Intravascular ultrasound imaging: an essential component of angioplasty assessment and vascular stent deployment.

Potential early complications of balloon angioplasty include occlusion due to vessel wall recoil, medial dissection, creation of intimal flaps, spasm and luminal thrombosis. These features have also been implicated in the development of restenosis and late occlusion. As a possible solution to these problems, an endovascular scaffold (stent) was proposed by Dotter in the 1960s, and initial studies suggested that use of such a device in specific circumstances may reduce complications related to major dissection, vessel recoil and spams. This paper reports the utility of two- and three-dimensional intravascular ultrasound (IVUS) imaging in assessing arterial morphology following balloon angioplasty, and guiding the need for, and adequacy of deployment of intravascular stents. IVUS imaging provides a technique to accurately assess the immediate results of angioplasty and examine both the luminal size and contour following intervention. Accurate imaging such as this is essential for the successful use of balloon expandable stents, by ensuring correct initial positioning and complete deployment at the time of balloon expansion. Two cases are reported which highlight the important issues which are critical to the ongoing development of endovascular therapies: (i) accurate assessment of the angioplasty results, and (ii) selection and confirmation of stent deployment. We conclude that IVUS imaging may provide a new standard for the assessment of angioplasty procedures and will play a pivotal role in identifying failure mechanisms of endovascular interventions.

Three-dimensional transrectal ultrasound: preliminary patient evaluation.

Transrectal ultrasound is uniquely useful in diagnosing and localizing the extent of lower colon and rectal disease. This paper reports the preliminary evaluation of three-dimensional intraluminal ultrasound imaging of normal and diseased rectal segments. The three-dimensional reconstructions were produced using a computerized PC based image analysis system which aligns ultrasound images to produce the three-dimensional images. A unique perspective for displaying both normal and pathologic anatomy is achieved using this new technology and the method has promising diagnostic and therapeutic potentials.

In vitro validation of three-dimensional intravascular ultrasound for the evaluation of arterial injury after balloon angioplasty.

OBJECTIVES: The hypothesis of this study was that three-dimensional ultrasound imaging would facilitate the evaluation of arterial dissection after balloon angioplasty. BACKGROUND: The presence and extent of arterial dissection occurring at the time of balloon angioplasty may be important predictors of abrupt vessel closure or late restenosis. METHODS: Forty-one human arterial segments obtained after death were imaged in an in vitro system at physiologic pressure (80 to 100 mm Hg) before and after balloon angioplasty. Images were acquired with a 20- to 30-MHz mechanical intravascular ultrasound imaging system (Cardiovascular Imaging Systems) with a constant pullback technique (1 mm/s). Standard 0.5-in. (1.27-cm) video tapes were used for data storage and later playback for analog to digital conversion. Digitized data were reconstructed to three-dimensional images with use of voxel space modeling. The vessels were opened longitudinally and subjected to pathologic examination, photographed and classified histologically as normal, fibrous or calcified. Dissection was defined as a disruption and separation of components of the arterial wall. The length and depth of arterial dissection were evaluated grossly and microscopically. RESULTS: Of the 41 arteries studied, 36 (88%) exhibited dissection on pathologic examination after balloon angioplasty. Three-dimensional reconstruction of intravascular ultrasound images identified dissection in 11 (92%) of 12 normal, 8 (100%) of 8 fibrous and 11 (69%) of 16 calcified arteries. Excellent agreement between ultrasound and pathologic findings was achieved in the evaluation of length and depth of dissection for histologically normal and fibrous arteries (kappa = 0.72 to 1.0). When the vessels were severely calcified, the agreement was not as good (kappa = 0.27 to 0.56), particularly in detection of small, non-raised intimal flaps. CONCLUSIONS: This histopathologic validation study suggests that three-dimensional intravascular ultrasound imaging facilitates the evaluation of both quantitative and morphologic features of arterial dissection induced by balloon angioplasty. The advantage of three-dimensional intravascular ultrasound is its ability to assess the length and morphology of arterial injury over an entire vessel segment.

Three dimensional vascular ultrasound imaging.

Intravascular ultrasound (IVUS) is a new catheter-based system that produces two-dimensional (2D) images of vascular structures. Existing systems produce real-time, cross-sectional "slices" of vessels using 5.0 French (Fr) (30 MHz) and 8.0 Fr (20 MHz) IVUS catheters containing ultrasound transducers at the tip. Computerized, three-dimensional (3D) reconstruction of these 2D images using a personal computer- (PC) based image analysis system is described. A set (n = 90) of longitudinally aligned, consecutive images is sampled from a 5.0 cm vessel segment, and computerized processing creates rendered 3D images. By adjusting image density threshold and viewing angle, the morphology, location, and spatial distribution of arterial pathology can be seen. Refinements in computer hardware and software have reduced processing time and improved image resolution to the point where 3D IVUS imaging is a clinically applicable tool. Possible applications include diagnosis of complex arterial pathology, guidance of intraluminal instruments, and assessment of the effects of endovascular interventions.

A new technique for intraluminal hollow organ imaging: three-dimensional ultrasound.

Intraluminal ultrasound (ILUS) is a new catheter-based system which produces two-dimensional (2D), cross-sectional images of tubular structures. The principle of image acquisition using 5.0 Fr (30 MHz) and 8.0 Fr (20 MHz) ILUS catheters containing ultrasound transducers at the tip, is equally applicable to all tubular or hollow organs. This article illustrates the feasibility of intraluminal imaging of hollow organ structures, and describes computerized three-dimensional (3D) reconstruction of the 2D images, using a PC-based image analysis system. A set (n = 90) of longitudinally aligned, consecutive 2D images was sampled from various organs (canine bladder, urethra, jejunum, esophagus, and trachea) and computer processed to produce 3D images. By adjusting image density threshold and viewing angle, the lumen and wall morphology can be examined in any projection. Possible applications include diagnosis of lumen encroaching pathology, guidance of intraluminal instruments, and assessment of the effects of endoluminal interventions.

Size-exclusion chromatography of DNA restriction fragments. Fragment length determinations and a comparison with the behaviour of proteins in size-exclusion chromatography.

Size-exclusion chromatography of double-stranded DNA restriction fragments on Superose 6 is shown to be an accurate method for chain length determination of unknown DNA. Ionic interaction was observed between DNA and the gel matrix but was easily prevented by the addition of 0.15-0.2 M sodium chloride to the eluent. Compared to protein, the selectivity curve of DNA fragments was found to be steeper reflecting the different chromatographic behaviour of rod-like and globular molecules. The relationships between the selectivity curves of DNA and protein were similar on Superose 6 and on Sephacryl S-500.

Separation of DNA restriction fragments by ion-exchange chromatography on FPLC columns Mono P and Mono Q.

Separation of DNA restriction fragments by FPLC ion-exchange chromatography on Mono Q and Mono P columns was investigated. The columns were found to be particularly suitable for the separation of fragments up to 500-600 bp long. Larger fragments can also be separated although less effectively. We found the following practical working ranges for the parameters investigated: pH, 4 to 11; flow rate, 0.05 to 0.6 ml/min corresponding to separation times between 2 and 20 h. (better resolution is achieved at lower flow rates); gradient slope; between 0.5 mM eluting salt/ml buffer and over 5 mM/ml (better resolution is achieved at lower gradient slopes; eluting ionic strength was found to be independent of gradient slope); gradient composition, chloride salts of smaller monovalent cations eluted the DNA at lower ionic strengths but separations obtained were similar; additives, substances such as urea, formamide, and EDTA can be added without chromatographic effects; sample amount: amounts from 2.5 to 200 micrograms were applied, corresponding to single peak content of from 42 ng to 74 micrograms DNA. Yields were generally over 90% and the chromatographed DNA was fully accessible to restriction enzyme cleavage. Separations occurred predominantly according to DNA size, but AT-rich fragments were retarded in a predictable way.

The isolectins of Helix pomatia. Separation by isoelectric focusing and preliminary characterization.

Helix pomatia lectin was fractionated into several (at least 12) components by isolectric focusing in PharmalyteTM. Eight of these were recovered from a preparative column experiment and shown to be essentially pure by analytical electrofocusing in polyacrylamide gel slabs. The lectin components had haemagglutinating activity against human group A erythrocytes and similar molecular weights of 80 000 as determined vidual components showed slight variations in composition. The components are considered to be isolectins. Isoelectric focusing of lectin samples prepared from single snails from two different biotopes showed isolectin patterns similar to that of pooled lectin. Gel filtration of the lectin and flat bed electrofocusing of isolated isolectins both in the presence of 6 M ura, indicated that the lectin molecules are formed by different combinations of a range subunits with similar molecular weight but with different isoelectric points.

Agarderivatives for chromatography, electrophoresis and gel-bound enzymes. IV. Benzylated dibromopropanol cross-linked sepharose as an amphophilic gel for hydrophobic salting-out chromatography of enzymes with special emphasis on denaturing risks.

The preparation of benzylated covalently cross-linked Sepharose 2B is described. Such gel was analyzed for its degree of substitution, and gels with three different degrees of substitution were used in chromatographic experiments with dextranase, alpha-amylase, lactate dehydrogenase, alpha-chymotrypsin and trypsin. Yields and chromatographic patterns for different eluting systems were determined. It was found that gradients combining an increase in ethylene glycol concentration with a decrease in salt concentration gave better results than did pure salt gradients. No denaturation was observed for dextranase or alpha-amylase, but the other enzymes tested were partly denatured. The most severe denaturation was observed for lactate dehydrogenase desorbed from the highest substituted gels, although the enzyme was highly active in the adsorbed state. The results and the use of amphophilic gels are discussed.

Agar derivatives for chromatography, electrophoresis and gel-bound enzymes. III. Rigid agarose gels cross-linked with divinyl sulphone (dvs).

Agarose cross-linked with divinyl sulphone (DVS) is a new matrix for chromatography and immobilized enzymes that has distinct advantages over common agarose gels. It has outstanding mechanical stability as compared with these gels, and the rigid gel beads form beds permitting very high flow-rates. In addition, DVS-agarose is superior to agarose gels with respect to chemical stability in acid and neutral media. In alkaline solutions above pH 8, there is a slow elimination of the sulphone-containing bridges, but without noticeable concomitant dissolution of the gels below pH 12 for moderately or highly cross-linked gels. The DVS-agarose is sufficiently thermostable to be heated in an autoclave.