Transcript
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Intravascular Elastography:palpating plaques with the finger of IVUS
C.L. de Korte1, F. Mastik1, J.A. Schaar1,M. Sierevogel1,3, G. Pasterkamp3,
P.W. Serruys1 and A.F.W van der Steen1,2
1Erasmus University, Thoraxcentre, Rotterdam, The Netherlands 2Interuniversity Cardiology Institute of the Netherlands
3Experimental Cardiology Laboratory, University Medical Center, Utrecht, The Netherlands
Supported by Netherlands Organization for Scientific Research (NWO) and the Dutch Technology Foundation (STW)
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Background : Vulnerable plaque
Plaque vulnerability :
Plaque composition• Large lipid pool
Mechanical properties
• High strain region
• Thin fibrous cap• presence of Macrophages
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Background : Principle of elastography
Soft Harduncompressed
compressed
• The response of tissue to mechanical excitation (e.g. compression) is a function of its mechanical properties.
Force Soft Hard
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IVUS elastography
(t1, P1)
(t2, P2)
Processing
IVUS at 100mmHg
IVUS at 80mmHg
IVUS elastogram
strain1%
0%
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strain1%
0%
Picrosirius-red Anti-CD68 antibodyAlpha-actin
Circulation 102(6) 617-623 (2000)
IVUS elastography plaque characterization
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strain1%
0%
Picrosirius-red Anti-CD68 antibodyAlpha-actin
IVUS elastography vulnerable plaque detection
ACC 2002, presentation 1054-20
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Predictive power of elastography to identify the vulnerable plaque
1 - Specificity1.00.75.50.25
Sens
itivi
ty
1.00
.75
.50
.25
0
Strain 1.26 %:
Sensitivity 88%
Specificity 89%
ACC 2002, presentation 1054-20
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0 20 40 60 80 100 12040
60
80
100
120
140
Frame no.
Intra
-cor
onar
ypr
essu
re [m
mH
g]In vivo elastography
Strain [%]
1.0
0.0
Eur Heart J 23(5): 405-413 (2002)
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Cross-section LAD of patient with U.A.P
Strain [%]2.0
0.0
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IVUS elastography before atherectomy
Strain [%]1.0
0.0
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Fibrous cap tissue
Fibro-fatty core tissue
Histology atherectomy specimen
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Echogram and elastogram obtained in vivo in Yucatanstrain
1%
0%
Elastic-von Giesson Picro-Sirius red Acid PhosphatasePolarized light
Circulation (2002) in press
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Tissue mean std
Normal segments (n=6) 0.21 0.09
Early fatty lesion (n=9) 0.46 0.17
Early fibrous lesion (n=3) 0.24 0.03
Advanced fibrous lesion (n=6) 0.22 0.04
Strain [%]
*
Strain and plaque composition in Yucatan
Univariate ANOVA on strain
Fat p=0.007M p=0.966
1 - Specificity
1.00.75.50.250.00
Sen
sitiv
ity
1.00
.75
.50
.25
0.00
Area=0.952
Circulation (2002) in press
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3 Dimensional Elastography
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Conclusion
Intravascular Ultrasound Elastography: A powerful technique to identify
the vulnerable plaque.
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