JACC: CARDIOVASCULAR INTERVENTIONS

VOL. 7, NO. 6, 2014

ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER INC.

ISSN 1936-8798/$36.00 http://dx.doi.org/10.1016/j.jcin.2013.08.021

IMAGES IN INTERVENTION

Detection of Angioscopic Yellow Plaque by Intracoronary Near-Infrared Spectroscopy Yasunori Ueda, MD, PHD,* Koshi Matsuo, MD,* Yuji Nishimoto, MD,* Ryuta Sugihara, MD,* Mayu Nishio, MD, PHD,* Akio Hirata, MD, PHD,* Mitsutoshi Asai, MD, PHD,* Takayoshi Nemoto, MD,* Ayaka Murakami, BS,* Kazunori Kashiwase, MD, PHD,* James E. Muller, MD,y Kazuhisa Kodama, MD, PHD* Osaka, Japan; and Burlington, Massachusetts

Angioscopy can detect vulnerable, lipid-rich coronary plaques (LRPs), but it requires removal of blood plus expert technique and interpretation (1,2). We studied the use of a near-infrared spectroscopy (NIRS) intravascular ultrasound (IVUS) catheter (3), which does not require

blood removal, to detect LRP identified by angioscopy. An angiogram (Fig. 1A) shows the mid-left anterior descending artery with a stent. Angioscopy shows a proximal, yellow LRP with a white fibrotic plaque under the stent. Through blood, NIRS

Figure 1. Detection of LRP by Angioscopy and NIRS-IVUS (A) The target lesion evaluated by angiography, angioscopy, and near-infrared spectroscopy (NIRS): The angiogram shows the target lesion in the mid-left anterior descending coronary artery where the stent was implanted. Angioscopy shows a proximal yellow lipid-rich plaque (LRP) with a white fibrotic plaque under the stent. NIRS detected the LRP (yellow halo on the intravascular ultrasound [IVUS] image), and IVUS detected the stent. (B) Angioscopic images throughout the vessel: Angioscopy detected yellow plaque at locations 2, 3, and 4 with white thrombus at 3 (Online Video 1). (C) Chemogram of the vessel: The chemogram shows LPR as a yellow area at locations 2, 3, and 4, with no LRP (shown as a red area) at 1 and 5, coinciding with the angioscopic findings. (D) NIRS-IVUS images throughout the vessel: NIRS-IVUS detected LRP (yellow) at locations 2, 3, and 4, with no LRP (red) at 1 and 5, coinciding with angioscopic findings (Online Video 2). NIRS-IVUS images also show the direction of the LPR on the IVUS image. The numbers in panels B, C, and D show the locations on the angiogram in panel A.

From the *Cardiovascular Division, Osaka Police Hospital, Osaka, Japan; and yInfraReDx, Inc., Burlington, Massachusetts. Dr. Muller is the chief medical officer of InfraReDx; and has equity ownership in the company. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received August 19, 2013; accepted August 31, 2013.

detected the LRP (yellow halo on the IVUS image), and IVUS detected the stent. Throughout the artery, angioscopy (Fig. 1B, Online Video 1) detected yellow plaque at locations 2, 3, and 4, with white thrombus at 3. NIRS-IVUS (Fig. 1C, Online Video 2) and a chemogram (Fig. 1D) detected LRP (yellow) at

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Ueda et al. Detection of Yellow Plaque by NIRS

locations 2, 3, and 4, with no LRP (red) at 1 and 5, coinciding with angioscopic findings. The NIRS-IVUS catheter, which is easy to use and quantitative, might be a valuable tool to detect vulnerable plaques. Reprint requests and correspondence: Dr. Yasunori Ueda, Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035 Japan. E-mail: [email protected]. REFERENCES

1. Ueda Y, Ohtani T, Shimizu M, Hirayama A, Kodama K. Assessment of plaque vulnerability by angioscopic classification of plaque color. Am Heart J 2004;148:333–5.

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2. Ohtani T, Ueda Y, Mizote I, et al. Number of yellow plaques detected in a coronary artery is associated with future risk of acute coronary syndrome: detection of vulnerable patients by angioscopy. J Am Coll Cardiol 2006;47: 2194–200. 3. Madder RD, Goldstein JA, Madden SP, et al. Detection by near-infrared spectroscopy of large lipid core plaques at culprit sites in patients with acute ST-segment elevation myocardial infarction. J Am Coll Cardiol Intv 2013;6:838–46.

Key Words: angioscopy - lipid-rich plaque - near-infrared spectroscopy. APPENDIX For accompanying videos, please see the online version of this paper.

Detection of angioscopic yellow plaque by intracoronary near-infrared spectroscopy.

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