Skip to main content
SpringerLink
Log in

Role of Near-Infrared Spectroscopy (NIRS) in Intracoronary Imaging

  • Intravascular Imaging (A Truesdell, Section Editor)
  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this article is to review the basic principles of near-infrared spectroscopy (NIRS) and its contemporary role in intracoronary imaging.

Recent Findings

NIRS has been demonstrated to effectively detect culprit lesions in acute coronary syndromes (ACS) and to potentially identify vulnerable plaque. Lipid-rich plaques detected by NIRS are also associated with higher incidence of future adverse cardiac events. Plaques with high lipid content detected by NIRS have been shown to predict periprocedural myocardial infarction during percutaneous coronary intervention (PCI). The beneficial effects of high-intensity statin therapy in terms of plaque regression and plaque stabilization have also been demonstrated using NIRS.

Summary

NIRS is a valuable intracoronary imaging tool to assess lipid burden in atherosclerotic plaques and has been validated against histopathologic data. The commercially available dual-modality NIRS-intravascular ultrasound (IVUS) catheter further provides complementary data regarding lesion and vessel characteristics, thereby facilitating planning and optimization of PCI. Finally, the ability of NIRS to detect vulnerable plaque opens up potential new opportunities for risk stratification and intensification of secondary preventive measures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Choi KH, Song YB, Lee JM, Lee SY, Park TK, Yang JH, et al. Impact of intravascular ultrasound-guided percutaneous coronary intervention on long-term clinical outcomes in patients undergoing complex procedures. JACC Cardiovasc Interv. 2019;12(7):607–20. https://doi.org/10.1016/j.jcin.2019.01.227.

    Article  PubMed  Google Scholar 

  2. Zhang J, Gao X, Kan J, Ge Z, Han L, Lu S, et al. Intravascular ultrasound versus angiography-guided drug-eluting stent implantation: the ULTIMATE Trial. J Am Coll Cardiol. 2018;72(24):3126–37. https://doi.org/10.1016/j.jacc.2018.09.013.

    Article  PubMed  Google Scholar 

  3. Kini AS, Motoyama S, Vengrenyuk Y, Feig JE, Pena J, Baber U, et al. Multimodality intravascular imaging to predict periprocedural myocardial infarction during percutaneous coronary intervention. JACC Cardiovasc Interv. 2015;8(7):937–45. https://doi.org/10.1016/j.jcin.2015.03.016.

    Article  PubMed  Google Scholar 

  4. Gardner CM, Tan H, Hull EL, Lisauskas JB, Sum ST, Meese TM, et al. Detection of lipid core coronary plaques in autopsy specimens with a novel catheter-based near-infrared spectroscopy system. JACC Cardiovasc Imaging. 2008;1(5):638–48. https://doi.org/10.1016/j.jcmg.2008.06.001.

    Article  PubMed  Google Scholar 

  5. Bharadwaj AS, Vengrenyuk Y, Yoshimura T, Baber U, Hasan C, Narula J, et al. Multimodality intravascular imaging to evaluate sex differences in plaque morphology in stable CAD. JACC Cardiovasc Imaging. 2016;9(4):400–7. https://doi.org/10.1016/j.jcmg.2016.02.007.

    Article  PubMed  Google Scholar 

  6. Madder RD, Goldstein JA, Madden SP, Puri R, Wolski K, Hendricks M, et al. Detection by near-infrared spectroscopy of large lipid core plaques at culprit sites in patients with acute ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2013;6(8):838–46. https://doi.org/10.1016/j.jcin.2013.04.012.

    Article  PubMed  Google Scholar 

  7. Madder RD, Husaini M, Davis AT, VanOosterhout S, Harnek J, Gotberg M, et al. Detection by near-infrared spectroscopy of large lipid cores at culprit sites in patients with non-ST-segment elevation myocardial infarction and unstable angina. Catheter Cardiovasc Interv. 2015;86(6):1014–21. https://doi.org/10.1002/ccd.25754.

    Article  PubMed  Google Scholar 

  8. Madder RD, Puri R, Muller JE, Harnek J, Gotberg M, VanOosterhout S, et al. Confirmation of the intracoronary near-infrared spectroscopy threshold of lipid-rich plaques that underlie ST-segment-elevation myocardial infarction. Arterioscler Thromb Vasc Biol. 2016;36(5):1010–5. https://doi.org/10.1161/ATVBAHA.115.306849.

    Article  CAS  PubMed  Google Scholar 

  9. Madder RD, Smith JL, Dixon SR, Goldstein JA. Composition of target lesions by near-infrared spectroscopy in patients with acute coronary syndrome versus stable angina. Circ Cardiovasc Interv. 2012;5(1):55–61. https://doi.org/10.1161/CIRCINTERVENTIONS.111.963934.

    Article  PubMed  Google Scholar 

  10. Stone GW, Maehara A, Muller JE, Rizik DG, Shunk KA, Ben-Yehuda O, et al. Plaque characterization to inform the prediction and prevention of periprocedural myocardial infarction during percutaneous coronary intervention: the CANARY trial (Coronary Assessment by Near-infrared of Atherosclerotic Rupture-prone Yellow). JACC Cardiovasc Interv. 2015;8(7):927–36. https://doi.org/10.1016/j.jcin.2015.01.032.

    Article  PubMed  Google Scholar 

  11. Goldstein JA, Maini B, Dixon SR, Brilakis ES, Grines CL, Rizik DG, et al. Detection of lipid-core plaques by intracoronary near-infrared spectroscopy identifies high risk of periprocedural myocardial infarction. Circ Cardiovasc Interv. 2011;4(5):429–37. https://doi.org/10.1161/CIRCINTERVENTIONS.111.963264.

    Article  PubMed  Google Scholar 

  12. Cardiology ACo. LRP: can NIRS imaging be used to identify patients and non-culprit arteries at high risk for future events? 2018. https://www.acc.org/latest-in-cardiology/articles/2018/09/19/16/55/mon-115pm-lrp-coronary-near-infrared-spectroscopy-imaging-tct-2018. Accessed April 7, 2019.

  13. Kini AS, Baber U, Kovacic JC, Limaye A, Ali ZA, Sweeny J, et al. Changes in plaque lipid content after short-term intensive versus standard statin therapy: the YELLOW trial (reduction in yellow plaque by aggressive lipid-lowering therapy). J Am Coll Cardiol. 2013;62(1):21–9. https://doi.org/10.1016/j.jacc.2013.03.058.

    Article  CAS  PubMed  Google Scholar 

  14. Kini AS, Vengrenyuk Y, Shameer K, Maehara A, Purushothaman M, Yoshimura T, et al. Intracoronary imaging, cholesterol efflux, and transcriptomes after intensive statin treatment: the YELLOW II study. J Am Coll Cardiol. 2017;69(6):628–40. https://doi.org/10.1016/j.jacc.2016.10.029.

    Article  CAS  PubMed  Google Scholar 

  15. Schuurman AS, Vroegindewey M, Kardys I, Oemrawsingh RM, Cheng JM, de Boer S, et al. Near-infrared spectroscopy-derived lipid core burden index predicts adverse cardiovascular outcome in patients with coronary artery disease during long-term follow-up. Eur Heart J. 2018;39(4):295–302. https://doi.org/10.1093/eurheartj/ehx247.

    Article  PubMed  Google Scholar 

  16. Danek BA, Karatasakis A, Karacsonyi J, Alame A, Resendes E, Kalsaria P, et al. Long-term follow-up after near-infrared spectroscopy coronary imaging: insights from the lipid cORe plaque association with CLinical events (ORACLE-NIRS) registry. Cardiovasc Revasc Med. 2017;18(3):177–81. https://doi.org/10.1016/j.carrev.2016.12.006.

    Article  PubMed  Google Scholar 

  17. Roleder T, Kovacic JC, Ali Z, Sharma R, Cristea E, Moreno P, et al. Combined NIRS and IVUS imaging detects vulnerable plaque using a single catheter system: a head-to-head comparison with OCT. EuroIntervention. 2014;10(3):303–11. https://doi.org/10.4244/EIJV10I3A53.

    Article  PubMed  Google Scholar 

  18. Raghunathan D, Abdel-Karim AR, Papayannis AC, daSilva M, Jeroudi OM, Rangan BV, et al. Relation between the presence and extent of coronary lipid core plaques detected by near-infrared spectroscopy with postpercutaneous coronary intervention myocardial infarction. Am J Cardiol. 2011;107(11):1613–8. https://doi.org/10.1016/j.amjcard.2011.01.044.

    Article  PubMed  Google Scholar 

  19. Oemrawsingh RM, Cheng JM, Garcia-Garcia HM, van Geuns RJ, de Boer SP, Simsek C, et al. Near-infrared spectroscopy predicts cardiovascular outcome in patients with coronary artery disease. J Am Coll Cardiol. 2014;64(23):2510–8. https://doi.org/10.1016/j.jacc.2014.07.998.

    Article  PubMed  Google Scholar 

  20. •• Kilic ID, Caiazzo G, Fabris E, Serdoz R, Abou-Sherif S, Madden S, et al. Near-infrared spectroscopy-intravascular ultrasound: scientific basis and clinical applications. Eur Heart J Cardiovasc Imaging. 2015;16(12):1299–306. https://doi.org/10.1093/ehjci/jev208 Provides an in-depth overview of the technical aspects and clinical applications of NIRS.

    Article  PubMed  Google Scholar 

  21. Infraredx. Makoto™ Intravascular Imaging System and the Dualpro™ IVUS+NIRS catheter. 2019. https://www.infraredx.com/ - p3. Accessed April 6 2019.

  22. Lansky AJ, Stone GW. Periprocedural myocardial infarction: prevalence, prognosis, and prevention. Circ Cardiovasc Interv. 2010;3(6):602–10. https://doi.org/10.1161/CIRCINTERVENTIONS.110.959080.

    Article  PubMed  Google Scholar 

  23. Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention. Circulation. 2008;117(24):3152–6. https://doi.org/10.1161/CIRCULATIONAHA.107.742312.

    Article  PubMed  Google Scholar 

  24. Brilakis ES, Abdel-Karim AR, Papayannis AC, Michael TT, Rangan BV, Johnson JL, et al. Embolic protection device utilization during stenting of native coronary artery lesions with large lipid core plaques as detected by near-infrared spectroscopy. Catheter Cardiovasc Interv. 2012;80(7):1157–62. https://doi.org/10.1002/ccd.23507.

    Article  PubMed  Google Scholar 

  25. Dixon SR, Grines CL, Munir A, Madder RD, Safian RD, Hanzel GS, et al. Analysis of target lesion length before coronary artery stenting using angiography and near-infrared spectroscopy versus angiography alone. Am J Cardiol. 2012;109(1):60–6. https://doi.org/10.1016/j.amjcard.2011.07.068.

    Article  PubMed  Google Scholar 

  26. Hanson ID, Goldstein JA, Dixon SR, Stone GW. Comparison of coronary artery lesion length by NIRS-IVUS versus angiography alone. Coron Artery Dis. 2015;26(6):484–9. https://doi.org/10.1097/MCA.0000000000000263.

    Article  PubMed  Google Scholar 

  27. • Erlinge D. Near-infrared spectroscopy for intracoronary detection of lipid-rich plaques to understand atherosclerotic plaque biology in man and guide clinical therapy. J Intern Med. 2015;278(2):110–25. https://doi.org/10.1111/joim.12381 Provides a thorough description of the role of NIRS in defining the composition of atherosclerotic plaque and its role in guiding therapy.

    Article  CAS  PubMed  Google Scholar 

  28. Narula J, Nakano M, Virmani R, Kolodgie FD, Petersen R, Newcomb R, et al. Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques. J Am Coll Cardiol. 2013;61(10):1041–51. https://doi.org/10.1016/j.jacc.2012.10.054.

    Article  PubMed  PubMed Central  Google Scholar 

  29. van der Wal AC, Becker AE. Atherosclerotic plaque rupture—pathologic basis of plaque stability and instability. Cardiovasc Res. 1999;41(2):334–44.

    Article  Google Scholar 

  30. Patel D, Hamamdzic D, Llano R, Patel D, Cheng L, Fenning RS, et al. Subsequent development of fibroatheromas with inflamed fibrous caps can be predicted by intracoronary near infrared spectroscopy. Arterioscler Thromb Vasc Biol. 2013;33(2):347–53. https://doi.org/10.1161/ATVBAHA.112.300710.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Loma Linda University, 11234 Anderson Street, Suite 2422, Loma Linda, CA, 92354, USA

    Pooja M. Swamy & Aditya S. Bharadwaj

  2. Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Primary Care and Health Sciences, Keele University, Newcastle, UK

    Mamas A. Mamas

Authors
  1. Pooja M. Swamy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mamas A. Mamas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aditya S. Bharadwaj
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aditya S. Bharadwaj.

Ethics declarations

Conflict of Interest

All authors have no conflict of interest to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Intravascular Imaging

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Swamy, P.M., Mamas, M.A. & Bharadwaj, A.S. Role of Near-Infrared Spectroscopy (NIRS) in Intracoronary Imaging. Curr Cardiovasc Imaging Rep 12, 34 (2019). https://doi.org/10.1007/s12410-019-9510-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12410-019-9510-8

Keywords

Search

Navigation