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Intravascular imaging of atherosclerosis

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1 Thoraxcenter Biomedical Engineering, Erasmus MC Rotterdam, the Netherlands; 2 Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. Corresponding e-mail:

Intravascular ultrasound (IVUS) is a technology that uses an ultrasound element on the tip of a catheter[1, 2]. This catheter is advanced through the groin into the coronary arteries. In this way a tomographic image of the vascular wall and atherosclerotic plaques can be produced. The steering of the ultrasound beam can be done by mechanically rotating a single ultrasound transducer, or electronically, using an array of 64 elements in the tip. Historically is has been used to assess the level of occlusion, the atherosclerotic plaque burden and the native size of the vessel. This information can be used to decide to treat or not and to determine the diameter and length of the stent to be used for treatment. It has also been used extensively to determine if the stent was well deployed. The composition and morphology of an atherosclerotic lesion are currently considered more important determinants of acute coronary ischemic syndromes that the degree of stenosis3. When a lesion is unstable, it can rupture and cause an acute thrombotic reaction. An unstable plaque can be characterized by a lipid core that is covered by a thin fibrous cap, which has been locally weakened by inflammatory cells. The last decade serious effort has been put in developing IVUS towards identifying these unstable plaques. This lecture will focus on the development of measuring the elastic properties of the plaque as a marker for plaque instability4 and measuring the vascularization in the plaque5, which plays an important role in the pathogenesis of unstable plaque. Furthermore the role of combined ultrasound/light catheters will be discussed[6, 7]. These will allow to image the luminal plaque at a resolution of around 10 ┬Ám, while maintaining the full overview. Furthermore photoacoustics and combination of NIR spectroscopy and imaging will be possible. Technology development in the elements, the echomachines and the signal processing will be presented as well as their validation and the role of IVUS to provide imaging biomarkers in natural history studies and trials for the development of new cardiovascular drugs[8, 9].


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