To report early clinical experience with virtual histology intravascular ultrasound (VH IVUS) in carotid endoluminal repair.
Technique:
A 2.9-F, 20-MHz catheter that utilizes computer software to demonstrate the histological components of arteriosclerotic plaque was evaluated during carotid angioplasty and stenting. VH IVUS images were created following a pullback through the carotid stenosis and produced a color-coded map of the different histological constituents of the disease (dark green: fibrous, yellow/green: fibrofatty, white: calcified, and red: necrotic lipid core plaque).
Conclusion:
VH IVUS produces a color-coded map of the different histological components of artery plaque. It has the potential to predict how the plaque is likely to behave at the moment of endoluminal treatment.
WilsonEPWhiteRAKopchokG. The utility of intravascular ultrasound in carotid stenting. J Endovasc Surg.1996; 3: 63–68.
5.
ReidDBDiethrichEBMarxP. Clinical applications of intravascular ultrasound in peripheral vascular disease. In: SiegelRJ, ed. Intravascular Ultrasound Imaging in Coronary Artery Disease. New York, NY: Marcel Dekker; 1998: 309–341.
6.
Greay-WealeACGrahamJCBurnettJR. Carotid artery atheroma: Comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg.1988; 29: 676–681.
7.
LusbyRJ. Lesions: Dynamic and pathogenic mechanisms responsible for ischemic events in the brain. In: MooreWS, ed. Surgery for Cerebrovascular Disease. New York, NY: Churchill Livingstone; 1987: 51–76.
8.
BiasiGMFroioADiethrichEB. Carotid plaque echolucency increases the risk of stroke in carotid stenting: The Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study. Circulation. 2004; 110: 756–762.
9.
OhkiTMarinMLLyonRT. Ex vivo human carotid artery bifurcation stenting: Correlation of lesion characteristics with embolic potential. J Vasc Surg.1998; 27: 463–471.
10.
ReidDB. Carotid plaque characterization: Helpful to endarterectomy and endovascular surgeons [Commentary]. J Endovasc Surg.1998; 5: 247–250.
NairAKubanBDObuchowskiN. Assessing spectral algorithms to predict atherosclerotic plaque composition with normalized and raw intravascular ultrasound data. Ultrasound Med Biol.2001; 27: 1319–1331.
13.
ReidDB. Early clinical experience with virtual histology intravascular ultrasound [Abstract]. J Endovasc Ther.2006; 13(Suppl): I-31.
14.
ReidDBDouglasMDiethrichEB. The clinical value of three-dimensional intravascular ultrasound imaging. J Endovasc Surg.1995; 2: 356–364.
15.
NairAKubanBDTuzcuEM. Coronary plaque calcification with intravascular ultrasound radiofrequency data analysis. Circulation. 2002; 106: 2200–2206.
16.
IrshadKReidDBMillerPH. Early clinical experience with color three-dimensional intravascular ultrasound in peripheral interventions. J Endovasc Ther.2001; 8: 329–338.
17.
IrshadKRahmanNBainD. The role of intravascular ultrasound and peripheral endovascular interventions. In: HeuserRRHenryM, eds. Textbook of Peripheral Vascular Interventions. London: Martin Dunitz; 2004: 25–34.
18.
IrshadKBainDMillerPH. The role of intravascular ultrasound in carotid angioplasty and stenting. In: HenryM, ed. Angioplasty and Stenting of the Carotid and Supra-Aortic Trunks. London: Martin Dunitz; 2004: 127–133.
19.
Rodriguez-GranilloGAGarcia-GarciaHMMcFaddenEP. In vivo intravascular ultrasound—derived thin-cap fibroartheroma detection using ultrasound radiofrequency data analysis. J Am Coll Cardiol.2005; 46: 2038–2042.
20.
DiethrichEBIrshadKReidDB. Virtual histology and color flow intravascular ultrasound in peripheral interventions. Semin Vasc Surg.2006; 19: 155–162.
21.
ReidDBIrshadKMillerS. Endovascular significance of the external carotid artery in the treatment of cerebrovascular insufficiency. J Endovasc Ther.2004; 11: 727–733.
22.
GomezCR. Carotid plaque morphology and risk for stroke. Stroke. 1990; 21: 148–151.
23.
VirmaniRKolodgieFDBurkeAP. Atherosclerotic plaque progression and vulnerability to rupture. Arterioscler Thromb Vasc Biol.2005; 25: 2054–2061.
SitzerMMullerWSieblarM. Plaque ulceration and lumen thrombus are the main source of cerebral micro emboli in high-grade internal carotid artery stenosis. Stroke. 1995; 26: 1231–1233.
26.
SpagnoliLGMaurielloASangiorgiG. Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke. JAMA. 2004; 292: 1845–1852.
27.
VirmaniRKolodgieFDBurkeAP. Lessons from sudden coronary death: A comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol.2000; 20: 1262–1275.
28.
KuchulakantiPRhaSWCheneauE. Identification of “vulnerable plaque” using virtual histology and angiographically benign looking lesion of proximal left anterior descending artery. Cardiovasc Radiat Med.2003; 4: 225–227.
29.
VirmaniRBurkeAPKolodgieFD. Pathology of the thin-cap fibro atheroma. J Interv Cardiol.2003; 16: 267–272.
30.
FujiiKKobayashiYMintzGS. Intravascular ultrasound assessment of ulcerated ruptured plaques: A comparison of culprit and non-culprit lesions of patients with acute coronary syndrome and lesions in patients without acute coronary syndromes. Circulation. 2003; 108: 2473–2478.
31.
VerheyeSDe MeyerGRVan LangenhoveG. In vivo temperature heterogeneity of atherosclerotic plaques is determined by plaque composition. Circulation. 2002; 105: 1596–1601.
32.
NaghaviMLibbiPFalkE. From vulnerable plaque to vulnerable patient. Circulation. 2003; 108: 1664–1672.
