Imaging and Physiology Summit 2009summitmd.com/pdf/pdf/Imaging09_1014.pdf · Red arrows: revised...
Transcript of Imaging and Physiology Summit 2009summitmd.com/pdf/pdf/Imaging09_1014.pdf · Red arrows: revised...
Imaging and Physiology Summit 2009November 20,21, 2009
Seoul, Korea
James E. Muller, MDCEO, InfraReDx, Inc.
Assessment of Vulnerable Plaque by Near-infrared Spectroscopy
The Imaging Goal Does the plaque have a
lipid core or is it fibrotic?
1100 1200 1300 1400 1500 1600 1700 1800 1900
Cholesterol
Cholesteryl Linoleate
Cholesteryl Oleate
Collagen
Cholesterol
Cholesteryl Linoleate
Cholesteryl Oleate
Collagen
1.0
0.8
0.6
0.4
0.2
wavelength
abso
rban
ce
NIR Spectroscopy is an Excellent Method to Identify theChemical Composition of Unknown Substances
NIR spectroscopy has not been available for use by interventional cardiologists.
InfraReDx Spectroscopy System
• Three components: console, PBR, catheter (3.2 Fr, monorail, 0.014” compatible)
• Automatically scans artery like IVUS
• Spectra processed by algorithm and displayed as a chemical image of lipid rich plaque probability (“Chemogram”)
NIR Sampling During Pullback and Rotation Within Coronary Artery
Comparison of NIR Derived Chemogram with Histology
low
high
Lipid-core plaques depicted as yellow on the Chemogram
Case Courtesy of Simon Dixon, MD, Beaumont Hospital –
Right Coronary Artery
This stenotic culprit plaque has a large lipid core plaque
This non-stenotic area also has a lipid core plaque
NIR Plaque Characterization Prior to Stenting
This stenosis has afibrotic plaque
Balloon Dilation of Stenotic, Circumferential Lipid Core Plaque
No flow in artery after angioplasty
Complete Heart Block,BP 30 mm Hg
Balloon angioplasty
Courtesy of Dr. Simon DixonBeaumont Hospital, Royal Oak, MI
Stenosis
Chemogramof RCA withring LCP at stenosisin 62 yo male
Distalembolizationfollowing dilationleading to MIand CPRSimilar
chemogramwith ring LCPfrom autopsyspecimen of48 yo male
SuddenCoronary Death
Massive LCPand remnantof fatalthrombus
Thrombus
remnant
1
2
3
4
5
6
7
22
23
24
25
26
27
28
15
16
17
18
19
20
21
8
9
10
11
12
13
14MI
MI
MI
MIChemogramPost PCIunchanged
LCP Very Distal in LAD
Chemograms Prior to Balloon Dilation of Stenosis in all 28 Patients with Data to Identify Peri-stenting MI in COLOR Registry
4 Patients Developed Peri-stenting MI
11 InfraRe D x
PeriPeri--stentingstenting MI and Changes in MI and Changes in ChemogramsChemogramsNIR COLOR RegistryNIR COLOR Registry
Major Decrease in Lipid Core Plaque
Pre PCI
Pre PCI
Pre PCI
Post PCIPost PCI
Post PCISmall Change in Lipid Core Plaque
Peri-stenting MI
No Peri-stenting MI MH
The Use of a Distal Protection Filter to Collect Emboli after Dilation of a Lipid Core Plaque
Yellow material in basket of a distal protection device post dilation of a stenotic lipid core plaque.
Courtesy of Dr. Manos Brilakis, Dallas, TexasLipiScanTM is approved only for LCP detection.
Blue arrows: original stent plan
Red arrows: revised stent plan based upon LipiScan information. Stent length increased to cover stenosis and adjacent LCP.
1: angiogram before LipiScan
2: LipiScan before stenting
3: angiogram after stenting
Case 2: NIR guidance to avoid ending stent in lipid core plaque
Case Courtesy of Beaumont Hospital –Simon Dixon, MD
SR Dixon, MD/JA Goldstein, MD Beaumont LipiScan Registry
B Maini, MD COLOR Registry
Longitudinal DataNIR Measurements at Sites that were Not Stented
Baseline ChemogramPost-stent
Pre-Stent
141 Days Later
55 yo m
59 yo m
MJH
171 Days Later Follow-up ChemogramUnstable Angina
Multimodality Coronary Imaging• IVUS
– Lumen Dimension– Plaque Size– Stent Expansion
• NIR– Automated Identification of
Lipid Core Plaques
• NIR-IVUS(Eyes and Ears) Catheter