PROBLEM

Insufficient treatment of vulnerable plaque in the coronary arteries leads to costly and health impairing re-interventions

In 2015, Coronary Artery Disease (CAD) affected 110 million people1 and resulted in 8.9 million deaths worldwide2.

CAD occurs when the arteries that supply the heart muscle with blood become hardened and narrowed, due to the build-up of cholesterol and plaque on their inner walls.

Current treatment: To open the blocked coronary arteries patients can be treated using Percutaneous Coronary Intervention (PCI).

Worldwide, there are 4 million PCI’s performed each year.

12% of patients who have PCI, need another intervention within 12 months of their initial procedure3,4,5.

50% of these re-interventions 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.

Total costs for these re-interventions are estimated at $2.4 billion. If these vulnerable plaques are treated in an early stage, repeat interventions could be prevented.

SOLUTION

Kaminari Medical combines Intravascular Ultrasound (IVUS) and Photoacoustic (PA) Imaging, providing better information on both plaque location and composition.

Intra vascular Ultrasound (IVUS)

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

IVUS: Imaging of the wall structure

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Photoacoustic (PA) imaging

Photoacoustic (PA) imaging capitalises 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 characterised.

PA: Vulnerable Plaque (yellow)

IVUS + PA = IVPA

Imaging coronary wall structure + plaque composition.

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

IVPA: structure & composition

INTRAVASCULAR PHOTOACOUSTIC (IVPA) 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). 7,8,9



STATUS

  • Proof-of-Concept
    Intracoronary lipid imaging demonstrated in vivo in swine6

  • Development

  • 2022: First in Human study

ReFERENCES

  1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet.
  2. GBD 2015 Mortality and Causes of Death Collaborators. (2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet.
  3. Stone et al. (2011). A prospective natural-history study of coronary atherosclerosis. NEJM.
  4. Stolker et al. (2012). Repeat revascularization after contemporary percutaneous coronary intervention. Circ Cardiovasc Interv.
  5. Taniwaki et al. (2014). 4-Year clinical outcomes and predictors of repeat revascularization in patients treated with new-generation drug-eluting stents. J. Am. Coll. Cardiol.
  6. Iskander-Rizk et al. (2019). In vivo intravascular photoacoustic imaging of plaque lipid in coronary atherosclerosis. Ultrasound Med Biol.
  7. Wu et al. (2017). Real-time volumetric lipid imaging in vivo by intravascular photoacoustics at 20 frames per second. Biomed. Opt. Express.
  8. Daeichin et al. (2016). Frequency analysis of the photoacoustic signal generated by coronary atherosclerotic plaque. Ultrasound in Med. & Biol.
  9. Daeichin et al. (2016). A broadband polyvinylidene difluoride-based hydrophone with integrated readout circuit for intravascular photoacoustic imaging. Ultrasound in Med. & Biol.