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and
Optical Coherence Tomography
(OCT)
Clare McLaren
Great Ormond Street Hospital
London
Introduction
IVUS and OCT
Intravascular
Ultrasound
IVUS Equipment
Volcano Corporation (San Diego, CA)
s5i Imaging System
integrated
s5 Imaging System
maneuverable, PC based
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
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
IVUS Case 1
IVUS Case 1
3 year old boy
severe hypertension 180/115 mmHg
145/83 mmHg on five anti-hypertensive drugs
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
..
.
.
.. . ..
Optical Coherence
Tomography
OCT
medical imaging
interventional radiology
interventional cardiology
urology
ophthalmology
non-medical imaging
artwork
industry
material thickness, surface roughness
characterisation
OCT
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
C7 Dragonfly Imaging
Catheter
C7 Dragonfly imaging catheter
135 cm
2.7 F
compatible with 0.014 steerable guide wire
hydrophilic
OCT
St. Jude Medical
Ilumien
C7 Dragonfly imaging catheter
Terumo
Lunawave
FastView
Lunawave
OCT
St. Jude Medical
Ilumien
C7 Dragonfly imaging catheter
Terumo
Lunawave
FastView
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
3D reconstruction
OCT Case 1
OCT Case 1
17 year old girl
renovascular hypertension
OCT Case 1
OCT Case 1
OCT Case 1
OCT Case 2
OCT Case 2
11 year old boy
renovascular hypertension
OCT Case 2
OCT Case 2
tight stenosis
OCT Case 2
renal artery branch
is not clearly seen
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
tracheal cartilage
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
OCT Case 4
OCT Case 4
bronchus
intermedius
left main
bronchus
right upper
lobe bronchus
OCT Case 4
OCT Case 5
OCT Case 5
OCT Case 5
OCT Case 5
OCT Case 5
abnormal
cartilage
absent
cartilage
normal
cartilage
secretions
cost
OCT wire $500
OCT catheter $1000
IVUS / OCT
IVUS
larger field of view
does not require clearing
of blood from vessel
feasible in aorta
OCT
smaller field of view
improved on newer
systems
Conclusions
both techniques can be performed in
children
OCT offers superior image resolution
stent assessment