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Intravascular Ultrasound (IVUS)

and
Optical Coherence Tomography
(OCT)
Clare McLaren
Great Ormond Street Hospital
London

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

Intravascular
Ultrasound

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

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
http://www.bostonscientific.com/templatedata/imports/HTML/virtual-learning-center/pdf/
90567278_IntrotoIVUSTech.pdf

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.

IVUS Indications
arterial wall abnormalities

wall thickness
calcium
dissection
aneurysm assessment

stent
in-stent re-stenosis
stent strut apposition

IVUS Indications
GI
esophageal strictures

airway
wall abnormalities

IVUS Equipment

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

Normal Arterial Wall

IVUS Case 1

IVUS Case 1
3 year old boy
severe hypertension 180/115 mmHg
145/83 mmHg on five anti-hypertensive drugs

severe left ventricular dilatation

IVUS Case 1

55/16(34) mmHg

58/16(34) mmHg

57/15(33) mmHg

23/8(15) mmHg

rated pressure
3.50 mm

3.5-mm
cutting balloon

maximum pressure
3.72 mm

before angioplasty
after
angioplasty

after stenting

4.0-mm
balloon-expandable
stent

IVUS Case 3

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

IVUS Case 3

Rt

IVUS Case 3

pre-angioplasty

post-angioplasty

IVUS Case 4

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

IVUS Case 4
65/21(42) mmHg

25/17(20) mmHg

IVUS Case 4
5 mm x 40 mm

L RA
R RA

SMA

5 mm cutting

7 mm x 40 mm

IVUS Case 4
89/50(68) mmHg

60/44(52) mmHg

IVUS Case 4

pre-angioplasty

post-angioplasty

IVUS Case 5

Multiple Abdominal
Pseudoaneurysms

Multiple Abdominal
Pseudoaneurysms

aorta

L renal

IVUS Case 6

Aneurysm

M 3 yr

Aneurysm
..
.
.
.. . ..

Intravascular Ultrasound (IVUS)


and
Optical Coherence Tomography
(OCT)
Clare McLaren
Great Ormond Street Hospital
London

Optical Coherence
Tomography

OCT
medical imaging

interventional radiology
interventional cardiology
urology
ophthalmology

non-medical imaging
artwork
industry
material thickness, surface roughness
characterisation

OCT

potential image resolution of 15 m


infrared light
beam splitter
interferometer
post-processed to provide real-time
cross-sectional or 3D images

How OCT Works

How OCT works

OCT Applications
arterial
arterial wall abnormalities
wall thickness
calcium
dissection
aneurysm assessment

stent
in-stent re-stenosis
stent strut apposition

OCT Applications
airway
complete tracheal cartilage rings
absent or deficient cartilage

esophagus
ureter
bladder wall tumors

OCT
St. Jude Medical
Ilumien
C7 Dragonfly imaging catheter

Terumo
Lunawave
FastView

Volcano Corporation (San Diego CA)


pending

St. Jude Medical


OCT equipment

C7 Dragonfly Imaging
Catheter
C7 Dragonfly imaging catheter

135 cm
2.7 F
compatible with 0.014 steerable guide wire
hydrophilic

C7 Dragonfly Imaging Catheter

OCT
St. Jude Medical
Ilumien
C7 Dragonfly imaging catheter

Terumo
Lunawave
FastView

Volcano Corporation (San Diego CA)


pending

Terumo OCT System

Lunawave

FastView OCT catheter

OCT
St. Jude Medical
Ilumien
C7 Dragonfly imaging catheter

Terumo
Lunawave
FastView

Volcano Corporation (San Diego, CA)


FDA approved

Calibration

uncalibrated catheter

calibrated catheter

Arterial OCT

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

OCT Case 1

OCT Case 1
17 year old girl
renovascular hypertension

OCT Case 1

OCT Case 1

normal arterial wall

OCT Case 1

abnormal arterial wall

OCT Case 2

OCT Case 2
11 year old boy
renovascular hypertension

OCT Case 2

OCT Case 2

normal arterial wall

tight stenosis

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)

OCT of the Airway

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

OCT Wire

Normal Airway Cartilage

tracheal cartilage

bronchial cartilage plates

OCT Case 3

OCT Case 3
11 week old boy
VSD repair
unable to ventilate
arrested
intubated, ?ECMO

rigid bronchoscopy
complete tracheal rings

OCT Case 3

OCT Case 3

OCT Case 3

OCT Case 3

OCT Case 4

OCT Case 4

6 year old boy


recurrent chest infections
no response to asthma medication
hyperinflation of right lower zone on
CXR

OCT Case 4

OCT Case 4
bronchus
intermedius
left main
bronchus

right upper
lobe bronchus

OCT Case 4

complete cartilage ring at origin


of bronchus intermedius

bronchial cartilage plates in distal


bronchus intermedius

OCT Case 5

OCT Case 5

4 year old boy


tracheo-esophageal fistula (TEF) repair
TEF cough
recurrent respiratory distress
? recurrent fistula
? tracheobronchomalacia
? tracheal stenosis

OCT Case 5

OCT Case 5

OCT Case 5

abnormal
cartilage

absent
cartilage
normal
cartilage

Limitations of Airway OCT


tracheal diameter
field of view

secretions
cost
OCT wire $500
OCT catheter $1000

poorer depth penetration than


endobronchial ultrasound

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

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