Cathet Cardio Intervent

2007

DOI: 10.1002/ccd.21310

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Three‐dimensional and quantitative analysis of atherosclerotic plaque composition by automated differential echogenicity

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Michiel Knaapen

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et al.

Abstract: This ex vivo feasibility study shows that automated three-dimensional differential echogenicity analysis of ICUS images allows identification of different tissue types within atherosclerotic plaques. This technology may play a role as an additional tool in longitudinal studies to trace possible changes in plaque composition.

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Echogenicity2

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Does Bioabsorption Occur?1

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Cited by 55 publications

(50 citation statements)

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“…This result is in line with what has already been reported, namely that the echogenic grade of carotid atherosclerotic plaques (correlated with the calcium content) may reflect the total amount of calcium and the degree of atherosclerosis, including coronary artery atherosclerosis. 6,15,16) Moreover, the amount of calcium and the rapid progression of calcification at the coronary arteries level have been associated in previous works with a higher risk of cardiovascular events. [17][18][19][20][21] Therefore, carotid calcifications could reflect diffuse coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

“…10,11) However, most of these studies analyzed carotid plaque morphology to obtain information useful for instrumental methods, especially ultrasound, for clinical practice, on the basis of the correlation between sonographic and microscopic aspects. [12][13][14][15][16] Histological analysis of carotid plaque has therefore been used in scientific research only to obtain data for instrumental methods and has little space in clinical use. Currently, in fact, the routine contribution of histological analysis of plaque is almost absent, even though in our opinion, on the contrary, it plays a fundamental prognostic role.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Can Carotid Plaque Histology Selectively Predict the Risk of an Acute Coronary Syndrome?

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et al. 2011

Int. Heart J.

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SummaryThe aim of this study was to assess whether carotid plaque morphology is an independent predictive factor of stroke and, innovatively, of acute coronary syndrome (ACS). We analyzed morphological aspects of carotid atherosclerotic plaque associated with an increased risk of ACS and stroke. We examined 72 carotid endarterectomy (CEA) specimens obtained between January 2005 and February 2009. All patients underwent follow-up for 12 months after the revascularization treatment to assess the occurrence of ACS and stroke. Data obtained showed that in patients with a previous ACS and in those who had developed an ACS during follow-up after CEA, the degree of carotid plaque calcification was more severe than in patients who did not develop an ACS, either before CEA or during follow-up. However, plaques of patients with ACS were mostly devoid of a significant inflammatory component, whereas a rich infiltrate, mainly consisting of monocytes-macrophages and lymphocytes, was present in plaques of subjects who did not develop an ACS. This element was particularly important since strokes occurred only in the latter group of patients (62% versus 0%). Therefore, we deduced that inflammation, from the histological point of view, is more correlated with cerebral circulation disorders than with coronary disease. In conclusion, while the finding of a soft plaque with a large necrotic core and a marked inflammatory component, often characterized by acute complications, may be predictive of an increased risk of cerebrovascular events, a heavily calcified plaque may be indicative of a high risk of coronary events. (Int Heart J 2011; 52: 72-77)

“…This result is in line with what has already been reported, namely that the echogenic grade of carotid atherosclerotic plaques (correlated with the calcium content) may reflect the total amount of calcium and the degree of atherosclerosis, including coronary artery atherosclerosis. 6,15,16) Moreover, the amount of calcium and the rapid progression of calcification at the coronary arteries level have been associated in previous works with a higher risk of cardiovascular events. [17][18][19][20][21] Therefore, carotid calcifications could reflect diffuse coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

“…10,11) However, most of these studies analyzed carotid plaque morphology to obtain information useful for instrumental methods, especially ultrasound, for clinical practice, on the basis of the correlation between sonographic and microscopic aspects. [12][13][14][15][16] Histological analysis of carotid plaque has therefore been used in scientific research only to obtain data for instrumental methods and has little space in clinical use. Currently, in fact, the routine contribution of histological analysis of plaque is almost absent, even though in our opinion, on the contrary, it plays a fundamental prognostic role.…”

mentioning

confidence: 99%

Can Carotid Plaque Histology Selectively Predict the Risk of an Acute Coronary Syndrome?

¹

,

²

,

³

et al. 2011

Int. Heart J.

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SummaryThe aim of this study was to assess whether carotid plaque morphology is an independent predictive factor of stroke and, innovatively, of acute coronary syndrome (ACS). We analyzed morphological aspects of carotid atherosclerotic plaque associated with an increased risk of ACS and stroke. We examined 72 carotid endarterectomy (CEA) specimens obtained between January 2005 and February 2009. All patients underwent follow-up for 12 months after the revascularization treatment to assess the occurrence of ACS and stroke. Data obtained showed that in patients with a previous ACS and in those who had developed an ACS during follow-up after CEA, the degree of carotid plaque calcification was more severe than in patients who did not develop an ACS, either before CEA or during follow-up. However, plaques of patients with ACS were mostly devoid of a significant inflammatory component, whereas a rich infiltrate, mainly consisting of monocytes-macrophages and lymphocytes, was present in plaques of subjects who did not develop an ACS. This element was particularly important since strokes occurred only in the latter group of patients (62% versus 0%). Therefore, we deduced that inflammation, from the histological point of view, is more correlated with cerebral circulation disorders than with coronary disease. In conclusion, while the finding of a soft plaque with a large necrotic core and a marked inflammatory component, often characterized by acute complications, may be predictive of an increased risk of cerebrovascular events, a heavily calcified plaque may be indicative of a high risk of coronary events. (Int Heart J 2011; 52: 72-77)

“…In the ABSORB trial, multiple imaging modalities/analyses were used in an attempt to evaluate the bioabsorption of the polymeric struts: IVUS echogenicity, IVUS radiofrequency analysis (VH), and OCT. 40,83,87 …”

Section: Does Bioabsorption Occur?mentioning

confidence: 99%

Bioresorbable Scaffold

2011

Self Cite

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T he invention of balloon angioplasty as a percutaneous treatment for obstructive coronary disease by Andreas Gruntzig in 1977 was a huge leap forward in cardiovascular medicine and undoubtedly will always be remembered as a revolution in the field of revascularization. However, this technique was plagued by multiple problems, including the risk of acute vessel closure secondary to occlusive coronary dissection, sometimes necessitating emergency coronary artery bypass surgery. 1-3 Although late luminal enlargement and vascular remodeling could take place, more often restenosis 4 -8 would occur instead. The restenosis would essentially be caused by constrictive remodeling 9 -13 and, to a lesser extent, by elastic recoil 14 or the neointimal hyperplastic healing response. [15][16][17] The advent of bare metal stenting (BMS) and the landmark Belgian-Netherlands Stent Study (BENESTENT) and Stent Restenosis Study (STRESS) trials have established BMS as the second revolution in interventional cardiology. 18,19 This technology provided a solution to acute vessel occlusion by sealing the dissection flaps and preventing recoil. The rate of subacute occlusion was reduced to 1.5%, making emergency bypass surgery a rare occurrence. Restenosis rates were further reduced from 32% to 22% at 7 months, but this rate was still high, and neointimal hyperplasia inside the stent was even more prominent than with angioplasty, necessitating repeat treatment in numerous patients. 18 Because the vessel was now caged with metal, late luminal enlargement and advantageous vascular remodeling could no longer occur. Another problem, namely late stent thrombosis (ST), was also first described. 20 To solve the problem of in-stent restenosis, after the historic failure of brachytherapy to resolve this problem, 21,22 drug-eluting stents (DES) were introduced. The first 45 patients implanted with the sirolimuseluting Bx velocity stent (Cordis, Johnson & Johnson, Warren, NJ) were found to have negligible neointimal hyperplasia at follow-up. 23,24 This was confirmed in the randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization (RAVEL) study. 25,26 The introduction of DES was thus dubbed the third revolution in interventional cardiology. Both large-scale randomized trials and all-comer registries showed excellent results in terms of the need for repeat revascularization. However, the early enthusiasm has been tempered in recent years after widespread concerns about the increased risk of late and very late ST. [27][28][29][30][31] Registries of all comers treated with DES showed late ST rates of 0.53%/y, with a continued increase to 3% over 4 years. 32,33 In the Arterial Revascularization Therapies Study II (ARTS II) trial, which enrolled patients with complex multivessel disease, the rate of combined definite, probable, and possible ST was as high as 9.4% at 5 years, accounting for 32% of major adverse cardiovascular events (MACEs). 34 In addition, postmortem pathological specimens of DES revealed sig...

“…Adventitia is defined as a layer extending from 0.2 to 0.5 mm outside of the external elastic membrane. A dedicated QCU software (CURAD) is used in detecting lumen-intima and external elastic membrane border (34). After the tissue identification process, the echogenicity value is calculated for the entire investigated segment.…”

Section: Echogenicitymentioning

confidence: 99%

Methods to assess bioresorbable vascular scaffold devices behaviour after implantation

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³

et al. 2017

J. Thorac. Dis.

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Bioresorbable vascular scaffolds (BRS) represent a novel approach for coronary revascularization offering several advantages as compared to current generation DES, potentially reducing rate of late adverse events and avoiding permanent vessel caging. Nevertheless, safety concerns have been raised for an increased risk of scaffold thrombosis (ScT) in both early and late phases, probably related to a suboptimal scaffold implantation. In this context, the use of different imaging methodologies has been strongly suggested in order to guarantee an optimal implantation. We herein analyze the different imaging methodologies available to assess BRS after implantation and at follow-up. J Thorac Dis 2017;9(Suppl 9):S959-S968 jtd.amegroups.com for BRS implantation in order to confirm optimal scaffold expansion, to exclude edge dissections, struts malapposition or underexpansion. Furthermore, imaging technique may evaluate at follow-up scaffold reabsorption and vessel changes over time. Keywords: Scaffold; intravascular ultrasound (IVUS); echogenicity; virtual histology-IVUS (VH-IVUS); optical coherence tomography (OCT); multislice coronary tomography (MSCT)SubmittedWe herein analyze the different imaging methodologies available to assess BRS after implantation and at follow-up. Quantitative coronary angiography (QCA)Coronary angiography is the most important method for assessing BRS implantation. As well as for conventional stent, at least two different projections with at least 30° difference for the right coronary artery and 3 different projections with at least 30° difference for the left coronary artery must be acquired before and after BRS implantation. The treated segment and the 5 mm proximal and distal to scaffold edges should be analyzed. As the bioresorbable devices are radiolucent, the QCA analysis may be performed visualizing the metallic markers of the scaffold.The following parameters can be measured. Acute recoilIt is defined as the difference between the mean diameter of the BRS delivery balloon (or, in case of post-dilatation, mean diameter of post-dilatation balloon) at the highest pressure and the mean lumen diameter (MLD) of the stented segment after balloon deflation. It can be expressed as absolute or relative value. The acute recoil is an important parameter in relation to the success of a PCI in acute and long-time period, as it has a direct impact on minimum stent area (MSA). A MSA less than 5.0 mm 2 is associated with high probability of in-stent restenosis (6).T h e a c u t e r e c o i l o f A b s o r b B V S 1 . 1 ( A b b o t t Laboratories, Abbott park, Illinois, USA) in the Absorb Cohort B trials and DESolve Nx BRS (Elixir Medical, Sunnyvale, California, USA) were 6.7%±6.4% and 6.4%±4.6%, respectively (7,8). These values are not dissimilar to those of metallic stent, showed in a Japanese study of 154 lesions comparing the biolimus eluting stent (Nobori stent, Terumo, Tokyo, Japan), cobalt chromium everolimus eluting stent (Xience V stent, Abbott Vascular, Santa Clara, CA, USA) and pl...

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