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156 intravascular elastography

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156 intravascular elastography

  1. 1. CdK ‘02 ICIN Intravascular Elastography: from Bench to Bedside 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 Vulnerable plaque detection In vitro 25 human coronary arteries with 78 cross-sections. Histology: • lipid core (> 40%) • thin cap with moderate/heavy macrophage infiltration Elastography: • high strain region on the surface of the plaque • an adjacent low strain region Definition used for plaque Vulnerability :
  7. 7. CdK ‘02 ICIN strain 1% 0% Picrosirius-red Anti-CD68 antibodyAlpha-actin IVUS elastography vulnerable plaque detection Circulation 104 (17): II-459 (2001)
  8. 8. CdK ‘02 ICIN sensitivity specificity Sensitivity and Specificity 3 0 0 0.5 1 1.5 2 2.5 Strain [%] 1 Strain 1.26 %: Sensitivity 88% Specificity 89% Circulation 104 (17): II-459 (2001)
  9. 9. CdK ‘02 ICIN IVUS elastography in patients • Patients referred for Percutaneous Coronary intervention • Pre intervention IVUS assessment of the culprit lesion using 20 MHz JOMED Avanar® IVUS catheter. • JOMED InVision Gold Echo system with digital acquisition system for off-line processing • Find phase of heart-cycle with minimal motion of catheter since motion decreases elastographic quality.
  10. 10. 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)
  11. 11. CdK ‘02 ICIN Cross-section LAD of patient with U.A.P Strain [%] 2.0 0.0
  12. 12. CdK ‘02 ICIN Patient with Angina Pectoris Strain [%] 1.0 0.0
  13. 13. CdK ‘02 ICIN Intravascular Elastogram of lesion pre-stenting Strain [%] 1.0 0.0
  14. 14. CdK ‘02 ICIN Intravascular Elastogram of stented lesion Strain [%] 1.0 0.0
  15. 15. CdK ‘02 ICIN • 6 Yucatan minipigs of 40 kg. • Acquired elastographic data in left and right femoral and external iliac artery (n=24). • Cross-sections marked using angiography after termination. • Processed for histology: Elastic-von Giesson Picro-Sirius red Acid Phosphatase Validation in atherosclerotic Yucatan minipig
  16. 16. 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 105 (14): 1627-1630 (2002)
  17. 17. CdK ‘02 ICIN Correlation elastography with histology • Relation mean strain in total plaque with plaque composition (fibrous, fatty, macrophages) 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 [%] * * P=0.007 Circulation 105 (14): 1627-1630 (2002)
  18. 18. CdK ‘02 ICIN Correlation elastography with histology • Presence of a high strain spot (>1% strain) with presence of fat and or macrophages. fat no fat ↑ ε 9 3 ↓ ε 0 12 MΦ no MΦ ↑ ε 11 1 ↓ ε 1 11 Circulation 105 (14): 1627-1630 (2002)
  19. 19. CdK ‘02 ICIN 3 Dimensional Elastography
  20. 20. CdK ‘02 ICIN Conclusion Intravascular Ultrasound Elastography: A powerful technique to identify the vulnerable plaque.

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