PROBLEM
Insufficient treatment of vulnerable plaque in the coronary arteries lead to costly and health impairing re-catheterizations


In 2015, Coronary Artery Disease (CAD) affected 110 million people and resulted in 8.9 million deaths worldwide. CAD occurs when the arteries that supply the heart muscle with blood become hardened and narrowed, due to the buildup of cholesterol and plaque on their inner walls.
Current treatment: To open the blocked coronary arteries, 80% of the patients are treated using a Percutaneous Coronary Intervention (PCI).

  • Of those patients treated with PCI, 12% get a re-catheterization within 12 months after the initial procedure.
  • Total costs for these re-catheterizations are estimated at $2.4 billion.
  • 50% of these re-catheterizations are caused by a type of stenosis called vulnerable plaques, that are formed by fat-filled cells with a thin cover. If the cover ruptures a blood clot is formed, blocking the coronary artery.
  • If these vulnerable plaques were treated in an early stage, repeat catheterizations could be prevented.

SOLUTION
Kaminari combines ultrasound (ivus) and photoacoustic (pa) imaging, providing better information on both plaque location and composition


ivus

IVUS: imaging of the wall structure

IntraVascular UltraSound (IVUS)
With the ultrasound technology in IVUS the walls of the blood vessels can be visualised. The catheter emits sound waves of 40-60 MHz. With the returning echo information, an image of the blood vessel wall can be made with 100 µm resolution.

pa

PA: vulnerable plaque (yellow)

PhotoAcoustic imaging (PA)
PA imaging capitalizes on the emission of an acoustic signal upon absorption of a short light pulse. Optical absorption enables chemical specificity, while the low acoustic scattering of tissue allows deep imaging. Therefore, lipids in the stenosis (plaque) can be characterized.
accolade
ivpa

IVPA: structure + composition

IVUS + PA = IVPA
Imaging coronary wall structure + plaque composition.


IntraVascular PhotoAcoustic (IVPA)
The Intravascular Photoacoustic (IVPA) catheter images the coronary wall while simultaneously identifying the plaque composition, thus leading to a better intervention strategy and clinical outcome.
ivpa-ivus

 

INTRAVASCULAR PHOTOACOUSTIC IMAGING.

 

(a) Principle of the technique; pulsed light (white arrow) gets absorbed by lipids (star) and emits an acoustic signal (blue wavefronts) that is registered by an ultrasound transducer on the catheter.

(b) Merged IVPA/US image of the plaque at locations with large plaque volume (the front surface of the volume in (c)).

(c) 3D reconstruction of pullback.

(d) Histology at the imaging plane corresponding to (b).

PROOF-OF-CONCEPT
Intracoronary lipid imaging demonstrated in vivo in swine