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Minimally Invasive Image Guided Therapy
This document summarizes a presentation about minimally invasive image-guided cardiovascular therapies. It discusses various catheter-based imaging technologies like intravascular ultrasound (IVUS) and optical coherence tomography (OCT) that can provide images of the inside of blood vessels and heart structures. These emerging technologies are able to characterize plaque and identify vulnerable plaques through methods like spectroscopy and tissue characterization. The document also discusses potential applications of these imaging technologies in areas like valvular interventions through guidance and visualization of procedures. In general, it promotes the benefits of minimally invasive image-guided approaches for cardiovascular applications.
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Minimally Invasive Image Guided Therapy
- 1. Minimally Invasive Image-GuidedTherapy: Cardiovascular Applications Kendall R. Waters, PhD [email protected] Presented on Mar. 4, 2010 Triple Ring Technologies, Newark, CA MedTech Frontiers Series www.tripleringtech.com
- 2. Original Image fromiStockPhoto.com Minimally Invasive Surgery without Image Guidance is Surgery Blindfolded
- 3. Animation from iStockPhoto.com 72BPM, 100,000 Day, 2.5 Billion Lifetime CVD: Affect over 86 Million Americans, Estimated direct and indirect costs for 2010 are $500 Billion
- 4. A silhouette missespart of the picture Pilobolus Video from YouTube.com Pilobulus @ 2007 Oscars
- 5. Is the standardgood enough? Angiograms are Silhouettes Contrast Angiography: Shadows hide some details
- 6. Is the standardgood enough? Poor Soft Tissue Contrast X-Ray: Poor Tissue Contrast
- 7. Coronary heart diseaseis the largest major killer Unable to predict which plaques will lead to clinical events Image from Northwest Houston Heart Center (www.houstonheartcenter.com) CHD: Largest killer, >17M pts $177B direct/indirect costs 2006 Unable to predict which plaques lead to events
- 8. Imaging inside thecoronary arteries Image from ShutterStock.com Catheter-Based Imaging: Retrograde approach
- 9. Courtesy of SeanMadden, PhD, InfraReDx Catheter-Based Imaging: Retrograde approach
- 10. Synthetic Aperture ArrayCatheter Mechanically Rotating Catheter Array Catheter: Ease of Use (No flushing required) Mechanically Rotating Catheters (US, OCT, NIRS): Image Quality
- 11. The Watch Childof Vulnerable Plaques Poster an artery get clogged Lipid-Rich or Necrotic Core ~25% Thin Fibrous Cap Courtesy of Geoff Vince, PhD, Volcano Corp <65 µm Normal > Constrictive Remodeling > Core Development > Rupture > Occlusion > MI Thin Cap Fibroatheroma: Thin Cap + Necrotic Core Content
- 12. IVUS this avulnerable plaque? Is image ... or Hurricane Map Zoomed View of a Diseased Vessel with Array Catheter Modest Spatial Resolution > Poor Tissue Differentiation Segmentation > Plaque Burden + Lumen Area > Advanced Analysis
- 13. Do advanced algorithmshelp? Volcano VH-IVUSTM BSC iMAP Fibrosis Necrotic Core Necrotic Fibrotic Fibro-Fatty Calcification Lipidic Calcified VH-IVUS > Spectral Parameters > Statistical Classification > 4 Categories > Colorized iMAP > Spectral Signatures > Statistics Classification > 4 Categories > Colorized PROSPECT Trial > Plaque Burden & Necrotic Core & Minimum Lumen Area
- 14. Will emerging technologies find plaques that lead to clinical events?
- 15. OCT provides strikingdetail Vulnerable ? but has limited penetration OCT > 15/30 um resolution > 1-2 mm penetration > Minimum Lumen Area 0')(.1'2+- Plaque Characterization > Fibrous (Signal Rich Homogeneous) & Lipid (Signal Poor with Diffuse Borders)
- 16. IVUS + OCTCombination IVUS OCT Penetration Fine Structural Detail Courtesy of Dr. Brian Courtney MD and Brian Liang, Sunnybrook Health Sciences Centre,Toronto, CA Sunnybrook + Colibri > IVUS + OCT > Penetration + Lumen Detail
- 17. Spectroscopy = ChemicalComposition Pullback Distance Angle Limited Spatial Resolution Courtesy of Sean Madden, PhD, InfraReDx NIRS > Spectroscopy = Chemical Composition > Lipid Content Limited Penetration and Resolution “This is the first device that can help assess the chemical makeup of coronary artery plaques and help doctors identify those of particular concern.” -- FDA
- 18. NIRS + IVUSCombination NIRS + IVUS Chemogram IVUS Long View Chemical Composition + Structural Detail Courtesy of Sean Madden, PhD, InfraReDx InfraReDx > NIRS + IVUS > Composition + Structure
- 19. A Much Better(HD) IVUS Very Good Structural Detail Better image quality. IVUS with near-optical resolution. Device simplicity.
- 20. Some valves becomeleaky 1% to 5 % mortality rate Image from Consultants in Cardiology (www.cicmd.com)
- 21. Can imaging help? Soft Tissue Imaging Image from the GE Healthcare Vivid Image Library Soft Tissue Structure Color Flow > MVR Jets
- 22. Can imaging help? Precision Guidance Image from Siemens Ultrasound PFO Closure mm Length Scale
- 23. Alignment of DeliveryCatheter in LA Can imaging help? Real-Time 3D Image from presentation by J. D. Carroll, MD at TCT 2009 Matrix Array Technology > RT3D Catheter > Transseptal > MV
- 24. Can imaging help? Reduced X-Ray Dose Procedure Length > X-Rays (Pt & Operator) US > Non-Ionizing > Reduce X-Ray Need
- 25. Imaging from insidethe heart Image from ShutterStock.com Access > Right Side > IVC & SVC
- 26. Image from Haoand Hongo, EPLab Digest 5(4) (2005). (www.eplabdigest.com) AcuNav > Steerable > 8-10F > 5-10MHz
- 27. Imaging from theesophagus Access > Eso > Proximity
- 28. Imaging from theesophagus Images from Toronto General Hospital Department of Anesthesia and Pain Management
- 29. Figure 6. 2D-and 3D-TEE guidance of percutan balloon valvuloplasty. (A) 2D-TEE demonstrating Image From Philips Healthcare (www.medical.philips.com) Image from Hudson et al., J Interv Cardiol 21(6) (2008). configuration of the anterior mitral valve leaflet (a typical of rheumatic mitral stenosis. (B) 3D volum Figure 1. Comparison of echocardiographic transducers. (A) ICE tion of an en face view of the restricted mitral valv Steerable > Matrix Array > Multi-plane transducer (AcuNav,TM Siemens, Mountain View, CA, USA). (B) Conventional two-dimensional multiplane TEE transducer. (C) 3D the left atrium demonstrating a narrowed mitral o commissural fusion (arrowheads). (C) 2D X-Plane matrix array TEE (X7-2t, Philips, Andover, MA, USA) transducer. atrial septum illustrating “septal tenting” (arrows) d puncture. (D) Live 3D-TEE guidance of the Inoue across the rheumatic mitral valve. (E) 3D-TEE view inflation across the rheumatic mitral valve. (F) 3D reconstruction demonstrating an enlarged mitral row) and split commissure (arrowhead). LA = left ventricle; RA = right atrium; RV = right ventricle ←−−−−−−−−−−−−−− −−−−−−−−−−−−−− Figure 4. Percutaneous ASD closure with an Amp cluder using 2D- and 3D-TEE guidance. (A) 2D-T small ASD (arrows). (B) Live 3D-TEE displaying of the ASD (arrow) from the left atrium, reveali with a long-axis twice the short-axis dimension. ( reconstruction with color Doppler demonstrating l ing across the ASD (arrow). (D) Live 3D-TEE of following deployment of the left atrial disk of a 1 Septal Occluder (arrowheads) with excellent vis delivery cable (arrow) through the ASD. (E) Live strating good positioning of ASD occluder follo
- 30. A Leaky MitralValve Normal Prolapse Image from Weill Cornell Medical College, Cardiothoracic Surgery (www.cornellheartsurgery.org) Normal Leaflets > One-way Flow Prolapse Leaflets > Leaky
- 31. We can visualizesoft tissue and blood flow Image from Philips Healthcare iE33 Echocardiography System Image Library Philips xPlane > Biplane TEE MVR > Mixing of Reds and Blues = Regurgitation
- 32. 3D Imaging ProvidesStunning Detail ... 3D TEE Photograph during Surgery Images from Ma et al., Chinese Med J 121(20) (2008). RT3D > Inferior View > Ruptured Chord Photograph > Ruptured Chord
- 33. ... and Roadmapsthe Repair Images from Ma et al., Chinese Med J 121(20) (2008). Quantitative Analysis > 3D Visualization > Specific Area Roadmap the Intervention
- 34. Image Guidance Devicesare Expensive Philips X7-2t Probe > Engineering Marvel > many $10Ks > outside CV system AcuNav > ~10 yrs old > $2500 disposable > Certified Resterilization
- 35. A Cardiologist ...and a Cast of Thousands Images from iStockPhoto.com and ShutterStock.com Complexity > Echo > Anasthesia > Surgeons
- 36. “Structural Heart DiseaseInterventions are to Cardiac Ultrasound what Percutaneous Coronary Interventions were to X-Ray Coronary Angiography.” John D. Carroll, MD Transcatheter Cardiovascular Therapeutics 2009
- 37. Acknowledgements All my colleagues at SVMI Sean Madden, PhD! InfraReDx, Boston, MA Geoff Vince, PhD! Volcano Corporation, San Diego, CA Brian Courtney, MD ! Sunnybrook Health Science Center,Toronto, Canada Chris Daft, PhD! Siemens Ultrasound, Mountain View, CA
- 38. Thank You Kendall R.Waters, PhD [email protected]