Medicine:Lumivascular
| Lumivascular | |
|---|---|
| Specialty | cartdiovascular |
Lumivascular refers to a minimally invasive procedure in which an interventional catheter with real time intravascular light (lumi) imaging capabilities is inserted percutaneously into a vascular blood vessel for the treatment of vascular disease.
Potential Advantages
Endovascular therapies have advanced to an improved approach called lumivascular. As opposed to the endovascular approach, which solely relies on the use of fluoroscopy, a lumivascular approach involves the use of light to achieve intravascular imaging. The provision of visibility into the vessel allows the physician user the opportunity to guide, orient, and protect the viability of the vessel structures while navigating and treating diseased arteries. Advantages of lumivascular include the potential to reduce harmful radiation exposure to the patient and the physician, and efficient and safe crossing of CTO's.[1] Adam et al. demonstrate that endovascular therapies carry less cost and associated complications when compared to surgery. Likewise, they are a safe alternative for non-viable surgical candidates as a result of their co-morbidities, lack of suitable target vessels, or poor venous conduits.[2] A lumivascular approach allows physicians to remain within the true lumen. Intraluminal crossing may have the benefit of reducing reactive inflammatory species associated with medial and adventitial disruption, while enabling a wide array of therapeutic options including angioplasty, stenting and atherectomy.[3]
Technology
Optical Coherence Tomography (OCT) guidance allows the user to view vessel morphology and differentiate between layered and non-layered tissue to locate and circumscribe the target lesion. The high-resolution images make it possible to visualize the different layers of healthy tissue and more complicated stratification present in various types and levels of disease.[4] Current lumivascular platforms involve the use of Optical Coherence Tomography (OCT).
Applications
Therapeutic products incorporating real-time intravascular optical coherence tomography offer physicians the capability of seeing within the vessel while treating vascular disease. Currently, lumivascular is used as an application to treat peripheral arterial chronic total occlusion using the Ocelot catheter Avinger, Inc. Redwood City, CA. The Ocelot device incorporates real-time optical coherence tomography built into the catheter to guide intraluminal crossing.[5] Utilizing a lumivascular approach allows physicians to remain within the true lumen of a chronic total occlusion.[6] Intraluminal crossing may have the benefit of enabling a wide array of therapeutic options including angioplasty, stenting and atherectomy.
Future Applications
Dermatology,[7] gastroenterology,[8] and ophthalmology have been early adopters of therapeutic OCT applications[9] while cardiovascular use is limited to diagnostic imaging. A lumivascular approach is valuable for peripheral arterial CTO crossing and future applications could likely improve coronary CTO crossing, and a multitude of therapeutic options for both peripheral and coronary atherosclerosis including atherectomy, angioplasty and stenting.
References
- ↑ Schwindt A, Reimers B, Scheinert D, Selmon M, Pigott JP, George JC, Robertson G, Janzer S, McDaniel HB, Shrikhande GV, Torsello G, Schaefers J, Saccà S, Versaci F. Crossing chronic total occlusions with the Ocelot system: the initial European experience. EuroIntervention. 2013 Jul 9. PMID 23838387
- ↑ Adam DJ, Beard JD, Cleveland T. et al. BASIL trial participants. Bypass versus angioplasty in severe ischemia of the leg (BASIL): multicenter, randomized controlled trial. Lancet. 2005; 336:1925-1934.
- ↑ Krishnan, P, et al. Histopathologic evidence of adventitial cuts predicts restenosis after directional atherectomy of lower extremity peripheral arterial disease: results from a randomized, open label, investigator-initiated trial comparing intravascular ultrasound-guided atherectomy to angiography guided atherectomy in peripheral vascular interventions for TASC's A, B lesions (utopia) pilot study. E2083 JACC march 27, 2012 volume 59, issue 13
- ↑ Tearney, GJ. et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol. 2012 Mar 20;59(12):1058-72.
- ↑ Usman, J., Lai, J. Specialty Crossing Devices: Understanding the learning curve. Technical pearls and new devices for crossing peripheral CTOs. Endovascular Today. 2012 May: 52-57.
- ↑ Schwindt A, Reimers B, Scheinert D, Selmon M, Pigott JP, George JC, Robertson G, Janzer S, McDaniel HB, Shrikhande GV, Torsello G, Schaefers J, Saccà S, Versaci F. Crossing chronic total occlusions with the Ocelot system: the initial European experience. EuroIntervention. 2013 Jul 9. PMID 23838387
- ↑ Welzel, J., Lankenau, E., Birngruber, R., Engelhardt, R. Optical Coherence Tomography of the Human Skin. Jam Acad Dermatol 1997; 37: 958-963.
- ↑ Li, XD, Boppart, SA, Van Dam, J, et al. Optical coherence tomography: advanced technology for the endoscopic imaging of Barret’s esophagus. Endoscopy 2000; 32: 921-930.
- ↑ Pinto, TL, Waksman, R. Clinical applications of optical coherence tomography. J Interv Cardiol 2006; 19: 566-573.
External links
 |
