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Thermography early clinical correlations

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Thermography early clinical correlations

  1. 1. Thermography early clinical correlations R Erbel, A Schmermund, M. Katz, F. Chwallek, D. Baumgart Department of Cardiology University Essen Germany
  2. 2. Thermography Catheter Basket Over the wire catheter system Pull back device with 0.5 mm/s 1 central blood thermo couple 5 thermo couples 3.3 F catheter 0.02 o C accuracy
  3. 3. 0.2 o C 0.1 10 mm
  4. 4. distal proximal mm 100.1 0.2 o C
  5. 5. Temperature 36,4 36,6 36,8 37 37,2 37,4 37,6 37,8 Blood TC TC1 TC2 TC3 TC4 TC5 Scan Distance
  6. 6. Study Aim Assessment of • Temperature recording • Steerability of catheter system • QCA of coronary arteries • Pull back recording, Endosonics device • Practicability • Safety
  7. 7. Clinical History of Patients • 12 patients included • 9 male, 3 female • 43 – 73 years • 8 stable angina • 4 unstable angina IIIb/IIIc • 4 diabetes melitus • 3 previous myocardial infarction • 9 on aspirin, 9 on statine
  8. 8. Unstable Angina, LAD stenosis Advancing the thermography catheter
  9. 9. Unstable Angina, LAD stenosis Positioning the thermography catheter
  10. 10. Unstable Angina, LAD stenosis Opening the basket
  11. 11. Unstable Angina Advancing the thermography catheter RCx lesionAmplatz catheter
  12. 12. Thermography Catheterization Technical Considerations • High 92% success rate • Over the wire catheter • Good steerability even with regular wires • Easy opening of thermography basket • Accurate pull back device
  13. 13. Patient Scan B2 35 35,2 35,4 35,6 35,8 36 36,2 36,4 36,6 36,8 37 1 10 19 28 37 46 55 64 73 82 91 100 109 118 Scan Distance (mm) Temperature(C) Blood TC TC1 TC2 TC3 TC4 TC5 Patient 2
  14. 14. Patient Scan B4 35,8 36 36,2 36,4 36,6 36,8 37 1 9 17 25 33 41 49 57 65 73 81 89 97 105 113 121 129 137 145 153 Scan Distance (mm) Temperature(C) Blood TC TC1 TC2 TC3 TC4 TC5 Distal Proximal Patient 4
  15. 15. Patient Scan B7 34,8 35 35,2 35,4 35,6 35,8 36 36,2 36,4 36,6 36,8 37 37,2 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 Scan Distance (mm) Temperature(C) Blood TC TC1 TC2 TC3 TC4 TC5 Patient 7
  16. 16. Patient 10 • 65 year old man • Unstable angina, Braunwald IIIB • Previous RCx PTCA and stenting 1996 • Risk factors arterial hypertension hypercholesterinemia smoking, diabetes mellitus • 175 cm, 88 kg, 2 m 2 BSA • 0.1 mg/dl CRP
  17. 17. Unstable Angina, LAD stenosis Angio
  18. 18. LAD Segment 7 Lesion 79% stenosis 14 mm length 16.1 mm 2 plaque area KH K
  19. 19. LAD Segment 7 lesion KH K 10
  20. 20. LAD Segment 7 lesion KH K 10
  21. 21. LAD Segment 7 lesion KH K
  22. 22. LAD Segment 7 lesion KH K
  23. 23. Unstable Angina, LAD stenosis Thermography
  24. 24. Patient 10 Patient Scan B10 35,6 35,8 36 36,2 36,4 36,6 36,8 37 1 9 17 25 33 41 49 57 65 73 81 89 97 105 113 121 129 137 145 153 Scan Distance (mm) Temperature(C) Blood TC TC1 TC2 TC3 TC4 TC5
  25. 25. Unstable Angina After stent implantation
  26. 26. LAD segment 7 lesion After drug- eluting stent Implantation 29% stenosis 3 mm length 2.7 mm 2 pla- que area
  27. 27. Patient 10 • Follow-up no troponin elevation o.o2 and o.o4 ng/ml (ref < 0.1) myoglobin stable 57 and 59 ug/dl (ref < 90) C-reactive protein 0.1 and 0.1 mg/dl (ref < 0.5)
  28. 28. Patient 11 • 43 years old man • Anterior AMI August 29 peak CK 3286 U/l treatment 50 mg tenecteplase (Prof Jansen, Leverkusen) • previous TIA April 01 • RF: hypercholesterinemia smoking 190 cm, 98 kg, 2.3 m 2 BSA • 2.1 mg/dl CRP
  29. 29. Unstable Angina Angio
  30. 30. LAD segment 6 lesion 73 % stenosis 12 mm length 9.7 mm 2 pla- que area
  31. 31. Unstable Angina Thermography Position 2 cm distal to segment 6 culprit lesion
  32. 32. Unstable Angina Thermography Position 69 mm within the lesion
  33. 33. ThermographyMain stem hot spot 2 mm proximal to stenotic segment 6 lesion, + 0.35 o C
  34. 34. Unstable Angina After stent implantation
  35. 35. LAD segment 6 lesion 26% stenosis 11 mm length 0.7 mm 2 pla- que area Reperfusion no - reflow VT UH
  36. 36. Patient 11 History of PCI • Detection of hot spot pre PCI • LAD 3.0 18 mm drug eluting stent 18 bar, post stent PTCA 4.0 mm 10 bar • RCA 90% stenosis, additional PCI 3.0 13 mm drug eluting stent • Lab tests: decline of CK, TnI and myoglobin 69 to 123 and 86 ug/d (ref 90) • CRP: 0.7 mg/dl (ref 0.5) • Further course uneventful
  37. 37. Thermography Results • 92 % success rate • 35.91 – 36.95 o C blood temperature • Up to + 0.14 up to + 0.36 o C in hot spots • 4/ 11 temperature increase • 4/ 11 focal hot spot • 3/ 4 multifocal hot spots • 1/ 4 MACE corresponding to CRP increase • 3/ 4 hot spots but normal CRP
  38. 38. Future of Thermography • Combination with IVUS • Preinterventional scanning in order to detect hot spots for futher protective intervention - aspiration systems or - filter devices or - graft stenting or - cooling down
  39. 39. Patient 9 • 61 year old woman • Unstable angina type IIIB • troponin I in the gray zone 0.14 ng/ml • C-reactive protein 0.1 and 0.2 mg/dl (ref. 0.1) • Risk factors: diabetes, hypertension hypercholesterinemia • Dialysis 1992 – 2001 • Renal transplantation
  40. 40. RCx Segment 11 lesion 70 % stenosis 14 mm length 19 mm 2 pla- que area HS
  41. 41. Unstable Angina IIIB Angio Suspicion of plaque rupture in distal RCx
  42. 42. Unstable Angina IIIB After thermography
  43. 43. RCx Segment 11 lesion 35%stenosis 15 mm length 6.8 mm 2 pla- que area HS
  44. 44. Patient • PCI protocol: • Heavily calcified vessels • Guidewire steering with balloon • Amplatz catheter AL 1 8F • 3.5 16 mm bare stenting • 16 bar • TnI 0.87 ng/ml (ref 0.1) CK, myoglobin remained stable
  45. 45. Patient 8 Patients History • 66 year old man • Unstable AP III after surgery by urology • Risk factors diabetes hypertension
  46. 46. Patient Scan B8 35,8 36 36,2 36,4 36,6 36,8 37 37,2 1 7 13 19 25 31 37 43 49 55 61 67 73 79 Scan Distance (mm) Temperature(C) Blood TC TC1 TC2 TC3 TC4 TC5
  47. 47. Unstable Angina IIIB Thermography
  48. 48. Thermography
  49. 49. Thermography
  50. 50. RCx lesion
  51. 51. RCx lesion
  52. 52. Patient 2
  53. 53. Patient 2
  54. 54. Patient 1
  55. 55. Patient 1
  56. 56. LAD segment 5 lesion 59 % stenosis 8 mm length 10 mm 2 pla- que area Patient 0
  57. 57. Thermography
  58. 58. Thermography
  59. 59. Thermography
  60. 60. Thermography
  61. 61. Thermography
  62. 62. Thermography
  63. 63. Unstable Angina, Circ lesion Angio
  64. 64. Unstable Angina, Circ lesion After thermography
  65. 65. LAD segment 6 lesion UH
  66. 66. LAD segment 6 lesion UH
  67. 67. LAD segment 6 lesion UH
  68. 68. 35,8 36 36,2 36,4 36,6 36,8 37 37,2 Scan Distance Blood TC TC1 TC2 TC3 TC4 TC5 Temperature
  69. 69. Patient Scan B1 34 34,2 34,4 34,6 34,8 35 35,2 35,4 35,6 35,8 36 36,2 36,4 36,6 36,8 37 37,2 37,4 37,6 37,8 38 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101 105 109 113 117 121 125 129 133 Scan Distance (mm) Temperature(C) Blood TC TC1 TC2 TC3 TC4 TC5
  70. 70. Patient B0 Partial Scan 35,8 36 36,2 36,4 36,6 36,8 37 37,2 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 Scan Distance (mm) Temperature(C) Blood TC TC1 TC2 TC3 TC4 TC5
  71. 71. Patient B6 - Scan 35 35,2 35,4 35,6 35,8 36 36,2 36,4 36,6 36,8 37 1 7 13 19 25 31 37 43 49 55 61 67 73 79 85 91 97 103 109 115 121 127 133 139 145 151 157 163 169 175 181 187 193 199 205 Scan Distance (mm) Temperature(C) Blood TC TC1 TC2 TC3 TC4 TC5
  72. 72. Temperature 36,4 36,6 36,8 37 37,2 37,4 37,6 37,8 Blood TC TC1 TC2 TC3 TC4 TC5 Scan Distance
  73. 73. Thermography Catheterization

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