DOI:

First use in patients of a combined near infra-red spectroscopy and intra-vascular ultrasound catheter to identify composition and structure of coronary plaque

Scot Garg1, MBChB, MRCP; Patrick W. Serruys1, MD, PhD; Martin van der Ent1, MD, PhD; Carl Schultz1, MD, PhD; Frits Mastik2; Gijs van Soest2; Antonius F.W. van der Steen2, MSc, PhD; Mark A. Wilder3; James E. Muller3, MD; Evelyn Regar1*, MD, PhD

A 70 year-old diabetic female with a history of hyperlipidaemia treated with statin therapy underwent coronary angioplasty of her right coronary artery (RCA, Figure 1).

Figure 1. RCA (A) pre- and (B) post-stenting.

Post-procedure the RCA was assessed using, for the first time, a combination intravascular ultrasound (IVUS) and near infrared spectroscopy (NIRS) catheter, which indicated that the proximal end of the stent was located in an area of lipid core plaque (Figure 2 and Video 1); a potential risk factor for stent thrombosis.1

Figure 2. The combined IVUS images and NIRS chemical information obtained from a single pullback through the RCA using the combination catheter. (A) The chemogram obtained from the NIRS is a map of the measured probability of lipid core plaque (LCP) from each scanned arterial segment. Yellow represents regions with the highest probability for the presence of LCP, whilst red regions represent those the lowest. The chemogram displays pullback position (x-axis) against circumferential position (y-axis) of the measurement in degrees. The § denotes a blacked-out region near a side branch where the NIRS system was unable to obtain a reliable signal. (B) The block chemogram provides a summary of all measurements (approximately 160) made for each 2 mm length of the chemogram. Increasing probability of LCP is indicated by a four colour display (from red indicating low likelihood of LCP to dark orange to light orange to yellow). (C) The longitudinal IVUS pullback, with NIRS block chemogram values in the centre. The lilac and blue lines mark the corresponding positions on the IVUS, and the chemogram (Figure 2A) during pullback, illustrating the ability of the system to co-localize plaque structure and composition. The proximal end of the stent is located in an area with a strong signal for lipid. The # indicates the side branch, identified in Figures 1B and 2E. (D) Transverse IVUS image obtained within the stented area demonstrates well opposed clearly identifiable stent struts (ss). The corresponding location on the longitudinal IVUS, and chemogram is denoted by the iliac line. The red colours on both the chemogram, which is displayed as a circular band surrounding the IVUS image, and the block chemogram, which is shown in the centre of the IVUS image indicate that there is a low probability of lipid in this area of the stent. (E) Transverse IVUS image obtained distal to the stent at the location indicated by the blue line on Figures 2A and 2C. The IVUS image demonstrates the presence of echolucent plaque between 1 and 7 o’clock. The chemogram displays a high probability of lipid in this plaque with a circumferential distribution (yellow ring surrounding the IVUS image).

Prospective studies are needed to assess the risk of ending a stent in a fibroatheroma, and to investigate the use of NIRS-IVUS to determine the optimal landing zone for a stent. In this manner, the co-localization of lipid core with structure may provide useful information that will enhance the safety of stenting and, with prospective studies, increase the ability to correctly identify plaque at risk of rupture.

Reference

Online data supplement

Video 1. IVUS images with the corresponding NIRS chemograms (circular band around IVUS) and block chemograms (centre of IVUS image) obtained during pullback through the implanted stent.

Supplementary data

To read the full content of this article, please download the PDF.

vid1
Volume 5 Number 6
Jan 15, 2010
Volume 5 Number 6
View full issue


Key metrics

On the same subject

Editorial

10.4244/EIJ-E-23-00052 Mar 18, 2024
Comparative preclinical assessment of drug-coated balloons: a blessing and a curse for clinical translation
Joner M and Wild L
free

Debate

10.4244/EIJ-E-24-00005 Mar 18, 2024
Ischaemic and viability testing for guiding PCI are overrated: pros and cons
McEntegart M et al
free

Original Research

10.4244/EIJ-D-23-00783 Mar 18, 2024
Redo-TAVI with the ACURATE neo2 and Prime XL for balloon-expandable transcatheter heart valve failure
Meier D et al
Trending articles
281.53

State-of-the-Art Review

10.4244/EIJ-D-21-00695 Nov 19, 2021
Transcatheter treatment for tricuspid valve disease
Praz F et al
free
243.2

State of the art

10.4244/EIJ-D-21-01117 Sep 20, 2022
Recanalisation of coronary chronic total occlusions
Di Mario C et al
free
208.35

State-of-the-Art Review

10.4244/EIJ-D-21-01034 Jun 3, 2022
Management of in-stent restenosis
Alfonso F et al
free
168.7

Translational research

10.4244/EIJ-D-21-00824 May 15, 2022
Bench test and in vivo evaluation of longitudinal stent deformation during proximal optimisation
Toth GG et al
free
167.05

Expert review

10.4244/EIJ-D-21-00690 May 15, 2022
Crush techniques for percutaneous coronary intervention of bifurcation lesions
Moroni F et al
free
151.03

State-of-the-Art

10.4244/EIJ-D-22-00776 Apr 3, 2023
Computed tomographic angiography in coronary artery disease
Serruys PW et al
free
118

Translational research

10.4244/EIJ-D-22-00718 Jun 5, 2023
Preclinical evaluation of the degradation kinetics of third-generation resorbable magnesium scaffolds
Seguchi M et al
110.35

Viewpoint

10.4244/EIJ-E-22-00007 May 15, 2022
TAVI at 20: how a crazy idea led to a clinical revolution
Eltchaninoff H et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 6.2
2022 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2023)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2024 Europa Group - All rights reserved