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      Optically Generated Ultrasound for Intracoronary Imaging

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          Abstract

          Conventional intravascular ultrasound (IVUS) devices use piezoelectric transducers to electrically generate and receive US. With this paradigm, there are numerous challenges that restrict improvements in image quality. First, with miniaturization of the transducers to reduce device size, it can be challenging to achieve the sensitivities and bandwidths required for large tissue penetration depths and high spatial resolution. Second, complexities associated with manufacturing miniaturized electronic transducers can have significant cost implications. Third, with increasing interest in molecular characterization of tissue in-vivo, it has been challenging to incorporate optical elements for multimodality imaging with photoacoustics (PA) or near-infrared spectroscopy (NIRS) whilst maintaining the lateral dimensions suitable for intracoronary imaging. Optical Ultrasound (OpUS) is a new paradigm for intracoronary imaging. US is generated at the surface of a fiber optic transducer via the photoacoustic effect. Pulsed or modulated light is absorbed in an engineered coating on the fiber surface and converted to thermal energy. The subsequent temperature rise leads to a pressure rise within the coating, which results in a propagating ultrasound wave. US reflections from imaged structures are received with optical interferometry. With OpUS, high bandwidths (31.5 MHz) and pressures (21.5 MPa) have enabled imaging with axial resolutions better than 50 μm and at depths >20 mm. These values challenge those of conventional 40 MHz IVUS technology and show great potential for future clinical application. Recently developed nanocomposite coating materials, that are highly transmissive at light wavelengths used for PA and NIRS light, can facilitate multimodality imaging, thereby enabling molecular characterization.

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          Most cited references41

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          2018 ESC/EACTS Guidelines on myocardial revascularization

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            A prospective natural-history study of coronary atherosclerosis.

            Atherosclerotic plaques that lead to acute coronary syndromes often occur at sites of angiographically mild coronary-artery stenosis. Lesion-related risk factors for such events are poorly understood. In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and gray-scale and radiofrequency intravascular ultrasonographic imaging after percutaneous coronary intervention. Subsequent major adverse cardiovascular events (death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina) were adjudicated to be related to either originally treated (culprit) lesions or untreated (nonculprit) lesions. The median follow-up period was 3.4 years. The 3-year cumulative rate of major adverse cardiovascular events was 20.4%. Events were adjudicated to be related to culprit lesions in 12.9% of patients and to nonculprit lesions in 11.6%. Most nonculprit lesions responsible for follow-up events were angiographically mild at baseline (mean [±SD] diameter stenosis, 32.3±20.6%). However, on multivariate analysis, nonculprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of 70% or greater (hazard ratio, 5.03; 95% confidence interval [CI], 2.51 to 10.11; P<0.001) or a minimal luminal area of 4.0 mm(2) or less (hazard ratio, 3.21; 95% CI, 1.61 to 6.42; P=0.001) or to be classified on the basis of radiofrequency intravascular ultrasonography as thin-cap fibroatheromas (hazard ratio, 3.35; 95% CI, 1.77 to 6.36; P<0.001). In patients who presented with an acute coronary syndrome and underwent percutaneous coronary intervention, major adverse cardiovascular events occurring during follow-up were equally attributable to recurrence at the site of culprit lesions and to nonculprit lesions. Although nonculprit lesions that were responsible for unanticipated events were frequently angiographically mild, most were thin-cap fibroatheromas or were characterized by a large plaque burden, a small luminal area, or some combination of these characteristics, as determined by gray-scale and radiofrequency intravascular ultrasonography. (Funded by Abbott Vascular and Volcano; ClinicalTrials.gov number, NCT00180466.).
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              Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging: a prospective, cohort study

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                Author and article information

                Contributors
                Journal
                Front Cardiovasc Med
                Front Cardiovasc Med
                Front. Cardiovasc. Med.
                Frontiers in Cardiovascular Medicine
                Frontiers Media S.A.
                2297-055X
                14 October 2020
                2020
                : 7
                : 525530
                Affiliations
                [1] 1Department of Cardiovascular Medicine, Royal Free NHS Foundation Trust , London, United Kingdom
                [2] 2Wellcome-Engineering & Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences , London, United Kingdom
                [3] 3Department of Medical Physics and Bioengineering, University College London , London, United Kingdom
                [4] 4William Harvey Cardiovascular Research Institute, Queen Mary University of London and Barts Health Centre London , London, United Kingdom
                Author notes

                Edited by: Christos Bourantas, Barts Health NHS Trust, United Kingdom

                Reviewed by: Erhan Tenekecioglu, University of Health Sciences, Turkey; Julien Bec, University of California, Davis, United States

                *Correspondence: Callum D. Little c.little@ 123456ucl.ac.uk

                This article was submitted to Cardiovascular Imaging, a section of the journal Frontiers in Cardiovascular Medicine

                †These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fcvm.2020.525530
                7591717
                33173786
                9af461b6-db67-4fa6-a163-84bb98f74af8
                Copyright © 2020 Little, Colchester, Noimark, Manmathan, Finlay, Desjardins and Rakhit.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 09 January 2020
                : 04 September 2020
                Page count
                Figures: 2, Tables: 0, Equations: 0, References: 41, Pages: 6, Words: 4371
                Funding
                Funded by: UCLH Biomedical Research Centre 10.13039/501100012317
                Funded by: Engineering and Physical Sciences Research Council 10.13039/501100000266
                Funded by: Wellcome Trust 10.13039/100004440
                Funded by: Royal Academy of Engineering 10.13039/501100000287
                Categories
                Cardiovascular Medicine
                Mini Review

                optical ultrasound,opus,optoacoustics,imaging,intravascular ultrasound,ivus

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