OCT Presentation with St. Jude. Medical System.
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The Optis system uses optical coherence tomography (OCT) to provide high-resolution cross-sectional images of coronary arteries. It consists of an ILUMIEN console, PressureWire and Aeris wireless FFR technologies, and a Dragonfly Duo catheter. The catheter contains an optical fiber that rapidly acquires images during a pullback at frame rates up to 180 fps. OCT can detect features not visible on angiography like thrombus, plaque rupture, and stent apposition. The procedure involves purging the catheter, positioning it in the artery, and acquiring pullback images during contrast injection to assess the vessel and guide clinical decision making.
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OCT Presentation with St. Jude. Medical System.
- 1. OPTIS SYSTEM (PART I) OPTICAL COHERENCE TOMOGRAPHY PRESENTED BY : MUHAMMAD NAVEED SAEED CATH LAB TECH. KING FAISAL SPECIALIST HOSPITAL & RESEACH CENTER. RIYADH, KSA
- 2. 2 OUTLINES : • Introduction • What is OCT • OCT from SJM • What is Optis system • Optis system components • What is DragonFly Duo Catheter • OCT procedures (How can we do) • Interpretation Image with OCT
- 5. 5 OCT FROM SJM 2004 2007 2009 2011 2012 M2 System M3 System C7XR™ System ILUMIEN™ System ILUMIEN™ OPTIS™ First Commercial OCT System 15 fps / 200 lines Occlusion + flush 2nd Generation 20 fps / 240 lines Occlusion + flush Europe and US only 100 fps / 500 lines Occlusion-free Commercially available 2011 100 fps / 54 mm pullback Combined FFR and OCT Wireless FFR Japan launch 2012 180 fps/75 and 54 mm pullback Advanced software tools for PCI Optimization Tableside control from DOC Occlusion balloon + ImageWireTM Occlusion-free Flush FFR and OCT System 2nd Gen FFR and OCT System
- 6. 6 OCT TECHNOLOGY FROM ST. JUDE MEDICAL • Console • Rapid exchange (Rx) imaging catheter • Contrast flush; balloon occlusion not required • Fast image acquisition: 7.5cm pullback in 2.5 sec
- 7. C7 DragonflyTM OCT Catheter OCTOCT 7 OPTIS – SYSTEM COMPONENTS PressureWireTM AerisTM ILUMIEN™ Console Wireless FFR Wireless FFR FFR and OCT
- 8. Physician’s Monitor DOC Removable Tray Connector Panel Service Access Panel Wheel Locks Main Power Cord Connector Main Power Switch Physician’s Side 8 ILUMIEN™ – CONSOLE OVERVIEW Operator’s Monitor Keyboard CD/DVD Drive Fan Filter Hibernate/ wake-up button Mouse Chart Holder Operator’s Side
- 9. 9 DRAGON-FLY DUO CATHETER ( WHAT IS NEW) • Fiber optic • Three radioparque marker • Compatible with G.C 6 or 7 Fr without holes • G.W 0.14”
- 10. 10 PULLBACK SETTINGS System Specifications C7/ILUMIEN C8 Clinical Impact Frame rate (frames per second) 100 fps 180 fps Higher frame rate = faster pullback Pullback speeds 10, 20, 25 mm/sec 18, 36 mm/sec Faster speed minimizes contrast required for longer pullback Pullback length 54 mm 75 mm ~90% of total lesions will occur in the proximal 50 mm of the left arterial system. In the RCA, 80% of lesions are within 75 mm of the ostium. Ref: Lesion locations within Arteries; J Am Coll Cardiol, 2005; 45:1186-1192
- 11. 11
- 13. 13 PRIOR TO STARTING A CASE Required Materials – Dragonfly™ Duo imaging catheter – Sterile DOC cover – 3 ml purge syringe – Contrast media indicated for coronary use – 0.014" guidewire – Guide catheter (6-7 F, with no sideholes) HOW CAN WE DO..............................
- 14. 14 TURNING ON THE SYSTEM – POWER SWITCHES Powerup / Wake-up button on upper right of keyboard . Main Switch next to power cable Tech.
- 15. 15 ENTERING PATIENT DATA…………………… Tech. Press Add new patient data. Put all the information's concerning the patient. Press New OCT Recording.
- 16. 16 CATHETER PREPARATION • Purge with contrast until 3-5 drops exit distal tip. Scrub Tech.
- 17. 17 CATHETER PREPARATION • Remove the hoop carefully from the catheter Scrub Tech.
- 19. 19 CONNECTING CATHETER TO DOC Counter clockwise clockwise Scrub Tech.
- 20. CATHETER PREPARATION Insert the DOC into the sterile bag. Scrub Tech Fix the DOC by her hand and the Technician pull the sterile cover. Place it on the table. Scrub Tech. Tech.
- 21. 21 PREPARATIONS • Watch the five yellow LEDs light up on the DOC
- 22. 22 PREPARATIONS
- 23. 23 PREPARATIONS OF CALIBARATION Press Live View Ask the physician to put his 2 fingers to calibrate the catheter Press Auto-Calibrate , The system is calibrated automatically Tech.
- 24. Stop Button Unload Button Laser Emission Symbol Advance Button Pullback Button Pullback Position LEDs Load LED DRIVE MOTOR OPTICAL CONTROLLER (DOC) – OVERVIEW 24
- 26. 26 PULLBACK PREPARATION – PURGE THE CATHETER • If blood enters the catheter lumen, purge with the attached 3 cc contrast syringe. Blood in catheter lumen Purged catheter lumen
- 27. 27 PREPARATION OF INJECTION Recommended Settings: • Injection by hand • Left coronary, Right coronary arteries: (16----20) ml ; • We can use 12-20 ml syring In your Cath. (Depend on operator) • When the operator is ready to inject contrast, click the “Enable Pullback ” button. • Ask the Physician to inject, 3 sec from the injection and when the image is clear press ”Start Pullback”
- 29. 29 PULLBACK PREPARATION – PUFF INTO THE VESSEL • During live scan, puff with the contrast injector to determine guiding catheter position for optimal image clarity. Suboptimal clearance, blood swirls Optimal clearance
- 30. 30 REVIEWING AN ACQUIRED IMAGE
- 33. 33 BOOKMARKS
- 36. 36 NEW RECORDING FOR THE SAME PATIENT Press New Recording Ask again the physician to put his 2 fingers to do calibration Repeat the same step of the Injection
- 37. 37
- 38. 38 ENDING PROCEDURE • Press “Unload” to disconnect catheter
- 39. WHAT WE CAN FOUND WITH OCT ................................ • Detect the Thrombus , not detected with Angio – Image • Rapture Plaque • Differentiate between the Red and white Thrombus • Stent Thrombosis and Malappositon
- 41. THROMBUS 41 White Thrombus Red Thrombus
- 43. 43
- 44. 44 THANK YOU FOR YOUR PARTICIPATION AND PATIENCE
- 45. 45
Editor's Notes
- I really appreciate having had this opportunity to share my ideas with you.
- This presentation is intended to give you an introduction to ILUMIEN OCT sytem and how can do OCT work in this system
- After knowing which lesion is to treat the next question is how to treat this lesion So OCT technology comes to ask this question
- What is oct Optical Coherence tomography (OCT) is a light based imaging modality with superior spatial resolution (~ 15Um) compared to other intravascular imaging system. This technology does not use x-ray The acquisition of this image is fast and easy to treat In other hand other type of coronary imaging is difficult to interpret and doesn't have the high resolution So the high resolution of oct makes it an excellent tool to visualize the vasculature Who that
- We have long history of OCT, competition is new to the field
- In order to perform OCT procedures, St. Jude Medical provides a console (C7-XR™) and an imaging catheter (Dragonfly™). With the current C7-XR technology, no balloon occlusion is required; rather, the vessel is cleared of blood for imaging by a rapid flush of contrast. The images themselves are acquired extremely quickly: acquiring a 5 cm pullback image takes only 2.5 seconds.
- This combination improve more insight to provide the diagnosis and the treatment of coronary artery daisies and optmize the intervention
- The image on the left shows the “physician’s side” of the system, which has the larger of the two monitor screens. The only component on the system that enters the sterile field is the DOC (Drive Motor and Optical Controller), which connects to Dragonfly catheter. The image on the right shows the system operator’s side of the system for nonsterile use. No components on this side of the console are considered sterile. The console is operated similar to an ordinary PC, with a mouse and keyboard. Files can be saved onto a CD/DVD drive or a memory stick.
- Long pullback : 75mm ; old one : 55mm 3 markeres : lens marke visible during the pullback ; distal and proximal to guide the phyisican on the best position The old : only 2 markres : distal and proximal markers ; to help the physician more and more to know where is the good position
- This box named : catheter kit Caheter Sleeve Syringe
- The ilumien system incorporat the most advanced oct techology to optmize PCI and visulazie the vessel anatomy How that By ……
- To turn the system on, connect the power cord to the power inlet at the base of the console, next to the Main Switch, and connect the other end to a power outlet. Once the system is plugged in, use the Main Switch to turn the system on. When the Main Switch is on, the power indicator light on the monitor will be amber.Once the Main Switch is turned on, the Hibernate/Wake-up button can be used to turn the system on and off. When the Hibernate/Wake-up button is turned on, the power indicator light on the monitor will be green. Before unplugging the system, turn the Main Switch off. If the power-on indicator light on the monitor is amber, press the Hibernate/Wake-up button to turn on (wake up) the system. After a few seconds, the power indicator light will flash, indicating system start-up. A self-test is performed and the main screen will appear in approximately 45 seconds.
- Choose existing patient or add new patient, and then choose New OCT Recording.
- When the catheter is removed from the hoop, purge it with contrast before connecting it to the DOC (use 100% contrast for the best images).Apply firm, steady pressure on the syringe for approximately 10 seconds (the viscosity of the contrast medium means it will take time to fill the catheter). When the catheter has been filled, 3-5 drops of contrast should exit the distal tip. Filling the catheter with highly viscous contrast prevents backflow of blood into the catheter. Blood in the catheter negatively affects the quality of the OCT images. Leave the purge syringe connected to the purge port. This prevents blood from entering the catheter and makes it easy to re-purge as needed. NOTE: this screen may be skipped for future cases by checking the box in the lower left corner.
- Remove the hoop carefully from the catheter. To avoid damage, grasp the proximal end of the catheter at the side port and hold firmly with your thumb and forefinger. With the other hand, gently twist and pull the hoop to release the catheter. Do not twist and pull the catheter. While withdrawing it from the hoop, gently wipe the catheter shaft with a compress moistened with heparinized saline. This activates the hydrophilic coating and prevents the catheter from spinning dry, causing possible fiber breaks. Handle carefully to prevent kinking the catheter.
- Once the catheter has been purged, it can be connected to the DOC.Remove the blue protective cap from the catheter hub by twisting the cap counterclockwise. Open the black connector cover on the front of the DOC. Align the four catheter hub sprockets inside the DOC connection port; turn clockwise until secure. Care should be taken not to touch the fiber optic core of the catheter and not to kink or bend the catheter.
- Insert the DOC into the sterile bag and place it on the table. NOTE: This step requires two people, one sterile and one nonsterile.
- The fiber optics connect automatically. When catheter loading is complete, the green light on the DOC will stop flashing and the Connecting Imaging Catheter progress bar on the system screen will be completely green.
- The screen will show the status of the connecting catheter, and the LED on the DOC will light up (see next slide).
- When the catheter is fully connected, this will be indicated on the screen.
- This is the DOC, which stands for Drive Motor and Optical Controller. The controls and indicators are: Load LED – Operator can attach or remove catheter when fully lit (not blinking) Unload – Press to unload imaging catheter Laser Emission Symbol – Illuminated when laser output is switched on Stop – Stops the imaging catheter motion and turns off laser output Advance – Starts or stops the optical fiber advance sequence Pullback – Starts or stops the optical fiber pullback sequence Pullback Position LEDs – Relative position of the optical carriage along the pullback range Once the DOC has been placed in a sterile pouch, it is ready for use together with a sterile Dragonfly imaging catheter.
- Once in position, press “Live View” to view a live image. Blood in the catheter lumen results in poor image quality. If blood enters the catheter lumen, as shown in the image on the left, purging is required.A lumen clear of blood is shown in the image on the right.
- When you have verified the calibration, click Enable Pullback. Fifteen seconds are allowed for the flush to start. A countdown icon and message will appear. If a flush is not initiated within 15 seconds, the DOC reverts to its pre-enabled state. When the flush is initiated, it causes the automatic trigger in the software to initiate the pullback. The DOC immediately increases speed to 100 Hz in preparation for the pullback. After the flush has been injected, the software detects a clear field and begins the pullback automatically. ILUMIEN system automatically replays the acquired pullback sequence and the lens returns to its original advanced position. The image acquisition procedure may be repeated if necessary. The pullback images are stored in the image management area on the right side of the screen. The active pullback and an L-mode (longitudinal) image are displayed on the large section on the left side of the screen. The system has the ability to store 2,400 images.
- During the live scan, a puff of contrast is used to ensure optimal blood clearance in the vessel, and good clarity of the pullback image. This puff should come from the contrast injector, and not the 3 cc syringe attached to the catheter. If clarity is marginal, as shown in the image on the left, the contrast may not be filling the vessel to clear the artery of blood as it should, and the physician may need to adjust the guide catheter for better engagement and to maximize contrast flow into the artery. Another puff showing optimal clearance is displayed in the image on the right. A “puff image” that looks like this is a good indication that the pullback image will have good clarity. Several puffs for one clear pullback will prevent the need to acquire additional pullbacks, and will ultimately require less contrast for the patient.
- Once an image has been acquired, use the toolbar below the image to: Play, pause, stop, move by frame or move by 1 mm segments Add or delete bookmarks Jump from bookmark to bookmark Export images and bookmark frames of interest The system will automatically play back at a default speed of 1 mm/sec. The optical fiber automatically advances to the original distal position.
- Once acquisition of a segment is complete, you still have the possibility to adjust calibration. Calibration may be adjusted either to a chosen frame and proximal or to the entire recorded segment.
- Once acquisition of a segment is complete, you still have the possibility to adjust calibration. Calibration may be adjusted either to a chosen frame and proximal or to the entire recorded segment.
- Icons are grouped in a logical sequence beginning with length and area (automatic or manual) measurement. When “Area” is calculated automatically, diameter is also shown automatically. This eliminates the need to initiate a second measurement for the diameter. The values displayed are area and mean, minimum and maximum diameters. The user either accepts or cancels the measurement values, then proceeds to the next measurement. When “Area” is calculated manually, using the multi-point icon, diameter is shown automatically. This eliminates the need to initiate a second measurement for the diameter. The values displayed are area and mean, minimum and maximum diameters. An Undo button allows the user to erase incorrectly placed points one at a time, from last to first. The user either accepts or cancels the measurement values, then proceeds to the next measurement. The user can select any frame as a reference (REF) frame once the measurement values are confirmed. This makes it possible to compare the target segment (e.g., stenosis or stented segment) with a reference segment. Example: Press REF to select a reference segment area to compare with a target segment. Go to the target segment in the pullback and press %AS and %DS to calculate what the maximum narrowing is in the vessel, compared to the reference segment you have chosen.
- Click the T icon to add a note to that frame.
- When the imaging session is finished, the unload button must be pressed on the DOC to release the catheter. If the Unload button is not pressed before attempting to remove the catheter, part of the catheter will remain locked into the DOC, which can damage the DOC.
- Thank you for finding the time to come and join me for this presentation.