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AS-101 Virtual Histology Intravascular Ultrasound Compared With Optical Coherence Tomography for Identification of Thin-cap Fibroatheroma
Wednesday, April 27 - Friday April 29, 2011 (Poster Abstract Zone)
Invasive Imaging: IVUS, OCT, Spectroscopy, and Other Thursday, April 28, 2011 8:30 AM ⬃ 12:30 PM (Abstract nos. AS-101, AS-112, AS-115, AS-119, AS-120, AS-246 –AS-251) AS-101 Virtual Histology Intravascular Ultrasound Compared With Optical Coherence Tomography for Identification of Thin-cap Fibroatheroma. Takashi Kubo2, Yoshiki Matsuo2, Yasushi Okumoto1, Kohei Ishibashi2, Kenichi Komukai2, Takashi Tanimoto2, Yasushi Ino2, Hironori Kitabata2, Keizo Kimura2, Masato Mizukoshi2, Toshio Imanishi2, Hideharu Akagi1, Tadao Yamamoto1, Takashi Akasaka2. 2Wakayama Medical University, Wakayama, Japan; 1Social Insurance Kinan Hospital, Tanabe, Japan. Background: Virtual histology intravascular ultrasound (VH-IVUS) allows detailed assessment of plaque composition in the clinical setting. Optical coherence tomography (OCT) has been developed as a highresolution imaging method, which might be a promising technique to identify the thin-cap fibroatheroma (TCFA) in vivo. The purpose of the present study is to evaluate the diagnostic accuracy of VH-IVUS to identify TCFA as determined by OCT. Methods: We examined 96 target lesions in patients with stable angina pectoris by using VH-IVUS and OCT. VH-IVUS derived TCFA was defined as a focal necrotic core-rich lesion without evident overlying fibrous tissue. OCT derived TCFA was defined as a plaque with the fibrous cap of ⬍65 m. Results: VH-IVUS correctly identified 16 TCFA and 67 non-TCFA but misclassified 2 TCFA and 11 non-TCFA as determined by OCT. The sensitivity, specificity, and positive and negative predictive values of VH-IVUS to identify TCFA as determined by OCT were 89%, 86%, 59%, and 97%, respectively. Conclusion: VH-IVUS showed an acceptable sensitivity and specificity to identify TCFA as determined by OCT. Although the positive predictive value was low reflecting a high number of false positives, the negative predictive value was notably high. Our results suggest a potential role for VH-IVUS to exclude high risk lesions for future coronary event.
AS-112 Stent Edge Assessment Using a Multi-Modality Imaging Approach: Angiography, IVUS And OCT. Eun-Seok Shin1, Takayuki Okamura2, Hector M. Garcia-Garcia2, Michael Magro2, Scot Garg2, Evelyn Regar2, Patrick W. Serruys2. 1Ulsan University Hospital, Ulsan, Korea (Republic of); 2Thoraxcenter, Rotterdam, Netherlands.
Background: Optical coherence tomography (OCT) has a high resolution of approximately 10 m allowing superior assessment of dissection at the stent edge. The aim of the present study was two-fold: 1. to compare the incidence of stent edge dissection between angiogram, intravascular ultrasound (IVUS), and OCT; and 2. to evaluate plaque composition using IVUS Virtual Histology (VH-IVUS) at the site of stent edge dissections detected by OCT after percutaneous coronary intervention (PCI). Methods: Thirty six consecutive patients (57 stent edges: 5 mm segments) who underwent balloon-expandable stent implantation and post stent assessment with OCT and VH-IVUS were included. Results: In 17 patients, 19 dissection sites were detected. Residual plaque burden (48.3⫾14.2% vs. 41.1⫾15.6%, p ⫽ 0.10) by IVUS and stent edge expansion index (0.82⫾0.10 vs. 0.90⫾0.17, p⫽0.09) by OCT were not significantly different between edge dissection and non-dissection groups. In the edge dissection group, absolute dense calcium volume was larger (3.4⫾2.5 mm3 vs. 1.7⫾2.8 mm3, p ⫽ 0.03), and percent necrotic core and dense calcium volume were significantly greater (22.8⫾7.7% vs. 15.4⫾11.1%, p⫽0.01 and 15.6⫾9.7% vs. 6.7⫾6.6%, p ⬍ 0.001) than the non-dissection group. One patient had implantation of an additional stent to treat the edge dissection during the index PCI. Conclusion: OCT is superior to IVUS and conventional coronary angiography in the identification of stent edge dissection. The risk of edge dissection may be reduced if underlying plaque composition is considered when assessing stent length thereby ensuring that stent landing zones are free of calcium and necrotic core.
AS-115 SYNTAX Scores Correlate with the Calcified Component of Plaques in Patients with Stable Angina. Kyuhachi Otagiri, Hiroshi Tsutsui, Setsuo Kumazaki, Yusuke Miyashita, Tatsuya Saigusa, Hikaru Kimura, Shinichi Asoh, Kazunori Aizawa, Megumi Koshikawa, Hiroki Kasai, Atsushi Izawa, Takeshi Tomita, Jun Koyama, Uichi Ikeda. Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan. Background: In recent times, the SYNTAX score can be used to score the complexity of coronary artery disease (CAD). Moreover, plaque characteristics can be assessed using integrated backscatter intravascular ultrasound (IB-IVUS). This study aimed to evaluate the correlation between the SYNTAX score and plaque characteristics in patients with stable angina (SAP) using IB-IVUS. Methods: Patients who underwent IB-IVUS before percutaneous coronary intervention were enrolled, and SYNTAX scores were calculated on the basis of initial angiography. Patients were divided into the high score and low score groups on the basis of SYNTAX scores. The plaque components, i.e., calcification (CA), dense fibrosis (DF), fibrosis (F), and lipid pool (LP), were assessed using IB values. We compared plaque components between the high score and low score groups. Further, we assessed correlations between the SYNTAX score and plaque components. Results: 40 patients were enrolled. Mean SYNTAX score was 31.25 in all studied patients. Significant differences were observed between the high score (n ⫽ 20) and low score groups (n ⫽ 20) in the percent volume of CA (6.6 % ⫾ 3.7 % vs. 4.4 % ⫾ 2.7 %; p ⬍ 0.039). Furthermore, percent volume of CA and SYNTAX scores were positively correlated (r ⫽ 0.316, p ⫽ 0.046).
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
95A
P O S T E R A B S T R A C T S
Invasive Imaging: IVUS, OCT, Spectroscopy, and Other Thursday, April 28, 2011 8:30 AM ⬃ 12:30 PM (Abstract nos. AS-101, AS-112, AS-115, AS-119, AS-120, AS-246 –AS-251) AS-101 Virtual Histology Intravascular Ultrasound Compared With Optical Coherence Tomography for Identification of Thin-cap Fibroatheroma. Takashi Kubo2, Yoshiki Matsuo2, Yasushi Okumoto1, Kohei Ishibashi2, Kenichi Komukai2, Takashi Tanimoto2, Yasushi Ino2, Hironori Kitabata2, Keizo Kimura2, Masato Mizukoshi2, Toshio Imanishi2, Hideharu Akagi1, Tadao Yamamoto1, Takashi Akasaka2. 2Wakayama Medical University, Wakayama, Japan; 1Social Insurance Kinan Hospital, Tanabe, Japan. Background: Virtual histology intravascular ultrasound (VH-IVUS) allows detailed assessment of plaque composition in the clinical setting. Optical coherence tomography (OCT) has been developed as a highresolution imaging method, which might be a promising technique to identify the thin-cap fibroatheroma (TCFA) in vivo. The purpose of the present study is to evaluate the diagnostic accuracy of VH-IVUS to identify TCFA as determined by OCT. Methods: We examined 96 target lesions in patients with stable angina pectoris by using VH-IVUS and OCT. VH-IVUS derived TCFA was defined as a focal necrotic core-rich lesion without evident overlying fibrous tissue. OCT derived TCFA was defined as a plaque with the fibrous cap of ⬍65 m. Results: VH-IVUS correctly identified 16 TCFA and 67 non-TCFA but misclassified 2 TCFA and 11 non-TCFA as determined by OCT. The sensitivity, specificity, and positive and negative predictive values of VH-IVUS to identify TCFA as determined by OCT were 89%, 86%, 59%, and 97%, respectively. Conclusion: VH-IVUS showed an acceptable sensitivity and specificity to identify TCFA as determined by OCT. Although the positive predictive value was low reflecting a high number of false positives, the negative predictive value was notably high. Our results suggest a potential role for VH-IVUS to exclude high risk lesions for future coronary event.
AS-112 Stent Edge Assessment Using a Multi-Modality Imaging Approach: Angiography, IVUS And OCT. Eun-Seok Shin1, Takayuki Okamura2, Hector M. Garcia-Garcia2, Michael Magro2, Scot Garg2, Evelyn Regar2, Patrick W. Serruys2. 1Ulsan University Hospital, Ulsan, Korea (Republic of); 2Thoraxcenter, Rotterdam, Netherlands.
Background: Optical coherence tomography (OCT) has a high resolution of approximately 10 m allowing superior assessment of dissection at the stent edge. The aim of the present study was two-fold: 1. to compare the incidence of stent edge dissection between angiogram, intravascular ultrasound (IVUS), and OCT; and 2. to evaluate plaque composition using IVUS Virtual Histology (VH-IVUS) at the site of stent edge dissections detected by OCT after percutaneous coronary intervention (PCI). Methods: Thirty six consecutive patients (57 stent edges: 5 mm segments) who underwent balloon-expandable stent implantation and post stent assessment with OCT and VH-IVUS were included. Results: In 17 patients, 19 dissection sites were detected. Residual plaque burden (48.3⫾14.2% vs. 41.1⫾15.6%, p ⫽ 0.10) by IVUS and stent edge expansion index (0.82⫾0.10 vs. 0.90⫾0.17, p⫽0.09) by OCT were not significantly different between edge dissection and non-dissection groups. In the edge dissection group, absolute dense calcium volume was larger (3.4⫾2.5 mm3 vs. 1.7⫾2.8 mm3, p ⫽ 0.03), and percent necrotic core and dense calcium volume were significantly greater (22.8⫾7.7% vs. 15.4⫾11.1%, p⫽0.01 and 15.6⫾9.7% vs. 6.7⫾6.6%, p ⬍ 0.001) than the non-dissection group. One patient had implantation of an additional stent to treat the edge dissection during the index PCI. Conclusion: OCT is superior to IVUS and conventional coronary angiography in the identification of stent edge dissection. The risk of edge dissection may be reduced if underlying plaque composition is considered when assessing stent length thereby ensuring that stent landing zones are free of calcium and necrotic core.
AS-115 SYNTAX Scores Correlate with the Calcified Component of Plaques in Patients with Stable Angina. Kyuhachi Otagiri, Hiroshi Tsutsui, Setsuo Kumazaki, Yusuke Miyashita, Tatsuya Saigusa, Hikaru Kimura, Shinichi Asoh, Kazunori Aizawa, Megumi Koshikawa, Hiroki Kasai, Atsushi Izawa, Takeshi Tomita, Jun Koyama, Uichi Ikeda. Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan. Background: In recent times, the SYNTAX score can be used to score the complexity of coronary artery disease (CAD). Moreover, plaque characteristics can be assessed using integrated backscatter intravascular ultrasound (IB-IVUS). This study aimed to evaluate the correlation between the SYNTAX score and plaque characteristics in patients with stable angina (SAP) using IB-IVUS. Methods: Patients who underwent IB-IVUS before percutaneous coronary intervention were enrolled, and SYNTAX scores were calculated on the basis of initial angiography. Patients were divided into the high score and low score groups on the basis of SYNTAX scores. The plaque components, i.e., calcification (CA), dense fibrosis (DF), fibrosis (F), and lipid pool (LP), were assessed using IB values. We compared plaque components between the high score and low score groups. Further, we assessed correlations between the SYNTAX score and plaque components. Results: 40 patients were enrolled. Mean SYNTAX score was 31.25 in all studied patients. Significant differences were observed between the high score (n ⫽ 20) and low score groups (n ⫽ 20) in the percent volume of CA (6.6 % ⫾ 3.7 % vs. 4.4 % ⫾ 2.7 %; p ⬍ 0.039). Furthermore, percent volume of CA and SYNTAX scores were positively correlated (r ⫽ 0.316, p ⫽ 0.046).
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
95A
P O S T E R A B S T R A C T S