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Intravascular imaging modalities in coronary intervention: insights from 3d-printed phantom coronary models
Session:
Prémio do Jovem Investigador
Speaker:
Catarina Oliveira
Congress:
CPC 2023
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
25.1 Invasive Imaging and Functional Assessment
Session Type:
Sessão de Prémios
FP Number:
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Authors:
Catarina Simões De Oliveira; Tiago Rodrigues; Joana Brito; Pedro Alves da Silva; Beatriz Valente Silva; Ana Margarida Martins; Beatriz Garcia; Ana Abrantes; Miguel Raposo; Catarina Gregório; Helena Santiago; Daniela Ricardo; Fausto J. Pinto; João Silva Marques
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Several studies have been performed comparing luminal measurements between OCT and IVUS, with conflicting results. OCT is consistently found to have smaller minimal lumen area (MLA) measurements However, head-to-head comparative assessment in clinical practice is difficult. 3D-printing allows creation of anatomically correct models that have an appropriate elastic response and obey geometric scaling laws. Those models offer a unique opportunity to accurately assess the performance of intravascular imaging modalities. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Aims</strong>: Compare the diagnostic performance of intravascular imaging modalities using a standard 3D-printed coronary artery in a pulsatile flow realistic simulator. Assess if OCT underestimates intravascular dimensions against IVUS and explore potential causes and corrections.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> A standard realistic left main (LM) anatomy with an eccentric ostial left anterior descending artery (LAD) lesion was replicated using 3D-printing and connected to a realistic pulsatile flow simulator that was used in the cath lab. After provisional stenting and optimization according to a standardized study protocol, intravascular imaging was obtained. Modalities included 20MHz digital IVUS (IVUS), 60MHz rotational IVUS (IVUS HD) and OCT. Imaging data was blindly reviewed and analyzed offline. We assessed luminal area and diameters at standard locations for coregistration (distal LAD, MLA, distal LM bifurcation and LM stent edge).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: OCT measurements using auto-calibration significantly underestimated luminal areas when compared to IVUS (Mean diff 3.0<span style="font-family:Symbol">±</span>1,9mm<sup>2</sup>; p<0.0001) and IVUS HD (Mean diff 2.7<span style="font-family:Symbol">±</span>1,3mm<sup>2</sup>; p<0.0001). No significant differences were found between IVUS and IVUS HD luminal areas (p=0.921).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">A significant systematic dimensional error was found in OCT auto-calibration by comparing known reference diameter of guiding catheter (1.8mm) to measured mean diameter (1.68mm+-0.04mm) (p=0,004). By applying a correction factor based on the reference guiding catheter area to OCT (cOCT) the luminal areas became not significantly different compared to IVUS (p=0.058) and IVUS HD (p=0.07). Also, by applying a geometric correction to OCT dimensions resulted in clinically non-significant differences between cOCT, IVUS and IVUS HD diameters (Table).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Our findings suggest that automatic spectral calibration method for OCT is inaccurate and results in a systematic underestimation of luminal dimensions. Guiding catheter dimensions are easily and precisely known and can be used as reference for geometric calibration. When guiding catheter correction is applied the performance of OCT estimation of phantom model dimensions is significantly improved. These results may be clinically relevant and need to be clinically validated.</span></span></p>
Slides
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