Korean Circ J.  2015 Mar;45(2):87-95. 10.4070/kcj.2015.45.2.87.

Practical Application of Coronary Imaging Devices in Cardiovascular Intervention

• Cho YK
• Hur SH

• KMID: 2297873
• DOI: http://doi.org/10.4070/kcj.2015.45.2.87

Abstract

The significant morbidity and mortality associated with coronary artery disease has spurred the development of intravascular imaging devices to optimize the detection and assessment of coronary lesions and percutaneous coronary interventions. Intravascular ultrasound (IVUS) uses reflected ultrasound waves to quantitatively and qualitatively assess lesions; integrated backscatter and virtual histology IVUS more precisely characterizes plaque composition; angioscopy directly visualize thrombus and plaque; optical coherence tomography using near-infrared (NIR) light with very high spatial resolution provides more accurate images; and the recently introduced NIR spectroscopy identifies chemical components in coronary artery plaques based on differential light absorption in the NIR spectrum. This article reviews usefulness of these devices and hybrids thereof.

Keyword

Coronary artery disease; Diagnostic imaging; Percutaneous coronary intervention

MeSH Terms

Absorption
Angioscopy
Coronary Artery Disease
Coronary Vessels
Diagnostic Imaging
Mortality
Percutaneous Coronary Intervention
Spectroscopy, Near-Infrared
Thrombosis
Tomography, Optical Coherence
Ultrasonography

Figure

• 

  Fig. 1 OCT-guided PCI. A 63-year-old man was diagnosed with non-ST segment elevation myocardial infarction. A: baseline coronary angiogram showed significant stenosis of the proximal left circumflex artery. Pre-interventional OCT revealed a minimal lumen area of 1.93 mm2 and red thrombi (red arrow). The minimal lumen diameters at the proximal and distal reference segments were 2.69 mm and 2.67 mm, respectively, and the lesion length was 16.9 mm. B: a coronary angiogram after biolimus-eluting stent (2.75×18 mm) implantation. Post-interventional OCT showed A minimal stent area of 6.77 mm2 and a thrombic protrusion (blue arrow). OCT: optical coherence tomography, PCI: percutaneous coronary intervention, MLA: minimal lumen area, MSA: minimal stent area.

• 

  Fig. 2 Angiographic and NIRS findings in acute STEMI. A 56-year-old patient with acute chest pain and inferior-posterior injury was referred for primary PCI (A). Angiography of the right coronary artery revealed complete occlusion (B). Aspiration yielded a thrombus characteristic of STEMI (C) and resulted in a TIMI flow grade 3 (D). NIRS performed after the TIMI flow grade 3 was established revealed a prominent, nearly circumferential lipid core plaque concentrated at the culprit site (E). NIRS: near-infrared spectroscopy, STEMI: ST segment elevation myocardial infarction, PCI: percutaneous coronary intervention, TIMI: Thrombolysis in Myocardial Infarction. Adopted from Madder RD, Goldstein JA, Madden SP, et al. JACC Cardiovasc Interv 2013;6:838-46.74)

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