3284Quantification of macrophage presence and identification of thin-cap fibroatheroma by optical coherence tomography image: histopathological validation study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Fujii ◽  
R Kawakami ◽  
T Imanaka ◽  
H Shibutani ◽  
K Kawai ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Predictive Value ◽  
Vulnerable Plaque ◽  
Necrotic Core ◽  
Macrophage Infiltration ◽  
Optical Coherence ◽  
Signal Attenuation ◽  
Fibrous Cap ◽  
Attenuation Ratio ◽  
Fibrous Cap Thickness

Abstract Background Intracoronary optical coherence tomography (OCT) is thought to be capable of identifying a vulnerable, rupture-prone plaque based on the presence of a thin-cap fibroatheroma (TCFA). Moreover, recent studies have reported that OCT may be able to identify macrophage infiltration of the fibrous cap, a key characteristic of vulnerable plaque. Purpose This study evaluated the accuracy of OCT image for characterizing TCFA and identifying macrophage infiltration in comparison with histopathology. Methods A total of 924 focal plaques in 206 coronary arteries from 78 autopsy hearts were examined to compare OCT and histological images. By histology, 16 plaques (1.7%) were classified as TCFAsthat contained a large necrotic core covered by a thin (<65μm) fibrous-cap. Correlating OCT-histological sections were identified and OCT-derived tissue property indexes named normalized standard deviation (NSD) and signal attenuation ratio were applied on the fibrous-cap to identify inflamed fibrous-cap defined as a macrophage percentage >10% by histology. Results With histology as standard, the sensitivity, specificity, and negative-predictive-value of TCFAs were extremely high (more than 90%). However, the positive-predictive-value of TCFAs was only 32%, which indicated a high proportion of false-positives. Most false-positive diagnoses of OCT for TCFAs contained large amounts of foam cell accumulations on luminal surface without necrotic core. Twelve of 16 fibrous-caps were considered as inflamed and the remaining 4 were non-inflamed on histology. However, no significant difference in NSD and signal attenuation ratio were identified between them. There was moderate correlation of the fibrous-cap thickness between OCT and histology (r2 = 0.41 and p<0.01). Conclusions OCT is a promising intracoronary imaging modality for differentiating tissue characteristics (fibrous, calcified, or lipid-rich plaque) and identifying TCFA. However, it is still challenging to precisely identify inflammation, fibrous-cap thickness, and necrotic core in the native coronary artery. Therefore, careful interpretation is required to assess coronary vulnerable plaque by OCT. Acknowledgement/Funding None

scholarly journals Optical Coherence Tomography Predictors for a Favorable Vascular Response to Statin Therapy

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Akihiro Nakajima ◽  
Yoshiyasu Minami ◽  
Makoto Araki ◽  
Osamu Kurihara ◽  
Tsunenari Soeda ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Statin Therapy ◽  
Optical Coherence ◽  
Vascular Response ◽  
Unique Identifier ◽  
Tomography Imaging ◽  
3 Dimensional ◽  
Fibrous Cap ◽  
Optical Coherence Tomography Imaging ◽  
Fibrous Cap Thickness

Background Specific plaque phenotypes that predict a favorable response to statin therapy have not been systematically studied. This study aimed to identify optical coherence tomography predictors for a favorable vascular response to statin therapy. Methods and Results Patients who had serial optical coherence tomography imaging at baseline and at 6 months were included. Thin‐cap area (defined as an area with fibrous cap thickness <200 μm) was measured using a 3‐dimensional computer‐aided algorithm, and changes in the thin‐cap area at 6 months were calculated. A favorable vascular response was defined as the highest tertile in the degree of reduction of the thin‐cap area. Macrophage index was defined as the product of the average macrophage arc and length of the lesion with macrophage infiltration. Layered plaque was defined as a plaque with 1 or more layers of different optical density. In 84 patients, 140 nonculprit lipid plaques were identified. In multivariable analysis, baseline thin‐cap area (odds ratio [OR] 1.442; 95% CI, 1.024–2.031, P =0.036), macrophage index (OR, 1.031; 95% CI, 1.002–1.061, P =0.036), and layered plaque (OR, 2.767; 95% CI, 1.024–7.479, P =0.045) were identified as the significant predictors for a favorable vascular response. Favorable vascular response was associated with a decrease in the macrophage index. Conclusions Three optical coherence tomography predictors for a favorable vascular response to statin therapy have been identified: large thin‐cap area, high macrophage index, and layered plaque. Favorable vascular response to statin was correlated with signs of decreased inflammation. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01110538.

107Diagnostic accuracy of optical coherence tomography for the identification of in-stent fibroatheroma following stent implantation: an ex-vivo histological validation study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Shibutani ◽  
K Fujii ◽  
R Kawakami ◽  
T Imanaka ◽  
K Kawai ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Cross Sections ◽  
Stent Implantation ◽  
Predictive Value ◽  
Signal Intensity ◽  
Necrotic Core ◽  
Optical Coherence ◽  
Low Intensity ◽  
Stent Strut ◽  
Histological Images

Abstract Background Previous histopathological studies have demonstrated that new atherosclerotic formation within the neointima, called neoatherosclerosis, is one of the most important mechanisms leading to both very late in-stent restenosis and stent thrombosis after stent implantation. Therefore, to distinguish lipid-containing atherosclerotic neointima from other tissues using intracoronary imaging modalities is clinically important to prevent late stent failures. Purpose This study evaluated the diagnostic performance of optical coherence tomography (OCT) for the detection of “in-stent fibroatheroma” following stent implantation by comparing cross-sections of the model with the corresponding histological images. Methods Fifty stented coronary arteries from the 31 autopsy hearts were imaged by OCT. Coronary arterial histopathological specimens, all of which included more than 30% of %neointimal hyperplasia, were compared with the corresponding OCT cross-sections. Histological in-stent fibroatheroma was defined as neointima containing large necrotic core and inflammatory cells. OCT-derived in-stent fibroatheroma comprised a low-intensity tissue containing a poorly delineated region with invisible stent strut behind low signal intensity. Results A total of 122 OCT cross-sections were compared with histological images. OCT examination revealed that 24 images (20%) contained low-intensity tissue inside the neointima. Of those, 5 images, in which stent strut behind low signal intensity was invisible, were diagnosed as OCT-derived in-stent fibroatheroma (4%) (Figure A). By histological analysis, only 4 images were classified as in-stent fibroatheroma (3%) (Figure B). With histology as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for OCT-derived in-stent fibroatheroma were 100%, 99%, 80%, 100%, and 99%, respectively. The only histological finding underlying the false-positive-diagnosis of OCT-derived in-stent fibroatheroma was foam cells accumulation without necrotic core on the neointimal surface (Figure C and D). Most tissue that showed low-intensity tissue with visible stent strut by OCT contained proteoglycan matrix and organized thrombus in the absence of an underlying necrotic core. Coregistration of OCT with histology Conclusion This study showed the potential capability of OCT based on the visualization of stent struts behind low-intensity regions for discriminating in-stent fibroatheroma from other neointimal tissues following stent implantation.

EFFECT OF STATIN THERAPY ON FIBROUS CAP THICKNESS IN CORONARY PLAQUE USING OPTICAL COHERENCE TOMOGRAPHY: INSIGHTS FROM A META-ANALYSIS

2018 ◽  
Vol 71 (11) ◽  
pp. A1246
Author(s):  
Hector Manuel Garcia Garcia ◽  
Yuichi Ozaki ◽  
Solomon S. Beyene ◽  
Alexandre Kajita ◽  
Viana Azizi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Statin Therapy ◽  
Meta Analysis ◽  
Coronary Plaque ◽  
Optical Coherence ◽  
Fibrous Cap ◽  
Fibrous Cap Thickness

Optical Coherence Tomography Image Interpretation and Image Processing Methodologies

2011 ◽  
pp. 194-208
Author(s):  
Simon D. Thackray ◽  
Christos V. Bourantas ◽  
Poay H. Loh ◽  
Vasilios D. Tsakanikas ◽  
Dimitrios I. Fotiadis
Keyword(s):  
Image Processing ◽  
Optical Coherence Tomography ◽  
Image Interpretation ◽  
Coronary Plaque ◽  
Optical Coherence Tomography Image ◽  
Imaging Method ◽  
Optical Coherence ◽  
Fibrous Cap ◽  
Stent Expansion ◽  
Fibrous Cap Thickness

Optical coherence tomography (OCT) is a light-based invasive imaging method allowing accurate evaluation of coronary luminal morphology and reliable characterization of plaque. Its high resolution (10-20µm) offers the unique possibility of identifying clinically important coronary plaque microstructures such as macrophages, the presence and type of thrombus, stent expansion and endothelization and provides accurate assessment of the fibrous cap thickness in high risk plaques. These attributes placed OCT in a unique position as useful tool in research and clinical practice. As a new image modality, many interventional cardiologists are not familiar with its interpretation. In addition, there are only few developed methodologies able to process the OCT data and give comprehensive vessel representation and reliable measurements. Thus, this chapter focuses on the interpretation of OCT images and discusses the available image processing methodologies.

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