Lumen Morphology and Vascular Resistance Measurements Data Collection Systems, Apparatus and Methods

Abstract

A method and apparatus of automatically locating in an image of a blood vessel the lumen boundary at a position in the vessel and from that measuring the diameter of the vessel. From the diameter of the vessel and estimate blood flow rate, a number of clinically significant physiological parameters are then determine and various user displays of interest generated. One use of these images and parameters is to aid the clinician in the placement of a stent. The system, in one embodiment, uses these measurements to allow the clinician to simulate the placement of a stent and to determine the effect of the placement. In addition, from these patient parameters various patient treatments are then performed.

Description

RELATED APPLICATIONS[0001]This application claims priority to provisional application U.S. Ser. No. 61 / 224,992 filed Sep. 23, 2009 and provisional application U.S. Ser. No. 61 / 334,834 filed May 14, 2010, the disclosures of which are herein incorporated by reference in their entirety.FIELD OF INVENTION[0002]This invention relates generally to the field of optical coherence tomographic imaging and more specifically to optical coherence techniques for diagnosing and treating vascular stenoses.BACKGROUND OF THE INVENTION[0003]Coronary artery disease is one of the leading causes of death worldwide. The ability to better diagnose, monitor, and treat coronary artery diseases can be of life saving importance. Intravascular optical coherence tomography (OCT) is a catheter-based imaging modality that employs safe, non-ionizing near-infrared light to peer into coronary artery walls and present images valuable for the study of the vascular wall architecture. Utilizing broad-band coherent light,...

AI Technical Summary

Problems solved by technology

While the luminal border in OCT images is clearly identifiable by the human eye, it is tedious, expensive, and time consuming to manually trace the luminal border.

However, the relationship of these geometric measurements to clinically relevant variables, such as ability of the artery to supply an adequate flow of blood to the myocardium when metabolic demands are high, is not well understood.

In early studies, the percent stenosis of an individual coronary lesion measured by angiography was found to be a relatively poor predictor of the physiological significance of the lesion.

The angle of the X-ray projection, in addition to the shadowing effect of lesions with irregular contours, can increase errors significantly beyond the theoretical minimums.

Even state-of-the-art IVUS imaging systems, which have resolutions of approximately 0.15 mm in the axial dimension and 0.3 mm in the angular dimensions, cannot accurately measure the cross-sectional areas of small eccentric lesions or lesions with irregular borders.

Second, the hemodynamic effects of a lesion depend on local variations of its cross-sectional area integrated over the entire length of a lesion.

Therefore, the minimum cross-sectional area alone is insufficient to characterize the pressure drop across a lesion at a given flow rate, especially in patients with diffuse coronary disease.

Especially at high blood flow rates, the eccentricity and local slope of the walls of the artery can influence the effective resistance of a lesion, because losses due to flow separation and turbulence depend on local flow velocity.

Therefore, even if the vascular resistance of a lesson in the vessel is high, revascularization may be contraindicated, because the pressure drop across the lesion may be clinically insignificant.

In spite of advances intravascular imagining, cardiologists frequently do not take full advantage of the capabilities of OCT and IVUS for planning and evaluating stent deployment, because the measurements currently derived from the images provide insufficient information to predict the effectiveness of treatment.

The wrong choice of the size or location of the stent may lead to the failure to restore blood flow and may even potentially serious clinical complications, such as stent migration, stent thrombosis, or dissection of the vessel wall.

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