Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT)

Transcription

1 Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) Clare McLaren Great Ormond Street Hospital London

2 Introduction IVUS and OCT supplementary techniques to angiography provide information about the arterial wall similar techniques to perform provide similar information each have their own strengths and weaknesses venous and extravascular applications

3 Intravascular Ultrasound

4 IVUS Equipment Volcano Corporation (San Diego, CA) s5i Imaging System integrated s5 Imaging System maneuverable, PC based range of imaging catheters available image resolution field of view DICOM store DICOM worklist

5 IVUS Equipment Boston Scientific ilab Imaging System Atlantis SR Pro 3.2 Fr tapering to 2.5 Fr 40 MHz monorail Ultra ICE 9 Fr 9 MHz _IntrotoIVUSTech.pdf

6 Virtual Histology 12-year-old boy with NF1 stented renal artery stent struts can be seen peripherally Virtual histology IVUS (Volcano Corporation) can be used to characterize plaque in adults.

7 IVUS Indications arterial wall abnormalities wall thickness calcium dissection aneurysm assessment stent in-stent re-stenosis stent strut apposition

8 IVUS Indications GI esophageal strictures airway wall abnormalities

9 IVUS Equipment

10 IVUS Technique prepare IVUS catheter flush with saline position imaging catheter across lesion place distal marker minimum 3 cm beyond the region of interest set gain and field of view image acquisition manual automated pull back

11 Normal Arterial Wall

12 IVUS Case 1

13 IVUS Case 1 3 year old boy severe hypertension 180/115 mmhg 145/83 mmhg on five anti-hypertensive drugs severe left ventricular dilatation

14 IVUS Case 1

15 55/16(34) mmhg 58/16(34) mmhg 57/15(33) mmhg 23/8(15) mmhg

16 rated pressure 3.50 mm 3.5-mm cutting balloon maximum pressure 3.72 mm

17 before angioplasty after angioplasty after stenting 4.0-mm balloon-expandable stent

18

19

20

21

22

23

24 IVUS Case 3

25 IVUS Case 3 16 year old boy neuroblastoma as a baby (1996) treated by resection and chemotherapy hypertension treated by aorto-birenal prosthetic grafts recurrent hypertension

26 Rt IVUS Case 3

27

28 IVUS Case 3 pre-angioplasty post-angioplasty

29 IVUS Case 4

30 IVUS Case 4 13 year old boy NF1 autism mid-aortic syndrome hypertension

31 IVUS Case 4 65/21(42) mmhg 25/17(20) mmhg

32 IVUS Case 4 5 mm x 40 mm 5 mm cutting 7 mm x 40 mm L RA R RA SMA

33 IVUS Case 4 89/50(68) mmhg 60/44(52) mmhg

34 IVUS Case 4 pre-angioplasty post-angioplasty

35 IVUS Case 5

36 Multiple Abdominal Pseudoaneurysms

37 Multiple Abdominal Pseudoaneurysms aorta L renal

38 IVUS Case 6

39 M 3 yr Aneurysm

40 Aneurysm

41 Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) Clare McLaren Great Ormond Street Hospital London

42 Optical Coherence Tomography

43 medical imaging OCT interventional radiology interventional cardiology urology ophthalmology non-medical imaging artwork industry material thickness, surface roughness characterisation

44 OCT potential image resolution of 15 µm infrared light beam splitter interferometer post-processed to provide real-time cross-sectional or 3D images

45 How OCT Works

46 How OCT works

47 OCT Applications arterial arterial wall abnormalities wall thickness calcium dissection aneurysm assessment stent in-stent re-stenosis stent strut apposition

48 OCT Applications airway complete tracheal cartilage rings absent or deficient cartilage esophagus ureter bladder wall tumors

49 OCT St. Jude Medical Ilumien Terumo C7 Dragonfly imaging catheter Lunawave FastView Volcano Corporation (San Diego CA) pending

50 St. Jude Medical OCT equipment

51

52 C7 Dragonfly Imaging Catheter C7 Dragonfly imaging catheter 135 cm 2.7 F compatible with steerable guide wire hydrophilic

53 C7 Dragonfly Imaging Catheter

54 OCT St. Jude Medical Ilumien Terumo C7 Dragonfly imaging catheter Lunawave FastView Volcano Corporation (San Diego CA) pending

55 Terumo OCT System Lunawave FastView OCT catheter

56 OCT St. Jude Medical Ilumien Terumo C7 Dragonfly imaging catheter Lunawave FastView Volcano Corporation (San Diego, CA) FDA approved

57 Calibration uncalibrated catheter calibrated catheter

58 Arterial OCT

59 OCT Technique need to clear artery of blood balloon occlusion catheter pump injection of saline and/or contrast monorail system (0.014-inch guidewire) image acquisition automated pullback manual 3D reconstruction

60 OCT Case 1

61 OCT Case 1 17 year old girl renovascular hypertension

62 OCT Case 1

63 OCT Case 1 normal arterial wall

64 OCT Case 1 abnormal arterial wall

65 OCT Case 2

66 OCT Case 2 11 year old boy renovascular hypertension

67 OCT Case 2

68 OCT Case 2 normal arterial wall tight stenosis

69 OCT Case 2 renal artery branch is not clearly seen limited field of view only just see whole lumen of a small artery (4 mm)

70 OCT of the Airway

71 OCT Technique general anesthesia or ventilation performed at same time as flexible bronchoscopy and bronchography 3 Fr angiographic catheter endotracheal tube flexible bronchoscope OCT wire position confirmed with bronchoscopy or fluoroscopy

72 OCT Wire

73 Normal Airway Cartilage tracheal cartilage bronchial cartilage plates

74 OCT Case 3

75 OCT Case 3 11 week old boy VSD repair unable to ventilate arrested intubated,?ecmo rigid bronchoscopy complete tracheal rings

76

77 OCT Case 3

78 OCT Case 3

79 OCT Case 3

80 OCT Case 3

81 OCT Case 4

82 OCT Case 4 6 year old boy recurrent chest infections no response to asthma medication hyperinflation of right lower zone on CXR

83 OCT Case 4

84 OCT Case 4 left main bronchus bronchus intermedius right upper lobe bronchus

85 OCT Case 4 complete cartilage ring at origin of bronchus intermedius bronchial cartilage plates in distal bronchus intermedius

86 OCT Case 5

87 OCT Case 5 4 year old boy tracheo-esophageal fistula (TEF) repair TEF cough recurrent respiratory distress? recurrent fistula? tracheobronchomalacia? tracheal stenosis

88 OCT Case 5

89 OCT Case 5

90 OCT Case 5

91 abnormal cartilage absent cartilage normal cartilage

92 Limitations of Airway OCT tracheal diameter field of view secretions cost OCT wire $500 OCT catheter $1000 poorer depth penetration than endobronchial ultrasound

93 IVUS / OCT IVUS larger field of view does not require clearing of blood from vessel feasible in aorta cheaper than OCT catheter OCT smaller field of view improved on newer systems can image in air airway applications better spatial resolution than IVUS

94 Conclusions both techniques can be performed in children OCT offers superior image resolution stent assessment OCT of the airway is easier to perform than endobronchial ultrasound IVUS has a larger field of view dependent on type of imaging catheter