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Intravascular elastography

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Intravascular elastography

  1. 1. CdK ‘02 ICIN Intravascular Elastography: palpating plaques with the finger of IVUS C.L. de Korte1 , F. Mastik1 , J.A. Schaar1 , M. Sierevogel1,3 ,G. Pasterkamp3 , P.W. Serruys1 and A.F.W van der Steen1,2 1 Erasmus University, Thoraxcentre, Rotterdam, The Netherlands 2 Interuniversity Cardiology Institute of the Netherlands 3 Experimental Cardiology Laboratory, University Medical Center, Utrecht, The Netherlands Supported by Netherlands Organization for Scientific Research (NWO) and the Dutch Technology Foundation (STW)
  2. 2. CdK ‘02 ICIN Background : Vulnerable plaque que vulnerability : que composition • Large lipid pool Mechanical properties • High strain region • Thin fibrous cap • presence of Macrophages
  3. 3. CdK ‘02 ICIN Background : Principle of elastography Soft Harduncompressed compressed • The response of tissue to mechanical excitation (e.g. compression) is a function of its mechanical properties. Force Soft Hard
  4. 4. CdK ‘02 ICIN IVUS elastography (t1, P1) (t2,P2) Processing IVUS at 100mmHg IVUS at 80mmHg IVUS elastogram strain 1% 0%
  5. 5. CdK ‘02 ICIN strain 1% 0% Picrosirius-red Anti-CD68 antibodyAlpha-actin Circulation 102(6) 617-623 (2000) IVUS elastography plaque characterization
  6. 6. CdK ‘02 ICIN strain 1% 0% Picrosirius-red Anti-CD68 antibodyAlpha-actin IVUS elastography vulnerable plaque detection ACC 2002, presentation 1054-20
  7. 7. CdK ‘02 ICIN Predictive power of elastography to identify the vulnerable plaque 1 - Specificity 1.00.75.50.25 Sensitivity 1.00 .75 .50 .25 0 Strain 1.26 %: Sensitivity 88% Specificity 89% ACC 2002, presentation 1054-20
  8. 8. CdK ‘02 ICIN 0 20 40 60 80 100 120 40 60 80 100 120 140 Frame no. Intra-coronary pressure[mmHg] In vivo elastography Strain [%] 1.0 0.0 Eur Heart J 23(5): 405-413 (2002)
  9. 9. CdK ‘02 ICIN Cross-section LAD of patient with U.A.P Strain [%] 2.0 0.0
  10. 10. CdK ‘02 ICIN IVUS elastography before atherectomy Strain [%] 1.0 0.0
  11. 11. CdK ‘02 ICIN Fibrous cap tissue Fibro-fatty core tissue Histology atherectomy specimen
  12. 12. CdK ‘02 ICIN Echogram and elastogram obtained in vivo in Yucatan strain 1% 0% Elastic-von Giesson Picro-Sirius red Acid Phosphatase Polarized light Circulation (2002) in press
  13. 13. CdK ‘02 ICIN Tissue mean std Normal segments (n=6) 0.21 0.09 Early fatty lesion (n=9) 0.46 0.17 Early fibrous lesion (n=3) 0.24 0.03 Advanced fibrous lesion (n=6) 0.22 0.04 Strain [%] * Strain and plaque composition in Yucatan Univariate ANOVA on strain Fat p=0.007 MΦ p=0.966 1 - Specificity 1.00.75.50.250.00 Sensitivity 1.00 .75 .50 .25 0.00 Area=0.952 Circulation (2002) in press
  14. 14. CdK ‘02 ICIN 3 Dimensional Elastography
  15. 15. CdK ‘02 ICIN Conclusion Intravascular Ultrasound Elastography: A powerful technique to identify the vulnerable plaque.

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