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Kawasaki Medical SchoolKawasaki Medical School
Angioplasty summit 2005Angioplasty summit 2005
Takashi Akasaka, MDKawasaki Medical School
Takashi Akasaka, MDKawasaki Medical School
Arterial Plaque Evaluation Using OCT:A comparison with IVUS and histological findings
Arterial Plaque Evaluation Using OCT:A comparison with IVUS and histological findings
Kawasaki Medical SchoolKawasaki Medical School
OCT vs histology
OCTOCT
HistologyHistology
Kawasaki Medical SchoolKawasaki Medical School
OCT Engine
Rotarycoupler
Laptop PC
OCT system ( LightLab prototype )OCT system ( LightLab prototype )ImageWire®
Kawasaki Medical SchoolKawasaki Medical School
PurposePurpose
To compare coronary vessel wall structural images
obtained by OCT and IVUS with histological findings
To compare coronary vessel wall structural images
obtained by OCT and IVUS with histological findings
Kawasaki Medical SchoolKawasaki Medical School
166 coronary lesions (28 autopsy cases)166 coronary lesions (28 autopsy cases)
SubjectsSubjects
Age 72±6 y.o. ( Male / Female: 16 / 12)Age 72±6 y.o. ( Male / Female: 16 / 12)
OMI 1OMI 1AMI 2AMI 2Pulmonary embolism 2Pulmonary embolism 2Liver chirrosis 3Liver chirrosis 3Pneumonia 4Pneumonia 4Leukemia 6Leukemia 6carcinoma 7carcinoma 7Others 3Others 3
Kawasaki Medical SchoolKawasaki Medical School
Methods 1Methods 1
Comparison between OCT & IVUS images with histology in 166 coronary lesions
Comparison between OCT & IVUS images with histology in 166 coronary lesions
OCT & IVUS recordings(37℃ PBS solution, 80mmHg)OCT & IVUS recordings(37℃ PBS solution, 80mmHg)
HE ・Masson-trichrome ・Elastica-van Gieson stainsHE ・Masson-trichrome ・Elastica-van Gieson stains
Pressure perfusion-fixed in 10% formalin (48 hours)Pressure perfusion-fixed in 10% formalin (48 hours)
Paraffin embedding4 μm thickness cut sections every 400 μm
Paraffin embedding4 μm thickness cut sections every 400 μm
Kawasaki Medical SchoolKawasaki Medical School
syringomanometersyringomanometer
PBS (37℃)
Coronary artery
PBS(37℃)
Methods 2Methods 2
IVUS:Atlantis SR ProⓇ 2.5Fr. 40MHz, Boston-Scientifics Ltd.
OCT :ImageWireTM, LightLab Imaging, Westford.
IVUS:Atlantis SR ProⓇ 2.5Fr. 40MHz, Boston-Scientifics Ltd.
OCT :ImageWireTM, LightLab Imaging, Westford.
Pressure inside the coronary artery was maintained at 80 mmHg
Pressure inside the coronary artery was maintained at 80 mmHg
* Serial images of OCT and IVUS were obtained using an automatic pullback device.
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OCT IVUSHistologyHistology(HE) (Masson)(EVG)
Every 400 μm Every 400 μm
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Fibrous plaqueFibrous plaque
Homogenous
Signal-richHigh-echoic
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Fibrous plaque
100μm
1mm
High-echoicHigh-echoic
AttenuationAttenuation
Signal-richSignal-richHomogenousHomogenous
Kawasaki Medical SchoolKawasaki Medical School
Fibrocalcific plaqueFibrocalcific plaque
1mm
100μm
EcholucentEcholucent
ShadowingShadowingHigh-echoicHigh-echoic
Sharp bordersSharp borders
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Lipid-rich plaqueLipid-rich plaque
1mm
EcholucentEcholucent
EcholucentEcholucent
Diffuse bordersDiffuse borders
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Fibro-lipidic plaqueFibro-lipidic plaque
EcholucentEcholucentPartially
echolucentPartially
echolucentDiffuse bordersDiffuse borders
within signal-rich
homogenus
within signal-rich
homogenus
Kawasaki Medical SchoolKawasaki Medical School
85 94 83 95
OCT image Fibrous (n=43) Fibrocalcific (n=82) Lipid (n=41)
IVUS imageFibrous (n=43) Fibrocalcific (n=82)Lipid (n=41)
OCT image Fibrous (n=43) Fibrocalcific (n=82) Lipid (n=41)
IVUS imageFibrous (n=43) Fibrocalcific (n=82)Lipid (n=41)
HIstopathologic Diagnosis Positive Negative
Sensitivity Specificity Predictive Value Predictive Value
Data are percentages. * p < 0.05 vs. OCT image.Data are percentages. * p < 0.05 vs. OCT image.
79 99 97 9379 99 97 9396 88 89 9696 88 89 96
88 86 69 9588 86 69 95
98 96 96 9898 96 96 9859 97 86 87*
Comparison between OCT and IVUS with histologyComparison between OCT and IVUS with histology
Kawasaki Medical SchoolKawasaki Medical School
Summary 1Summary 1
1. Fibrous plaques were observed as homogenoussignal-rich findings.
1. Fibrous plaques were observed as homogenoussignal-rich findings.
2. Calcific plaques were recorded as echo-lucent images with sharp borders.
2. Calcific plaques were recorded as echo-lucent images with sharp borders.
3. Lipid rich plaques were demonstrated as echo-lucent images with diffuse borders.
3. Lipid rich plaques were demonstrated as echo-lucent images with diffuse borders.
OCT findings of plaque morphologyOCT findings of plaque morphology
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Thrombus
White thrombusRed thrombus
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Thin fibrous cap (vulnerable plaque)Thin fibrous cap (vulnerable plaque)OCT IVUS
HE
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IMT (OCT vs IVUS)
intimaintimaintima-media complexintima-media complexadventitia adventitia
mediamedia
adventitia adventitia
Kawasaki Medical SchoolKawasaki Medical School
Intima-Media Complex Thickness ( IMT ) Histology vs IVUS
Intima-Media Complex Thickness ( IMT ) Histology vs IVUS
His
tolo
gy –
IVU
S (m
m)
His
tolo
gy –
IVU
S (m
m)
Histology (mm)Histology (mm)
IVU
S (m
m)
IVU
S (m
m) +2SD+2SD
-2SD-2SD
Average IMT (mm)Average IMT (mm)0.10.1 0.40.4 0.70.7 1.01.0 1.31.3
-0.2-0.2-0.1-0.1
00
0.20.20.30.3
0.10.1
-0.3-0.3p<0.001p<0.001
0.40.4
0.80.8
1.21.2
0.60.6
1.01.0
0.20.2
0.20.2 0.40.4 0.60.6 0.80.8 1.01.0 1.21.2 1.41.40.00.00.00.0
r = 0.878r = 0.878
Kawasaki Medical SchoolKawasaki Medical School
Intima-Media Complex Thickness ( IMT ) Histology vs OCT
Intima-Media Complex Thickness ( IMT ) Histology vs OCT
His
tolo
gy –
OC
T (m
m)
His
tolo
gy –
OC
T (m
m)
Average (mm)Average (mm)
+2SD+2SD
-2SD-2SD-0.2-0.2-0.1-0.1
00
0.20.20.30.3
0.10.1
-0.3-0.3
0.10.1 0.40.4 0.70.7 1.01.0 1.31.3
Histology (mm)Histology (mm)
OC
T (m
m)
OC
T (m
m)
p <0.001p <0.0010.40.4
0.80.8
1.21.2
0.60.6
1.01.0
0.20.2
0.20.2 0.40.4 0.60.6 0.80.8 1.01.0 1.21.2 1.41.40.00.0
0.00.0
r = 0.946r = 0.946
Kawasaki Medical SchoolKawasaki Medical School
Summary 2Summary 2
1. Lumen area and diameter could be measuredcorrectly by OCT as those measured by IVUS.
1. Lumen area and diameter could be measuredcorrectly by OCT as those measured by IVUS.
2. OCT could identify three layers of the coronaryartery wall clearly compared with IVUS.
2. OCT could identify three layers of the coronaryartery wall clearly compared with IVUS.
3. Thickness of intima-media complexes could be measured more accurately by OCT compared with IVUS.
3. Thickness of intima-media complexes could be measured more accurately by OCT compared with IVUS.
Kawasaki Medical SchoolKawasaki Medical School
OCT findings
CD68(macrophage)
CD68(macrophage)
OCTOCT
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Endothel
CollagenCollagenAgarAgar
EndothelEndothel
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Endothel
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Endothel (+)
OCT catheter
Endothel ?
Lab. dish
CollagenCollagenAgarAgar
Kawasaki Medical SchoolKawasaki Medical School
Endothel (-)
OCT catheter
Lab. dish
CollagenCollagenAgarAgar
Kawasaki Medical SchoolKawasaki Medical School
Macrophages
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Collagen・Ox-LDL gelCollagen・Ox-LDL gel
EndothelEndothel
RBCRBCMonocyteMonocyteSerumSerum
BloodBlood
MonocyteMonocyte
Foam cellFoam cell
Culture for a few weeksCulture for a few weeks
Culture for a few daysCulture for a few days
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Histological findingsHistological findings
Infiltration of monocytes to collagen gel layer
500μm
Collagen-gell layerCollagen-gell layer
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Histrogical findingsHistrogical findings
Foam cell formations of monocytes by phagocytosisof Ox-LDL can be observed in the collagen gel layer 3 weeks after cell culture as demonstrated below.
Foam cell formations of monocytes by phagocytosisof Ox-LDL can be observed in the collagen gel layer 3 weeks after cell culture as demonstrated below.
Kawasaki Medical SchoolKawasaki Medical School
OCT findings
BeforeBefore
1 week later1 week later
3 weeks later3 weeks later
Kawasaki Medical SchoolKawasaki Medical School
Summary 3Summary 3
3. OCT may have a possibility to identify the accumulation of macrophages within the fibrous cap of vulnerable plaques as the different light reflections.
3. OCT may have a possibility to identify the accumulation of macrophages within the fibrous cap of vulnerable plaques as the different light reflections.
1. OCT could identify the different tissues by the reflections between the layer of the different tissue components.
1. OCT could identify the different tissues by the reflections between the layer of the different tissue components.
2. Endothelial cell could not be demonstrated by OCT directly.
2. Endothelial cell could not be demonstrated by OCT directly.
Kawasaki Medical SchoolKawasaki Medical School
ConclusionsConclusions
1. OCT may allow us to identify tissue characterization more accurately than IVUS.
1. OCT may allow us to identify tissue characterization more accurately than IVUS.
2. OCT might have a limitation in the depth of beam penetration.
2. OCT might have a limitation in the depth of beam penetration.
3. OCT may have a possibility to identify vulnerable plaques by the findings of the accumulation of macrophages within the fibrous cap.
3. OCT may have a possibility to identify vulnerable plaques by the findings of the accumulation of macrophages within the fibrous cap.
Kawasaki Medical SchoolKawasaki Medical School
Thank you for your attention !!Thank you for your attention !!
Kawasaki Medical SchoolKawasaki Medical School
Kawasaki Medical SchoolKawasaki Medical School
Superficial calcificationSuperficial calcification
EcholucentEcholucentShadowingShadowingHigh-echoicHigh-echoic
Sharp bordersSharp borders