185 towards the future cath lab
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This document discusses the potential for using MRI as an alternative to x-ray guidance in cardiac catheterization labs and interventional procedures. It outlines the history of MRI in cardiovascular imaging and interventions. Recent studies are presented that demonstrate the feasibility of MRI-guided coronary catheterization and balloon angioplasty in animals. However, technological barriers remain for implementing MRI guidance in cath labs clinically due to challenges making equipment MRI-compatible and other accreditation/reimbursement issues. The potential for combined x-ray and MRI systems is also raised.
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3) Post-PCI, a minimum stent area (MSA) below 5mm2 seen on IVUS/OCT is associated with higher risk of restenosis and stent thrombosis. Under expansion is still common.
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2) The Gamma Knife machine uses 201 cobalt-60 sources arranged in a hemispherical pattern to deliver beams of radiation that converge at a focal point within the brain where the tumor is located.
3) During treatment, a stereotactic frame is attached to the patient's head to precisely position their brain at the focal point, and radiation is delivered in a single session that usually lasts 2-4 hours allowing patients to go home the same day.
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III. While MR guidance has advantages over x-ray for interventional cardiology like reduced radiation and better imaging, challenges remain from respiratory and cardiac motion as well as the small, tortuous anatomy of coronary arteries.
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182 non invasive coronary angiography
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182 non invasive coronary angiography
This document discusses the potential for non-invasive coronary angiography using computed tomography (CT) techniques such as electron beam CT (EBCT) and multi-slice CT (MSCT). It provides an overview of the history and technological developments in CT as well as results from studies comparing CT to invasive coronary angiography. The document concludes that use of a 16-slice MSCT scanner combined with beta-blockers has significantly improved the diagnostic accuracy of CT for non-invasively detecting coronary stenosis, and that fast MSCT is becoming a leading screening technique for coronary artery disease.
Esv2n41
This document discusses the potential for non-invasive coronary angiography using computed tomography (CT) techniques such as electron beam CT (EBCT) and multi-slice CT (MSCT). It provides an overview of the history and technological developments of CT as well as results of studies evaluating the diagnostic accuracy of EBCT and MSCT for detecting coronary artery disease compared to invasive angiography. The document concludes that with improvements in rotation speed and larger detector arrays, fast MSCT is becoming the leading screening technique for non-invasive detection of coronary stenosis without radiation or contrast exposure of invasive methods.
Maximum intensity projection (mip) (2)
The implementation of MDCT in urological imaging has solved much of the diagnostic dilemma. Thanks to its multiplanar capabilities and post processing techniques.
Very High Resolution Ultrasound Imaging for Real-Time Quantitative Visualizat...
Very High Resolution Ultrasound Imaging for Real-Time Quantitative Visualizat...Dr Reaz Vawda, MSc PhD
This study evaluated the use of very high resolution ultrasound (VHRUS) to image vascular disruption in a rat model of spinal cord injury (SCI). VHRUS was able to accurately depict the normal anatomy of the intact spinal cord as well as changes after SCI, including the development of hemorrhage. There was strong correlation between VHRUS measurements of hemorrhage and quantitative measures of hemorrhage and vascular disruption. Time-lapse VHRUS videos demonstrated the evolution of hemorrhage over time, showing it first appearing in new areas around the injury before expanding into the surrounding parenchyma. This suggests VHRUS could be a useful non-invasive tool for longitudinally assessing vascular changes following SCI.Long term post Ventricular tachycardia ablation guided by non contact mapping...
This study assessed radiofrequency catheter ablation guided by non-contact mapping for treatment of monomorphic ventricular tachycardia after myocardial infarction. Fifteen patients underwent either targeted ablation of exit sites and areas of slow conduction (Group I, 7 patients) or substrate modification with linear ablation lesions (Group II, 8 patients). Acute success rates were high for both groups. Long term success was also good, with no recurrence of ablated ventricular tachycardias during follow up for most patients. Substrate modification using linear ablation guided by non-contact mapping showed promise for preventing reinduction of arrhythmias.
E-poster06 Rusza aimradial20170921 Coronary artery fistula
E-poster06 Rusza aimradial20170921 Coronary artery fistulaInternational Chair on Interventional Cardiology and Transradial Approach
Transradial coil embolization of coronary artery fistulas (CAF) and left internal mammary artery (LIMA) side branches from radial approach. A case series - Zoltan RuzsaCt scan and its interpretation in omfs
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Feasibility of using 3D MR elastography to determine pancreatic stiffness in ...
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245 mri scanner
1. MRI was first developed in 1946 and has since evolved into a powerful non-invasive diagnostic tool known as magnetic resonance imaging (MRI).
2. In the early 1980s, researchers began exploring applications of MRI in cardiovascular medicine such as detecting structural abnormalities, tissue characterization, and evaluating patients with known or suspected coronary artery disease.
3. A 1991 study demonstrated MRI's ability to correctly identify substantial coronary artery stenosis, and a 1993 study showed MRI could provide visualization of major epicardial vessels in a single breath-hold.
245 mri scanner
1. MRI was first developed in 1946 and has since evolved into a powerful non-invasive diagnostic tool known as magnetic resonance imaging (MRI).
2. In the early 1980s, researchers began exploring applications of MRI in cardiovascular medicine such as detecting structural abnormalities, tissue characterization, and evaluating patients with known or suspected coronary artery disease.
3. A 1991 study demonstrated MRI's ability to correctly identify substantial coronary artery stenosis, and a 1993 study showed MRI could provide visualization of major epicardial vessels in a single breath-hold.
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Interventional Radiology And Cardiology
Interventional cardiology and radiology use minimally invasive techniques guided by imaging to diagnose and treat diseases. Some common procedures include radiofrequency ablation to treat cancers, coronary angioplasty and stent placement to open blocked arteries, transjugular intrahepatic portosystemic shunt placement to reduce portal hypertension, and coronary angiography to image heart arteries using contrast dye. These procedures use catheters and stents along with imaging like fluoroscopy to precisely deliver treatments to diseased areas while minimizing patient trauma.
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AHA SHAPE Symposium 2017 Dr. Naghavi Presentation
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This document discusses developing an artificial intelligence system to predict short-term cardiovascular disease (CVD) events. The goal is to eradicate unexpected heart attacks by predicting risk similar to hurricane forecasts. Existing studies are cited that show over 50% of heart attacks are first symptoms of underlying disease. The document outlines previous work by SHAPE to define vulnerable patients and release guidelines. It proposes using machine learning on existing cohort data to develop algorithms predicting heart attacks within 12 months, and validate the system. The hope is this can trigger preventative actions and add over 10 years to life expectancy. Funding is needed to implement the proposed "Machine Learning Vulnerable Patient Project".AHA SHAPE Symposium 2017 Dr. Kloner Presentation
Triggers of cardiovascular events can include physical and emotional stress. Stress from events like earthquakes, blizzards, intense sporting games, and overexertion from activities like snow shoveling have been shown to increase the risk of acute cardiovascular outcomes like myocardial infarction. While modern therapies have improved cardiovascular health, research continues to show temporary increases in cardiovascular mortality associated with highly emotional sporting events even in recent years. Managing risk factors, reducing stress, and utilizing preventative therapies may help reduce the impact of triggers on cardiovascular health.
AHA SHAPE Symposium 2017 Dr. Greenland Presentation
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The document introduces the All of Us Research Program, which aims to collect health data from one million Americans to advance precision medicine research. It was announced by President Obama in 2015. The program receives funding from the federal government and private partners. It collects various types of health data from participants through surveys, health records, samples, and devices. The data is stored and shared securely while protecting privacy. The goal is to generate new medical discoveries and more personalized healthcare through collaboration between researchers and participants.AHA SHAPE Symposium 2017 Dr. Yen Presentation
A machine learning model outperformed the ACC/AHA Pooled Cohort Equations Risk Calculator in detecting high-risk asymptomatic individuals and recommending statin treatment for cardiovascular disease prevention in the Multi-Ethnic Study of Atherosclerosis. The machine learning model used support vector machines and data augmentation to derive a CVD risk predictor from nine variables in the MESA study population. It demonstrated higher sensitivity, specificity, and AUC compared to the ACC/AHA risk calculator, recommending statin treatment for fewer individuals while missing fewer cardiovascular events.
AHA SHAPE Symposium 2017 Dr. Slomka Presentation
This document discusses machine learning applications in cardiac imaging presented by Piotr Slomka. It describes how machine learning can improve image analysis, diagnosis, and risk prediction. Machine learning combines multiple data points like imaging and clinical data to predict outcomes. Deep learning can perform tasks like image segmentation. Machine learning provides quantitative scores that predict disease, need for intervention, or patient outcomes to help clinicians. The goal is to integrate machine learning into clinical decision making.
Vu lplaque1 pasterkamp
This document summarizes a post-mortem study examining the prevalence of inflammatory cells in non-ruptured atherosclerotic plaques. The study found that moderate or heavy staining for macrophages was present in 45% of femoral artery cross-sections and 84% of femoral arteries had at least one cross-section with moderate/heavy inflammation. There was no observed relationship between the degree of inflammation in the left and right coronary arteries within individuals, indicating the level of local inflammation is locally determined with little predictive value for other arteries.
Vulnerable plaque vulnerable patient
The document provides guidelines for defining vulnerable plaque and vulnerable patients from the Association for Eradication of Heart Attack. It outlines major and minor histopathological and clinical criteria for vulnerable plaque including active inflammation, thin fibrous cap with large lipid core, endothelial denudation, and stenosis. Potential screening and diagnostic methods are discussed at the plaque, systemic, and blood levels ranging from non-invasive imaging to intravascular techniques. Different types of vulnerable plaque that can cause acute coronary events are also categorized.
Vulnerable plaque overview
Vulnerable plaque refers to dangerous forms of atherosclerotic plaques that can rupture or induce thrombosis, disrupting blood flow. The document discusses the history and research around vulnerable plaque, including pioneers in the field and emerging techniques to detect vulnerable plaque such as intravascular ultrasound, optical coherence tomography, and magnetic resonance imaging. It summarizes that vulnerable plaques are typically characterized by a thin fibrous cap, large lipid core, and presence of macrophages.
Vulnerable patient talk in poland
The document summarizes research on vulnerable plaques and markers of vulnerability. It finds that ruptured plaques are the most common type of culprit lesion, accounting for around 70% of cases. Major criteria for defining vulnerable plaque include outward remodeling, endothelial dysfunction, and a thin fibrous cap with a large lipid core. Both plaque morphology and activity need to be assessed to identify vulnerability.
Vulnerable patient slides without movies
This document contains a summary of a presentation on vulnerable patient syndrome. It includes PowerPoint slides and videos on defining and identifying vulnerable plaques and patients. It thanks sponsors for their support of the educational event. The slides define vulnerable plaques as those likely to rupture in the future, causing heart attacks, and provide criteria for identifying them based on morphology and activity. Biomarkers and conditions that increase plaque and myocardial vulnerability are also summarized. The presentation outlines a pyramid approach for screening, diagnosing, and treating vulnerable patients annually to help reduce heart attacks and their high costs.
Vulnerable patient mar 04
This document discusses triggers for sudden cardiac arrest (SCA) and death (SCD). It notes that over 2/3 of SCD cases are unable to be predicted due to a lack of well-established risk factors. While population risk factors can identify at-risk groups, they cannot predict risk for individuals. The document explores various biological, anatomical, and environmental factors that can precipitate fatal arrhythmias and discusses how the timing of transient initiating events is critical for the development of ventricular tachyarrhythmias. It emphasizes that myocardial electrophysiological processes likely determine the onset or lack of VT/VF/SCD and that immediate access to automated external defibrillators is needed to save lives.
Vulnerable (thrombogenic blood
This document summarizes presentations from symposia on vulnerable plaque and discusses the relationship between plaque, blood, and patients in atherothrombosis. It notes that multiple factors like diabetes, smoking, and hyperlipidemia can make blood more thrombogenic and moderate the severity of acute events after plaque rupture. Statins, aspirin, and other drugs that target tissue factor or thrombin pathways may be promising antithrombotic agents by inhibiting thrombosis initiation and propagation.
Vuln shape aha 2005
The document discusses vulnerable plaque and challenges in detecting and treating it. It describes various imaging techniques for detecting vulnerable plaque such as thermography, MRI, CT angiography, and optical coherence tomography. However, it notes that while these can identify high-risk features, it remains unclear what exactly defines vulnerable plaque and whether imaging findings truly correlate with risk. The document also notes that while statins reduce events, the relationship between plaque burden and events is unclear, and better defining and detecting the disease is still needed before new therapies can be developed.
Vuln plaque poster burke
1) The study examined 92 hearts from patients with severe coronary artery disease who died suddenly. The hearts were sectioned and plaque types were classified.
2) The number of "vulnerable" plaques, particularly thin cap atheromas, was highest in hearts of patients who died from acute plaque rupture and lowest in those with incidental disease.
3) Thin cap atheromas and other unstable plaque types were concentrated in the proximal coronary segments, similar to the distribution of plaque ruptures. The study suggests vulnerable plaques contribute to acute coronary syndromes and are non-uniformly distributed within the coronary arteries.
Vp watch editorial_slide 25short-
1) Drug-coated stents, particularly those coated with sirolimus, have shown promise in reducing restenosis compared to bare metal stents. Sirolimus inhibits cell proliferation and has been shown in studies to reduce intimal hyperplasia and restenosis in animal models by 50% or more.
2) A study by Suzuki et al. found that a sirolimus-coated stent reduced restenosis by 50% through inhibiting cellular proliferation in a dose-dependent manner compared to a bare metal stent. Adding dexamethasone to the coating did not provide additional benefit.
3) If results of the RAVEL clinical trial showing "zero" restenosis out to 5 years
Vp watch editorial_slide25
This document discusses drug-coated stents for preventing restenosis. It summarizes a study showing that stents coated with sirolimus via a polymer matrix reduced restenosis by 50% by inhibiting cell proliferation. Adding dexamethasone provided no additional benefit. Other studies also showed sirolimus inhibits smooth muscle cell proliferation. If results of the RAVEL trial showing "zero" restenosis at 210 days hold true long-term, sirolimus-coated stents may become the standard therapy for coronary revascularization. Questions are raised about whether coating vulnerable plaques could be a primary treatment and if multiple vulnerable plaques would all be stented.
Vp watch editorial_slide25short-
1) Drug-coated stents, particularly those coated with sirolimus, have shown promise in reducing restenosis compared to bare metal stents. Sirolimus inhibits cell proliferation and has been shown in studies to reduce intimal hyperplasia and restenosis in animal models by 50% or more.
2) A study by Suzuki et al. found that a sirolimus-coated stent reduced restenosis by 50% through inhibiting cellular proliferation in a dose-dependent manner compared to a bare metal stent. Adding dexamethasone to the coating did not provide additional benefit.
3) If results of the RAVEL clinical trial showing "zero" restenosis out to 5 years
Vp watch2002
I. This document discusses various animal models that have been used to study atherosclerosis and plaque rupture, including quail, pigeons, chickens, dogs, monkeys, pigs, rats, rabbits, and mice. It provides details on the types of lesions developed and similarities to human disease for each model.
II. The double knockout LDL/apoE mice are highlighted as offering improvements in studying clinical complications of atherosclerosis like human heart disease. However, it is unclear how closely they model vulnerable plaques.
III. Questions are raised about how closely the coagulation systems of these animal models resemble humans and whether any model fully captures repeated plaque ruptures and the role of aging in natural history as seen in humans.
Vp symposium31602
Trans-Blood Vision is a patented infrared technique that uses short-wave infrared wavelengths to see directly through blood. It has the potential to find vulnerable plaque lesions without first entering them, determine their size and surface characteristics in high resolution, and look at their material constituents both on and below the surface. While it cannot provide direct visual guidance for therapy or penetrate as deeply as ultrasound, combining it with augmentative technologies could allow for real-time multi-mode detection, analysis, and therapy guidance of vulnerable plaque lesions. The document concludes that Trans-Blood Vision warrants significant investigation, possibly in combination with other emerging technologies.
Vpschoenhagen
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in 131 patients with either stable angina or recent unstable symptoms. Patients with unstable presentations had greater plaque burden at the culprit lesion despite similar luminal narrowing, and a greater extent of positive arterial remodeling compared to those with stable angina. The culprit lesions in unstable patients also showed a higher rate of echolucent plaque morphology. This suggests that bulky, remodeled plaques may be more vulnerable to rupture, leading to acute coronary syndromes. Further prospective study is needed to better understand the relationship between clinical presentation and plaque features.
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185 towards the future cath lab
- 1. Editorial Slides VP Watch, February 5, 2003, Volume 3, Issue 5 Towards The Future Cath Lab Jarek Wosik Paul Cherukuri Texas Heart Institute
- 2. – In the past two decades, MRI has been slowly introduced into the world of cardiovascular medicine. – In early 1980s Higgins and others envisioned MRI applications for detection of cardiac structural abnormalities (such as congenital anomalies) as well as acute and remote myocardial infarctions, atherosclerotic plaques, hypertrophic cardiomyopathy, pericardial diseases, aneurysms, and patency of bypass graft. 2
- 3. Manning et al. demonstrated the power of noninvasive MRI coronary angiography to identify substantial stenosis correctly within the proximal portion of major coronary arteries in a group of patients undergoing conventional contrast coronary angiography. Other investigators also introduced MRI application in non-invasive coronary imaging.3,4,5
- 4. • Intravascular MRI (iMRI) is a potential tool for the detailed characterization and localization of plaques as well as having the added benefit of implementing local therapy. • iMRI is simply a wire resonator tuned to the external applied pulse generated by an extravascular MRI system. The resonator due to it’s close proximity to the target body increases the signal from that region thereby capable of providing microscopic images
- 5. This image is a selective angiogram of a kidney after a catheter is placed in the renal artery using real-time MRI guidance. The image shows good spatial detail of the renal artery, renal parenchyma, and collecting system.
- 6. This panel of images shows a sequence of real-time MRI- guided cardiac injections. NHLBI - Robert Lederman
- 7. Atlar also showed a new development that uses high-resolution MR imaging as an in vivo imaging tool to monitor catheter-based vascular gene delivery. 9 In another study Atalar et al showed that coronary artery catheterization and intracoronary balloon angioplasty are feasible with MRI guidance indicating that iMRI maybe an alternative to X-ray guidance in coronary artery interventions in the future. 8
- 8. Intercept™ Vascular .030" Internal MR Coil Pre-Clinical Animal Image www.Surgi-Vision.com
- 9. • Guenther RW et al have shown that active tip tracking simultaneous with MRI of the vascular anatomy-both in real time-is possible, enabling MR-guided percutaneous dilatation (PTA) of iliac arteries.10 • Buecker A et al presented a new sequence for real-time MR imaging sequence reliably allowed for high-quality coronary MR fluoroscopy without motion artifacts in all pigs for accurate stent placement. Ten of 11 coronary stents were correctly placed under MR guidance. 11
- 10. • Wilke NM et al recently demonstrated that catheter tracking and ASD device closure can be performed under real-time MRI guidance with the use of intravascular antenna guide wires. 12
- 11. • As highlighted in VP Watch of this week, Serfaty, Atalar and colleagues have shown the feasibility of using an MR imaging guide wire as a potential tool for use in endovascular interventional MR imaging-guided balloon angioplasty. 7
- 12. • A prototype 0.014-inch coronary MRI guidewire, a prototype 7 French MRI-guiding catheter, and two flexible surface coils were connected to a GE 1.5 T CV/i scanner for simultaneous visualization of the guidewire, guiding catheter, and chest anatomy.
- 13. • Images were displayed in real time on an in-room monitor. A nongated, single-slice fast gradient-echo sequence was used to obtain real-time images of the catheters and background anatomy during the intervention.
- 14. • Fifteen selective catheterizations were attempted in the coronary arteries, and all were successful. • Selective injection of diluted gadolinium into the MRI-guiding catheter provided dynamic 2D projection coronary angiography in all cases, confirming successful catheterization.
- 15. • Percutaneouse transluminal coronary angioplasty (PTCA) was attempted after two catheterizations, and all attempts were successful. Inflation of the balloon angioplasty catheter was performed successfully in the left anterior and circumflex arteries.
- 16. Conclusion: • Coronary artery catheterization and intracoronary balloon angioplasty are feasible with MRI guidance only. • MRI guidance may be used as an alternative to X-ray guidance in coronary artery interventions in the future.
- 17. Questions: • 1- What are the technological and non-technological barriers for the implementation of MRI guided PCI? • 2- Can we make everything in cath labs MR compatible? Or should we try to make MRI cath lab compatible?
- 18. Questions: • 3- What are the accreditation and reimbursement issues in cardiovascular MRI? • 4- Can MRI replace X-ray systems in future cath labs?
- 19. Is XMR (combined X-Ray and MRI) a viable solution for cath labs?
- 20. MRI X-Ray