thermography early clinical correlations

Thermographyearly clinical correlations

R Erbel, A Schmermund, M. Katz, F. Chwallek, D. Baumgart

Department of CardiologyUniversity Essen

Germany

Thermography Catheter Basket

Over the wire catheter systemPull back device with 0.5 mm/s

1 central blood thermo couple5 thermo couples3.3 F catheter 0.02 oC accuracy

0.2 oC

0.1 10mm

distal

proximal

mm100.1

0.2 oC

Temperature

36,436,636,8

3737,237,437,637,8

Blood TCTC1TC2TC3TC4TC5

Scan Distance

Study Aim Assessment of• Temperature recording• Steerability of catheter system• QCA of coronary arteries• Pull back recording, Endosonics device• Practicability• Safety

Clinical History of Patients

• 12 patients included• 9 male, 3 female• 43 – 73 years• 8 stable angina• 4 unstable angina IIIb/IIIc• 4 diabetes melitus• 3 previous myocardial infarction• 9 on aspirin, 9 on statine

Unstable Angina, LAD stenosis

Advancing the thermography catheter

Unstable Angina, LAD stenosis

Positioning the thermography catheter

Unstable Angina, LAD stenosis

Opening the basket

Unstable Angina

Advancing the thermography catheter

RCxlesionAmplatz

catheter

Thermography Catheterization

Technical Considerations• High 92% success rate • Over the wire catheter• Good steerability even with regular

wires• Easy opening of thermography basket• Accurate pull back device• Smooth artery tracking• Excellent console, with good

documentation

Patient Scan B2

3535,235,435,635,8

3636,236,436,636,8

371 10 19 28 37 46 55 64 73 82 91 100

109

118

Scan Distance (mm)

Tem

pera

ture

(C) Blood TC

TC1TC2TC3TC4TC5

Patient 2

Patient Scan B4

35,8

36

36,2

36,4

36,6

36,8

371 9 17 25 33 41 49 57 65 73 81 89 97 105

113

121

129

137

145

153

Scan Distance (mm)

Tem

pera

ture

(C) Blood TC

TC1TC2TC3TC4TC5

Distal Proximal

Patient 4

Patient Scan B7

34,835

35,235,435,635,8

3636,236,436,636,8

3737,2

1 10 19 28 37 46 55 64 73 82 91 100

109

118

127

Scan Distance (mm)

Tem

pera

ture

(C) Blood TC

TC1TC2TC3TC4TC5

Patient 7

Patient 10• 65 year old man• Unstable angina, Braunwald IIIB• Previous RCx PTCA and stenting 1996• Risk factors arterial hypertension hypercholesterinemia smoking, diabetes mellitus• 175 cm, 88 kg, 2 m 2 BSA• 0.1 mg/dl CRP

Unstable Angina, LAD stenosis

Angio

LAD Segment 7 Lesion79%stenosis14 mm length16.1 mm 2

plaque area

KH K

LAD Segment 7 lesion

KH K 10

LAD Segment 7 lesion

KH K 10

LAD Segment 7 lesion

KH K

LAD Segment 7 lesion

KH K

Unstable Angina, LAD stenosis

Thermography

Patient 10Patient Scan B10

35,6

35,8

36

36,2

36,4

36,6

36,8

37

1 9 17 25 33 41 49 57 65 73 81 89 97 105

113

121

129

137

145

153

Scan Distance (mm)

Tem

pera

ture

(C) Blood TC

TC1TC2TC3TC4TC5

Unstable Angina

After stent implantation

LAD segment 7 lesionAfter drug-eluting stentImplantation29% stenosis3 mm length2.7 mm 2 pla-que area

Patient 10

• Follow-up no troponin elevation o.o2 and o.o4 ng/ml (ref < 0.1) myoglobin stable 57 and 59 ug/dl (ref < 90) C-reactive protein 0.1 and 0.1 mg/dl (ref < 0.5)

Patient 11• 43 years old man• Anterior AMI August 29 peak CK 3286 U/l treatment 50 mg tenecteplase (Prof Jansen, Leverkusen)• previous TIA April 01• RF: hypercholesterinemia smoking 190 cm, 98 kg, 2.3 m 2 BSA• 2.1 mg/dl CRP

Unstable Angina

Angio

LAD segment 6 lesion

73 % stenosis12 mm length9.7 mm 2 pla-que area

Unstable Angina

Thermography

Position 2 cmdistal to segment6 culprit lesion

Unstable Angina

Thermography

Position 69 mmwithin the lesion

ThermographyMain stem hot spot 2 mm proximal to stenotic segment 6 lesion, + 0.35 oC

Unstable Angina

After stent implantation

LAD segment 6 lesion

26% stenosis11 mm length0.7 mm 2 pla-que areaReperfusionno - reflow VT

UH

Patient 11 History of PCI • Detection of hot spot pre PCI• LAD 3.0 18 mm drug eluting stent 18 bar, post stent PTCA 4.0 mm 10 bar• RCA 90% stenosis, additional PCI 3.0 13 mm drug eluting stent• Lab tests: decline of CK, TnI and

myoglobin 69 to 123 and 86 ug/d (ref 90)• CRP: 0.7 mg/dl (ref 0.5)• Further course uneventful

Thermography Results• 92 % success rate• 35.91 – 36.95 o C blood temperature• Up to + 0.14 up to + 0.36 o C in hot spots• 4/ 11 temperature increase• 4/ 11 focal hot spot• 3/ 4 multifocal hot spots• 1/ 4 MACE corresponding to CRP increase• 3/ 4 hot spots but normal CRP

Future of Thermography

• Combination with IVUS• Preinterventional scanning in order to detect hot spots for futher protective intervention - aspiration systems or - filter devices or - graft stenting or - cooling down

Patient 9• 61 year old woman• Unstable angina type IIIB• troponin I in the gray zone 0.14 ng/ml• C-reactive protein 0.1 and 0.2 mg/dl (ref.

0.1)• Risk factors: diabetes, hypertension hypercholesterinemia• Dialysis 1992 – 2001• Renal transplantation

RCx Segment 11 lesion70 % stenosis14 mm length19 mm 2 pla-que area

HS

Unstable Angina IIIB

Angio

Suspicion of plaque rupture in distal RCx

Unstable Angina IIIB

After thermography

RCx Segment 11 lesion

35%stenosis15 mm length6.8 mm 2 pla-que area

HS

Patient• PCI protocol:• Heavily calcified vessels• Guidewire steering with balloon• Amplatz catheter AL 1 8F• 3.5 16 mm bare stenting• 16 bar• TnI 0.87 ng/ml (ref 0.1) CK, myoglobin remained stable

Patient 8 Patients History• 66 year old man• Unstable AP III after surgery by urology• Risk factors diabetes hypertension

Patient Scan B8

35,8

36

36,2

36,4

36,6

36,8

37

37,2

1 7 13 19 25 31 37 43 49 55 61 67 73 79

Scan Distance (mm)

Tem

pera

ture

(C) Blood TC

TC1TC2TC3TC4TC5

Unstable Angina IIIB

Thermography

Thermography

Thermography

RCx lesion

RCx lesion

Patient 2

Patient 2

Patient 1

Patient 1

LAD segment 5 lesion

59 % stenosis 8 mm length10 mm 2 pla-que area

Patient 0

Thermography

Thermography

Thermography

Thermography

Thermography

Thermography

Unstable Angina, Circ lesion

Angio

Unstable Angina, Circ lesion

After thermography

LAD segment 6 lesion

UH

LAD segment 6 lesion

UH

LAD segment 6 lesion

UH

35,8

36

36,2

36,4

36,6

36,8

37

37,2

Scan Distance

Blood TCTC1TC2TC3TC4TC5

Temperature

Patient Scan B1

34

34,2

34,4

34,6

34,8

35

35,2

35,4

35,6

35,8

36

36,2

36,4

36,6

36,8

37

37,2

37,4

37,6

37,8

38

1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101

105

109

113

117

121

125

129

133

Scan Distance (mm)

Tem

pera

ture

(C) Blood TC

TC1

TC2

TC3

TC4

TC5

Patient B0 Partial Scan

35,8

36

36,2

36,4

36,6

36,8

37

37,2

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43

Scan Distance (mm)

Tem

pera

ture

(C) Blood TC

TC1

TC2

TC3

TC4

TC5

Patient B6 - Scan

35

35,2

35,4

35,6

35,8

36

36,2

36,4

36,6

36,8

37

1 7 13 19 25 31 37 43 49 55 61 67 73 79 85 91 97 103

109

115

121

127

133

139

145

151

157

163

169

175

181

187

193

199

205

Scan Distance (mm)

Tem

pera

ture

(C) Blood TC

TC1

TC2

TC3

TC4

TC5

Temperature

36,436,636,8

3737,237,437,637,8

Blood TCTC1TC2TC3TC4TC5

Scan Distance

Thermography Catheterization