A wide variety of therapeutic procedures have been developed to intervene in patients with coronary artery disease. Whether the intervention is intended to increase lumen size by dilating the artery or to decrease atheroma mass by laser ablation, mechanical atherectomy, or by lowering serum cholesterol, it will be important to quantitate atherosclerotic plaque volume before and after treatment. The purpose of the proposed study is to further our knowledge about the structural changes of arterial remodeling that occur during and following interventional procedures performed to increase the lumen of atherosclerotic arteries. This evaluation will be accomplished using a new method of imaging arteries in vivo with an intravascular ultrasound imaging catheter. The interventions that will be studied are balloon dilatation, atherectomy, laser ablation, and a cholesterol drug intervention trial. Studies will be performed in vitro to evaluate the accuracy and reproducibility of the imaging catheter for obtaining quantitative information about lumen cross-sectional area, and atherosclerotic plaque thickness and volume. In vivo animal studies will be used to assess its function and safety. Human clinical studies will be undertaken to correlate the findings of the intravascular ultrasound images with angiography. In addition, the ultrasound imaging catheter will be used in clinical studies after balloon dilatation, atherectomy,and laser interventions to understand the biologic changes that occur during these procedures and to determine whether intravascular ultrasound images can be used to predict the short- term and long-term results of the intervention. The intravascular ultrasound technology will also be used to assess the mechanism of restenosis following balloon angioplasty in a drug intervention trial using cilazapril, an ACE inhibitor. There will also be a long term secondary prevention trial using pravastatin, an HMG CoA reductase inhibitor, to lower serum cholesterol. Intravascular ultrasound will be used at baseline and at a 3 year follow-up period to directly measure the effect of chronic cholesterol reduction on atheroma area in human coronary arteries.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL045077-01A1
Application #
3363967
Study Section
Diagnostic Radiology Study Section (RNM)
Project Start
1991-08-16
Project End
1994-07-31
Budget Start
1991-08-16
Budget End
1992-07-31
Support Year
1
Fiscal Year
1991
Total Cost
Indirect Cost
Name
University of California Irvine
Department
Type
Schools of Medicine
DUNS #
161202122
City
Irvine
State
CA
Country
United States
Zip Code
92697
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Hiro, T; Hall, P; Maiello, L et al. (1998) Clinical feasibility of 0.018-inch intravascular ultrasound imaging device. Am Heart J 136:1017-20
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Kasaoka, S; Tobis, J M; Akiyama, T et al. (1998) Angiographic and intravascular ultrasound predictors of in-stent restenosis. J Am Coll Cardiol 32:1630-5
Hiro, T; Leung, C Y; De Guzman, S et al. (1997) Are soft echoes really soft? Intravascular ultrasound assessment of mechanical properties in human atherosclerotic tissue. Am Heart J 133:1-7
Tobis, J; Aharonian, V; Mansukhani, P et al. (1997) Video networking of cardiac catheterization laboratories. J Digit Imaging 10:113-5
Hiro, T; Leung, C Y; Russo, R J et al. (1997) Intravascular ultrasound identification of stent entrapment in vivo with in vitro confirmation. Cathet Cardiovasc Diagn 40:40-5
Hiro, T; Leung, C Y; Russo, R J et al. (1996) Variability of a three-layered appearance in intravascular ultrasound coronary images: a comparison of morphometric measurements with four intravascular ultrasound systems. Am J Card Imaging 10:219-27
Hiro, T; Leung, C Y; Russo, R J et al. (1996) Variability in tissue characterization of atherosclerotic plaque by intravascular ultrasound: a comparison of four intravascular ultrasound systems. Am J Card Imaging 10:209-18

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