Optical Coherence Tomography: A New Imaging Modality for Plaque Characterization and Stent Implantation

Objective: Optical coherence tomography (OCT) has recently been applied for the characterization of carotid plaques, but few studies have compared OCT findings with findings from histopathologic examination of carotid plaques. We consider the accuracy, problems, and limitation of OCT findings by comparing OCT findings of carotid artery stenosis and pathological specimen of removed carotid plaque, and confirm that the interpretation of coronary artery findings of OCT can be applied to OCT findings of carotid artery plaque.Case Presentation: A 63-year-old man with asymptomatic left carotid stenosis underwent carotid endarterectomy (CEA).Findings for histopathologic assessment of excised plaque were compared with those from preoperative OCT images at the same section levels. Preoperative OCT findings of carotid artery stenosis were similar to histopathologic examination of carotid plaques removed by CEA. This suggests that OCT has great ability to visualize pathological fibrous cap and ulceration and to visualize the structure of neovascularization in the neointima. However, OCT was unable to differentiate between lesions that were visualized in histopathological examination as lipid component, hemorrhagic transformation, and necrotic transformation. Conclusion:The high resolution of OCT enables real-time acquisition of carotid plaque data. Although OCT is invasive examination, it may contribute to the evaluation of carotid plaque characterization.

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“…[12][13][14][15] Some studies have investigated the one mass without any incision during CEA ( Figs. 2A and 2B).…”

Section: Discussionmentioning

confidence: 99%

Comparison between Preoperative Optical Coherence Tomography Findings of Carotid Artery Stenosis and Pathological Specimen of Removed Carotid Plaque: Case Report

Matsumoto

Takemoto

Nishiyama

et al. 2017

JNET

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“…Presently, optical coherence tomography (OCT) is increasingly favoured in coronary artery visualization due to its high resolution capabilities and allowance for imaging of various structures such as stent strut malappositions, post-stent restenoses, assessment of stent endothelialization, atherosclerotic plaque and thrombus formation106. However, OCT inherently remains an invasive procedure, with the insertion of an intravascular catheter.…”

Section: Molecular Imaging Platformmentioning

confidence: 99%

“…However, OCT inherently remains an invasive procedure, with the insertion of an intravascular catheter. Furthermore, whilst OCT may be FDA-approved, there are a lack of large-scale studies demonstrating an association between OCT collected data and clinical outcomes106, 107. Thus, the use of nanoparticles in molecular imaging offers a possible non-invasive alternative to OCT as well as enhancement of current molecular imaging techniques.…”

Section: Molecular Imaging Platformmentioning

confidence: 99%

Bioabsorbable Stent Quo Vadis: A Case for Nano-Theranostics

Gundogan¹,

Tan²,

Farhatnia³

et al. 2014

Theranostics

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Percutaneous coronary intervention (PCI) is one of the most commonly performed invasive medical procedures in medicine today. Since the first coronary balloon angioplasty in 1977, interventional cardiology has seen a wide array of developments in PCI. Bare metal stents (BMS) were soon superseded by the revolutionary drug-eluting stents (DES), which aimed to address the issue of restenosis found with BMS. However, evidence began to mount against DES, with late-stent thrombosis (ST) rates being higher than that of BMS. The bioabsorbable stent may be a promising alternative, providing vessel patency and support for the necessary time required and thereafter degrade into safe non-toxic compounds which are reabsorbed by the body. This temporary presence provides no triggers for ST, which is brought about by non-endothelialized stent struts and drug polymers remaining in vivo for extended periods of time. Likewise, nano-theranostics incorporated into a bioabsorbable stent of the future may provide an incredibly valuable single platform offering both therapeutic and diagnostic capabilities. Such a stent may allow delivery of therapeutic particles to specific sites thus keeping potential toxicity to a minimum, improved ease of tracking delivery in vivo by embedding imaging agents, controlled rate of therapy release and protection of the implanted therapy. Indeed, nanocarriers may allow an increased therapeutic index as well as offer novel post-stent implantation imaging and diagnostic methods for atherosclerosis, restenosis and thrombosis. It is envisioned that a nano-theranostic stent may well form the cornerstone of future stent designs in clinical practice.

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“…Based on the significant amount of literature on the morphological and biomechanical mechanisms that confer plaque rupture risk, many groups in the medical imaging community have attempted to develop noninvasive modalities that can reliably characterize atherosclerotic lesions (for a background on invasive plaque characterization imaging modalities, the reader is referred to the reviews by Jaguszewski et al (2013), Garcia-Garcia et al (2011), and Ben-Dor et al (2011)). X-ray computed tomography (CT) has shown excellent sensitivity to calcium deposition, but only moderate accuracy for lipid cores and hemorrhage (Wintermark et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Non-invasive in Vivo Characterization of Human Carotid Plaques with Acoustic Radiation Force Impulse Ultrasound: Comparison with Histology after Endarterectomy

Czernuszewicz

Homeister

Caughey

et al. 2015

Ultrasound in Medicine & Biology

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Ischemic stroke from thromboembolic sources is linked to carotid artery atherosclerotic disease with a trend toward medical management in asymptomatic patients. Extent of disease is currently diagnosed by noninvasive imaging techniques that measure luminal stenosis, but it has been suggested that a better biomarker for determining risk of future thromboembolic events is plaque morphology and composition. Specifically, plaques that are composed of mechanically-soft lipid/necrotic regions covered by thin fibrous caps are the most vulnerable to rupture. An ultrasound technique that noninvasively interrogates the mechanical properties of soft tissue, called acoustic radiation force impulse (ARFI) imaging, has been developed as a new modality for atherosclerotic plaque characterization using phantoms and atherosclerotic pigs, but the technique has yet to be validated in vivo in humans. In this preliminary study, in vivo ARFI imaging is presented in a case-study format from four patients undergoing clinically-indicated carotid endarterectomy and compared to histology. In two type Va plaques, characterized by lipid/necrotic cores covered by fibrous caps, mean ARFI displacements in focal regions were high relative to the surrounding plaque material, suggesting soft features covered by stiffer layers within the plaques. In two type Vb plaques, characterized by heavy calcification, mean ARFI peak displacements were low relative to the surrounding plaque and arterial wall, suggesting stiff tissue. This pilot study demonstrates the feasibility and challenges of transcutaneous ARFI for characterizing the material and structural composition of carotid atherosclerotic plaques via mechanical properties, in humans, in vivo.

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Optical Coherence Tomography: A New Imaging Modality for Plaque Characterization and Stent Implantation

Cited by 9 publications

References 49 publications

Comparison between Preoperative Optical Coherence Tomography Findings of Carotid Artery Stenosis and Pathological Specimen of Removed Carotid Plaque: Case Report

Comparison between Preoperative Optical Coherence Tomography Findings of Carotid Artery Stenosis and Pathological Specimen of Removed Carotid Plaque: Case Report

Bioabsorbable Stent Quo Vadis: A Case for Nano-Theranostics

Non-invasive in Vivo Characterization of Human Carotid Plaques with Acoustic Radiation Force Impulse Ultrasound: Comparison with Histology after Endarterectomy

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