Near Infrared Spectroscopy: Case Studies and Clinical Relevance

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Presentation transcript:

Near Infrared Spectroscopy: Case Studies and Clinical Relevance Brijeshwar Maini MD, FACC Chair Structural Heart Division Cardiovascular Research Division Pinnacle Health Cardiovascular Institute Harrisburg, PA

I have no real or apparent conflicts of interest to report. Brijeshwar S. Maini, MD I have no real or apparent conflicts of interest to report.

NIRS

In vivo characterization of coronary plaques: novel findings from comparing greyscale and virtual histology intravascular ultrasound and near-infrared spectroscopy: Eur Heart J (2012) 33 (3): 372-38 Pu, Maini, Stone, Maehara et al A positive relationship between VH-derived %NC and NIRS-derived lipid core burden index was found in non-calcified plaques, but not in calcified plaques.

Brijeshwar Maini, MD‡, Larisa Buyantseva, MD‡, Avneep Dhanju, MS†, In Vivo Tissue Characterization of Coronary Lipid Plaques: Novel Findings from Comparing Optical Coherence Tomography and Near-Infrared Spectroscopy. Brijeshwar Maini, MD‡, Larisa Buyantseva, MD‡, Avneep Dhanju, MS†, Gregg W Stone, MD* *Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY; †Pennsylvania State University, Harrisburg, PA; ‡PinnacleHealth Cardiovascular Institute, Harrisburg, PA

What is their distribution LARGE LIPID POOL SMALL LIPID POOL What is their distribution

Stent Thrombosis STENOSIS

RESTENOSIS LAD STENOSIS

Stent edge

RESTENOSIS LCX STENOSIS

Nouveau Atherosclerosis

Nouveau Atherosclerosis

PLAQUE PROTRUSION

X I E N C V

PLAQUE PROTRUSION AND EXTENSIVE LIPID BEHIND STENT IN PROXIMAL LAD LCX LM XIENCE V LAD

Analysis of saphenous vein graft lesion composition using near-infrared spectroscopy and intravascular ultrasonography with virtual histology: Atherosclerosis. 2010 Oct;212(2):528-33 Wood FO, Badhey N, Garcia B, Abdel-karim AR, Maini B, Banerjee S, Brilakis ES. NIRS-measured lipid core plaque in SVGs increases with increasing SVG age and is infrequent in anastomotic lesions.

Detection of lipid-core plaques by intracoronary near-infrared spectroscopy identifies high risk of periprocedural myocardial infarction: Goldstein JA, Maini B et al Circ Cardiovasc Interv. 2011 Oct 1;4(5):429-37 NIRS provides rapid, automated detection of extensive LCPs that are associated with a high risk of periprocedural MI, presumably due to embolization of plaque contents during coronary intervention

QUESTIONS ? HOW BIG IS BIG? WHEN DOES A LIPID POOL REACH A POINT OF NO RETURN? WILL WE BE ABLE TO PREVENT DISTAL EMBOLIZATION DUE TO INSTRUMENTATION? ARE LARGE LIPID POOLS RESISTANT TO STATIN THERAPY?

SHOULD THESE PATIENTS WITH LARGE LIPID POOLS BE ON LIFELONG DAPT? IS RESIDUAL LIPID BEHIND THE STENT/PLAQUE PROTRUSION A POOR PROGNOSTIC MARKER? SHOULD WE BE SCAFFOLDING THEM WITH BIOABSORBABLE STENTS? WOULD CETP INHIBITORS HOLD ANY PROMISE?

IS THIS VULNERABLE PLAQUE?