Imaging of post-mortem coronary arteries by 30 MHz intravascular ultrasound

Abstract

Intravascular ultrasound cross-sectional imaging of the atherosclerotic artery may be employed to guide plaque ablation by spark erosion, atherectomy, laser irradiation or other means. To assess whether in the coronary artery the echolucent zone of the three-layered ultrasound appearance of muscular arteries might be a reliable boundary to halt transluminal ablative angioplasty, epicardial coronary arteries were scanned under pressure over a distance of 4–8 cm at 1 mm intervals. A 5.2F catheter with a 30 MHz transducer rotating at 600 RPM was used. In 419 images from four post-mortem hearts, aged at death 22, 31, 56 and 82 years, the presence of a distinct echolucent zone was scored as percentage of the wall circumference. The median scores were 0%, 0%, 10% and 75%, respectively. In the three youngest hearts, the three-layered appearance was largely absent. In the 82 year old heart, in contrast, the three-layered appearance could generally be identified. Within subjects, the presence of an echolucent zone was variable in location. Qualitatively, neither abundant medial elastin tissue nor a reduced medial thickness could explain the absence of an echolucent zone when the ultrasound image was compared to the corresponding microscopic section.

The results show that in the 82 year old heart, 30 MHz intravascular ultrasound discrimination of coronary wall layers would be adequate to guide transluminal plaque ablation. In the younger hearts, guided ablation would fail due to the limited presence of a distinct echolucent zone as an ultrasound landmark of the media. Whether the presence or absence of an echolucent zone is related to age remains to be determined.