Abstract WMP39: Laser Angioscopy in Carotid Artery Disease: Imaging Findings and Histopathological Correlation

• DOI: 10.1161/str.50.suppl_1.wmp39
• Publication Date: 2019-01-30T09:26:49Z
• Authors: Luis E Savastano; David Gordon; Ankur Bhambri; Aditya Pandey; Joshua Cockrum; B. Gregory Thompson; Adithya Reddy; Eric Seibel
• Keywords: Angioscopy; Fibrous cap; Stroke

Our understanding and management of carotid artery disease has largely relied on angiography, US MR. However, existing modalities cannot accurately identify the spectrum thrombogenic lesions vascular surface or reliably detect structural markers instability. Thus, natural history different histopathological hallmarks advanced complicated plaques is unknown, many patients with culprit substenotic are misdiagnosed cryptogenic stroke. An intraluminal approach to directly inspect endovascular surfaces at unprecedented resolutions would enable detailed analysis identification root cause carotid-related strokes. A scanning fiber angioscope (SFA), a high-definition 1.2-mm forward-viewing camera that generates videos by spirally low-power laser beams, was developed for clinical use employed analyze ex vivo human arteries (n=95) endarterectomized (n=20). Specimens were then imaged micro-CT, all diagnostic tests obtained in undergoing revascularization accessed. Imaging findings validated histomorphological >300 lesions, an angioscopic classifier atherosclerosis generated. Full-color 30Hz resolution >200,000 pixels generated from entire circumference specimens depth-of-focus larger than 5cm saline solution. The ability anatomy unparalleled detail allowed early, intermediate, complex atherosclerotic including ulceration fibrotic cap, excavation necrotic core leading pseudolumens, intimal flaps, exposed lumen, erosions, recent remote hemorrhages, luminal thrombus, eruptive calcified nodules sheaths plates. SFA offers direct view endoluminal potential revolutionize research, diagnosis, prognosis image-guided therapy atherosclerosis.