Intravascular ultrasound: Techniques, developments, clinical perspectives PDF
Preview Intravascular ultrasound: Techniques, developments, clinical perspectives
Intravascular ultrasound Intravascular ultrasound Techniques, developments, clinical perspectives edited by N.Bom J. Roelandt Rotterdam Postgraduate School of Cardiology Kluwer Academic Publishers Dordrecht / Boston / London The articles in this publication have been reprinted from the International Journal of Cardiac Imaging, Volume 4, Nos. 2--4, 1989 with the original pagination of the journal. ISBN-13: 978-94-010-6943-4 e-ISBN-13: 978-94-009-1007-2 DOl: 10.1007/978-94-009-1007-2 Printed on acid-free paper Published by Kluwer Academic Publishers, P.O. Box 17,3300 AA Dordrecht, The Netherlands. Kluwer Academic Publishers incorporates the publishing programmes of D. Reidel, Martinus Nijhoff, Dr W. Junk and MTP Press. Sold and distributed in the U.S.A. and Canada by Kluwer Academic Publishers, 101 Philip Drive, Norwell, MA 02061, U.S.A. In all other countries, sold and distributed by Kluwer Academic Publishers Group, P.O. Box 322, 3300 AH Dordrecht, The Netherlands. All Rights Reserved © 1989 Kluwer Academic Publishers Softcover reprint ofthe hardcover I st edition 1989 No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner. v Editorial New interventional techniques in vascular therapy include balloon dilatation, atherectomy and, for instance, laser ablation. The open arterial lumen can be studied angiographically. With this technique, however, little information on the obstruction itself becomes available. The new intervention methods have created a strong demand for techniques to visualize better the obstruction and the possible effect of therapy. Intravascular ultrasound has great potential to fill in this diagnostic demand. Top experts in the field of intravascular ultrasound have jointly put together this publication which is the first to contain all the presently known aspects of this new, exciting field. The various chapters cover the full spectrum, which ranges from atherogenesis in arteries, through clinical applications, to aspects of more technical nature such as artifacts and catheter design. Although emphasis has been put on catheter tip imaging, intravascular Doppler blood velocity measurement techniques have also been included. The main scope of this publication is to convey to the reader new ideas and possible clinical applications resulting from experience with today's fascinating new miniature catheter tip ultrasound imaging devices. Rotterdam, June 1989 N. Born, Ph.D. J. Roelandt, M.D. Head Bioengineering Head Dept. of Cardiology Thoraxcentre, Rotterdam and Thoraxcentre, University Deputy Director of the Hospital Rotterdam-Dijkzigt and Interuniversity Cardiology Erasmus University Rotterdam, Institute of the Netherlands the Netherlands VI Intravascular ultrasound is an exciting new area. Top experts have been asked to dedicate their efforts to compile together this first thorough book on catheter tip echography. Presentation of this book took place on the occasion of the 8th Symposium on Echocardiology held in Rotterdam, June 1989. The conference was organized in association with: - the Interuniversity Cardiology Institute of the Netherlands - the Netherlands Heart Foundation 1111111111 - the Dutch Society of Ultrasound in Medicine and Biology VII Table of contents Editorial .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V N. Born, J. Roelandt Early and recent intraluminal ultrasound devices ............................................ 79 N. Born, H. ten Hoff, C.T. Lancee, W.J. Gussenhoven, J.C. Bosch Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Early intraluminal measurements ........................................................ 80 Intravascular Doppler methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Intraluminal imaging .................................................................. 82 Combination of techniques ............................................................. 84 Present intra-arterial echo methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Future developments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Conclusions .......................................................................... 87 Intraluminal real-time ultrasonic imaging: Clinical perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 J. Roelandt, P .W. Serruys Introduction ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Applications in cardiovascular disease .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Applications in non-cardiovascular disease .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Factors influencing image quality and interpretation ........................................ 94 Future perspectives .................................................................... 94 Conclusion ........................................................................... 95 Ultrasound imaging and atherogenesis ..................................................... 99 A.E. Becker Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Atherosclerotic lesions: A matter of definition ............................................. 99 Atherogenesis: Basic mechanisms... ...... .. .... . . .... .. ..... .... ..... ...... .... ......... 100 Atherosclerosis: Component make up variability. .. ..... ... .. .. .... . .............. ......... 101 Atherosclerosis and arteries: Tissue characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Atherosclerosis: Ultrasound imaging ..................................................... 102 Intravascular echographic assessment of vessel wall characteristics: A correlation with histology ... 105 W.J. Gussenhoven, C.E. Essed, P. Frietman, F. Mastik, C.T. Lancee, c.J. Slager, P.W. Serruys, P. Gerritsen, H. Pieterman, N. Born Introduction. . . . . .. . . ... .... . ........ .. ... . .... .. . ....... ... . .... .... ................. 105 Technique. . . .. .... .. ........ . . ... . .. .. .... ...... ...... .. ... . .... ............ .... ..... 105 VIII Microscopic investigation 106 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Data analysis 106 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 •••••••• 0 •••••••••••• 0 0 ••••••••• 0 •• 0 0 • • • • • • • • •• Results: Arteries ............ 106 0 ••••• 0 0 •••••••••••• 0 ••• 0 •• 0 ••••• 0 ••• 0 •• 0 0 •••••••••••• 0 0 •• Veins ........ o. . o. . :. 107 0 0 0 ••••• 0 0 • 0 0 • 0 •••• 0 • 0 •• 0 •••••••••••••• 0 ••••••••••••• 0 •••••• 0 ••• Aorta-coronary artery bypass grafts 110 0 •••••••••••••••••••••••••••••••• 0 0 •••••• 0 •••• 0 0 • • • • •• Vascular prostheses ... o. 110 0 • 0 ••••••••• 0 •• 0 •••••••• 0 .00 ••••• 0 • 0 •••••• 0 ••• 0 ••••• 0 •••••••• 0 • Atherosclerotic lesions 111 0 0 0 0 • 0 •••••• 0 •• 0 0 •••••••••• 0 0 ••••••••••••• 0 •••••••••••••••••• 0 • 0 0 Limitations. 115 0 0 ••• 0 ••••••• 0 •••••• 0 ••••••••••••••••••••••••••••••• 0 ••••• 0 • 0 0 •••• 0 0 • • • • •• Conclusions ................................. 115 0 • 0 •••• 0 •••••• 0 0 ••• 0 0 ••••••••••••• 00. • • •• Clinical applications of intravascular ultrasound imaging in atherectomy ... 117 0 •••••••• 0 • • • • • • • • • • • P.G. Yock, D.T. Linker, NoW. White, M.H. Rowe, M.R. Selmon, G.C. Robertson, T. Hinohara, J.B. Simpson Introduction 117 0 •••• 0 ••••• 0 •• 0 ••••••••••••••••••••••••••••••• 0 ••••••••••• 0 ••••••••• 0 •• 0 • • The atherectomy devices: initial clinical studies ............... 117 0 0 ••• 0 •••••••• 0 ••• 0 • • • • • • • • •• The need for improved imaging ..... 119 0 0 •••••••••••••••••••••• 0 •• 0 • • • • • • • • • • • • • • • • • • • • • • •• Initial experience with imaging guidance in peripheral atherectomy .......... o. 120 0 0 ••••••••••••• Future technical and clinical directions ..................... 122 0 0 0 ••••••••••• 0 • • • • • • • • • • • • • •• Conclusions ....... 124 0 •• 0 •••••••••••••••••••••••• 0 ••••••••• 0 •• 0 0 ••••••••• 0 0 •• 0 • • • • • • • • •• Laser ablation and the need for intra-arterial imaging ....... 127 0 • 0 •••••• 0 •••••• 0 • • • • • • • • • • • • • • •• C. Borst, R. Rienks, W.P.T.M. Mali, L. van Erven Introduction . 127 0 ••••••••••••••••••••• 0 •••••••••••••• 0 ••••••••••••••••••••• 0 •••••••••••• 0 Methods ............ 128 0.0 •• 0 •••••••••••••••••• 00 ••••••••••• 00 •• 00 •••••• 0 ••• 0........... Results ............................ 128 0 •••••••• 0 •• 0 ••••• 0 • 0 • • • • • • • • • • • • • • • • • • • • • • • • • • • •• Discussion .......................... o. 129 0 : ••••••••••••••••••••••••••••••••••••• 0 ••••• 0 • Conclusions .................... 131 0 ••• 0 • 0 •••••••••••••••••• 0 0 •••••••••••••• 0 0 •• 0 • • • • • • •• 3-D visualization of arterial structures using ultrasound and Voxel modelling ................ 135 0 • •• R.1. Kitney, L. Moura, K. Straughan Introduction ........................... 135 0 • 0 •••••• 0 0 •••••• 0 •••••••••••••••••••••••••••• 0 3-D space and object description .... o. ........................ 135 0 0 • • • • • • • • • •• • • •• • • • • •• • • •• . Constructive solid geometry - CGS modelling ....... 136 0 0 •• 0 • 0 ••••• 0 0 ••••••••••••••••••••• 0 •• Boundary representation .............. 136 0 •• 0 • 0 •••••• 0 ••••• 0 •••••••••••••••••••• 0 •••••••• 0 V oxel modelling ......... 137 0 ••••••••• 0 ••••••••••••••••••••• 0 ••••••••••••••••••• 0 0 0 • 0 • • •• Voxel modelling of arterial structures ................. 138 0 ••••••• 0 •• 0 0 ••••••••••••••••••• 0 0 •• Contour definition ............................. 139 0 •• 0 •••••••••••••••••••• 0 0 •••••••••• 0 • •• 3-D interpolation ...... 139 0 •••••••••• 0.00 ••••••••••••••••••••• 0 0 •• 0 0 • • • • • • • • • • • • • • • • • • • • •• 3-D visualisation of arterial structures using ultrasound 141 .0 0 ••• 0 •••••• 0 • • • • • • • • • • • • • • • • • • • • • •• Results ......... 141 0 •• 0 •••••••••••• 0 ••• 0.0.0 0 •••••• 0 •••••••••• 0 •••••••••• 0 •••• 0 ••••• 0 • •• Discussion ......... 142 0 ••••••••••••••••••••••••• 00 •• 0 ••••••••• 0......................... IX Optimized ultrasound imaging catheters for use in the vascular system ......................... 145 R.J. Crowley, P.L. von Behren, L.A. Couvillon Jr., D.E. Mai, J.E. Abele Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 145 Motivation ........................................................................... 145 Design evolution ...................................................................... 146 Design alternatives .................................................................... 147 Transducer technology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 149 Future directions ...................................................................... 150 Intraluminal ultrasound guidance of transverse laser coronary atherectomy 153 H.T. Aretz, M.A. Martinelli, E.G. LeDet Introduction .................................................................. . . . . . . .. 153 The ideal coronary laser atherectomy system .............................................. 153 System description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 155 Conclusion ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 157 Review of intra coronary Doppler catheters 159 C.J. Hartley Introduction ................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 159 Instrumentation ....................................................................... 160 Transducers .......................................................................... 161 Validation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 162 Clinical applications and results ......................................................... 164 Discussion ........................................................................... 166 Conclusions .........................., ................................................ 167 What have we learned about coronary artery disease from high-frequency epicardial echocardiography? ........................................ , ............................. 169 R.E. Kerber, D.O. McPherson, S.J. Sirna, A. Ross, M.L. Marcus Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 169 Intraoperative ultrasound evaluation of the coronary arteries: High frequency epicardial echocardiography ................................................................... 170 Echocardiographic-angiographic correlations using high frequency echo . . . . . . . . . . . . . . . . . . . . . .. 171 Remodeling of atherosclerotic coronary arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 174 Analysis of backscattered ultrasound from normal and diseased arterial wall .................... 177 D.T. Linker, P.G. Yock, A. Gr0nnings::ether, E. Johansen, B.A.J. Angelsen Introduction ..................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 177 Properties of backscattered ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 177 Special aspects of intra-arterial tissue characterization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 180 Preliminary studies on ultrasonic backscatter from arteries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 181 Future plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 183 x Conclusions 184 Clinical percutaneous imaging of coronary anatomy using an over-the-wire ultrasound catheter system 187 J.McB. Hodgson, S.P. Graham, A.D. Savakus, S.G. Dame, D.N. Stephens, P.S. Dhillon, D. Brands, H. Sheehan, M.J. Eberle Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 187 Methods .................. 188 0 ••••• 0 ••••• 0 •••••••••••• 0.0 •• 0 •••••••••• 0 •••••••••••••• 0" Results ... o. 189 0 ••••••••••••••••••••••••••••••••••••••••••••••••••• 0 •••••••••••••••• 0 •• 0 Discussion ........ 191 0 • 0 ••• 0 •••• 0 ••••••••••••• 0 •••• 0 •••• 0 ••• 0 •• 0 0 ••••••• 0 • 0 ••• 0 • 0 • • • • • • • Imaging artifacts in mechanically driven ultrasound catheters ............. 195 0 0 • • • • • • • • • • • • • • • • • • H. ten Hoff, A. Korbijn, Th.H. Smit, J.FoF. Klinkhamer, N. Born Introduction .......................... 195 0 ••••••••••••••••••••••••••••••••••••••• 0 •••• 0 • 0 Image artifacts related to catheter tip motion ................. 195 0 • 0 0 •• 0 0 ••••••••••••••• 0 • • • • •• Conclusions .. 199 0 •• 0 •••••••••••••• 0 •••••••••••••••••• 0 0.0 ••••••••••••• " ••••••• 0 • • •• • • •• Design characteristics for intravascular ultrasonic catheters ....... 201 0 •••••••••••••••••••••••••• 0 R.W. Martin, C.Co Johnson Introduction ........................ 201 0 ••••••••••••••••••••••••••••••••••••••••••••• 0 • •• Mechanical considerations .......... 201 0 ••• 0 •••••••••• 0 0 ••••• 0 • 0 ••• 0 ••••••• 0 • 0 ••••• 0 • • • • • •• Derivation of force equations .. 202 0 0 ••••••• 0 • 0 •• 0 0 ••••• 0 •• 0 ••••••••••••• 0 •••••••• 0 • • • • • • • •• Flexible drive cables ........ 207 0 •••••••••••••••••••••••• 0 • 0 •••••••••••••••••••••••••••• 0 • 0 Use of catheter pathways to calculate forces, torques and torsion angles. o. 208 0 •••••••••••••••• 0 0 •• Electrical wire for connecting the transducer ............ 209 0 0 • 0 •• 0 • 0 ••• 0 •••••••••••••••••• 0 • •• Discussion ...................... 212 0 ••• 0 • : •••••••••••• 0 •••• 0 • • • • • • • • • • • • • • • • • • • • • • • • • • •• List of first authors .... 217 0 •• 0 •••• 0 •••••••••••••• 0 ••••••• 0 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• International Journal of Cardiac Imaging 4: 79-88, 1989. © 1989 Kluwer Academic Publishers. Early and recent intraluminal ultrasound devices N. Bomi.2, H. ten Hoffi, c.T. Lanceel, W.J. Gussenhoven2 & J.G. Boschi Thoraxcentre, Erasmus University Rotterdam and Interuniversity Cardiology Institute of the Netherlands, 1 2 P.O. Box 1738,3000 DR Rotterdam, the Netherlands Abstract The history of intraluminal echography dates back to the very beginning of diagnostic ultrasound. Over the years many fascinating ideas and applications of catheter tip or gastroscopic tube tip mounted transducers have been described. This chapter surveys these methods, subdividing them into a) measurements; b) Doppler and c) imaging. The survey ranges from early work of Cieszynski on the feasibility of echocardiog raphy to more recent intra-arterial catheter tip Doppler with guidewire and balloon as described by Serruys. Examples of ultrasound catheter tip echography in combination with other techniques such as angioscopy, laser ablation and spark erosion are also described. Today practical approaches are limited to imaging only. The three major approaches for catheter tip echo imaging are described and compared. This paper concludes with the results of automatic contour analysis of the inner arterial boundaries. Introduction Angioscopy only allows visualizing of the inner most arterial layers. On the other hand, diagnostic Interventional catheter-based therapeutic tech ultrasound is well-known for cross-sectional imag niques have recently become important as they ing of soft tissue. Therefore, ultrasound seems like may avoid the necessity of some surgical proce an ideal approach to image soft tissue such as the dures. Techniques to widen a luminal obstruction arterial wall or fibrotic plaque. in an artery include balloon dilatation, tip abra The strong interest in catheter tip echography sion, atherectomy and laser ablation. The possibil has appeared only very recently. Nevertheless re ity that stenosis may reoccur is well documented. ports of intraluminal diagnostic ultrasound meth Apparently the therapeutic methods are not yet ods date back to the early fifties. Also in those days optimal, or cannot be optimally applied without researchers described echographic methods where further knowledge of the obstruction. the acoustic element was mounted either on a cath The arterial obstruction may consist of a variety eter tip, gastroscopic pipe or other means for in of components, and geometric configurations. traluminal diagnostic application of ultrasound. With contrast X-ray angiography only the remain In the early period of diagnostic ultrasound, one ing lumen can be visualized; not the obstruction of the compelling reasons for the intraluminal ap itself. proach was the low sensitivity of the existing echo A new and enthusiastic interest for intraluminal transducers and, therefore the need to closely ap echography has been created in order to provide proach the organs to be studied. better patient selection and 'steering' of the in A number of parameters exists which further terventional procedure. In addition, mUlti-purpose favor the intraluminal approach. With higher fre catheter tips, where echo is combined with a des quency the wavelength becomes shorter. As a re obstruction method, have been suggested. For this sult the acoustic element can be small, still yielding purpose cross-sectional information is essential. a sufficient acoustic aperture in wavelength and
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