Table Of ContentSpringer Japan KK
y. Saijo, A.F.W. van der Steen (Eds.)
Vascular Ultrasound
With 156 Figures, Including 28 in Color
Yoshifumi Saijo, M.D., Ph.D.
Department of Medical Engineering and Cardiology
Institute of Development, Aging and Cancer, Tohoku University
4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
Antonius Franciscus Wilhelmus van der Steen, Ph.D.
Thorax Center, Erasmus Medical Center Rotterdam
PO Box 1738, 3000 DR Rotterdam, The Netherlands
ISBN 978-4-431-68003-1
Library of Congress Cataloging-in-Publication Data
Vascular Ultrasound I [edited by] Y. Saijo, A.F. W. van der Steen.
p.;cm.
Includes index.
ISBN 978-4-431-68003-1 ISBN 978-4-431-67871-7 (eBook)
DOI 10.1007/978-4-431-67871-7
1. Blood-vessels--Ultrasonic imaging. 1. Saijo, Y. (Yoshifumi), 1962-II. Steen, A. F.
W. van der (Antonius Franciscus Wilhelmus), 1964-
[DNLM: 1. Cardiovascular Diseases--ultrasonography. 2. Ultrasonography,
Interventional--methods. WG 141 V331 2003]
RC691.6.U47V3752003
616.1 '307543--dc22
2003057290
Printed on acid-free paper
© Springer Japan 2003
Originally published by Springer-Veriag Tokyo in 2003
Softcover reprint ofthe hardcover Ist edition 2003
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SPIN: \0855423
To those who inspired us
Motonao Tanaka
Klaas Born
And to our families
Terumi
Naoya
Fumika
Minjon
Inez
OUf yet-to-be-born child
Foreword
I have been asked to write a short foreword to this book. As a matter of fact the
two editors have nicely and candidly introduced themselves and their book in
their preface, to which I have little to add. It is true that the format and the content
of this monograph differ in many aspects from those of a conventional "textbook
ofIVUS." Not only is this monograph a glimpse into the future, but many of the
chapters have been written by bioengineers, deeply involved in the clinical field.
The motto of this monograph could be "High tech of the future, but down to
Earth." I believe that this quite unique monograph will be an eye-opener for many
interventional cardiologists who should pay attention to some of the new
developments and IVUS tools, which are going to playa pivotal role in the
assessment of new physio-pathology of the coronary and peripheral vasculature
and circulation. I can only commend the two editors and their coauthors for their
remarkable achievement. Their work will be appreciated by the readers of this
book, whatever their discipline.
Patrick W. Serruys, M.D., Ph.D., FACC, FESC
Professor in Interventional Cardiology
Thorax Center
Erasmus Medical Center Rotterdam
The Netherlands
VII
Preface
About Ton:
It was October 1993 in Innsbruck, Austria, that Dr. van der Steen and 1 first met
each other at the 8th Congress of the European Federation of Societies for
Ultrasound in Medicine and Biology (EFSUMB). At that time, we presented two
different papers on acoustic microscopy in the same session. After the session
with some constructive discussions and comments, he might have said to me, "I
am going to the department of cardiology, Erasmus University, Rotterdam." As
my understanding of English conversation was poor (it is not at all excellent even
now), 1 misunderstood him to be a cardiologist with great knowledge of ultrasound
engineering. This really great "cardiologist" made me study very hard about
ultrasound engineering and signal processing besides my clinical activities in
cardiology, especially coronary interventional therapy and echocardiography, ever
since that meeting.
Yoshifumi Saijo
About Yoshi:
When 1 started to work on acoustic microscopy of biological tissue, 1 found out
that there was a group in Sendai, Japan, that was doing seminal work in this field.
My admiration grew for the technical development that they had achieved. By the
time I first met somebody from the Sendai group, 1 had done extensive studies on
the effects of tissue preparation. During a session at the EFSUMB in 1993 in
which Dr. Saijo presented, my criticism of his handling of tissue was more
aggressive than I had intended. To my surprise J had a very pleasant discussion
with him after the session. Since that date 1 have been running into him at all the
technical ultrasound conferences. When 1 asked him years later why he attended
all those meetings and how he could cope with simultaneously running a cardiology
practice and keeping up with engineering, his reply was simply: "You can do it, so
why shouldn't I?" It was only then that 1 realized that he had thought that 1 was a
cardiologist as well.
Ton van der Steen
IX
x
Around the beginning of this century the editors started realizing that a cardiologist
working in basic ultrasonics and an engineer in applied physics, working in a
clinical cardiology setting, may be able to bridge the gap between fundamental
ultrasonics and clinical application. It was the beginning of the idea of publishing
this international and interdisciplinary monograph entitled Vascular Ultrasound.
Over the last decades, percutaneous coronary intervention therapy has developed
dramatically, and the number of cases has nearly doubled year by year. Besides
percutaneous balloon angioplasty, "new devices" for interventional therapy such
as the cutting balloon, directional coronary atherectomy, and stents, being bare,
radioactive, or drug coated, have become clinically available. Also, the scale of
diagnostic devices has been extended continuously. Coronary angiography using
X-ray was the main diagnostic method in the age of classical coronary intervention.
In the late 1980s, coronary angioscopy was clinically applied first as a new imaging
device, although it was not successful around that period because it only visualized
the surface morphology of the arterial wall. The clinical significance of
intravascular ultrasound (IVUS) was first reported in 1989. It has advantages over
angiography and angioscopy because IVUS can visualize and assess the pathology
beneath the surface of coronary arteries. Today, IVUS has achieved its position as
a useful clinical tool to measure both the inner and outer diameter of coronary
arteries and the expansion of the stent to the arterial wall.
In the field of vascular biology, the concept that inflammation plays an important
role in the progression of atherosclerosis has become very popular. Development
of molecular biology together with classical pathology has proven this concept in
vitro. Acute myocardial infarction was believed to be the end stage of severe
narrowing of the coronary arteries. In 1985 Dr. MJ. Davies and Dr. E. Falk reported
independently the epoch-making discovery that plaque rupture was the main cause
of acute coronary syndrome, and that the plaque that ruptures usually is not the
most narrowing or culprit lesion. Not only the autopsy specimen, but also clinical
findings have shown that plaque rupture leads to acute myocardial infarction. The
great progress of vascular biology in the 1990s finally made clinical cardiologists
believe that inflammation and its relation to plaque rupture are the main cause of
acute coronary syndrome, initiating the hunt for the "vulnerable plaque".
This book contains five sections. In the first section a pathologist, a cardiologist,
and a vascular surgeon disclose their wish list with regards to vascular ultrasound.
In the second section the current technical potential of IVUS is illustrated. The
third section describes clinical applications ofIVUS, including diagnosis, therapy
guidance, and vulnerable plaque detection. In the final sections, carotid ultrasound
scanning is addressed, followed by low-and high-frequency acoustic microscopy
of vascular tissue.
XI
The editors intend this monograph to introduce novel techniques to medical doctors
and researchers in the field of medical ultrasound, thus narrowing the gap between
fundamental and clinically applied vascular ultrasound.
Yoshifumi Saijo, M.D., Ph.D.
Cardiologist
Department of Medical Engineering and Cardiology
Institute of Development, Aging and Cancer
Tohoku University
Sendai, Japan
Antonius Franciscus Wilhelmus van der Steen, Ph.D.
Professor in Biomedical Engineering in Cardiology
Thorax Center
Erasmus Medical Center Rotterdam
The Netherlands
Contents
Foreword .......................................................................................................... VII
Preface ................................................................................................................ IX
Part 1: Introduction to Vascular Ultrasound
What Do Cardiologists Want from Vascular Ultrasound?
H. KANEDA, Y. HONDA, P.G. YOCK, and PJ. FITZGERALD ................................................ 3
What Pathologists Want from Vascular Ultrasound
G. P ASTERKAMP and E. F ALK ........................................................................................ 28
What Vascular Surgeons Want from Vascular Ultrasound
M.R.H.M. VAN SAMBEEK and H. VAN URK ................................................................... 44
Part 2: The Technical Potential of IVUS
History and Principles
N. BaM, A.F.W. VAN DER STEEN, and C.T. LANCEE ...................................................... 51
High Frequency IVUS
T.-J. TEO ...................................................................................................................... 66
Quantitative IVUS Flow Estimation
A.F.W. VAN DER STEEN, F.A. LUPOTTI, F. MASTIK, E.!. CESPEDES, S.G. CARLIER,
W. LI, P.W. SERRUYS, and N. BaM .............................................................................. 79
Intravascular Elastography: From Idea to Clinical Tool
C.L. DE KORTE, F. MASTIK, IA. SCHAAR, P.w. SERRUYS, andA.F.W. VAN DER STEEN ........ 91
3D ICUS
N. BRUINING, R. HAMERS, P.w. SERRUYS, and IR.T.C. ROELANDT ............................. 106
Coronary 3-D Angiography, 3-D Ultrasound and Their Fusion
CJ. SLAGER, II WENTZEL, IC.H. SCHUURBIERS, IA.F. OOMEN, FJ.H. GUSEN,
R. KRAMS, WJ. VAN DER GIESSEN, P.W. SERRUYS, and PJ. DE FEYTER ........................ 121
Shear Stress and the IVUS Derived Vessel Wall Thickness
II WENTZEL, C. CHENG, R. DE CRaM, N. STERGIOPULOS, P.W. SERRUYS,
CJ. SLAGER, and R. KRAMS ....................................................................................... 148
XIII
XIV
Part 3: Clinical Applications of IVUS
What Have We Learned from 10 Years Peripheral Intravascular Ultrasound?
E.1. GUSSENHOVEN, T. HAGENAARS, lA. VAN ESSEN, T.C. LEERTOUWER,
1 HONKOOP, and N. BOM ........................................................................................... 167
Intra-Coronary Ultrasound to Guide Percutaneous Coronary Intervention
1 LIGTHART and P.1. DE FEYTER ................................................................................. 184
Detection of Vulnerable Coronary Plaque; The Emerging Role of
Intravascular Ultrasound
P. SCHOENHAGEN, E.M. Tuzcu, and S.E. NISSEN ........................................................ 199
Diagnosis of Vulnerable Plaques in the Cardiac Catheterization Laboratory
lA. SCHAAR, A.F.W. VAN DER STEEN, C.A. ARAMPATZIS, R. KRAMS, C.1. SLAGER,
A.G. TEN HAVE, S.W. VAN DE POLL, F.1. GIJSEN, J.1. WENTZEL, P.1. DE FEYTER,
and P.W. SERRUYS ..................................................................................................... 220
Part 4: Carotid Scanning
Conventional and Compound Scanning of the Carotid Artery
J.E. WILHJELM ........................................................................................................... 237
3D Imaging of the Carotid Arteries
A. FENSTER and D.B. DOWNEY .................................................................................. 254
Carotid Elasticity Measurements
A.P.G. HOEKS, 1.M. MEINDERS, and R. DAMMERS ...................................................... 269
Cross-Sectional Imaging of Elasticity Around Atherosclerotic Plaque with
Transcutaneous Ultrasound
H. KANAI, H. HASEGAWA, and Y. KOIWA .................................................................... 284
Part 5: Acoustic Microscopy of Vascular Tissue
Quantitative Backscatter Acoustic Microscopy (30 to 50MHz)
S.L. BRIDAL ............................................................................................................... 299
Evaluation of Atherosclerosis by Acoustic Microscopy
Y. SAIJO ..................................................................................................................... 310
Key Word Index ............................................................................................... 327
