Effect of statins on coronary bifurcation atherosclerosis: an intravascular ultrasound virtual histology study

This study is aimed at assessing by intravascular ultrasound virtual histology (VH-IVUS) the effect of statins on coronary bifurcation atherosclerosis in non-culprit vessels. In this non-randomized study, in 48 patients, 51 bifurcation atherosclerotic sites in non-culprit vessels without significant angiographic stenosis, underwent baseline and 12 months follow-up VH-IVUS. Patients received treatment with either simvastatin (20 mg daily, n = 24) or rosuvastatin (10 mg daily, n = 24) for the same period. VH-IVUS analysis of bifurcation lesions included the 5-mm proximal, bifurcation only (side-branch point) and 5-mm distal subsegments. Overall plaque and external elastic membrane volume decreased after 1 year (115.7 ± 35.5 to 106.1 ± 29.3 mm3, P < 0.001; and 241.0 ± 57.0 to 232.4 ± 54.2 mm3, P = 0.005, respectively). Similarly, overall dense calcium volume significantly increased (7.1 ± 5.3 to 11.0 ± 8.5 mm3, P < 0.010), while fibrous and fibrofatty volumes significantly decreased (36.9 ± 19.2 to 24.1 ± 11.7 mm3, P < 0.001; and 5.1 ± 3.8 to 2.3 ± 2.0 mm3, P < 0.001, respectively), and necrotic core volume did not change significantly (17.0 ± 11.1 to 19.8 ± 13.5 mm3, P = 0.053). There were no significant differences in compositional analysis between the simvastatin and rosuvastatin treatment groups. However, within groups, necrotic core volume significantly increased in the simvastatin treatment group (19.7 ± 13.9 to 24.3 ± 16.1 mm3, P = 0.029) but not in the rosuvastatin treatment group. (14.3 ± 6.7 to 15.6 ± 8.7 mm3, P = 0.423). The independent clinical predictors for reduction of necrotic core volume by multiple stepwise logistic regression analysis were the percent change of HDL-cholesterol level (P = 0.041, odds ratio: 1.052, 95% confidence interval (CI): 1.002 to 1.104) and the percent change of hsCRP level (P = 0.021, odds ratio: 0.989, 95% CI: 0.980 to 0.998). After 1 year, overall dense calcium volume significantly increased whilst fibrous and fibrofatty volumes significantly decreased; no significant change in the content of necrotic core was observed. Although changes in the volumes of all plaque components were not significantly different between the simvastatin and rosuvastatin treatment groups, halting of necrotic core progression was apparent in the rosuvastatin group

High-speed intracoronary optical frequency domain imaging: Implications for three-dimensional reconstruction and quantitative analysis

Aim: To assess the reproducibility of quantitative analysis of optical frequency domain imaging (OFDI) acquired at different pullback speeds (20, 30, 40 mm/sec), as well as the impact of cardiac motion artefact on three-dimensional (3D) reconstructions. Methods and results: A total of 36 OFDI pullbacks were obtained pre- and post-stent implantation at the pullback speeds of 20, 30 and 40 mm/sec in non-diseased swine coronary arteries. The amount of x-ray contrast needed for blood clearance during OFDI imaging was recorded. Three-dimensional images of stented segments were rendered and artefacts on 3D images were assessed. Lumen areas (LA) were measured on each individual frame in pre- and post-stent pullbacks. The volume of contrast used with a pullback speed of 40 mm/sec was significantly smaller than with those of 30 and 20 mm/sec (10.8±1.8, 12.9±1.6, 15.9±2.6 ml, p<0.01, respectively). Three-dimensional reconstruction was feasible in all pullbacks. Faster pullback speeds resulted in a smaller number of artefacts. For quantitative measurement, a total of 7,426 frames were analysed. In non-stented vessels, LA derived from corresponding selected frames increased significantly with increasing pullback speeds (6.35±2.14 vs. 6.58±2.10 mm 2 for 20 vs. 30 mm/sec [p<0.001], 6.36±2.13 vs. 6.75±2.09 mm 2 for 20 vs. 40 mm/sec [p<0.001]), whereas in stented vessels there was no significant difference in mean LA between the three different pullback speeds (6.75±1.30 vs. 6.78±1.36 mm 2 for 20 vs. 30 mm/sec [NS], 6.74±1.30 vs. 6.76±1.31 mm 2 for 20 vs. 40 mm/sec [NS]). Conclusions: Quantitative analysis of OFDI obtained at different pullback speeds in non-stented coronary arteries could potentially vary in LA measurement. OFDI with high-speed pullback allows quantitative analysis of stented vessels while reducing the amount of contrast and cardiac motion artefacts

In vivo evaluation of stent strut distribution patterns in the bioabsorbable everolimus-eluting device: An OCT ad hoc analysis of the revision 1.0 and revision 1.1 stent design in the ABSORB clinical trial

Aims: The ABSORB Cohort A clinical study has shown the feasibility and safety of the fully bioabsorbable everolimus-eluting structure (BVS, revision 1.0). However, the study also demonstrated somewhat higher acute and late recoil with the BVS structure compared to metallic drug eluting stents. Based on these clinical observations, modifications to the stent design (BVS, revision 1.1) were introduced for the ABSORB Cohort B study in order to decrease recoil. The aim was to compare in vivo the strut distribution between the BVS revision 1.0 (Cohort A), and BVS revision 1.1 (Cohort B) designs. Methods and results: OCT analysis was performed by two independent analysts in four patients from each cohort of the ABSORB study. Strut distribution was assessed in cross-section, and longitudinally in a frame-by-frame analysis. Variables recorded included inter-strut angle, maximum inter-strut angle and number of frames with ≥3 struts. The inter-observer correlation coefficient was also assessed. For both designs, on a patient level there was no significant difference in the number of analysed struts corrected for the length of the scaffold (p=0.78). Likewise, on a frame by frame analysis mean stent area, number of struts per frame, mean maximum inter-strut angle, and mean inter-strut angle were similar for both groups. However, in both structures there was a cyclical variation in the maximum number of struts per frame. The frequency of this variation was significantly higher in Cohort B. The inter-observer correlation coefficient for strut counts, inter-strut angle and maximum inter-strut angle was 0.91, 0.87 and 0.74 respectively. Conclusions: This ad hoc analysis confirms that the revision 1.1 BVS design has a different longitudinal strut distribution to the revision 1.0 BVS design, indicating that the new design has a reduced maximum circular unsupported cross sectional area

Atherosclerotic tissue characterization in vivo by optical coherence tomography attenuation imaging

Optical coherence tomography (OCT) is rapidly becoming the method of choice for assessing arterial wall pathology in vivo. Atherosclerotic plaques can be diagnosed with high accuracy, including measurement of the thickness of fibrous caps, enabling an assessment of the risk of rupture. While the OCT image presents morphological information in highly resolved detail, it relies on interpretation of the images by trained readers for the identification of vessel wall components and tissue type. We present a framework to enable systematic and automatic classification of atherosclerotic plaque constituents, based on the optical attenuation coefficient mu(t) of the tissue. OCT images of 65 coronary artery segments in vitro, obtained from 14 vessels harvested at autopsy, are analyzed and correlated with histology. Vessel wall components can be distinguished based on their optical properties: necrotic core and macrophage infiltration exhibit strong attenuation, mu(t) >= 10 mm(-1), while calcific and fibrous tissue have a lower mu(t) approximate to 2 - 5 mm(-1). The algorithm is successfully applied to OCT patient data, demonstrating that the analysis can be used in a clinical setting and assist diagnostics of vessel wall pathology. (C) 2010 Society of Photo-Optical Instrumentation Engineers. [DOI: 10.1117/1.3280271

First-in-man evaluation of intravascular optical frequency domain imaging (OFDI) of Terumo: A comparison with intravascular ultrasound and quantitative coronary angiography

Aims: The objective of this study is to evaluate the feasibility and safety of imaging human coronary arteries in vivo by optical frequency domain imaging (OFDI) in comparison to intravascular ultrasound (IVUS). OFDI has been recently developed to overcome the limitations of conventional time-domain optical coherence tomography (OCT), namely the need for proximal balloon occlusion. The Terumo-OFDI system is capable of acquiring images with high-speed automated pullback (up to 40 mm/sec) and requires only a short injection (3-4 sec) of small amount of x-ray contrast (9-16 ml). Methods and results: Nineteen patients who underwent stent implantation were enrolled. IVUS/OFDI were performed before and after stenting. The incidences of any adverse event and angiographic adverse findings were recorded. Lumen area (LA) was measured by IVUS and OFDI at 1 mm intervals in the stented segments (n=19) as well as in the proximal, distal, and to-be-stented segments (n=40). In addition, lumen area in the stented segment was also measured by edge (E-) and video-densitometric (VD-) quantitative coronary angiography (QCA). The OFDI images were obtained without any adverse event related to imaging procedures. Post stenting (n=19), minimal LA (MLA) measured by OFDI (5.84±1.89 mm2) was larger than that of E-QCA (4.16±1.

Inter-technique consistency and prognostic value of intra-procedural angiographic and echocardiographic assessment of aortic regurgitation after transcatheter aortic valve implantation

Background: We investigated the relationship between intraprocedural angiographic and echocardiographic AR severity after TAVI, and the clinical robustness of angiographic assessment. Methods and Results: In 74 consecutive patients, the echocardiographic circumferential extent (CE) of the paravalvular regurgitant jet was retrospectively measured and graded based on the VARC-2 cut-points; and angiographic post-TAVI AR was retrospectively quantified using contrast videodensitometry (VD) software that calculates the ratio of the contrast time-density integral in the LV outflow tract to that in the ascending aorta (LVOT-AR). Seventy-four echocardiograms immediately after TAVI were analyzable, while 51 aortograms were analyzable for VD. These 51 echocardiograms and VD were evaluated. Median LVOT-AR across the echocardiographic AR grades was as follows: none-trace, 0.07 (IQR, 0.05–0.11); mild, 0.12 (IQR, 0.09–0.15); and moderate, 0.17 (IQR, 0.15–0.22; Pmild AR patients compared with no-mild AR on intra-procedural echocardiography (41.5% vs. 12.4%, P=0.03) as well as in patients with LVOT-AR >0.17 compared with LVOT-AR ≤0.17 (59.5% vs. 16.6%, P=0.03). Conclusions: VD (LVOT-AR) has good intra-procedural inter-technique consistency and clinical robustness. Greater than mild post-TAVI AR, but not mild post-TAVI AR, is associated with late mortality