Clinical Characterization of Coronary Atherosclerosis With Dual-Modality OCT and Near-Infrared Autofluorescence Imaging.
Clinical Characterization of Coronary Atherosclerosis With Dual-Modality OCT and Near-Infrared Autofluorescence Imaging.
复制标题
DOI：
10.1016/j.jcmg.2015.11.020
复制
发表时间：
2016-11
期刊：
影响因子：
--
通讯作者：
Tearney GJ
中科院分区：
文献类型：
--
作者：
Ughi GJ;Wang H;Gerbaud E;Gardecki JA;Fard AM;Hamidi E;Vacas-Jacques P;Rosenberg M;Jaffer FA;Tearney GJ
我们提出了第一个临床成像人体冠状动脉在体内使用多模态OCT和近红外自体荧光（NIRAF）血管内成像系统和导管。虽然血管内OCT能够提供冠状动脉粥样硬化病变的显微结构图像，但其确定斑块的成分/分子特征（包括坏死核心的确定存在）的能力有限。最近的一项尸体冠状动脉斑块研究表明，内源性NIRAF在坏死核心病变中升高。因此，将这两种技术结合在一种器械中可以提供协同数据，以帮助诊断体内冠状动脉病变。我们开发了一种双模态血管内成像系统和2.6-F导管，可以从动脉壁上的同一位置同时采集OCT和NIRAF数据。利用该技术获得了12例接受PCI的冠状动脉疾病患者的体积OCT NIRAF图像。在以100帧/秒的速度和20或40 mm/秒的回撤速率进行短暂的非闭塞性3-4 ml/sec造影剂冲洗期间采集图像。分析OCT-NIRAF数据，以确定NIRAF信号相对于OCT描绘的斑块形态特征的分布。所有患者（17支冠状动脉）均成功采集了高质量冠状动脉内OCT和NIRAF图像数据（回撤长度>50 mm），无并发症。将每个斑块的最大NIRAF信号强度与OCT定义的类型进行比较，显示斑块类型之间存在统计学显著差异（单因素ANOVA，p<0.0001）。有趣的是，冠状动脉NIRAF强度仅在具有高风险形态表型的斑块中局灶性升高（p<0.05），包括OCT纤维粥样硬化、斑块破裂和与支架内再狭窄相关的纤维粥样硬化。这项首次人体OCT-NIRAF研究表明，双模态显微结构和荧光冠状动脉内成像可以安全有效地在人类患者中进行。我们的研究结果表明，NIRAF与高风险形态斑块表型相关。NIRAF在这些病变中的局灶性分布进一步表明，这种内源性成像生物标志物可以提供单独通过结构成像获得的补充信息。
We present the first clinical imaging of human coronary arteries in vivo using a multimodality OCT and near-infrared autofluorescence (NIRAF) intravascular imaging system and catheter. While intravascular OCT is capable of providing microstructural images of coronary atherosclerotic lesions, it is limited in its capability to ascertain compositional/molecular features of plaque, including the definitive presence of a necrotic core. A recent study in cadaver coronary plaque has shown that endogenous NIRAF is elevated in necrotic core lesions. The combination of these two technologies in one device may therefore provide synergistic data to aid in the diagnosis of coronary pathology in vivo. We developed a dual-modality intravascular imaging system and 2.6-F catheter that can simultaneously acquire OCT and NIRAF data from the same location on the artery wall. This technology was utilized to obtain volumetric OCT-NIRAF images from 12 patients with coronary artery disease undergoing PCI. Images were acquired during a brief, non-occlusive 3-4 ml/sec contrast purge at a speed of 100 frames per second and a pullback rate of 20 or 40 mm/sec. OCT-NIRAF data were analyzed to determine the distribution of the NIRAF signal with respect to OCT-delineated plaque morphological features. High quality intracoronary OCT and NIRAF image data (>50 mm pullback length) were successfully acquired without complication in all patients (17 coronary arteries). The maximum NIRAF signal intensity of each plaque was compared to OCT-defined type, showing a statistically significant difference between plaque types (one-way ANOVA, p<0.0001). Interestingly, coronary arterial NIRAF intensity was elevated only focally in plaques with a high-risk morphologic phenotype (p<0.05), including OCT fibroatheroma, plaque rupture, and fibroatheroma associated with in-stent restenosis. This first-in-human OCT-NIRAF study demonstrates that dual-modality microstructural and fluorescence intracoronary imaging can be safely and effectively conducted in human patients. Our findings show that NIRAF is associated with a high-risk morphologic plaque phenotype. The focal distribution of NIRAF in these lesions furthermore suggests that this endogenous imaging biomarker may provide complementary information to that obtained by structural imaging alone.