Clinical utility of negative contrast intravascular ultrasound to evaluate plaque morphology before and after coronary interventions

Honye, Junko; Saito, Satoshi; Takayama, Tadateru; Yajima, Junji; Shimizu, Tomoo; Chiku, Masaaki; Mizumura, Tsuneo; Takaiwa, Yoshiaki; Horiuchi, Kunio; Moriuchi, Masahito; Komaki, Koichi; Ozawa, Yukio; Kanmatsuse, Katsuo; Tobis, Jonathan M.

doi:10.1016/s0002-9149(98)00971-0

Cited by 16 publications

(14 citation statements)

References 6 publications

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“…Blood speckle with Ͼ40 MHz ultrasound can cause confusion when identifying the lumen-tissue border, detecting in-stent neointimal tissue, etc; but it is easily solved by saline (negative contrast) injection through the guiding catheter. 4 Standard grayscale IVUS is limited, in part, because it uses only reflected ultrasound amplitude to formulate the image and requires significant postprocessing. In an effort to improve on the qualitative assessment of the reflected ultrasound signal, Kawasaki et al developed a plaque characterization algorithm called IB-IVUS using time domain information directly from the radiofrequency signal.…”

Section: Ivus Ib-ivus and Vh-ivusmentioning

confidence: 99%

Advances in Intravascular Imaging

Maehara

Mintz

Weissman

2009

Circ: Cardiovascular Interventions

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his review updates the role of various intravascular imaging techniques (1) in the detection of vulnerable plaque and (2) during percutaneous coronary intervention (PCI), especially drug-eluting stent (DES) implantation and follow-up-including intravascular ultrasound (IVUS), virtual histology (VH-IVUS) and integrated backscatter (IB-IVUS), optical coherent tomography (OCT), near-infrared (NIR) spectroscopy, angioscopy, and MRI. IVUS, IB-IVUS, and VH-IVUSThe current intracoronary ultrasound imaging frequency range of 20 to 45 MHz provides 70 to 200 m axial resolution with Ͼ5 mm penetration. 1,2 Grayscale IVUS allows robust quantitative measurements including lumen, vessel, and plaque area; qualitative assessment of lesions preintervention; and quantitative assessment and complications of lesions postintervention; however, it has poor sensitivity for detecting lipid-rich plaque (67%). 3 High-frequency IVUS transducers can produce better resolution that should also improve plaque characterization but at the trade off of greater ultrasound reflection from blood. Blood speckle with Ͼ40 MHz ultrasound can cause confusion when identifying the lumen-tissue border, detecting in-stent neointimal tissue, etc; but it is easily solved by saline (negative contrast) injection through the guiding catheter. 4 Standard grayscale IVUS is limited, in part, because it uses only reflected ultrasound amplitude to formulate the image and requires significant postprocessing. In an effort to improve on the qualitative assessment of the reflected ultrasound signal, Kawasaki et al developed a plaque characterization algorithm called IB-IVUS using time domain information directly from the radiofrequency signal. This process has resulted in improved plaque characterization with a reported in vitro sensitivity of 90% and specificity or 92% for lipid-rich plaque. 5,6 In a similar effort to improve plaque characterization, spectral analysis (VH-IVUS) combined frequency and amplitude analysis and used an algorithm developed from known tissue types to detect fibrous plaque, fibrofatty plaque, necrotic core (NC), and dense calcium ( Figure 1AЈ, 1BЈ). Reported sensitivity and specificity of VH-IVUS are 91.7% and 96.6% for identification of the lipid-rich NC. 7-10 VH-IVUS cannot detect thrombus formation (in fact, thrombus appears as either fibrotic or fibrofatty plaque depending on the age of the thrombus) and has not been validated for assessment of stent metal or intimal hyperplasia. OCTOCT uses a light source with a wavelength centered at 1.3 m to "reflect" off the plaque and form an image analogous to the use of reflected ultrasound. Because of the short wavelength of OCT, it will reflect (and detect) very small objects including blood cells; therefore, in order for OCT to image the vessel wall, it requires a blood-free field. The original time-domain OCT technique requires continuous flushing with proximal balloon occlusion to displace the blood. Recently, faster data and image acquisition with optical frequency domain imaging (OFDI) allows r...

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Section: Ivus Ib-ivus and Vh-ivusmentioning

confidence: 99%

Advances in Intravascular Imaging

Maehara

Mintz

Weissman

2009

Circ: Cardiovascular Interventions

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“…8 Injection of a small amount of contrast medium often assisted recognition of the intimal leading edge of the site examined 14 and also provided a method of insuring that insertion of the ultrasound catheter probe had not itself induced coronary spasm. After observing the site distal to the spasm, the imaging probe was carefully pulled back through the spastic site, again confirming the presence or absence of any lesions.…”

Section: Ivus Examinationmentioning

confidence: 99%

Plaque Morphology at Coronary Sites With Focal Spasm in Variant Angina-Study Using Intravascular Ultrasound-

Saito

Yamagishi

Takayama

et al. 2003

Circ J

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“…Small amounts of contrast were helpful for detecting the interface of the vessel lumen and wall. 8,9 Special care was taken to visualize the vessel lumen as circular as possible, and when the lumen was imaged as elliptical, the transducer was positioned as central as possible in the vessel lumen. Visual depth, ultrasound gain, acoustic power and gray levels were optimized for identification of the vessel wall morphology and to delineate the intima -lumen interface.…”

Section: Examination Protocolmentioning

confidence: 99%

Coronary Disease Morphology and Distribution Determined by Quantitative Angiography and Intravascular Ultrasound. Re-Evaluation in a Cooperative Multicenter Intravascular Ultrasound Study (COMIUS).

Yamagishi

Hosokawa

Saito

et al. 2002

Circ J

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However, it is well known that angiography can not accurately determine lesion morphology in the clinical setting because it only shows the silhouette of the contrast material passing through the stenotic lesions, even when using quantitative coronary angiography (QCA). 1,2 This impacts on the choice of coronary intervention because the preinterventional coronary morphology is a significant factor in the prognosis after the interventional procedure. 3 Intravascular ultrasound (IVUS) can accurately determine the morphology and distribution of the atherosclerotic disease when compared with the histologic findings. 4,5 In addition, miniaturization of the IVUS probe has enabled the stenotic lesion to be accessed and observed, which has assisted in the choice of treatment. 6 This suggests that the stenotic lesion should be evaluated by IVUS prior to the interventional procedure, but there are few systematic studies of the possible differences in disease morphology assessed by QCA and IVUS, particularly in Japanese patients. Therefore, we prospectively studied patients by Although previous studies have demonstrated that even quantitative coronary angiography (QCA) can not provide accurate disease morphology, there has not been a systematic comparison of disease morphology determined by QCA and intravascular ultrasound (IVUS), particularly in Japanese patients. Therefore, the present study prospectively examined patients in a multicenter cooperative study. A total of 491 coronary sites from 562 patients (446 men, 116 women; mean age, 64±11 years) who underwent coronary interventions were enrolled. The target lesions (>50% diameter stenosis) were evaluated pre-operatively by both QCA and IVUS operating at 30-40 MHz and the percent area stenosis, eccentricity index (EI) and lesion length were determined. The minimal (min) and maximal (max) distances from the center of the stenotic lesion to the outline of the vessel wall were measured, and the EI was calculated by the formula: {(max -min) / max}. By QCA, lesion length was determined by measuring the distance between the proximal and distal shoulders of the lesion. When the lesions were observed by IVUS with a motorized pull-back system, the length was calculated by multiplying the time for observation of the disease and 0.5 or 1 mm/s. Although the severity of the stenosis determined by QCA (86±10%, mean ± SD) did not differ from that by IVUS (83±13%), there was no correlation between them (r=0.32, y = 0.25x + 65) and the correlation did not improve when lesions with remodeling, enlargement (n=176) or shrinkage (n=79) were omitted from the calculation. The EIs by QCA and IVUS were 0.51±0.26 and 0.52±0.22, respectively (NS), and there was no correlation between them (r=0.30, y = 0.36x + 33). However, when the lesions with remodeling were excluded, the correlation greatly improved (r=0.80, y = 0.84x + 10.6, p<0.05). Lesion length determined by QCA (12.4±6.1 mm) was significantly shorter than that by IVUS (16.3±8.9 mm, p<0.01). These results demonstrate that coronary angiogr...

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Clinical utility of negative contrast intravascular ultrasound to evaluate plaque morphology before and after coronary interventions

Abstract: Clinical utility of negative contrast intravascular ultrasound to evaluate plaque morphology before and after coronary interventions.

Cited by 16 publications

References 6 publications

Advances in Intravascular Imaging

Advances in Intravascular Imaging

Plaque Morphology at Coronary Sites With Focal Spasm in Variant Angina-Study Using Intravascular Ultrasound-

Coronary Disease Morphology and Distribution Determined by Quantitative Angiography and Intravascular Ultrasound. Re-Evaluation in a Cooperative Multicenter Intravascular Ultrasound Study (COMIUS).

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