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Plaque Characterization
with OCT
LightLab OCT
Optical Coherence
Tomography (OCT) is a new
class of ultra high-resolution
imaging technology using
near infrared light.
In addition to morphological imaging,
LightLab OCT is capable of:
 Spectroscopic Imaging
 Polarization Imaging
 Doppler
 Elastography
 Real time Imaging (to 30fps)
 Portable & Modular Design
 Digital System Architecture
LightLab Imaging PlatformLightLab Imaging Platform
(Pending 510(k) Clearance)
LightLab OCT
 .006” micro-optic core
 Microscopic resolution (12
µm)
 .014” ImageWire & Balloon
Imaging System
Catheters
Precision Imaging
Intimal ThickeningIntimal Thickening
Human Cadaver, Left Diagonal Branch
Intima
Media
Adventitia
Precision Imaging
Ex-vivo LAD
Thin capped FibroatheromaThin capped Fibroatheroma
Lesion
Cap < 60µm
(Renu Virmani, MD, AFIP)
NC
Ca++
FC
NC
F
C
Ca++ NC necrotic core
calcium
lumen
Precision Imaging
(Renu Virmani, MD, AFIP)
FC fibrous cap
Over sampling enables detailedOver sampling enables detailed
interrogationinterrogation
Ex-vivo LAD, LightLab .014” ImageWire(Renu Virmani, MD, AFIP)
Precision Imaging
Core
Thrombus
Core
Precision Imaging
OCT Cine Pullback
Human Cadaver Circumflex Artery
Thin Capped LesionsThin Capped Lesions
Precision Imaging
Pull-back in stentPull-back in stent (note early side branch)(note early side branch)
In-vivo HumanIn-vivo Human
.014” ImageWire
Prof. Eberhard Grube, Siegburg Heart Center
Precision Imaging
In-vivo Human Lesion 400 micrometer capIn-vivo Human Lesion 400 micrometer cap
.014” ImageWire
Prof. Eberhard Grube, Siegburg Heart Center
Bringing a microscope into theBringing a microscope into the
coronaries improves the clinicians abilitycoronaries improves the clinicians ability
to:to:
 Select the appropriate therapy
 Titrate the delivery of specific therapies
 Direct the delivery to targeted lesions
 Develop entire new therapeutic approaches
Precision Therapy
Imaging BalloonImaging Balloon
In-vivo pig, LightLab Imaging Balloon, 3mm
and .014” ImageWire – No Flush
Brigham&Women’s Hospital ECI Lab
Real-time inflation visualization
Precision Therapy
Stent and ThrombiStent and Thrombi
Full Screen
In-vivo pig, LightLab .014” ImageWire
Dr. Campbell Rogers, Brigham&Women’s Hospital ECI Lab
Precision Therapy
Zoom
In-vivo Human Stent in StentIn-vivo Human Stent in Stent
.014” ImageWire
Prof. Eberhard Grube, Siegburg Heart Center
Precision Therapy
 Upgrades
• Polarization Imaging
• Spectroscopic Imaging
• Doppler
• Elastography
LightLab Imaging Platform – FutureLightLab Imaging Platform – Future
(Pending 510(k) Clearance)
LightLab OCT Technology
 Sub selective flush
 Forward looking lens designs
 Integrated therapeutic catheters
Imaging System
Catheters
Polarization
Information for a better understanding ofInformation for a better understanding of
microanatomic plaque characteristicsmicroanatomic plaque characteristics
Evaluate plaque
structure and
orderliness
Grey Scale
Detailed
Morphological
understanding
Cap thickness, identify
fissures, calcium, lipid
Cap/plaque Fiber
Spectroscopy
Determine
chemical content
of visualized
lesions
Lipid concentration
Polarization
LightLab OCT Technology
Different tissues exhibit differentDifferent tissues exhibit different
polarization effectspolarization effects
OCT
is inherently sensitive to
changes in the polarization
of the probe beam.
Birefringence
is the major source
of contrast in polarization-
sensitive OCT imaging.
Very High
Very low
Media (healthy)
Cholesterol crystals
Soft (lipid) plaque
Fibrotic plaque
Intima (healthy)
Calcified plaque
Structure
Birefringence
LightLab OCT Technology
Grayscale Polarization Difference
Table
Surface
Laminated
Structure
LightLab OCT Technology
(Birefringent)
(Non-Birefringent)
Polarization helps differentiate organizedPolarization helps differentiate organized
(linear) from disorganized structures(linear) from disorganized structures
Magnitude
Polarization
Combined
Grey scale and polarization information may beGrey scale and polarization information may be
combined to localize and identify tissuecombined to localize and identify tissue
characteristicscharacteristics
Platform FuturesPlatform Futures
Polarization
Evaluate plaque
structure and
orderliness
Grey Scale
Detailed
Morphological
understanding
Cap thickness, identify
fissures, calcium, lipid
Cap/plaque Fiber
Spectroscopy
Determine
chemical content
of visualized
lesions
Lipid concentration
Polarization
LightLab OCT Technology
Information for a better understanding ofInformation for a better understanding of
microanatomic plaque characteristicsmicroanatomic plaque characteristics
Lipid imaging in phantom
Spectroscopic image
Lipid+calcium Protein+calcium
Gray-scale image
Lipid+calcium Protein+calcium
OCT Spectroscopy identifies differences in
composition
LightLab OCT Technology
Today’sToday’s
State-of-the-artState-of-the-art
OpticalOptical
CoherenceCoherence
TomographyTomography
100µm
In vivo 1µm OCT
(Image Courtesy of J. Fujimoto, MIT)
The Future of OCT Imaging
Changing the way
you see things.

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Plaque characterization with oct

  • 2. LightLab OCT Optical Coherence Tomography (OCT) is a new class of ultra high-resolution imaging technology using near infrared light. In addition to morphological imaging, LightLab OCT is capable of:  Spectroscopic Imaging  Polarization Imaging  Doppler  Elastography
  • 3.  Real time Imaging (to 30fps)  Portable & Modular Design  Digital System Architecture LightLab Imaging PlatformLightLab Imaging Platform (Pending 510(k) Clearance) LightLab OCT  .006” micro-optic core  Microscopic resolution (12 µm)  .014” ImageWire & Balloon Imaging System Catheters
  • 4. Precision Imaging Intimal ThickeningIntimal Thickening Human Cadaver, Left Diagonal Branch Intima Media Adventitia
  • 5. Precision Imaging Ex-vivo LAD Thin capped FibroatheromaThin capped Fibroatheroma Lesion Cap < 60µm (Renu Virmani, MD, AFIP)
  • 6. NC Ca++ FC NC F C Ca++ NC necrotic core calcium lumen Precision Imaging (Renu Virmani, MD, AFIP) FC fibrous cap
  • 7. Over sampling enables detailedOver sampling enables detailed interrogationinterrogation Ex-vivo LAD, LightLab .014” ImageWire(Renu Virmani, MD, AFIP) Precision Imaging Core Thrombus Core
  • 8. Precision Imaging OCT Cine Pullback Human Cadaver Circumflex Artery Thin Capped LesionsThin Capped Lesions
  • 9. Precision Imaging Pull-back in stentPull-back in stent (note early side branch)(note early side branch) In-vivo HumanIn-vivo Human .014” ImageWire Prof. Eberhard Grube, Siegburg Heart Center
  • 10. Precision Imaging In-vivo Human Lesion 400 micrometer capIn-vivo Human Lesion 400 micrometer cap .014” ImageWire Prof. Eberhard Grube, Siegburg Heart Center
  • 11. Bringing a microscope into theBringing a microscope into the coronaries improves the clinicians abilitycoronaries improves the clinicians ability to:to:  Select the appropriate therapy  Titrate the delivery of specific therapies  Direct the delivery to targeted lesions  Develop entire new therapeutic approaches Precision Therapy
  • 12. Imaging BalloonImaging Balloon In-vivo pig, LightLab Imaging Balloon, 3mm and .014” ImageWire – No Flush Brigham&Women’s Hospital ECI Lab Real-time inflation visualization Precision Therapy
  • 13. Stent and ThrombiStent and Thrombi Full Screen In-vivo pig, LightLab .014” ImageWire Dr. Campbell Rogers, Brigham&Women’s Hospital ECI Lab Precision Therapy Zoom
  • 14. In-vivo Human Stent in StentIn-vivo Human Stent in Stent .014” ImageWire Prof. Eberhard Grube, Siegburg Heart Center Precision Therapy
  • 15.  Upgrades • Polarization Imaging • Spectroscopic Imaging • Doppler • Elastography LightLab Imaging Platform – FutureLightLab Imaging Platform – Future (Pending 510(k) Clearance) LightLab OCT Technology  Sub selective flush  Forward looking lens designs  Integrated therapeutic catheters Imaging System Catheters
  • 16. Polarization Information for a better understanding ofInformation for a better understanding of microanatomic plaque characteristicsmicroanatomic plaque characteristics Evaluate plaque structure and orderliness Grey Scale Detailed Morphological understanding Cap thickness, identify fissures, calcium, lipid Cap/plaque Fiber Spectroscopy Determine chemical content of visualized lesions Lipid concentration Polarization LightLab OCT Technology
  • 17. Different tissues exhibit differentDifferent tissues exhibit different polarization effectspolarization effects OCT is inherently sensitive to changes in the polarization of the probe beam. Birefringence is the major source of contrast in polarization- sensitive OCT imaging. Very High Very low Media (healthy) Cholesterol crystals Soft (lipid) plaque Fibrotic plaque Intima (healthy) Calcified plaque Structure Birefringence LightLab OCT Technology
  • 18. Grayscale Polarization Difference Table Surface Laminated Structure LightLab OCT Technology (Birefringent) (Non-Birefringent) Polarization helps differentiate organizedPolarization helps differentiate organized (linear) from disorganized structures(linear) from disorganized structures
  • 19. Magnitude Polarization Combined Grey scale and polarization information may beGrey scale and polarization information may be combined to localize and identify tissuecombined to localize and identify tissue characteristicscharacteristics Platform FuturesPlatform Futures
  • 20. Polarization Evaluate plaque structure and orderliness Grey Scale Detailed Morphological understanding Cap thickness, identify fissures, calcium, lipid Cap/plaque Fiber Spectroscopy Determine chemical content of visualized lesions Lipid concentration Polarization LightLab OCT Technology Information for a better understanding ofInformation for a better understanding of microanatomic plaque characteristicsmicroanatomic plaque characteristics
  • 21. Lipid imaging in phantom Spectroscopic image Lipid+calcium Protein+calcium Gray-scale image Lipid+calcium Protein+calcium OCT Spectroscopy identifies differences in composition LightLab OCT Technology
  • 23. Changing the way you see things.