Editorial Slides VP Watch January 15 2003 Volume 1 Issue 2

Can OCT Catheter See Plaque Macrophages

ndash Optical coherence tomography (OCT) is analogous to ultrasound measuring the intensity of back-reflected light (near infrared light) rather than sound (acoustical waves)

ndash An OCT image represents a cross sectional picture of the optical reflectance properties of tissue 4

ndash OCT originally developed to image the transparent tissue of the eye with unprecedented resolution

Brezinski Tearney Bouma Fujimoto and colleagues in 1997 discussed the advantages of OCT as following

bull High resolution bull Broad dynamic range and bull Ability to be delivered through

intravascular catheters 2

ndash In vitro studies have shown that the resolution of OCT (10-20 micron) can resolve the thin fibrous caps thought to be responsible for plaque vulnerability 1

ndash Catheter-based diagnostic techniques can provide structural information with higher resolution than non-invasive methods OCT achieves at least 10 times higher resolution than IVUS and can be adapted for catheter-based imaging of vulnerable plaque 3

IVUS OCT

Coronary IVUS vs Coronary OCT

Tearney Boma Chang et al

Brezinski Tearney Bouma Fujimoto and colleagues in 1997 discussed the advantages of OCT as following

bull High resolution bull Broad dynamic range and bull Ability to be delivered through

intravascular catheters 2

ndash In vitro studies have shown that the resolution of OCT (10-20 micron) can resolve the thin fibrous caps thought to be responsible for plaque vulnerability 1

ndash Catheter-based diagnostic techniques can provide structural information with higher resolution than non-invasive methods OCT achieves at least 10 times higher resolution than IVUS and can be adapted for catheter-based imaging of vulnerable plaque 3

IVUS OCT

Coronary IVUS vs Coronary OCT

Tearney Boma Chang et al

ndash In vitro studies have shown that the resolution of OCT (10-20 micron) can resolve the thin fibrous caps thought to be responsible for plaque vulnerability 1

ndash Catheter-based diagnostic techniques can provide structural information with higher resolution than non-invasive methods OCT achieves at least 10 times higher resolution than IVUS and can be adapted for catheter-based imaging of vulnerable plaque 3

IVUS OCT

Coronary IVUS vs Coronary OCT

Tearney Boma Chang et al

IVUS OCT

Coronary IVUS vs Coronary OCT

Tearney Boma Chang et al

Tearney Jang and colleagues showed that in vivo OCT imaging of normal coronary arteries intimal dissections and deployed stents in swine is feasible and allows identification of clinically relevant coronary artery morphology with high-resolution and contrast 4

bull As highlighted in VP Watch of this week Tearney and colleagues showed OCT can characterize structure of atherosclerotic plaque ex-vivo5

bull They further showed that macrophage content of plaque cap can be identified by OCT 5

bull Ex vivo studiesndash Plaque characterizationndash Cap thicknessndash Macrophage density

bull In vivo studiesndash Feasibilityndash Post-MI

Fibrous

Calcific

LIPID

Yabushita Tearney et al Circulation 2002

Plaque Characterization Studybull Evaluate diagnostic potential (lipid pools)

bull Methodsndash 357 diseased arterial segments from 90 cadavers

bull 78 Coronary 86 Carotid 143 Aortandash OCT imaging histology processing registrationndash Correlation of OCT with histology

ndash Develop OCT criteria for characterization (training set n=50)ndash Prospectively test OCT criteria (validation set n = 307)ndash Two OCT readers and two pathologists

Yabushita Tearney et al Circulation 2002

Plaque Characterization

lp

lp

HomogeneousSignal-rich

Fibrous Lipid pool

Echolucent Diffuse Borders

Echolucent Sharp Borders

CalcificOCT Criteria training set (n=50)

500 microm

Plaque Characterization Results

SENS 79SPEC 97

SENS 95SPEC 97

SENS 90SPEC 92

bull Accuracy Statistics

bull Fibrous

bull Calcific

bull Lipid pool

Interobserver = 088 Intraobserver = 091 Yabushita Tearney et al Circulation 2002

bull Technology development

bull Ex vivo studiesndash Plaque characterizationndash Cap thicknessndash Macrophage density

bull In vivo studiesndash Feasibilityndash Post-MIndash Epidemiologyndash Prospective trials

M produce proteasesDegrade collagen and matrix

Impair structural integrity of cap

CD68 Immunoperoxidase

Cap

Lipid

Tearney Bouma et al Circulation 2003

Macrophage Studybull Can OCT quantify macrophage content

bull Methodsndash 26 diseased arterial segments from 17 cadavers

bull 7 Carotid 19 Aortandash OCT imagingndash Histology processing - CD68 SMA trichromendash Correlation of OCT with histologyndash 500x125 microm ROIndash Histology - automatic segmentation - area stainingndash OCT - quantitative image analysis

NSD

Smax Smin

Tearney Bouma et al Circulation 2003

Macrophage Study

250 microm

OCT

CD68

Low M High M

Tearney Bouma et al Circulation 2003

Linear NSD vs CD68

CD68 area gt 10 - NSD cutoff 62

R = 084P lt 00001

Tearney Bouma et al Circulation 2003

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

bull As highlighted in VP Watch of this week Tearney and colleagues showed OCT can characterize structure of atherosclerotic plaque ex-vivo5

bull They further showed that macrophage content of plaque cap can be identified by OCT 5

bull Ex vivo studiesndash Plaque characterizationndash Cap thicknessndash Macrophage density

bull In vivo studiesndash Feasibilityndash Post-MI

Fibrous

Calcific

LIPID

Yabushita Tearney et al Circulation 2002

Plaque Characterization Studybull Evaluate diagnostic potential (lipid pools)

bull Methodsndash 357 diseased arterial segments from 90 cadavers

bull 78 Coronary 86 Carotid 143 Aortandash OCT imaging histology processing registrationndash Correlation of OCT with histology

ndash Develop OCT criteria for characterization (training set n=50)ndash Prospectively test OCT criteria (validation set n = 307)ndash Two OCT readers and two pathologists

Yabushita Tearney et al Circulation 2002

Plaque Characterization

lp

lp

HomogeneousSignal-rich

Fibrous Lipid pool

Echolucent Diffuse Borders

Echolucent Sharp Borders

CalcificOCT Criteria training set (n=50)

500 microm

Plaque Characterization Results

SENS 79SPEC 97

SENS 95SPEC 97

SENS 90SPEC 92

bull Accuracy Statistics

bull Fibrous

bull Calcific

bull Lipid pool

Interobserver = 088 Intraobserver = 091 Yabushita Tearney et al Circulation 2002

bull Technology development

bull Ex vivo studiesndash Plaque characterizationndash Cap thicknessndash Macrophage density

bull In vivo studiesndash Feasibilityndash Post-MIndash Epidemiologyndash Prospective trials

M produce proteasesDegrade collagen and matrix

Impair structural integrity of cap

CD68 Immunoperoxidase

Cap

Lipid

Tearney Bouma et al Circulation 2003

Macrophage Studybull Can OCT quantify macrophage content

bull Methodsndash 26 diseased arterial segments from 17 cadavers

bull 7 Carotid 19 Aortandash OCT imagingndash Histology processing - CD68 SMA trichromendash Correlation of OCT with histologyndash 500x125 microm ROIndash Histology - automatic segmentation - area stainingndash OCT - quantitative image analysis

NSD

Smax Smin

Tearney Bouma et al Circulation 2003

Macrophage Study

250 microm

OCT

CD68

Low M High M

Tearney Bouma et al Circulation 2003

Linear NSD vs CD68

CD68 area gt 10 - NSD cutoff 62

R = 084P lt 00001

Tearney Bouma et al Circulation 2003

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

bull Ex vivo studiesndash Plaque characterizationndash Cap thicknessndash Macrophage density

bull In vivo studiesndash Feasibilityndash Post-MI

Fibrous

Calcific

LIPID

Yabushita Tearney et al Circulation 2002

Plaque Characterization Studybull Evaluate diagnostic potential (lipid pools)

bull Methodsndash 357 diseased arterial segments from 90 cadavers

bull 78 Coronary 86 Carotid 143 Aortandash OCT imaging histology processing registrationndash Correlation of OCT with histology

ndash Develop OCT criteria for characterization (training set n=50)ndash Prospectively test OCT criteria (validation set n = 307)ndash Two OCT readers and two pathologists

Yabushita Tearney et al Circulation 2002

Plaque Characterization

lp

lp

HomogeneousSignal-rich

Fibrous Lipid pool

Echolucent Diffuse Borders

Echolucent Sharp Borders

CalcificOCT Criteria training set (n=50)

500 microm

Plaque Characterization Results

SENS 79SPEC 97

SENS 95SPEC 97

SENS 90SPEC 92

bull Accuracy Statistics

bull Fibrous

bull Calcific

bull Lipid pool

Interobserver = 088 Intraobserver = 091 Yabushita Tearney et al Circulation 2002

bull Technology development

bull Ex vivo studiesndash Plaque characterizationndash Cap thicknessndash Macrophage density

bull In vivo studiesndash Feasibilityndash Post-MIndash Epidemiologyndash Prospective trials

M produce proteasesDegrade collagen and matrix

Impair structural integrity of cap

CD68 Immunoperoxidase

Cap

Lipid

Tearney Bouma et al Circulation 2003

Macrophage Studybull Can OCT quantify macrophage content

bull Methodsndash 26 diseased arterial segments from 17 cadavers

bull 7 Carotid 19 Aortandash OCT imagingndash Histology processing - CD68 SMA trichromendash Correlation of OCT with histologyndash 500x125 microm ROIndash Histology - automatic segmentation - area stainingndash OCT - quantitative image analysis

NSD

Smax Smin

Tearney Bouma et al Circulation 2003

Macrophage Study

250 microm

OCT

CD68

Low M High M

Tearney Bouma et al Circulation 2003

Linear NSD vs CD68

CD68 area gt 10 - NSD cutoff 62

R = 084P lt 00001

Tearney Bouma et al Circulation 2003

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Plaque Characterization Studybull Evaluate diagnostic potential (lipid pools)

bull Methodsndash 357 diseased arterial segments from 90 cadavers

bull 78 Coronary 86 Carotid 143 Aortandash OCT imaging histology processing registrationndash Correlation of OCT with histology

ndash Develop OCT criteria for characterization (training set n=50)ndash Prospectively test OCT criteria (validation set n = 307)ndash Two OCT readers and two pathologists

Yabushita Tearney et al Circulation 2002

Plaque Characterization

lp

lp

HomogeneousSignal-rich

Fibrous Lipid pool

Echolucent Diffuse Borders

Echolucent Sharp Borders

CalcificOCT Criteria training set (n=50)

500 microm

Plaque Characterization Results

SENS 79SPEC 97

SENS 95SPEC 97

SENS 90SPEC 92

bull Accuracy Statistics

bull Fibrous

bull Calcific

bull Lipid pool

Interobserver = 088 Intraobserver = 091 Yabushita Tearney et al Circulation 2002

bull Technology development

bull Ex vivo studiesndash Plaque characterizationndash Cap thicknessndash Macrophage density

bull In vivo studiesndash Feasibilityndash Post-MIndash Epidemiologyndash Prospective trials

M produce proteasesDegrade collagen and matrix

Impair structural integrity of cap

CD68 Immunoperoxidase

Cap

Lipid

Tearney Bouma et al Circulation 2003

Macrophage Studybull Can OCT quantify macrophage content

bull Methodsndash 26 diseased arterial segments from 17 cadavers

bull 7 Carotid 19 Aortandash OCT imagingndash Histology processing - CD68 SMA trichromendash Correlation of OCT with histologyndash 500x125 microm ROIndash Histology - automatic segmentation - area stainingndash OCT - quantitative image analysis

NSD

Smax Smin

Tearney Bouma et al Circulation 2003

Macrophage Study

250 microm

OCT

CD68

Low M High M

Tearney Bouma et al Circulation 2003

Linear NSD vs CD68

CD68 area gt 10 - NSD cutoff 62

R = 084P lt 00001

Tearney Bouma et al Circulation 2003

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Plaque Characterization

lp

lp

HomogeneousSignal-rich

Fibrous Lipid pool

Echolucent Diffuse Borders

Echolucent Sharp Borders

CalcificOCT Criteria training set (n=50)

500 microm

Plaque Characterization Results

SENS 79SPEC 97

SENS 95SPEC 97

SENS 90SPEC 92

bull Accuracy Statistics

bull Fibrous

bull Calcific

bull Lipid pool

Interobserver = 088 Intraobserver = 091 Yabushita Tearney et al Circulation 2002

bull Technology development

bull Ex vivo studiesndash Plaque characterizationndash Cap thicknessndash Macrophage density

bull In vivo studiesndash Feasibilityndash Post-MIndash Epidemiologyndash Prospective trials

M produce proteasesDegrade collagen and matrix

Impair structural integrity of cap

CD68 Immunoperoxidase

Cap

Lipid

Tearney Bouma et al Circulation 2003

Macrophage Studybull Can OCT quantify macrophage content

bull Methodsndash 26 diseased arterial segments from 17 cadavers

bull 7 Carotid 19 Aortandash OCT imagingndash Histology processing - CD68 SMA trichromendash Correlation of OCT with histologyndash 500x125 microm ROIndash Histology - automatic segmentation - area stainingndash OCT - quantitative image analysis

NSD

Smax Smin

Tearney Bouma et al Circulation 2003

Macrophage Study

250 microm

OCT

CD68

Low M High M

Tearney Bouma et al Circulation 2003

Linear NSD vs CD68

CD68 area gt 10 - NSD cutoff 62

R = 084P lt 00001

Tearney Bouma et al Circulation 2003

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Plaque Characterization Results

SENS 79SPEC 97

SENS 95SPEC 97

SENS 90SPEC 92

bull Accuracy Statistics

bull Fibrous

bull Calcific

bull Lipid pool

Interobserver = 088 Intraobserver = 091 Yabushita Tearney et al Circulation 2002

bull Technology development

bull Ex vivo studiesndash Plaque characterizationndash Cap thicknessndash Macrophage density

bull In vivo studiesndash Feasibilityndash Post-MIndash Epidemiologyndash Prospective trials

M produce proteasesDegrade collagen and matrix

Impair structural integrity of cap

CD68 Immunoperoxidase

Cap

Lipid

Tearney Bouma et al Circulation 2003

Macrophage Studybull Can OCT quantify macrophage content

bull Methodsndash 26 diseased arterial segments from 17 cadavers

bull 7 Carotid 19 Aortandash OCT imagingndash Histology processing - CD68 SMA trichromendash Correlation of OCT with histologyndash 500x125 microm ROIndash Histology - automatic segmentation - area stainingndash OCT - quantitative image analysis

NSD

Smax Smin

Tearney Bouma et al Circulation 2003

Macrophage Study

250 microm

OCT

CD68

Low M High M

Tearney Bouma et al Circulation 2003

Linear NSD vs CD68

CD68 area gt 10 - NSD cutoff 62

R = 084P lt 00001

Tearney Bouma et al Circulation 2003

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

bull Technology development

bull Ex vivo studiesndash Plaque characterizationndash Cap thicknessndash Macrophage density

bull In vivo studiesndash Feasibilityndash Post-MIndash Epidemiologyndash Prospective trials

M produce proteasesDegrade collagen and matrix

Impair structural integrity of cap

CD68 Immunoperoxidase

Cap

Lipid

Tearney Bouma et al Circulation 2003

Macrophage Studybull Can OCT quantify macrophage content

bull Methodsndash 26 diseased arterial segments from 17 cadavers

bull 7 Carotid 19 Aortandash OCT imagingndash Histology processing - CD68 SMA trichromendash Correlation of OCT with histologyndash 500x125 microm ROIndash Histology - automatic segmentation - area stainingndash OCT - quantitative image analysis

NSD

Smax Smin

Tearney Bouma et al Circulation 2003

Macrophage Study

250 microm

OCT

CD68

Low M High M

Tearney Bouma et al Circulation 2003

Linear NSD vs CD68

CD68 area gt 10 - NSD cutoff 62

R = 084P lt 00001

Tearney Bouma et al Circulation 2003

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Macrophage Studybull Can OCT quantify macrophage content

bull Methodsndash 26 diseased arterial segments from 17 cadavers

bull 7 Carotid 19 Aortandash OCT imagingndash Histology processing - CD68 SMA trichromendash Correlation of OCT with histologyndash 500x125 microm ROIndash Histology - automatic segmentation - area stainingndash OCT - quantitative image analysis

NSD

Smax Smin

Tearney Bouma et al Circulation 2003

Macrophage Study

250 microm

OCT

CD68

Low M High M

Tearney Bouma et al Circulation 2003

Linear NSD vs CD68

CD68 area gt 10 - NSD cutoff 62

R = 084P lt 00001

Tearney Bouma et al Circulation 2003

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Macrophage Study

250 microm

OCT

CD68

Low M High M

Tearney Bouma et al Circulation 2003

Linear NSD vs CD68

CD68 area gt 10 - NSD cutoff 62

R = 084P lt 00001

Tearney Bouma et al Circulation 2003

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Linear NSD vs CD68

CD68 area gt 10 - NSD cutoff 62

R = 084P lt 00001

Tearney Bouma et al Circulation 2003

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Human Coronary Artery In Vivo

P

G

L

F

G

2x

ma

i

iel eel

F

OCT IVUS

Tearney Bouma et al Circulation 2003

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Calcified Plaques In Vivo

OCT IVUS

Tearney Bouma et al Circulation 2003

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Lipid-rich Plaque In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Thrombus In VivoOCT IVUS

Tearney Bouma et al Circulation 2003

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Conclusionbull Intracoronary OCT represents a new

technology for microscale imaging of atherosclerotic plaque

bull In exvivo studies OCT can identify macrophage intensity in plaque cap

bull Given above OCT can be an important addition to cardiovascular cat labs may completely replace IVUS catheter

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Questions

I Presence of blood induces artifacts for OCT imaging knowing the time constraint in cath labs the question is how practically OCT catheter can be utilized for screening vulnerable plaques throughout total coronary arteries

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

Questionsbull Assuming the limited use of IVUS

(lt20) for plaque characterization in cath labs is due to cost issue would OCT with equal price be cost effective

bull With the trend towards non-invasive diagnosis and using invasive procedure only for therapy how will OCT be greeted by interventional cardiologists

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113

ReferencesReferences

1- Fujimoto JG Boppart SA Tearney GJ Bouma BE Pitris C Brezinski ME High resolution in vivo intra-arterial imaging with optical coherence tomography Heart 1999 Aug82(2)128-33

2- Brezinski ME Tearney GJ Weissman NJ Boppart SA Bouma BE Hee MR Weyman AE Swanson EA Southern JF Fujimoto JG Assessing atherosclerotic plaque morphology comparison of optical coherence tomography and high frequency intravascular ultrasound Heart 1997 May77(5)397-403

3- Ik-Kyung Jang Brett E Bouma Dong-Heon Kang Seung-Jung Park Seong-Wook Park Ki-Bae Seung Kyu-Bo Choi Milen Shishkov Kelly Schlendorf Eugene Pomerantsev et al Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography comparison with intravascular ultrasound Pages 604-609 Journal of the American College of Cardiology 2002 Volume 39(4) 604-609

4- Tearney GJ Jang IK Kang DH Aretz HT Houser SL Brady TJ Schlendorf K Shishkov M BoumaBE Porcine coronary imaging in vivo by optical coherence tomography Acta Cardiol 2000 Aug55(4)233-7

5- Quantification of Macrophage Content in Atherosclerotic Plaques by Optical Coherence Tomography Tearney Guillermo Yabushita Hiroshi Houser Stuart Aretz H Jang Ik-kyung Schlendorf Kelly Kauffman Christopher Shishkov Milen Halpern Elkan Bouma Brett Circulation 2003107113