Quantification of the minimal luminal cross-sectional area after coronary stenting by two-and three-dimensional intravascular ultrasound versus edge detection and videodensitometry

doi:10.1016/S0002-9149(96)00356-6

The American Journal of Cardiology

Volume 78, Issue 5, 1 September 1996, Pages 520-525

https://doi.org/10.1016/S0002-9149(96)00356-6 Get rights and content

Abstract

The use of 2-dimensional intravascular ultrasound (2-D IVUS) to improve the outcome of coronary stenting has gained clinical acceptance, and recently 3-D IVUS has been introduced to clinical practice. However, there have been no comprehensive studies comparing the measurements of the coronary dimensions after stenting obtained by the different approaches of IVUS and quantitative coronary angiography. We examined the minimal luminal cross-sectional area of 38 stents using 2-D IVUS, 3-D IVUS, and 2 standard methods of quantitative coronary angiography, edge detection (ED) and videodensitometry (VD). Correlations between 2-D IVUS and ED (r = 0.72; p < 0.0001), VD (r = 0.87; p < 0.0001), and 3-D IVUS (r = 0.81; p < 0.0001) were higher than the correlations seen between 3-D IVUS and ED (r = 0.58; p < 0.0005) and VD (r = 0.70; p < 0.0001). The measurements by 2-D and 3-D IVUS (8.32 ± 2.50 mm² and 8.05 ± 2.66 mm²) were larger than the values obtained by the quantitative angiographic techniques ED and VD (7.55 ± 2.22 mm² and 7.27 ± 2.21 mm²). Thus, concordance was seen among all of the 4 techniques, confirming the validity of using IVUS for determination of the minimal luminal cross-sectional area after coronary stenting. A particularly good correlation was found between VD and IVUS, perhaps because measurement of the luminal area is the basic quantification approach of both techniques, whereas the lower correlations of ED with IVUS and VD may be explained by the dependence of ED on the angiographic projections used, which is especially important in eccentric stent configurations.

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Cited by (46)

Diagnostic Accuracy of Coronary CT Angiography for the Evaluation of Bioresorbable Vascular Scaffolds
2018, JACC: Cardiovascular Imaging
Citation Excerpt :
Angiographic binary restenosis was defined as a diameter stenosis of ≥50%. For the calculation of luminal areas, the videodensitometric method was used (12). Grayscale IVUS was acquired with a 3.2-F, 45-MHz rotational IVUS catheter (Revolution 45 MHz, Volcano Corporation, Rancho Cordova, California), using automated pullbacks at 0.5 mm/s and 30 frames/s. All pullbacks were analyzed off-line at 1 mm longitudinal intervals and analyzed by an independent core laboratory (Cardialysis BV) using a validated software (QIvus 2.2, Medis, Leiden, the Netherlands).
The purpose of this study was to assess the diagnostic accuracy of coronary computed tomography angiography (CTA) for bioresorbable vascular scaffold (BVS) evaluation.
Coronary CTA has emerged as a noninvasive method to evaluate patients with suspected or established coronary artery disease. The diagnostic accuracy of coronary CTA to evaluate angiographic outcomes after BVS implantation has not been well established.
In the ABSORB II (A Bioresorbable Everolimus-Eluting Scaffold Versus a Metallic Everolimus-Eluting Stent II) study, patients were randomized either to receive treatment with the BVS or everolimus-eluting metallic stent. At the 3-year follow-up, 238 patients (258 lesions) treated with BVS underwent coronary angiography with intravascular ultrasound (IVUS) evaluation and coronary CTA. The diagnostic accuracy of coronary CTA was assessed by the area under the receiver-operating characteristic curve with coronary angiography and IVUS as references.
The mean difference in coronary CTA-derived minimal luminal diameter was −0.14 mm (limits of agreement −0.88 to 0.60) with quantitative coronary angiography as reference, whereas the mean difference in minimal lumen area was 0.73 mm² (limits of agreement −1.85 to 3.30) with IVUS as reference. The per-scaffold diagnostic accuracy of coronary CTA for detecting stenosis based on coronary angiography diameter stenosis of ≥50% revealed an area under the receiver-operating characteristic curve of 0.88 (95% confidence interval [CI]: 0.82 to 0.92) with a sensitivity of 80% (95% CI: 28% to 99%) and a specificity of 100% (95% CI: 98% to 100%), whereas diagnostic accuracy based on IVUS minimal lumen area ≤2.5 mm² showed an area under the receiver-operating characteristic curve of 0.83 (95% CI: 0.77 to 0.88) with a sensitivity of 71% (95% CI: 44% to 90%) and a specificity of 82% (95% CI: 75% to 87%). The diagnostic accuracy of coronary CTA was similar to coronary angiography in its ability to identify patients with a significant lesion based on the IVUS criteria (p = 0.75).
Coronary CTA has good diagnostic accuracy to detect in-scaffold luminal obstruction and to assess luminal dimensions after BVS implantation. Coronary angiography and coronary CTA yielded similar diagnostic accuracy to identify the presence and severity of obstructive disease. Coronary CTA might become the method of choice for the evaluation of patients treated with BVS.
Small-vessel treatment with contemporary newer-generation drug-eluting coronary stents in all-comers: Insights from 2-year DUTCH PEERS (TWENTE II) randomized trial
2016, American Heart Journal
Citation Excerpt :
Angiography is limited in its capacity to distinguish between true small vessel size and apparently small vessels in patients with diffuse coronary disease. Intravascular ultrasound is superior to angiography in assessing true vessel size and coronary remodeling.35,36 In diabetic patients, the lack of angiographic follow-up may be associated with some underestimation of events.
Treatment of lesions in small vessels was associated with worse clinical outcome, and various definitions of “small vessels” have been used. Data with novel drug-eluting stents are scarce.
To compare the outcome of patients with vs without small-vessel treatment, we assessed 2-year follow-up data of the DUTCH PEERS randomized trial (ClinicalTrials.gov: NCT01331707), in which 1,811 all-comers were treated with contemporary zotarolimus-eluting (Resolute Integrity) or everolimus-eluting (Promus Element) stents. Primary end point was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization.
The rates of TLF (9.5% vs 5.4%; P log rank = .001) and 2 individual components thereof—target vessel myocardial infarction (3.1% vs 1.3%; P log rank = .006) and target lesion revascularization (4.8% vs 2.8%; P log rank = .02)—were higher among 798 (44.1%) patients treated in at least one small vessel (<2.50 mm by quantitative coronary angiography). Multivariate analysis with propensity score adjustment demonstrated that treatment of small-vessel lesions independently predicted TLF at 2-year follow-up (hazard ratio 1.60, 95% CI 1.09-2.34). Patients with the smallest target vessel being <2.25 mm had TLF rates similar to patients with smallest target vessels of 2.25 to <2.50 mm; however, patients treated in vessels no smaller than 2.50 to <3.00 mm and patients treated in vessels ≥3.00 mm had lower TLF rates (9.3%, 9.8%, 5.0%, and 5.8%, respectively; P log rank = .009).
Patients treated with novel drug-eluting stents in small-vessel lesions had higher adverse event rates than did patients who had no small-vessel treatment. Our data suggest that with current stents, a vessel diameter <2.50 mm is a suitable threshold to identify small target vessels.
Three-Dimensional Optical Coherence Tomographic Analysis of Eccentric Morphology of the Jailed Side-Branch Ostium in Coronary Bifurcation Lesions
2016, Canadian Journal of Cardiology
The severity of angiographic diameter stenosis of the jailed side-branch ostium is usually overestimated over the 3-D optical coherence tomography (OCT)-measured actual stenosis. Using 3-D OCT, morphologic changes in the jailed side-branch ostium were evaluated before and after a single stent crossover at coronary bifurcation lesions.
In 109 patients who received a single stent crossover at coronary bifurcation lesions, the minimal lumen area (MLA) before and after intervention and the eccentricity of the jailed side-branch ostium were measured with 3-D OCT. The eccentricity index was defined as the ratio of maximal diameter/minimal diameter of the jailed side-branch ostium. When the eccentricity index was < 1.5, the shape of the jailed side-branch ostium was defined as circular. The MLA of the jailed side-branch ostium was also calculated from the quantitative coronary angiography (QCA) minimal lumen diameter assuming a circular lumen.
The 3-D OCT-measured MLA of the jailed side-branch ostium decreased from 2.91 ± 1.65 mm² before intervention to 2.37 ± 1.48 mm² after intervention (P < 0.01). The QCA-derived MLA also decreased from 2.35 ± 1.71 mm² before intervention to 1.68 ± 1.56 mm² after intervention (P < 0.01). However, the 3-D OCT-measured MLA was significantly larger than the QCA-derived MLA (P < 0.01). The shape of the jailed side-branch ostium changed from circular to elliptical after the stent implantation (eccentricity index: 1.40 ± 0.33 before intervention; 1.71 ± 0.60 after intervention; P < 0.01).
Compared with QCA measurements, 3-D OCT analysis could be useful to guide decisions regarding additional intervention after stent implantation across coronary bifurcation lesions.
L’importance de la sténose de l’orifice du côté fermé de la branche latérale est généralement surestimée à l’angiographie par rapport à l’évaluation faite à l’aide de la tomographie par cohérence optique en 3-D (TCO 3-D). On a évalué les modifications morphologiques de l’orifice du côté fermé de la branche latérale avant et après l’installation d’une endoprothèse unique jouxtant des lésions de la bifurcation coronaire.
Chez 109 patients munis d’une endoprothèse unique à la bifurcation coronaire, on a mesuré le diamètre minimal de la lumière avant et après l’intervention de même que l’excentricité de l’orifice à l’aide d’une TCO 3-D. L’indice d’excentricité a été défini comme le rapport entre le diamètre maximal et le diamètre minimal de l’orifice du côté fermé de la branche latérale. Lorsque l’indice d’excentricité était < 1,5, la forme de l’orifice était considérée comme circulaire. Le diamètre minimal de la lumière de l’orifice du côté fermé de la branche latérale a également été calculé à l’aide d’une angiographie coronaire quantitative, en présumant que la lumière était circulaire.
Le diamètre minimal de la lumière de l’orifice du côté fermé de la branche latérale mesuré par TOC 3-D était passé de 2,91 ± 1,65 mm² avant l’intervention à 2,37 ± 1,48 mm² après l’intervention (p < 0,01). L’angiographie coronaire quantitative a pour sa part indiqué que le diamètre minimal de la lumière de l’orifice du côté fermé de la branche latérale était passé de 2,35 ± 1,71 mm² avant l’intervention à 1,68 ± 1,56 mm² après celle-ci (p < 0,01). Le diamètre minimal de la lumière de l’orifice du côté fermé de la branche latérale mesuré par TOC 3-D était donc significativement plus important que celui mesuré par l’angiographie coronaire quantitative (p < 0,01). De plus, toujours selon la TOC 3-D, la forme de l’orifice était passée de circulaire à elliptique suivant l’implantation de l’endoprothèse (indice d’excentricité de 1,40 ± 0,33 avant l’intervention et de 1,71 ± 0,60 après celle-ci; p < 0,01).
Comparativement à l’angiographie coronaire quantitative, la TOC 3-D pourrait être utile pour déterminer si on doit ou non procéder à une intervention additionnelle suivant l’implantation d’une endoprothèse jouxtant des lésions de la bifurcation.
Eccentric morphology of jailed side-branch ostium after stent crossover in coronary bifurcation lesions: A three-dimensional optical coherence tomographic analysis
2015, Journal of Cardiology
Citation Excerpt :
The minimal lumen area (MLA) of side-branch ostium by QCA (MLA-QCA) was calculated using the equation π × (MLD/2)2 based on the assumption that the lumen of the side-branch ostium is circular. The assumption for calculating MLA from QCA is classic but instinctively acceptable and has been employed in previous studies [10–12]. OCT imaging of the main vessel was serially performed three times (immediately post-intervention, 3–6 months post-intervention, and 1–2 year post-intervention) in all patients using a frequency-domain OCT system (C7-XR OCT Imaging System, LightLab Imaging, Inc., St. Jude Medical, St. Paul, MN, USA).
Angiographic stenosis of a jailed side-branch ostium is usually observed after a single-stent crossover at coronary bifurcation lesions. However, the stenosis severity is typically overestimated due to the limited information obtained from two-dimensional morphology by angiography. We evaluated the actual stenosis of jailed side-branch ostium using three-dimensional (3D) optical coherence tomography (OCT).
Using 3D reconstructions of OCT data, we analyzed minimal lumen area (MLA) and eccentricity of the jailed side-branch ostium in 41 patients who were treated with single stent crossover at coronary bifurcation lesions and subsequently underwent serial OCT follow-up.
The MLA of jailed side-branch ostium calculated from quantitative coronary angiography (QCA) assuming a circular lumen markedly decreased after stent implantation (1.73 ± 1.22 mm² pre-intervention to 0.84 ± 0.91 mm² post-intervention, p < 0.001). However, the MLA of jailed side-branch ostium measured at post-intervention by 3D-OCT (2.67 ± 1.75 mm²) was significantly larger than that measured by QCA (p < 0.001). There were no statistically significant changes in MLA of jailed side-branch ostium based on 3D-OCT measurements during the follow-up (2.35 ± 1.50 mm² at 3–6 months post-intervention; 2.44 ± 1.27 mm² at 1–2 years post-intervention, p = 0.098). The shapes of the jailed side-branch ostium were nearly elliptical (mean eccentricity index: 2.97 ± 1.27 post-intervention; 2.79 ± 1.17 at 3–6 months post-intervention; 2.59 ± 1.02 at 1–2 years post-intervention).
Compared to 3D-OCT measurements, QCA measurements overestimated the jailed side-branch ostial stenosis after single stent crossover due to eccentric morphology from orthogonal projection in coronary angiography. Significant changes in the MLA of jailed side-branch ostium by 3D-OCT were not observed during the follow-up.
OCT compared with IVUS in a coronary lesion assessment: The OPUS-CLASS study
2013, JACC: Cardiovascular Imaging
The aim of this study was to investigate the reliability of frequency domain optical coherence tomography (FD-OCT) for coronary measurements compared with quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS).
Accurate luminal measurement is expected in FD-OCT because this technology offers high resolution and excellent contrast between lumen and vessel wall.
In 5 medical centers, 100 patients with coronary artery disease were prospectively studied by using angiography, FD-OCT, and IVUS. In addition, 5 phantom models of known lumen dimensions (lumen diameter 3.08 mm; lumen area 7.45 mm²) were examined using FD-OCT and IVUS. Quantitative image analyses of the coronary arteries and phantom models were performed by an independent core laboratory.
In the clinical study, the mean minimum lumen diameter measured by QCA was significantly smaller than that measured by FD-OCT (1.81 ± 0.72 mm vs. 1.91 ± 0.69 mm; p < 0.001) and the minimum lumen diameter measured by IVUS was significantly greater than that measured by FD-OCT (2.09 ± 0.60 mm vs. 1.91 ± 0.69 mm; p < 0.001). The minimum lumen area measured by IVUS was significantly greater than that by FD-OCT (3.68 ± 2.06 mm² vs. 3.27 ± 2.22 mm²; p < 0.001), although a significant correlation was observed between the 2 imaging techniques (r = 0.95, p < 0.001; mean difference 0.41 mm²). Both FD-OCT and IVUS exhibited good interobserver reproducibility, but the root-mean-squared deviation between measurements was approximately twice as high for the IVUS measurements compared with the FD-OCT measurements (0.32 mm² vs. 0.16 mm²). In a phantom model, the mean lumen area according to FD-OCT was equal to the actual lumen area of the phantom model, with low SD; IVUS overestimated the lumen area and was less reproducible than FD-OCT (8.03 ± 0.58 mm² vs. 7.45 ± 0.17 mm²; p < 0.001).
The results of this prospective multicenter study demonstrate that FD-OCT provides accurate and reproducible quantitative measurements of coronary dimensions in the clinical setting.
Quantitative Ex Vivo and in Vivo Comparison of Lumen Dimensions Measured by Optical Coherence Tomography and Intravascular Ultrasound in Human Coronary Arteries
2009, Revista Espanola de Cardiologia
La relación entre las dimensiones del lumen medidas por ecografía intravascular (IVUS) y tomografía de coherencia óptica (OCT) en arterias coronarias humanas no es bien conocida. Los objetivos son comparar las dimensiones del lumen en IVUS, OCT e histología en arterias coronarias humanas ex vivo, y comparar in vivo las dimensiones del lumen obtenidas en pacientes con IVUS, OCT con oclusión y OCT sin oclusión.
Estudio ex vivo: el área luminal se midió en secciones anatómicas correspondientes en IVUS, OCT e histología en arterias coronarias humanas. Estudio in vivo: el área luminal se midió en regiones correspondientes en IVUS y OCT con y sin oclusión.
Ex vivo: en las 8 muestras estudiadas, el área del lumen fue más grande en IVUS y OCT que en histología –diferencia media, 0,8 ± 1 mm² (28%) para OCT y 1,3 ± 1,1 mm² (40%) para IVUS–. In vivo: en los cinco vasos analizados las dimensiones del lumen fueron más grandes en IVUS que en OCT –diferencia area media del lumen, 1,67 ± 0.54 mm² (33,7%) para IVUS y OCT con oclusión y 1,11 ± 0.53 mm² (21,5%) para IVUS y OCT sin oclusión–. Las dimensiones del lumen fueron más grandes en OCT sin oclusión que en OCT con occlusion –diferencia media, 0,61 ± 0,23 mm² (13%).
En arterias coronarias humanas fijadas, IVUS y OCT sobrestimaron el área del lumen en comparación con la histología. In vivo, las dimensiones del lumen fueron más grandes en IVUS que en OCT con o sin oclusión. La técnica de adquisición de OCT (con o sin oclusión) influye en las dimensiones del lumen.
The relationship between the lumen dimensions obtained in human coronary arteries using intravascular ultrasound (IVUS) and those obtained using optical coherence tomography (OCT) is not well understood. The objectives were to compare the lumen measurements obtained ex vivo in human coronary arteries using IVUS, OCT and histomorphometry, and in vivo in patients using IVUS and OCT with and without balloon occlusion.
Ex vivo study: the lumen areas of matched anatomical sections of human coronary arteries were measured using IVUS, OCT and histology. In vivo study: the lumen areas in matched sections were measured using IVUS and OCT with and without occlusion.
Ex vivo: in the eight specimens studied, the lumen area obtained using OCT and IVUS was larger than that obtained using histomorphometry: mean difference 0.8 ± 1 mm² (28%) for OCT and 1.3 ± 1.1 mm² (40%) for IVUS. In vivo: in the five vessels analyzed, the lumen area obtained using IVUS was larger than that obtained using OCT: mean difference 1.67 ± 0.54 mm² (33.7%) for IVUS relative to OCT with occlusion and 1.11 ± 0.53 mm² (21.5%) relative to OCT without occlusion. The lumen area obtained using OCT without occlusion was larger than that obtained using OCT with occlusion: mean difference 0.61 ± 0.23 mm² (13%).
In fixed human coronary arteries, both IVUS and OCT overestimated the lumen area compared with histomorphometry. In vivo the lumen dimensions obtained using IVUS were larger than those obtained using OCT, with or without occlusion. Moreover, the OCT image acquisition technique (i.e. with or without occlusion) also had an impact on lumen measurement.

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¹: Dr. von Birgelen is the recipient of a fellowship of the German Research Society (DFG, Bonn, Germany).

²: Dr. Kutryk is the recipient of a Clinician Scientist Award of the Medical Research Council of Canada (Ottawa, Canada)

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Quantification of the minimal luminal cross-sectional area after coronary stenting by two-and three-dimensional intravascular ultrasound versus edge detection and videodensitometry

Abstract

Am Heart J

Am J Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am Heart J

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary artery disease

N Engl J Med

Quantitative coronary arteriographic methods in the interventional catheterization laboratory: an update and perspective

J Am Coll Cardiol

Videodensitometry in percutaneous coronary interventions: a critical appraisal of its contributions and limitations

Edge detection versus densitometry in the quantitative assessment of stenosis phantoms: an in vivo comparison in porcine coronary arteries

Am Heart J

Intravascular stenting without anticoagulation accomplished with intravascular ultrasound guidance

Circulation