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Intravascular Ultrasound for Plaque Characterization Scott R. Smith Boston Scientific Corporation The 3rd Vulnerable Plaque Symposium March 16, 2002

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Intravascular Ultrasound for Plaque Characterization

Scott R. SmithBoston Scientific Corporation

The 3rd Vulnerable Plaque SymposiumMarch 16, 2002

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Who needs interventional diagnosis and treatment?

Population Size Annual Risk

Healthy People Huge <<1%

“Risk Factors” Really Big ~1%

Walking TimeBombs

Still quite a few >10%

Summary ofNational Heart, Lung, and Blood InstituteWorkshop on Cardiovascular Risk Assessment

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Diagnosis of Vulnerable Plaqueselecting a population

positive negative67%positive predictive value99%negative predictive value

likelyhood ratio


9% 5%

total unaffected

14%true positive false positive

1% 86% 87%false negative true negative



1890% 95%sensitivity specificity

10% 90%total affected

Total 100at risk 10treated 14saved 9unnecessary 5missed 1

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Plaque Structure

Courtesy of Dr. Renu VirmaniArmed Forces Institute of Pathology

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IVUS Plaque Imaging

Ruptured plaque

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Boston Scientific Imaging Systems

Atlantis SR Plus Catheter Galaxy IVUS System

Features & Intended Benefits• Tapered tip; 2.5 Fr. Crossing

Profile• High definition 40MHz IVUS

catheter. • 6F Guide Catheter


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Galaxy System Features and Intended Benefits

Time-Saving Features– Image Bookmarking– LongView™ longitudinal

measurements– Pullback sled

Enhanced Ease of Use– TraceAssist™ automatic lumen

trace function– Angiographic compatibility– Push button control

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Galaxy System Research Capabilities

Expanded Functionality– Digital image storage– Patient database– Pre/post intervention analysis.

RF Output– Direct Access to RF signal for

acquisition and analysis– Future plans may include direct

RF signal acquisition

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Imaging vs. Analysis


Rectified and Log compressed

Low passed filtered - 10MHz

One image vector

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Other Imaging Modalities

IVUS acousticimpedance

MRI protonrelaxation

Thermal temperatureOCT refractive

indexSpectroscopy chemical


IndependenceSpatial resolution Contrast

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• Intravascular Ultrasound currently widely used for intravascular imaging

• Broad potential for plaque volume measurement and tissue characterization

• Variety of research efforts aimed at improving tissue contrast and resolution

Thanks to: – Tat Jin Teo, PhD - BSC Imaging– Renu Virmani, MD - AFIP– Jay Kokate, PhD - BSC Applied Research