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The International Journal of Cardiovascular Imaging

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01-08-2015 | Original Paper

Optimizing flushing parameters in intracoronary optical coherence tomography: an in vivo swine study

Authors: Melissa J. Suter, Manabu Kashiwagi, Kevin A. Gallagher, Seemantini K. Nadkarni, Nayan Asanani, Atsushi Tanaka, Gerard B. Conditt, Armando Tellez, Krzysztof Milewski, Greg L. Kaluza, Juan F. Granada, Brett E. Bouma, Guillermo J. Tearney

Published in: The International Journal of Cardiovascular Imaging | Issue 6/2015

Abstract

Intracoronary optical frequency domain imaging (OFDI), requires the displacement of blood for clear visualization of the artery wall. Radiographic contrast agents are highly effective at displacing blood however, may increase the risk of contrast-induced nephropathy. Flushing media viscosity, flow rate, and flush duration influence the efficiency of blood displacement necessary for obtaining diagnostic quality OFDI images. The aim of this work was to determine the optimal flushing parameters necessary to reliably perform intracoronary OFDI while reducing the volume of administered radiographic contrast, and assess the influence of flushing media choice on vessel wall measurements. 144 OFDI pullbacks were acquired together with synchronized EKG and intracoronary pressure wire recordings in three swine. OFDI images were graded on diagnostic quality and quantitative comparisons of flushing efficiency and intracoronary cross-sectional area with and without precise refractive index calibration were performed. Flushing media with higher viscosities resulted in rapid and efficient blood displacement. Media with lower viscosities resulted in increased blood-media transition zones, reducing the pullback length of diagnostic quality images obtained. Flushing efficiency was found to increase with increases in flow rate and duration. Calculations of lumen area using different flushing media were significantly different, varying up to 23 % (p < 0.0001). This error was eliminated with careful refractive index calibration. Flushing media viscosity, flow rate, and flush duration influence the efficiency of blood displacement necessary for obtaining diagnostic quality OFDI images. For patients with sensitivity to contrast, to reduce the risk of contrast induced nephrotoxicity we recommend that intracoronary OFDI be conducted with flushing solutions containing little or no radiographic contrast. In addition, our findings show that careful refractive index compensation should be performed, taking into account the specific contrast agent used, in order to obtain accurate intravascular OFDI measurements.

Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, Hee MR, Flotte T, Gregory K, Puliafito CA et al (1991) Optical coherence tomography. Science 254(5035):1178–1181PubMedCrossRef

Tearney GJ, Jang IK, Bouma BE (2006) Optical coherence tomography for imaging the vulnerable plaque. J Biomed Opt 11(2):021002PubMedCentralPubMedCrossRef

Barlis P, Serruys PW, Gonzalo N, van der Giessen WJ, de Jaegere PJ, Regar E (2008) Assessment of culprit and remote coronary narrowings using optical coherence tomography with long-term outcomes. Am J Cardiol 102(4):391–395PubMedCrossRef

Jang IK, Tearney GJ, MacNeill B, Takano M, Moselewski F, Iftima N, Shishkov M, Houser S, Aretz HT, Halpern EF, Bouma BE (2005) In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation 111(12):1551–1555PubMedCentralPubMedCrossRef

Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, Tanimoto T, Matsuo Y, Masho T, Kitabata H, Tsuda K, Tomobuchi Y, Akasaka T (2007) Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol 50(10):933–939PubMedCrossRef

Gupta R, Raffel OC, Jang IK (2007) Severe intimal hyperplasia after sirolimus eluting stent deployment: evaluation by optical coherence tomography. Heart 93(6):754PubMedCrossRef

Rieber J, Meissner O, Babaryka G, Reim S, Oswald M, Koenig A, Schiele TM, Shapiro M, Theisen K, Reiser MF, Klauss V, Hoffmann U (2006) Diagnostic accuracy of optical coherence tomography and intravascular ultrasound for the detection and characterization of atherosclerotic plaque composition in ex vivo coronary specimens: a comparison with histology. Coron Artery Dis 17(5):425–430PubMedCrossRef

Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, Kauffman CR, Shishkov M, Kang DH, Halpern EF, Tearney GJ (2002) Characterization of human atherosclerosis by optical coherence tomography. Circulation 106(13):1640–1645PubMedCrossRef

Kume T, Okura H, Kawamoto T, Akasaka T, Toyota E, Watanabe N, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2007) Relationship between coronary remodeling and plaque characterization in patients without clinical evidence of coronary artery disease. Atherosclerosis 197(2):799–805

10.

MacNeill BD, Jang IK, Bouma BE, Iftimia N, Takano M, Yabushita H, Shishkov M, Kauffman CR, Houser SL, Aretz HT, DeJoseph D, Halpern EF, Tearney GJ (2004) Focal and multi-focal plaque macrophage distributions in patients with acute and stable presentations of coronary artery disease. J Am Coll Cardiol 44(5):972–979PubMedCrossRef

11.

Bouma BE, Tearney GJ, Yabushita H, Shishkov M, Kauffman CR, Gauthier DD, MacNeill BD, Houser SL, Aretz HT, Halpern EF, Jang IK (2003) Evaluation of intracoronary stenting by intravascular optical coherence tomography. Heart 89(3):317–320PubMedCentralPubMedCrossRef

12.

Tearney GJ, Jang IK, Bouma BE (2003) Evidence of cholesterol crystals in atherosclerotic plaque by optical coherence tomographic (OCT) imaging. Eur Heart J 24(15):1462CrossRef

13.

Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 97(12):1713–1717PubMedCrossRef

14.

Toutouzas K, Vaina S, Riga MI, Stefanadis C (2007) Evaluation of dissection after coronary stent implantation by intravascular optical coherence tomography. Clin Cardiol 32(7):E47–E48

15.

Regar E, Schaar J, Serruys PW (2006) Images in cardiology. Acute recoil in sirolimus eluting stent: real time, in vivo assessment with optical coherence tomography. Heart 92(1):123PubMedCentralPubMedCrossRef

16.

Raffel OC, Hannan JC, Jang IK (2006) Coronary stent malapposition as a result of a post-stenotic aneurysm detected by optical coherence tomography. J Invasive Cardiol 18(11):561–562PubMed

17.

Sawada T, Shite J, Shinke T, Watanabe S, Otake H, Matsumoto D, Imuro Y, Ogasawara D, Paredes OL, Yokoyama M (2006) Persistent malapposition after implantation of sirolimus-eluting stent into intramural coronary hematoma: optical coherence tomography observations. Circ J 70(11):1515–1519PubMedCrossRef

18.

Takano M, Jang IK, Mizuno K (2006) Neointimal proliferation around malapposed struts of a sirolimus-eluting stent: optical coherence tomography findings. Eur Heart J 27(15):1763PubMedCrossRef

19.

Regar E, van Beusekom HM, van der Giessen WJ, Serruys PW (2005) Images in cardiovascular medicine. Optical coherence tomography findings at 5-year follow-up after coronary stent implantation. Circulation 112(23):e345–e346PubMedCrossRef

20.

Barlis P, Tanigawa J, Di Mario C (2007) Coronary bioabsorbable magnesium stent: 15-month intravascular ultrasound and optical coherence tomography findings. Eur Heart J 28(19):2319

21.

Tanigawa J, Barlis P, Di Mario C (2007) Do unapposed stent struts endothelialise? In vivo demonstration with optical coherence tomography. Heart 93(3):378PubMedCentralPubMedCrossRef

22.

Takano M, Inami S, Jang IK, Yamamoto M, Murakami D, Seimiya K, Ohba T, Mizuno K (2007) Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation. Am J Cardiol 99(8):1033–1038PubMedCrossRef

23.

Tearney GJ, Waxman S, Shishkov M, Vakoc BJ, Suter MJ, Freilich MI, Desjardins AE, Oh WY, Bartlett LA, Rosenberg M, Bouma BE (2008) Three-dimensional coronary artery microscopy by intracoronary optical frequency domain imaging. JACC Cardiovasc Imaging 1(6):752–761PubMedCentralPubMedCrossRef

24.

Gonzalo N, Tearney GJ, Serruys PW, van Soest G, Okamura T, Garcia-Garcia HM, Jan van Geuns R, van der Ent M, Ligthart J, Bouma BE, Regar E. (2010) Second-generation optical coherence tomography in clinical practice. High-speed data acquisition is highly reproducible in patients undergoing percutaneous coronary intervention. Rev Esp Cardiol 63(8):893–903

25.

Garcia-Garcia HM, Gonzalo N, Regar E, Serruys PW (2009) Virtual histology and optical coherence tomography: from research to a broad clinical application. Heart 95(16):1362–1374PubMedCrossRef

26.

Gonzalo N, Serruys PW, Okamura T, van Beusekom HM, Garcia-Garcia HM, van Soest G, van der Giessen W, Regar E (2009) Optical coherence tomography patterns of stent restenosis. Am Heart J 158(2):284–293PubMedCrossRef

27.

Choma M, Sarunic M, Yang C, Izatt J (2003) Sensitivity advantage of swept source and Fourier domain optical coherence tomography. Opt Express 11(18):2183–2189PubMedCrossRef

28.

Yun S, Tearney G, de Boer J, Iftimia N, Bouma B (2003) High-speed optical frequency-domain imaging. Opt Express 11(22):2953–2963PubMedCentralPubMedCrossRef

29.

Yun SH, Tearney GJ, Vakoc BJ, Shishkov M, Oh WY, Desjardins AE, Suter MJ, Chan RC, Evans JA, Jang IK, Nishioka NS, de Boer JF, Bouma BE (2006) Comprehensive volumetric optical microscopy in vivo. Nat Med 12(12):1429–1433PubMedCentralPubMedCrossRef

30.

Petitjeans P, Maxworthy T (1996) Miscible displacements in capillary tubes. Part 1. Experiments. J Fuild Mech 326:37–56CrossRef

31.

Prati F, Cera M, Ramazzotti V, Imola F, Giudice R, Giudice M, Propris SD, Albertucci M (2008) From bench to bedside: a novel technique of acquiring OCT images. Circ J 72(5):839–843PubMedCrossRef

32.

Cigarroa RG, Lange RA, Williams RH, Hillis LD (1989) Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. American J Med 86(6 Pt 1):649–652CrossRef

33.

Raposeiras-Roubin S, Abu-Assi E, Ocaranza-Sanchez R, Alvarez-Alvarez B, Cambeiro-Gonzalez C, Fandino-Vaquero R, Garcia-Castelo A, Garcia-Acuna JM, Gonzalez-Juanatey JR (2013) Dosing of iodinated contrast volume: a new simple algorithm to stratify the risk of contrast-induced nephropathy in patients with acute coronary syndrome: A new simple algorithm to stratify the risk of contrast-induced nephropathy in patients with acute coronary syndrome. Catheter Cardiovasc Interv 82(6):888–897

34.

Jacobsen EA, Mortensen E, Refsum H, Klow NE (1992) The effect of the temperature of contrast media on cardiac electrophysiology and hemodynamics during coronary arteriography. Invest Radiol 27(11):942–946PubMed

Title: Optimizing flushing parameters in intracoronary optical coherence tomography: an in vivo swine study
Authors: Melissa J. Suter
Manabu Kashiwagi
Kevin A. Gallagher
Seemantini K. Nadkarni
Nayan Asanani
Atsushi Tanaka
Gerard B. Conditt
Armando Tellez
Krzysztof Milewski
Greg L. Kaluza
Juan F. Granada
Brett E. Bouma
Guillermo J. Tearney
Publication date: 01-08-2015
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 6/2015
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-015-0668-0

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Optimizing flushing parameters in intracoronary optical coherence tomography: an in vivo swine study

Abstract

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