thermography early clinical correlations
TRANSCRIPT
Thermographyearly clinical correlations
R Erbel, A Schmermund, M. Katz, F. Chwallek, D. Baumgart
Department of CardiologyUniversity Essen
Germany
Thermography Catheter Basket
Over the wire catheter systemPull back device with 0.5 mm/s
1 central blood thermo couple5 thermo couples3.3 F catheter 0.02 oC accuracy
0.2 oC
0.1 10mm
distal
proximal
mm100.1
0.2 oC
Temperature
36,436,636,8
3737,237,437,637,8
Blood TCTC1TC2TC3TC4TC5
Scan Distance
Study Aim Assessment of• Temperature recording• Steerability of catheter system• QCA of coronary arteries• Pull back recording, Endosonics device• Practicability• Safety
Clinical History of Patients
• 12 patients included• 9 male, 3 female• 43 – 73 years• 8 stable angina• 4 unstable angina IIIb/IIIc• 4 diabetes melitus• 3 previous myocardial infarction• 9 on aspirin, 9 on statine
Unstable Angina, LAD stenosis
Advancing the thermography catheter
Unstable Angina, LAD stenosis
Positioning the thermography catheter
Unstable Angina, LAD stenosis
Opening the basket
Unstable Angina
Advancing the thermography catheter
RCxlesionAmplatz
catheter
Thermography Catheterization
Technical Considerations• High 92% success rate • Over the wire catheter• Good steerability even with regular
wires• Easy opening of thermography basket• Accurate pull back device• Smooth artery tracking• Excellent console, with good
documentation
Patient Scan B2
3535,235,435,635,8
3636,236,436,636,8
371 10 19 28 37 46 55 64 73 82 91 100
109
118
Scan Distance (mm)
Tem
pera
ture
(C) Blood TC
TC1TC2TC3TC4TC5
Patient 2
Patient Scan B4
35,8
36
36,2
36,4
36,6
36,8
371 9 17 25 33 41 49 57 65 73 81 89 97 105
113
121
129
137
145
153
Scan Distance (mm)
Tem
pera
ture
(C) Blood TC
TC1TC2TC3TC4TC5
Distal Proximal
Patient 4
Patient Scan B7
34,835
35,235,435,635,8
3636,236,436,636,8
3737,2
1 10 19 28 37 46 55 64 73 82 91 100
109
118
127
Scan Distance (mm)
Tem
pera
ture
(C) Blood TC
TC1TC2TC3TC4TC5
Patient 7
Patient 10• 65 year old man• Unstable angina, Braunwald IIIB• Previous RCx PTCA and stenting 1996• Risk factors arterial hypertension hypercholesterinemia smoking, diabetes mellitus• 175 cm, 88 kg, 2 m 2 BSA• 0.1 mg/dl CRP
Unstable Angina, LAD stenosis
Angio
LAD Segment 7 Lesion79%stenosis14 mm length16.1 mm 2
plaque area
KH K
LAD Segment 7 lesion
KH K 10
LAD Segment 7 lesion
KH K 10
LAD Segment 7 lesion
KH K
LAD Segment 7 lesion
KH K
Unstable Angina, LAD stenosis
Thermography
Patient 10Patient Scan B10
35,6
35,8
36
36,2
36,4
36,6
36,8
37
1 9 17 25 33 41 49 57 65 73 81 89 97 105
113
121
129
137
145
153
Scan Distance (mm)
Tem
pera
ture
(C) Blood TC
TC1TC2TC3TC4TC5
Unstable Angina
After stent implantation
LAD segment 7 lesionAfter drug-eluting stentImplantation29% stenosis3 mm length2.7 mm 2 pla-que area
Patient 10
• Follow-up no troponin elevation o.o2 and o.o4 ng/ml (ref < 0.1) myoglobin stable 57 and 59 ug/dl (ref < 90) C-reactive protein 0.1 and 0.1 mg/dl (ref < 0.5)
Patient 11• 43 years old man• Anterior AMI August 29 peak CK 3286 U/l treatment 50 mg tenecteplase (Prof Jansen, Leverkusen)• previous TIA April 01• RF: hypercholesterinemia smoking 190 cm, 98 kg, 2.3 m 2 BSA• 2.1 mg/dl CRP
Unstable Angina
Angio
LAD segment 6 lesion
73 % stenosis12 mm length9.7 mm 2 pla-que area
Unstable Angina
Thermography
Position 2 cmdistal to segment6 culprit lesion
Unstable Angina
Thermography
Position 69 mmwithin the lesion
ThermographyMain stem hot spot 2 mm proximal to stenotic segment 6 lesion, + 0.35 oC
Unstable Angina
After stent implantation
LAD segment 6 lesion
26% stenosis11 mm length0.7 mm 2 pla-que areaReperfusionno - reflow VT
UH
Patient 11 History of PCI • Detection of hot spot pre PCI• LAD 3.0 18 mm drug eluting stent 18 bar, post stent PTCA 4.0 mm 10 bar• RCA 90% stenosis, additional PCI 3.0 13 mm drug eluting stent• Lab tests: decline of CK, TnI and
myoglobin 69 to 123 and 86 ug/d (ref 90)• CRP: 0.7 mg/dl (ref 0.5)• Further course uneventful
Thermography Results• 92 % success rate• 35.91 – 36.95 o C blood temperature• Up to + 0.14 up to + 0.36 o C in hot spots• 4/ 11 temperature increase• 4/ 11 focal hot spot• 3/ 4 multifocal hot spots• 1/ 4 MACE corresponding to CRP increase• 3/ 4 hot spots but normal CRP
Future of Thermography
• Combination with IVUS• Preinterventional scanning in order to detect hot spots for futher protective intervention - aspiration systems or - filter devices or - graft stenting or - cooling down
Patient 9• 61 year old woman• Unstable angina type IIIB• troponin I in the gray zone 0.14 ng/ml• C-reactive protein 0.1 and 0.2 mg/dl (ref.
0.1)• Risk factors: diabetes, hypertension hypercholesterinemia• Dialysis 1992 – 2001• Renal transplantation
RCx Segment 11 lesion70 % stenosis14 mm length19 mm 2 pla-que area
HS
Unstable Angina IIIB
Angio
Suspicion of plaque rupture in distal RCx
Unstable Angina IIIB
After thermography
RCx Segment 11 lesion
35%stenosis15 mm length6.8 mm 2 pla-que area
HS
Patient• PCI protocol:• Heavily calcified vessels• Guidewire steering with balloon• Amplatz catheter AL 1 8F• 3.5 16 mm bare stenting• 16 bar• TnI 0.87 ng/ml (ref 0.1) CK, myoglobin remained stable
Patient 8 Patients History• 66 year old man• Unstable AP III after surgery by urology• Risk factors diabetes hypertension
Patient Scan B8
35,8
36
36,2
36,4
36,6
36,8
37
37,2
1 7 13 19 25 31 37 43 49 55 61 67 73 79
Scan Distance (mm)
Tem
pera
ture
(C) Blood TC
TC1TC2TC3TC4TC5
Unstable Angina IIIB
Thermography
Thermography
Thermography
RCx lesion
RCx lesion
Patient 2
Patient 2
Patient 1
Patient 1
LAD segment 5 lesion
59 % stenosis 8 mm length10 mm 2 pla-que area
Patient 0
Thermography
Thermography
Thermography
Thermography
Thermography
Thermography
Unstable Angina, Circ lesion
Angio
Unstable Angina, Circ lesion
After thermography
LAD segment 6 lesion
UH
LAD segment 6 lesion
UH
LAD segment 6 lesion
UH
35,8
36
36,2
36,4
36,6
36,8
37
37,2
Scan Distance
Blood TCTC1TC2TC3TC4TC5
Temperature
Patient Scan B1
34
34,2
34,4
34,6
34,8
35
35,2
35,4
35,6
35,8
36
36,2
36,4
36,6
36,8
37
37,2
37,4
37,6
37,8
38
1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101
105
109
113
117
121
125
129
133
Scan Distance (mm)
Tem
pera
ture
(C) Blood TC
TC1
TC2
TC3
TC4
TC5
Patient B0 Partial Scan
35,8
36
36,2
36,4
36,6
36,8
37
37,2
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43
Scan Distance (mm)
Tem
pera
ture
(C) Blood TC
TC1
TC2
TC3
TC4
TC5
Patient B6 - Scan
35
35,2
35,4
35,6
35,8
36
36,2
36,4
36,6
36,8
37
1 7 13 19 25 31 37 43 49 55 61 67 73 79 85 91 97 103
109
115
121
127
133
139
145
151
157
163
169
175
181
187
193
199
205
Scan Distance (mm)
Tem
pera
ture
(C) Blood TC
TC1
TC2
TC3
TC4
TC5
Temperature
36,436,636,8
3737,237,437,637,8
Blood TCTC1TC2TC3TC4TC5
Scan Distance
Thermography Catheterization