0000000000266371
AUTHOR
P. Kearney
Three dimensional reconstruction of intracoronary ultrasound images: roadmapping with simultaneously digitised coronary angiograms
Three dimensional reconstruction of intracoronary ultrasound images offers a better appreciation of the axial relationship of vessel features and permits volumetric assessment, both of which depend critically on the spatial accuracy of the technique. This in turn is dependent on precise longitudinal orientation of the transducer in the vessel. The authors have developed a system which utilises simultaneously digitised fluoroscopic tracking of the radio-opaque transducer to orient the corresponding 2D ICUS images. This system may offer improved spatial accuracy of the three dimensional reconstruction and a means of precise identification of the 2D ICUS image which corresponds with a selected…
Imaging in the catheterization laboratory
Recent work confirms that visual assessment of the effect of widely employed coronary interventions is highly inaccurate. Rapid and reliable on-line angiographic quantitation is a useful advance, but problems in the application of the technique are encountered in a substantial number of cases. New algorithms have been devised to provide a comprehensive assessment of the geometry and likely functional significance of lesions as well as an objective evaluation of lesion morphology, and recent work has provided the framework for the quantitation of diffuse disease. Studies with intravascular ultrasound confirm the inadequate sensitivity of angiography in demonstrating mild to moderate atheroma…
Acute coronary artery closure following intracoronary ultrasound examination
Two patients undergoing intracoronary ultrasound examination were complicated by acute coronary artery closure. One of the complications was thought to be caused by intimal dissection and thrombus formation and the other was thought to be caused by intimal dissection and subsequent embolization. The complications were successfully managed conservatively in both cases. © 1995 Wiley-Liss, Inc.
Clinical predictors of unstable coronary lesion morphology.
We evaluated prospectively clinical and angiographic data in 400 patients, 200 with unstable and 200 with stable angina in order to determine which clinical markers could reliably predict unstable coronary artery lesions. Comparison of the angiogram of 200 patients with unstable and 200 with stable angina revealed a high-grade lesion (42% vs 23%, P < 0.0001), complex lesion morphology (49% vs 20%, P < 0.0001) and thrombus-containing lesions (7% vs 1%, P = 0.006) as typical findings in patients with unstable angina. A high-grade lesion and/or complex lesion (including thrombotic lesions but excluding total occlusion) was found in 61% of unstable and 34% of stable patients (P < 0.0001). Clini…
Aortic intramural hemorrhage visualized by transesophageal echocardiography: Findings and prognostic implication
Abstract Objectives. This study describes the transesophageal echocardiographic and follow-up findings in patients with aortic intramural hemorrhage. Background. Localized aortic intramural hemorrhage resulting in layered thickening of the aortic wall seems to represent a variant of acute aortic dissection without communication or a typical moving intimal flap. In autopsy studies this variant, attributed to a rupture of the van vasorum, has been described in 5% to 10% of patients with dissection. Methods. In a prospective transesophageal echocardiographic study in patients with aortic dissection performed between 1986 and 1991, the diagnosis of intramural hemorrhage was established in 15 of…
Interventional cardiology: Differences in the morphology of unstable and stable coronary lesions and their impact on the mechanisms of angioplasty. An in vivo study with intravascular ultrasound
The aim of this study was to compare the morphology of stable and unstable coronary lesions using intravascular ultrasound in patients undergoing coronary balloon angioplasty and to determine whether lesion morphology had any influence on the mechanism of balloon angioplasty. Thirty three (15 stable and 18 unstable) patients undergoing single lesion percutaneous transluminal coronary angioplasty were studied with intravascular ultrasound before and after intervention. All examinations, recorded on S-VHS video tape, were studied off-line and matched sites from the point of minimum lumen area after the procedure and the corresponding site prior to intervention were compared. The morphology of…
Intravascular ultrasound detected classification of coronary lesions as a predictor of dissections after balloon angioplasty.
Dissection after balloon angioplasty of coronary arteries may give rise to an unfavourable early outcome. Compared with coronary angiography, intravascular ultrasound (IVUS) allows more detailed characterisation of dissections. We investigated the incidence and type of dissections after balloon angioplasty in calcified coronary lesions. IVUS was performed in 43 patients with 48 lesions before and after percutaneous balloon angioplasty. Significant calcification was defined as an arc of more than 90 degrees with typical acoustic shadowing. Dissections were classified as type A when the media was not involved by the dissection and as type B when media involvement had occurred. In the group wi…
Spontaneous plaque rupture visualized by intravascular ultrasound.
An intravascular ultrasound examination was performed in order to evaluate an angiographically complicated lesion. Intravascular ultrasound was able to demonstrate spontaneous plaque rupture in a patient with recent acute subendocardial infarction. The inconclusive angiographic appearance was clarified by the intravascular examination and led us to conclude that the myocardial infarction was due to plaque rupture with subsequent thrombotic occlusion, which had spontaneously resolved by the time of the study.
Three-dimensional imaging of cardiac mass lesions by transesophageal echocardiographic computed tomography.
Three-dimensional echocardiography is a new imaging technique that allows more realistic visualization of cardiac morphology. This study presents data about the diagnostic potentials of this technique concerning cardiac mass lesions, as well as its feasibility in clinical application. After the conventional investigation, multiple cross-sectional images were obtained during automatic forward advancement of a monoplane transducer mounted on a transesophageal probe. Three-dimensional reconstruction and volume determination were performed off line. Twenty-four patients were studied. In 14 cases results of echocardiographic computed tomography (echo-CT) were compared with those of monoplane/bip…