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Intravascular Ultrasound for
Plaque Characterization
Scott R. Smith
Boston Scientific Corporation
The 3rd Vulnerable Plaque Symposium
March 16, 2002
Who needs interventional diagnosis
and treatment?
Population Size Annual Risk
Healthy People Huge <<1%
“Risk Factors” Really Big ~1%
Walking Time
Bombs
Still quite a few >10%
Summary of
National Heart, Lung, and Blood Institute
Workshop on Cardiovascular Risk Assessment
Diagnosis of Vulnerable Plaque
selecting a population
positive negative
67%
positive predictive value
99%
negative predictive value
likelyhood ratio
test
9% 5%
total unaffected
14%
true positive false positive
1% 86%
87%
false negative true negative
positive
negative
18
90% 95%
sensitivity specificity
10% 90%
total affected
Total 100
at risk 10
treated 14
saved 9
unnecessary 5
missed 1
Plaque Structure
Courtesy of
Dr. Renu Virmani
Armed Forces Institute
of Pathology
IVUS Plaque Imaging
Ruptured plaque
Boston Scientific Imaging Systems
Atlantis™ SR Plus Catheter Galaxy™ IVUS System
Features & Intended Benefits
• Tapered tip; 2.5 Fr. Crossing
Profile
• High definition 40MHz IVUS
catheter.
• 6F Guide Catheter
Compatibility.
Galaxy™ System Features and
Intended Benefits
Time-Saving Features
– Image Bookmarking
– LongView™ longitudinal
measurements
– Pullback sled
Enhanced Ease of Use
– TraceAssist™ automatic
lumen trace function
– Angiographic compatibility
– Push button control
Galaxy™ System Research
Capabilities
Expanded Functionality
– Digital image storage
– Patient database
– Pre/post intervention analysis.
RF Output
– Direct Access to RF signal for
acquisition and analysis
– Future plans may include
direct RF signal acquisition
Imaging vs. Analysis
RF
Rectified and Log compressed
Low passed filtered - 10MHz
One image vector
Other Imaging Modalities
IVUS acoustic
impedance
MRI proton
relaxation
Thermal temperature
OCT refractive
index
Spectroscopy chemical
bonds
Independence
Spatial resolution
Contrast
Conclusion
• Intravascular Ultrasound currently widely used
for intravascular imaging
• Broad potential for plaque volume
measurement and tissue characterization
• Variety of research efforts aimed at improving
tissue contrast and resolution
Thanks to:
– Tat Jin Teo, PhD - BSC Imaging
– Renu Virmani, MD - AFIP
– Jay Kokate, PhD - BSC Applied Research

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077 intravascular ultrasound for plaque characterization

  • 1. Intravascular Ultrasound for Plaque Characterization Scott R. Smith Boston Scientific Corporation The 3rd Vulnerable Plaque Symposium March 16, 2002
  • 2. Who needs interventional diagnosis and treatment? Population Size Annual Risk Healthy People Huge <<1% “Risk Factors” Really Big ~1% Walking Time Bombs Still quite a few >10% Summary of National Heart, Lung, and Blood Institute Workshop on Cardiovascular Risk Assessment
  • 3. Diagnosis of Vulnerable Plaque selecting a population positive negative 67% positive predictive value 99% negative predictive value likelyhood ratio test 9% 5% total unaffected 14% true positive false positive 1% 86% 87% false negative true negative positive negative 18 90% 95% sensitivity specificity 10% 90% total affected Total 100 at risk 10 treated 14 saved 9 unnecessary 5 missed 1
  • 4. Plaque Structure Courtesy of Dr. Renu Virmani Armed Forces Institute of Pathology
  • 6. Boston Scientific Imaging Systems Atlantis™ SR Plus Catheter Galaxy™ IVUS System Features & Intended Benefits • Tapered tip; 2.5 Fr. Crossing Profile • High definition 40MHz IVUS catheter. • 6F Guide Catheter Compatibility.
  • 7. Galaxy™ System Features and Intended Benefits Time-Saving Features – Image Bookmarking – LongView™ longitudinal measurements – Pullback sled Enhanced Ease of Use – TraceAssist™ automatic lumen trace function – Angiographic compatibility – Push button control
  • 8. Galaxy™ System Research Capabilities Expanded Functionality – Digital image storage – Patient database – Pre/post intervention analysis. RF Output – Direct Access to RF signal for acquisition and analysis – Future plans may include direct RF signal acquisition
  • 9. Imaging vs. Analysis RF Rectified and Log compressed Low passed filtered - 10MHz One image vector
  • 10. Other Imaging Modalities IVUS acoustic impedance MRI proton relaxation Thermal temperature OCT refractive index Spectroscopy chemical bonds Independence Spatial resolution Contrast
  • 11. Conclusion • Intravascular Ultrasound currently widely used for intravascular imaging • Broad potential for plaque volume measurement and tissue characterization • Variety of research efforts aimed at improving tissue contrast and resolution Thanks to: – Tat Jin Teo, PhD - BSC Imaging – Renu Virmani, MD - AFIP – Jay Kokate, PhD - BSC Applied Research