Serial volumetric (three-dimensional) intravascular ultrasound analysis of restenosis after directional coronary atherectomy
Evelyn A. de Vrey, MD*,
Gary S. Mintz, MD, FACC*,
Clemens von Birgelen, MD ,
Takeshi Kimura, MD, FACC ,
Masakiyo Noboyoshi, MD, FACC,
Jeffrey J. Popma, MD, FACC*,
Patrick W. Serruys, MD, PhD, FACC and
Martin B. Leon, MD, FACC*
* Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Washington Hospital Center, Washington, DC, USA
Kokura Memorial Hospital, Kitakyushu, Japan
Thoraxcenter, University Hospital Rotterdam Dijkzigt, The Netherlands
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Figure 1 Schematic drawing of automated contour detection of lumen-tissue and media-adventitia boundaries in a coronary segment. The processing technique is based on the concept that longitudinal contours facilitate the automated contour detection on the cross-sectional intravascular ultrasound (IVUS) images by defining the center and the range of the boundary-searching process. After digitalization of a motorized IVUS video recording, two longitudinal sections (X,Y) are processed. The tissue-lumen and media-adventitia boundaries in these longitudinal sections are automatically traced. Subsequently, this information is used as points to define regions-of-interest in the cross-sectional image to guide a second automatic contour detection process. Finally, the volumetric results are calculated from the contour data of the cross-sectional IVUS images.
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Figure 2 Plots showing individual IVUS measurements of external elastic membrane (EEM), lumen, and plaque+media (P+M) volumes postintervention (Post) and at follow-up (6 mo FU) in the entire cohort of 31 patients.
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Figure 3 A serial (preintervention, postintervention, and 6-month follow-up) three-dimensional IVUS analysis is shown. Lesion length is plotted on the x-axis. The external elastic membrane (EEM) cross-sectional area over the length of the lesion is shown by the upper line, and the lumen cross-sectional area over the length of the lesion is shown by the lower line, and the plaque+media (P+M) cross-sectional area over the length of the lesion is shown by both the gray area and by the dark black line. Preintervention, the minimum lumen cross-sectional area, is at the 5-mm length marker. In this example, the increase in lumen during the directional atherectomy procedure (DCA) is almost entirely the result of a decrease in P+M cross-sectional area at the center of the lesion. At follow-up, the stenosis recurs with minimum lumen cross-sectional area again located at the 5-mm length marker. There has been a reduction in EEM cross-sectional area over the length of the lesion, but especially from the 0-mm to the 15-mm length marker. There has been no change in P+M cross-sectional area over the length of the lesion. Thus, recurrence was entirely the result of negative arterial remodeling (decrease in EEM).
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Figure 4 In the overall cohort of 31 lesions, the change in lumen volume correlated with the change in EEM volume from postintervention to follow-up (r = 0.842, p < 0.0001), but not with the change in P+M volume (r = 0.244, p = 0.186).
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Figure 5 In the 18 lesions from the SURE Trial over the time course of the study (representing three intervals per lesion for a total of 54 observations), the change in lumen volume (from postintervention to 24 h, from 24 h to 1 month, and from 1 to 6 months) correlated with the change in EEM volume (r = 0.903, p < 0.0001), but not with the change in P+M volume (r = 0.246, p = 0.073).
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