Embolic protection device utilization during stenting of native coronary artery lesions with large lipid core plaques as detected by near‐infrared spectroscopy

Brilakis, Emmanouil S.; Abdel-Karim, Abdul Rahman R; Papayannis, Aristotelis; Rangan, Bavana V.; Johnson, Jason L.; Banerjee, Subhash

doi:10.1002/ccd.23507

Cited by 39 publications

(16 citation statements)

References 22 publications

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“…Brilakis et al (19) reported that use of a filter-based catheter in the native coronary circulation before PCI of high-risk plaques may protect the distal microvasculature from embolization. Whether native coronary artery lesions prone to periprocedural myonecrosis can be identified before PCI and whether the use of a distal embolic protection device can reduce the incidence of periprocedural MI in high-risk lesions so identified have never been prospectively examined in a multicenter trial.…”

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confidence: 98%

Plaque Characterization to Inform the Prediction and Prevention of Periprocedural Myocardial Infarction During Percutaneous Coronary Intervention

Stone

Maehara

Muller

et al. 2015

JACC: Cardiovascular Interventions

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confidence: 98%

Plaque Characterization to Inform the Prediction and Prevention of Periprocedural Myocardial Infarction During Percutaneous Coronary Intervention

Stone

Maehara

Muller

et al. 2015

JACC: Cardiovascular Interventions

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100

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“…Distal embolization, as an important mechanism of periprocedural MI, was further supported by several studies that have demonstrated a significant decrease in the size of LCP after stenting [122][123][124]. Stone et al showed in the CANARY trial that LCP measured as LCBI by NIRS in the stented vessels reduces with PCI treatment, with a significant reduction of median LCBI from 143.2 before PCI to 17.9 after PCI (P < 0.001) [125].…”

Section: Prevention Of Periprocedural Complicationsmentioning

confidence: 91%

Near-Infrared Spectroscopy (NIRS): A Novel Tool for Intravascular Coronary Imaging

Bertrand¹,

Lavoie-L'Allier²,

Jean-ClaudeTardif³

2017

Developments in Near-Infrared Spectroscopy

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Acute coronary syndrome (ACS) arising from plaque rupture is the leading cause of mortality worldwide. Near-infrared spectroscopy (NIRS) combined with intravascular ultrasound (NIRS-IVUS) is a novel catheter-based intravascular imaging modality that provides a chemogram of the coronary artery wall, which enables the detection of lipid core and specific quantification of lipid accumulation measured as the lipid-core burden index (LCBI) in patients undergoing coronary angiography. Recent studies have shown that NIRS-IVUS can identify vulnerable plaques and vulnerable patients associated with increased risk of adverse cardiovascular events, whereas an increased coronary plaque LCBI may predict a higher risk of future cardiovascular events and periprocedural events. NIRS is a promising tool for the detection of vulnerable plaques in CAD patients, PCI-guidance procedures, and assessment of lipid-lowering therapies. Previous trials have evaluated the impact of statin therapy on coronary NIRS defined lipid cores, whereas NIRS could further be used as a surrogate end point of future ACS in phase II clinical trials evaluating novel anti-atheromatous drug therapies. Multiple ongoing studies address the different potential clinical applications of NIRS-IVUS imaging as a valuable tool for coronary plaque characterization and predictor of future coronary events in CAD patients.

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“…Second, fibroatheroma detection within a lesion for which PCI is planned suggests a high risk for periprocedural myocardial infarction (9,10) due to distal embolization and/or aggressive in situ thrombus formation (11). Potential clinical strategies to mitigate this risk include vasodilator administration (nicardipine is the authors' preferred medication due to longer half-life and modest hypotensive effect), aggressive anticoagulation (with addition of a glycoprotein IIb/IIIa inhibitor, which is usually given as bolus only without post-PCI infusion), attempts for plaque "vaporization" (e.g., by using laser), and deployment of an embolic protection device (usually a filter that can capture both embolized plaque and/or thrombus) (12).…”

Section: Fibroatheroma Detected: Now What?mentioning

confidence: 99%

How to Detect and Treat Coronary Fibroatheromas

Brilakis

Banerjee

2015

JACC: Cardiovascular Imaging

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As you set out for Ithaka hope the voyage is a long one, full of adventure, full of discovery.-Constantine P. Cavafy, Ithaka (1) C oronary fibroatheromas can cause a wide spectrum of adverse events, such as sudden death, acute coronary syndromes, and procedural complications during percutaneous coronary interventions (PCI) (2). Accurate fibroatheroma detection could significantly enhance our ability to treat these lesions and prevent complications. FIBROATHEROMA DETECTION DURING CARDIAC CATHETERIZATION Fibroatheromas can be detected noninvasively with coronary computed tomography angiography. Three imaging modalities are currently available for fibroatheroma detection during cardiac catheterization: intravascular ultrasonography (IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy (NIRS) (3) (Figure 1).Grayscale IVUS, which is the oldest and most widely available intravascular imaging modality, was not developed specifically for the detection of fibroatheroma. However, IVUS-attenuated plaque (attenuation of the ultrasound beam in the absence of calcification), especially when superficial (closer to the lumen than the media), is a specific (but not sensitive) fibroatheroma "signature" (4,5).Analysis of the backscattered radiofrequency IVUS signals (virtual histology IVUS and integrated backscatter IVUS) also allows plaque characterization, but it is challenging to perform in real time during the procedure because it requires accurate segmentation of the IVUS images, which is a time-consuming and labor-intensive process (3).OCT identifies fibroatheromas as signal-poor regions with ill-defined borders (6), but OCT image interpretation is subjective and highly dependent on operator experience (3). Moreover, deep fibroatheromas may be harder to detect due to poor penetration of the near-infrared light beam.NIRS was developed to specifically detect lipid core plaque in coronary arteries, on the basis of the specific chemical signature of the fibroatheroma (7).Near-infrared light is directed to the coronary artery wall, and the reflected light is collected and analyzed using algorithms developed based on histological analyses (7). NIRS is currently available as a combination catheter with IVUS (TVC, Infraredx, Burlington, Massachusetts)-the only such catheter currently in clinical use. In this issue of iJACC, Kang et al. (8) advance our understanding of fibroatheroma detection with IVUS and NIRS, compared with the gold standard, histology. In an autopsy study of 103 coronary arteries from 56 autopsied hearts, they compared superficial IVUS attenuation (for IVUS) and a yellow or tan block chemogram (for NIRS) with the histopathology obtained from 1,943 sections. Superficial IVUS attenuation had excellent specificity, yet low sensitivity for fibroatheroma detection, which was significantly improved by NIRS. The addition of NIRS significantly increased SEE PAGE 184 *Editorials published in JACC: Cardiovascular Imaging reflect the views of the authors and do not necessarily represent the views of JACC:...

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Embolic protection device utilization during stenting of native coronary artery lesions with large lipid core plaques as detected by near‐infrared spectroscopy

Abstract: Use of EPDs frequently resulted in embolized material retrieval after stenting of native coronary artery lesions with large LCPs. These findings support further study of EPDs as a means to prevent poststenting MI.

Cited by 39 publications

References 22 publications

Plaque Characterization to Inform the Prediction and Prevention of Periprocedural Myocardial Infarction During Percutaneous Coronary Intervention

Plaque Characterization to Inform the Prediction and Prevention of Periprocedural Myocardial Infarction During Percutaneous Coronary Intervention

Near-Infrared Spectroscopy (NIRS): A Novel Tool for Intravascular Coronary Imaging

How to Detect and Treat Coronary Fibroatheromas

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