Assessment of Coronary Arterial Thrombus by Optical Coherence Tomography
Kawasaki Medical University, Kurasiki, Okayama, Japan The American Journal of Cardiology
(Impact Factor: 3.28).
07/2006; 97(12):1713-7. DOI: 10.1016/j.amjcard.2006.01.031
We analyzed optical coherence tomographic (OCT) characteristics of different types of coronary thrombi that had been confirmed at postmortem histologic examination. We examined 108 coronary arterial segments of 40 consecutive human cadavers. OCT images of red and white thrombi were obtained and the intensity property of these thrombi was analyzed. Red and white thrombi were found in 16 (17%) and 19 (18%) of the 108 arterial segments, respectively. Red thrombi were identified as high-backscattering protrusions inside the lumen of the artery, with signal-free shadowing in the OCT image. White thrombi were identified as low-backscattering projections in the OCT image. There were no significant differences in peak intensity of OCT signal between red and white thrombi (130+/-18 vs 145+/-34, p=0.12). However, the 1/2 attenuation width of the signal intensity curve, which was defined as the distance from peak intensity to its 1/2 intensity, was significantly different between red and white thrombi (324+/-50 vs 183+/- 42 microm, p<0.0001). A cut-off value of 250 microm in the 1/2 width of signal intensity attenuation can differentiate white from red thrombi with a sensitivity of 90% and specificity of 88%. We present the first detailed description of the characteristics of different types of coronary thrombi in OCT images. Optical coherence tomography may allow us not only to estimate plaque morphology but also to distinguish red from white thrombi.
Available from: PubMed Central
- "Complete neointimal coverage is defined as all the stent struts were covered by the visible neointimal, strut uncoverage is confirmed if no visible neointimal coverage on the strut. Thrombosis is defined as an irregular mass with dorsal shadowing protruding from the lumen . "
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ABSTRACT: The vessel healing in patients with coronary artery aneurysms (CAA) that form after drug-eluting stent (DES) implantation is not clear. This study aims to assess the vessel healing in patients with CAA formation after DES implanation.
From June 2008 to August 2011, follow-up coronary angiography was conducted on 1160 patients who underwent percutaneous coronary intervention (PCI). The average period of follow-up was about (18.95 ± 13.05) months. A total of 175 patients who underwent DES implantation into de novo lesions and who underwent coronary angiography and optical coherence tomography (OCT) examination during follow-up were identified. Patients were divided into the CAA group (n = 31) and non-CAA group (n = 144) based on the results of the coronary angiography. The cardiac events including angina and acute myocardial infarction were noted; in addition, the neointimal thickness and the frequency of strut malapposition and strut uncoverage were also noted.
A greater proportion of incomplete neointimal coverage (17.17% vs. 1.90%, P < 0.001) and strut malapposition (18.20% vs. 1.38%, P < 0.001) were observed in the CAA group. The neointimal thickness in the CAA group was significantly thinner than that in the non-CAA group ((146.6 ± 94.8) µm vs. (192.5 ± 97.1) µm, P < 0.001), as detected via OCT. Patients with CAA formation had a higher frequency of cardiac events including angina pectoris (25.81% vs. 6.25%, P = 0.001) and acute myocardial infarction (9.68% vs. 0.13%, P = 0.002) and thrombosis (16.13% vs. 0.69%, P < 0.001). The longitudinal length of the CAA in the cardiac event group was significantly longer than in the no cardiac event group ((20.0 ± 9.07) mm vs. (12.05 ± 5.38) mm, P = 0.005).
CAA formation after DES implantation is frequently associated with cardiac events as a result of stent malapposition and incomplete neointimal coverage.
Available from: Hiromasa Otake
- "Intracoronary thrombus was defined as a mass protruding beyond the stent strut into the lumen with significant attenuation behind the mass.5,6 Resolved thrombus was defined as that observed after stent implantation, but absent at the follow-up. "
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We performed this study to clarify natural consequences of abnormal structures (stent malapposition, thrombus, tissue prolapse, and stent edge dissection) after percutaneous coronary intervention (PCI).
Methods and results
Thirty-five patients treated with 40 drug-eluting stents underwent serial optical coherence tomography (OCT) imaging immediately after PCI and at the 8-month follow-up. Among a total of 73 929 struts in every frame, 431 struts (26 stents) showed malapposition immediately after PCI. Among these, 49 remained malapposed at the follow-up examination. The mean distance between the strut and vessel wall (S–V distance) of persistent malapposed struts on post-stenting OCT images was significantly longer than that of resolved malapposed struts (342 ± 99 vs. 210 ± 49 μm; P <0.01). Based on receiver-operating characteristic curve analysis, an S–V distance ≤260 µm on post-stenting OCT images was the corresponding cut-off point for resolved malapposed struts (sensitivity: 89.3%, specificity: 83.7%, area under the curve = 0.884). Additionally, 108 newly appearing malapposed struts were observed on follow-up OCT, probably due to thrombus dissolution or plaque regression. Thrombus was observed in 15 stents post-PCI. Serial OCT analysis revealed persistent thrombus in 1 stent, resolved thrombus in 14 stents, and late-acquired thrombus in 8 stents. Tissue prolapse observed in 38 stents had disappeared at the follow-up. All eight stent edge dissections were repaired at the follow-up.
Most cases of stent malapposition with a short S–V distance, thrombus, tissue prolapse, or minor stent edge dissection improved during the follow-up. These OCT-detected minor abnormalities may not require additional treatment.
Available from: Giovanni Jacopo Ughi
- "When compared to other vascular imaging modalities, IV-OCT presents an axial resolution (~10-15 µm) improved of approximately one order of magnitude than intravascular ultrasound (IVUS) (>100 µm), coronary angiography (~200 µm) and computed tomography (CT) (>300 µm) . This exceptional resolution makes IV-OCT the most suitable imaging modality for the visualization of small intraluminal structures such as thrombus , atherosclerotic plaques, vessel dissections and coronary stent struts . "
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ABSTRACT: Intravascular optical coherence tomography (IV-OCT) is an imaging modality that can be used for the assessment of intracoronary stents. Recent publications pointed to the fact that 3D visualizations have potential advantages compared to conventional 2D representations. However, 3D imaging still requires a time consuming manual procedure not suitable for on-line application during coronary interventions. We propose an algorithm for a rapid and fully automatic 3D visualization of IV-OCT pullbacks. IV-OCT images are first processed for the segmentation of the different structures. This also allows for automatic pullback calibration. Then, according to the segmentation results, different structures are depicted with different colors to visualize the vessel wall, the stent and the guide-wire in details. Final 3D rendering results are obtained through the use of a commercial 3D DICOM viewer. Manual analysis was used as ground-truth for the validation of the segmentation algorithms. A correlation value of 0.99 and good limits of agreement (Bland Altman statistics) were found over 250 images randomly extracted from 25 in vivo pullbacks. Moreover, 3D rendering was compared to angiography, pictures of deployed stents made available by the manufacturers and to conventional 2D imaging corroborating visualization results. Computational time for the visualization of an entire data sets resulted to be ~74 sec. The proposed method allows for the on-line use of 3D IV-OCT during percutaneous coronary interventions, potentially allowing treatments optimization.
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