Intracoronary dual-modal optical coherence tomography-near-infrared fluorescence structural-molecular imaging with a clinical dose of indocyanine green for the assessment of high-risk plaques and stent-associated inflammation in a beating coronary artery

Sunwon Kim, Min Woo Lee, Tae Shik Kim, Joon Woo Song, Hyeong Soo Nam, Han Saem Cho, Sun Joo Jang, Jiheun Ryu, Dong Joo Oh, Dae Gab Gweon, Seong Hwan Park, Kyeongsoon Park, Wang Yuhl Oh, Hongki Yoo, Jin Won Kim

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Aims Inflammation plays essential role in development of plaque disruption and coronary stent-associated complications. This study aimed to examine whether intracoronary dual-modal optical coherence tomography (OCT)-near-infrared fluorescence (NIRF) structural-molecular imaging with indocyanine green (ICG) can estimate inflammation in swine coronary artery. Methods and results After administration of clinically approved NIRF-enhancing ICG (2.0 mg/kg) or saline, rapid coronary imaging (20 mm/s pullback speed) using a fully integrated OCT-NIRF catheter was safely performed in 12 atheromatous Yucatan minipigs and in 7 drug-eluting stent (DES)-implanted Yorkshire pigs. Stronger NIRF activity was identified in OCT-proven high-risk plaque compared to normal or saline-injected controls (P = 0.0016), which was validated on ex vivo fluorescence reflectance imaging. In vivo plaque target-to-background ratio (pTBR) was much higher in inflamed lipid-rich plaque compared to fibrous plaque (P < 0.0001). In vivo and ex vivo peak pTBRs correlated significantly (P < 0.0022). In vitro cellular ICG uptake and histological validations corroborated the OCT-NIRF findings in vivo. Indocyanine green colocalization with macrophages and lipids of human plaques was confirmed with autopsy atheroma specimens. Two weeks after DES deployment, OCT-NIRF imaging detected strong NIRF signals along stent struts, which was significantly higher than baseline (P = 0.0156). Histologically, NIRF signals in peri-strut tissue co-localized well with macrophages. Conclusion The OCT-NIRF imaging with a clinical dose of ICG was feasible to accurately assess plaque inflammation and DES-related inflammation in a beating coronary artery. This highly translatable dual-modal molecular-structural imaging strategy could be relevant for clinical intracoronary estimation of high-risk plaques and DES biology.

Original languageEnglish
Pages (from-to)2833-2844
Number of pages12
JournalEuropean Heart Journal
Volume37
Issue number37
DOIs
Publication statusPublished - 2016 Oct 1

Keywords

  • Atherosclerosis
  • Imaging
  • Inflammation
  • Plaque
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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