Title: Detection of Luminal-Intimal Border and Coronary Wall Enhancement in Intravascular Ultrasound Imaging After Injection of Microbubbles and Simultaneous Sonication With Transthoracic Echocardiography
Abstract: HomeCirculationVol. 112, No. 1Detection of Luminal-Intimal Border and Coronary Wall Enhancement in Intravascular Ultrasound Imaging After Injection of Microbubbles and Simultaneous Sonication With Transthoracic Echocardiography Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBDetection of Luminal-Intimal Border and Coronary Wall Enhancement in Intravascular Ultrasound Imaging After Injection of Microbubbles and Simultaneous Sonication With Transthoracic Echocardiography Manolis Vavuranakis, Ioannis A. Kakadiaris, Sean M. O'Malley, Christodoulos Stefanadis, Sophia Vaina, Maria Drakopoulou, Ioannis Mitropoulos, Stephane Carlier and Morteza Naghavi Manolis VavuranakisManolis Vavuranakis From Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece (M.V., C.S., S.V., M.D., I.M.); Department of Computer Science, University of Houston, Houston, Tex (I.A.K., S.M.O.); Intravascular Imaging & Physiology, Cardiovascular Research Foundation, New York, NY (S.C.); and Association for Eradication of Heart Attack, Houston, Tex (M.N.). , Ioannis A. KakadiarisIoannis A. Kakadiaris From Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece (M.V., C.S., S.V., M.D., I.M.); Department of Computer Science, University of Houston, Houston, Tex (I.A.K., S.M.O.); Intravascular Imaging & Physiology, Cardiovascular Research Foundation, New York, NY (S.C.); and Association for Eradication of Heart Attack, Houston, Tex (M.N.). , Sean M. O'MalleySean M. O'Malley From Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece (M.V., C.S., S.V., M.D., I.M.); Department of Computer Science, University of Houston, Houston, Tex (I.A.K., S.M.O.); Intravascular Imaging & Physiology, Cardiovascular Research Foundation, New York, NY (S.C.); and Association for Eradication of Heart Attack, Houston, Tex (M.N.). , Christodoulos StefanadisChristodoulos Stefanadis From Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece (M.V., C.S., S.V., M.D., I.M.); Department of Computer Science, University of Houston, Houston, Tex (I.A.K., S.M.O.); Intravascular Imaging & Physiology, Cardiovascular Research Foundation, New York, NY (S.C.); and Association for Eradication of Heart Attack, Houston, Tex (M.N.). , Sophia VainaSophia Vaina From Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece (M.V., C.S., S.V., M.D., I.M.); Department of Computer Science, University of Houston, Houston, Tex (I.A.K., S.M.O.); Intravascular Imaging & Physiology, Cardiovascular Research Foundation, New York, NY (S.C.); and Association for Eradication of Heart Attack, Houston, Tex (M.N.). , Maria DrakopoulouMaria Drakopoulou From Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece (M.V., C.S., S.V., M.D., I.M.); Department of Computer Science, University of Houston, Houston, Tex (I.A.K., S.M.O.); Intravascular Imaging & Physiology, Cardiovascular Research Foundation, New York, NY (S.C.); and Association for Eradication of Heart Attack, Houston, Tex (M.N.). , Ioannis MitropoulosIoannis Mitropoulos From Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece (M.V., C.S., S.V., M.D., I.M.); Department of Computer Science, University of Houston, Houston, Tex (I.A.K., S.M.O.); Intravascular Imaging & Physiology, Cardiovascular Research Foundation, New York, NY (S.C.); and Association for Eradication of Heart Attack, Houston, Tex (M.N.). , Stephane CarlierStephane Carlier From Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece (M.V., C.S., S.V., M.D., I.M.); Department of Computer Science, University of Houston, Houston, Tex (I.A.K., S.M.O.); Intravascular Imaging & Physiology, Cardiovascular Research Foundation, New York, NY (S.C.); and Association for Eradication of Heart Attack, Houston, Tex (M.N.). and Morteza NaghaviMorteza Naghavi From Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece (M.V., C.S., S.V., M.D., I.M.); Department of Computer Science, University of Houston, Houston, Tex (I.A.K., S.M.O.); Intravascular Imaging & Physiology, Cardiovascular Research Foundation, New York, NY (S.C.); and Association for Eradication of Heart Attack, Houston, Tex (M.N.). Originally published5 Jul 2005https://doi.org/10.1161/CIRCULATIONAHA.104.479915Circulation. 2005;112:e1–e2A 61-year-old man presented with unstable angina (Braunwald class 2B). Coronary angiography revealed a mild lesion on the very proximal segment of the left anterior descending coronary artery (LAD) and a significant stenosis (80%) in the mid-segment. Intracoronary ultrasound was used to further evaluate proximal coronary artery stenosis. It was found to be a soft plaque without significant luminal stenosis but without clear definition of the luminal-intimal boundary.Intravenous injection of gas-filled microbubble ultrasound contrast agents have been used for endocardial border detection, especially when they are sonicated by acoustic power and produce harmonics. We performed continuous intracoronary ultrasound recordings (EndoSonics; 20 MHz) in the proximal left anterior descending coronary artery before (Figure 1, A), during (Figure 1, B) and after injection (Figure 1, C) of 4 mL of SonoVue (ultrasound contrast agent with lyophilized capsule filled with sulfurhexafluoride). Simultaneously with contrast injection, ultrasound acoustic power of 0.6 mechanical index was delivered via a transthoracic transducer (2.5 MHz) toward the left main to sonicate the delivered microbubbles. Immediately after the passage of the microbubble contrast agent, which was clearly detected by the intracoronary ultrasound probe, an enhancement of the entire plaque and adventitia was seen. The luminal-intimal boundary appeared to show a ring-like enhancement, which clearly defined the inner borders of the coronary arterial wall (Figure 2). The precise mechanism of this observation is not clearly defined, although the adhesion of microbubbles to inflamed endothelial cells was reported previously. Sonication of the microbubbles by the external acoustic energy may facilitate adherence to endothelium for a short time, and then may be washed out by the forthcoming blood. Acute coronary syndromes are the result of plaque rupture or endothelial erosion in the majority of cases. Therefore, techniques that can help define the integrity of the luminal-intimal border and intraplaque leakage of blood through the vasa vasorum or plaque cap could be of major importance for detecting vulnerable plaque and understanding the pathophysiology of acute coronary syndromes. Download figureDownload PowerPointFigure 1. A, Baseline IVUS image of a non–flow-limiting plaque (35%) in the proximal LAD. Arrows indicate areas where the luminal-intimal border is not clearly defined. B, Detection of gas-filled microbubble ultrasound contrast agent passage around the intracoronary ultrasound catheter at the imaging site. C, Significant changes in the signal intensity of the entire plaque area, including the adventitia, are observed. Note the luminal-intimal interface ring, indicating an echo-reflectant halo by microbubbles.Download figureDownload PowerPointFigure 2. Differential IVUS images showing the subtracted postinjection signals from baseline signals. A, Black and white (signal intensity of Figure 1A−Figure 1C); B, color-coded panel A; C, thresholded to show most significant areas of enhancement.DisclosureDr Naghavi is a share-holder in and consultant to Volcano Corporation and Endothelix Inc and is a scientific advisor to Pfizer Inc.FootnotesCorrespondence to Manolis Vavuranakis, MD, for the Ultimate IVUS at University of Houston Collaborative Project, Haimanda 24-26, Marousi 15122, Greece. 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