Multimodality Intravascular Imaging of High-Risk Coronary Plaque.

The majority of coronary atherothrombotic events presenting as myocardial infarction (MI) occur as a result of plaque rupture or erosion. Understanding the evolution from a stable plaque into a life-threatening, high-risk plaque is required for advancing clinical approaches to predict atherothrombotic events, and better treat coronary atherosclerosis. Unfortunately, none of the coronary imaging approaches used in clinical practice can reliably predict which plaques will cause an MI. Currently used imaging techniques mostly identify morphological features of plaques, but are not capable of detecting essential molecular characteristics known to be important drivers of future risk. To address this challenge, engineers, scientists, and clinicians have been working hand-in-hand to advance a variety of multimodality intravascular imaging techniques, whereby 2 or more complementary modalities are integrated into the same imaging catheter. Some of these have already been tested in early clinical studies, with other next-generation techniques also in development. This review examines these emerging hybrid intracoronary imaging techniques and discusses their strengths, limitations, and potential for clinical translation from both an engineering and clinical perspective.

Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Funding Support and Author Disclosures The authors have been supported by the National Health and Medical Research Council (NHMRC) Ideas Grant (APP2001646), the Australian Research Council (CE140100003) and The Hospital Research Foundation Group 2020 translational project grant. Dr. Li is the recipient of a Postdoctoral Fellowship from National Heart Foundation of Australia (102093). Dr. Hoogendoorn is the recipient of a Netherlands Heart Institute Fellowship (2018). Dr. Bursill is the recipient of a Lin Huddleston Senior Fellowship from the National Heart Foundation of Australia. Dr. Peter is the recipient of a NHMRC Investigator L3 Fellowship (GNT1174098); is an inventor on a patent describing near-infrared autofluorescence for the detection of unstable, rupture-prone atherosclerotic plaques; and has served as Chief Medical Officer of NIRTEK. Dr. Nicholls is the recipient of a NHMRC Principal Research Fellowship (1111630); has received research support from AstraZeneca, Amgen, Anthera, CSL Behring, Cerenis, Eli Lilly, Esperion, Resverlogix, Novartis, InfraReDx and Sanofi-Regeneron; and has served as a consultant for Amgen, Akcea, AstraZeneca, Boehringer Ingelheim, CSL Behring, Eli Lilly, Esperion, Kowa, Merck, Takeda, Pfizer, Sanofi-Regeneron, and Novo Nordisk. Dr. McLaughlin has received financial support from NHMRC Development Grant (APP1178912) and NHMRC Ideas Grant (APP2002254); is a cofounder and director of Miniprobes Pty Ltd., a company that develops novel optical imaging systems. Miniprobes Pty Ltd. did not contribute to this study. Dr. Psaltis is the recipient of a Future Leader Fellowship from the National Heart Foundation of Australia (FLF102056) and a Career Development Fellowship from the NHMRC (CDF1161506); has received research support from Abbott Vascular; has received consulting fees from Amgen and Esperion; and has received speaker honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Merck Schering-Plough, and Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.