Utility of intracoronary imaging in the cardiac catheterization laboratory: comprehensive evaluation with intravascular ultrasound and optical coherence tomography

Parviz, Yasir; Shlofmitz, Evan; Fall, Khady; Konigstein, Maayan; Maehara, Akiko; Jeremias, Allen; Shlofmitz, Richard; Mintz, Gary S.; Ali, Ziad A.

doi:10.1093/bmb/ldx049

Cited by 17 publications

(10 citation statements)

References 57 publications

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“…Ultimately, a structured feedback-based curriculum may benefit those seeking to improve their capacity to interpret and apply intracoronary imaging to guide diagnostic and therapeutic decision-making in the cardiac catheterization laboratory. This is particularly important as the marked advantages of OCT become increasingly apparent commensurate with the growth of complex interventional cases and wider adoption of device technology [ 1 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Optical coherence tomography (OCT) has emerged as a core intravascular imaging modality for characterizing structural features of coronary vessels and atherosclerotic lesions and for optimizing coronary stent implantation in select patients [ 1 – 3 ]. Efficient, accurate interpretation and analysis of OCT images is of critical importance yet remains an obstacle, particularly for novice readers.…”

Section: Introductionmentioning

confidence: 99%

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Immersive educational curriculum on intracoronary optical coherence tomography image analysis among naïve readers

et al. 2022

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Background Optical coherence tomography (OCT) is an intravascular imaging modality for analysing coronary vessels. Image interpretation remains an obstacle for novice readers due to technical artefacts and uncertainty in tissue characterization. Despite an expanding clinical and research role for OCT, few training efforts exist, and there is an absence of a national standardized educational curriculum. We sought to determine whether an interactive, feedback-based OCT curriculum improved image interpretation among naive readers. Methods Naive OCT readers completed both a Standard curriculum, comprised of self-directed didactics and consensus statements, and an Augmented curriculum, which provided real-time digital feedback of feature identification and measurements. Modules were separated by a minimum one-week washout period. After each module, and blinded to the exam answers, subjects completed an identical expert-designed 413-item exam to assess technical knowledge and ability to identify and measure vessel features. Performances were compared using Exact Wilcoxon signed-rank tests. Results Among the 7 included subjects were 3 medical students, 3 internal medicine residents, and 1 cardiovascular medicine fellow with no prior OCT experience. The technical knowledge score (maximum 13) was significantly higher with the Augmented compared with the Standard curriculum (median 11 vs. 7, p = 0.03). After undergoing the Augmented curriculum, all 7 subjects were able to identify features of plaque rupture (Standard curriculum: 5/7 subjects, p = 0.5) and macrophages (Standard curriculum: 6/7 subjects, p = 0.99), differentiate the components between red and white thrombus (Standard curriculum: 6/7 subjects, p = 0.99), and characterize lipid plaque by attenuation, signal, homogeneity, and borders (Standard curriculum: 5/7 subjects, p = 0.5). Performances on the remaining exam portions did not differ between curricula. Conclusions The need for standardized, effective training in OCT image interpretation is increasingly essential as the intravascular imaging modality becomes widely utilized among interventional cardiologists and trainees. A novel interactive OCT curriculum enhanced naive readers’ technical knowledge and may supplement traditional self-learning in refining analytic skills.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immersive educational curriculum on intracoronary optical coherence tomography image analysis among naïve readers

et al. 2022

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“…Also, they required longer procedure and fluoroscopy time and were more costly due to the use of specialized equipment (cutting/scoring balloons, rotational [RA]/orbital atherectomy [OA], excimer laser angioplasty, and covered stents or coils). Intravascular ultrasound (IVUS) may explain mechanisms of PCI failure 3 . The purpose of the current study was to use IVUS to clarify anatomical and morphological lesion characteristics of uncrossable lesions.…”

Section: Introductionmentioning

confidence: 99%

“…Intravascular ultrasound (IVUS) may explain mechanisms of PCI failure. 3 The purpose of the current study was to use IVUS to clarify anatomical and morphological lesion characteristics of uncrossable lesions.…”

Section: Introductionmentioning

confidence: 99%

Reasons for lesion uncrossability as assessed by intravascular ultrasound

Salem

Mintz

Matsumura

et al. 2022

Cathet Cardio Intervent

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Objectives: The purpose of the current study was to use intravascular ultrasound (IVUS) to clarify anatomical and morphological lesion characteristics of uncrossable lesions.Background: Uncrossable lesions are not always severely calcified. The prevalence of uncrossable lesions that are nonseverely calcified as well as other mechanisms for uncrossability has not been well clarified.Methods: A total of 252 de novo uncrossable lesions in native coronary arteries that underwent either rotational or orbital atherectomy due to inability of any balloon to cross the lesion and 38 lesions with severe calcium in which IVUS crossed preatherectomy were included. Severe calcium is defined as maximum arc of calcium ≥270°.Results: Severe calcification was absent in 16% of uncrossable lesions, 83% of which had a significant vessel bend. Compared with crossable lesions with severe calcium, uncrossable lesions with severe calcium more often had a bend in the vessel (71% vs. 21%, p < 0.001) and a longer length of continuous severe calcium (median length of calcium ≥270°3.8 mm vs. 1.9 mm, p = 0.001). Other than severe calcium (especially long continuous calcium) or a bend in the vessel, anatomical factors associated with uncrossabilty were aorto-ostial lesion location and small vessels.Conclusions: Uncrossable lesions are not always severely calcified. The interaction of lesion morphology (continuous long and large arcs of calcium) and vessel geometry (bend in the vessel or ostial lesion location) affect lesion crossability.

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“…Definite diagnosis can be difficult to be established and a number of diagnostic criteria have been proposed [1]. CE has been categorized as a potential cause of a type 2 myocardial infarction [4] while the use of imaging modalities such as intravascular ultrasound (IVUS) or optimal coherence tomography (OCT) have been proposed as diagnostic tools for the assessment of intravascular patency and the detection of intracoronary thrombus [5][6][7]. Moreover, cardiac magnetic resonance imaging (CMR) provides valuable information regarding late gadolinium enhancement (LGE), fibrosis/scarring and subendocardial or transmural oedema in the distribution area of the affected vessel [7,8].…”

Section: Introductionmentioning

confidence: 99%

Cardiac amyloidosis presenting with coronary artery embolization

Papageorgiou

Tsagalou

Baraboutis

et al. 2021

Rev. Cardiovasc. Med.

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Amyloid light-chain (AL) amyloidosis is a multisystemic disease. Among its clinical manifestations, vein and arterial thromboembolic events are included. We report the unusual case of a 57-year-old female patient with AL amyloidosis presenting with an ST segment elevation myocardial infarction due to coronary artery embolization (CE). The patient reported a history of exertional dyspnoea along with episodes of haemoptysis for the last few months. Her coronary angiography demonstrated embolization of the distal segment of the left anterior descending artery. The main findings of her cardiac ultrasound included concentric left ventricular hypertrophy, mildly impaired left ventricular systolic function, left atrium enlargement and a restrictive-like filling pattern, while her chest computed tomography (CT) demonstrated bilateral pleural effusions. Cardiac magnetic resonance imaging that was performed afterwards, indicated areas of microvascular infarction, a small apex infarct and findings compatible with possible amyloidosis, a diagnosis that was confirmed later by fat tissue biopsy. Patient was referred for an oncology consultation, started therapy with direct oral anticoagulants, angiotensin converting enzyme inhibitor, statins and anti-plasma cell therapy. She has been improving since then and has been free of cardiovascular events for a follow-up period of 12 months. Cardiologists ought to be aware of amyloidosis as a rare but possible cause of coronary embolization, while close collaboration with oncologists is required for the establishment of the correct diagnosis.

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Utility of intracoronary imaging in the cardiac catheterization laboratory: comprehensive evaluation with intravascular ultrasound and optical coherence tomography

Abstract: While the clinical benefits of intravascular ultrasound have been well validated, optical coherence tomography in comparison is a newer technology, with robust clinical trials assessing its clinical benefit are underway.

Cited by 17 publications

References 57 publications

Immersive educational curriculum on intracoronary optical coherence tomography image analysis among naïve readers

Immersive educational curriculum on intracoronary optical coherence tomography image analysis among naïve readers

Reasons for lesion uncrossability as assessed by intravascular ultrasound

Cardiac amyloidosis presenting with coronary artery embolization

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