steven E. Nissen
Over the last 30 years, vascular imaging has been integral to the development of therapeutic strategies targeting residual cardiovascular risk. Since the observation that coronary angiography only visualizes obstructive complications of atherosclerotic disease, intravascular ultrasound and other modalities were developed to address the need to visualize plaque in the vessel wall and quantify the burden of disease. Imaging anatomically matched segments at different time points provided the ability to evaluate the effect of medical therapies on plaque progression. Early stages of drug development have utilized randomized trials assessing serial changes in atheroma volume to identify therapies most promising to succeed in clinical outcomes trials. Post hoc analyses of these trials have provided novel insights into factors associated with coronary atheroma progression and may prove to have important therapeutic implications with further research. Intravascular imaging will likely continue to play a pivotal role in advancing our understanding of atherosclerosis and subsequent therapeutic development.
Chronic kidney disease and coronary atherosclerosis: evidences from intravascular imaging
Published in Expert Review of Cardiovascular Therapy, 2019
Takamasa Iwai, Yu Kataoka, Fumiyuki Otsuka, Yasuhide Asaumi, Stephen J Nicholls, Teruo Noguchi, Satoshi Yasuda
A continuing rise of frequency in atherogenic risk factors will have alarming the increase in patients with CKD in the future. With technological advances in intravascular imaging tools, it has enabled to visualize the extent of coronary atherosclerosis. Furthermore, plaque imaging is capable to assess a beneficial effect of intensive control of established risk factors on atheroma progression. As such, integration of intravascular imaging has a great potential to establish effective therapies for slowing progression of atherosclerosis in subjects with CKD. Several studies using serial IVUS imaging did not identify favorable effects of lowering LDL-C, SBP and CRP levels on the natural history of coronary atherosclerosis in CKD patients. More efforts toward searching therapeutic target associated with atherosclerosis of CKD are required. In particular, identifying drivers associated with plaque calcification will lead to the development of new agents which regress calcium accumulation. We need to conduct more plaque imaging studies, which will clarify atherogenic stimuli to pharmacologically modify in the setting of CKD.
Contemporary practices using intravascular imaging guidance with IVUS or OCT to optimize percutaneous coronary intervention
Published in Expert Review of Cardiovascular Therapy, 2020
The development and evolution of intravascular imaging overcome some of the limitations of angiography. There is significant observational and randomized trial evidence that intravascular imaging guidance improves the outcome after PCI. Specifically, many studies have demonstrated that intravascular imaging-guided PCI is associated with lower rates of target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis, major adverse cardiac events (MACE), and cardiovascular (CV) death compared to coronary angiography-guided PCI [1,2]. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the most commonly used modalities for intravascular imaging.