title: Clinical Characterization of Coronary Atherosclerosis With Dual-Modality OCT and Near-Infrared Autofluorescence Imaging.
abstract: The authors present the clinical imaging of human coronary arteries in vivo using a multimodality optical coherence tomography (OCT) and near-infrared autofluorescence (NIRAF) intravascular imaging system and catheter.
  
  
  
  Although intravascular OCT is capable of providing microstructural images of coronary atherosclerotic lesions, it is limited in its capability to ascertain the compositional/molecular features of plaque. A recent study in cadaver coronary plaque showed that endogenous NIRAF is elevated in necrotic core lesions. The combination of these 2 technologies in 1 device may therefore provide synergistic data to aid in the diagnosis of coronary pathology in vivo.
  
  
  
  We developed a dual-modality intravascular imaging system and 2.6-F catheter that can simultaneously acquire OCT and NIRAF data from the same location on the artery wall. This technology was used to obtain volumetric OCT-NIRAF images from 12 patients with coronary artery disease undergoing percutaneous coronary intervention. Images were acquired during a brief, nonocclusive 3- to 4-ml/s contrast purge at a speed of 100 frames/s and a pullback rate of 20 or 40 mm/s. OCT-NIRAF data were analyzed to determine the distribution of the NIRAF signal with respect to OCT-delineated plaque morphological features.
  
  
  
  High-quality intracoronary OCT and NIRAF image data (>50-mm pullback length) were successfully acquired without complication in all patients (17 coronary arteries). The maximum NIRAF signal intensity of each plaque was compared with OCT-defined type, showing a statistically significant difference between plaque types (1-way analysis of variance, p < 0.0001). Interestingly, coronary arterial NIRAF intensity was elevated only focally in plaques with a high-risk morphological phenotype (p < 0.05), including OCT fibroatheroma, plaque rupture, and fibroatheroma associated with in-stent restenosis.
  
  
  
  This OCT-NIRAF study demonstrates that dual-modality microstructural and fluorescence intracoronary imaging can be safely and effectively conducted in human patients. Our findings show that NIRAF is associated with a high-risk morphological plaque phenotype. The focal distribution of NIRAF in these lesions furthermore suggests that this endogenous imaging biomarker may provide complementary information to that obtained by structural imaging alone.
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Giovanni J
authors.initials: GJ
authors.lastname: Ughi
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Edouard
authors.initials: E
authors.lastname: Gerbaud
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Gardecki
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Fard
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Hamidi
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Paulino
authors.initials: P
authors.lastname: Vacas-Jacques
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Mireille
authors.initials: M
authors.lastname: Rosenberg
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Research Center and Cardiology Division, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts. Electronic address: fjaffer@mgh.harvard.edu.
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts; Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Harvard-MIT Health Sciences and Technology, Boston, Massachusetts. Electronic address: gtearney@partners.org.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Tearney
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D061848:Optical Imaging / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012422:Rupture, Spontaneous; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: first-in-human; multimodality imaging; near-infrared fluorescence; optical coherence tomography