1. Intravascular/ Diagnostics Imaging
FFR
OCT
INTRAVASULAR
ULTRASOUND
INFRAREDX
TVC IVUS
VH IMAGING
Dr. Waksman
IVUS
OPTICAL COHERENCE
TOMOGRAPHY BY
DONALD HARRINGTON

2. Donald L. Harrington, RCIS
I/we have no real or apparent conflicts of interest to report.

3. Objective: To share an overview of the imaging technologies used in the Washington Hospital Center’s Cath. Lab.

4. TOOLS OF THE TRADE FOR Intravascular/ Diagnostics Imaging In THE WHC CATH. LAB
Knowing which lesion or lesions to treat and how to treat these diseased areas is the key for best PCI treatment strategies.
All of our systems are the first to combine the function of:
Fractional Flow Reserve (FFR)
Optical Coherence Tomography (OCT)
Intravascular Ultrasound (IVUS)/ VH
LipiScan/ IVUS
To provide the physician with the best insight to help diagnose and treat coronary artery disease
FFR- TWO SYSTEMS
ST. JUDE
VOLCANO
OCT- ONE SYSTEM
IVUS- THREE SYSTEMS
BSC
INFRAREDX
VH - ONE SYSTEMS
LipiScan/ IVUS –ONE SYSTEM

5. The Benefits of Our Tools
Our mobile units are easy to move
The ease of use of integrated systems in our Cath. Lab rooms
Flexibility and cost effectiveness for staff and procedures
Fast and easy - Wireless FFR, FFR, IVUS and OCT set-up in one or multiple labs
Move between FFR and OCT modalities with one touch
Easy on-screen guide simplifies ILUMIEN FFR or FFR and OCT or IVUS procedures with a new user interface touch
Flexible and quick set-up
Integrated case storage and easy patient ID retrieval info
Accommodates future updates and technologies to come
Quick and accurate information of the lesion study to be analyzed for intervention

6. ILUMIEN PCI Optimization System
The system provide high resolution imaging to show:
Plaque rupture
Intracoronary thrombus
Fibrous caps, calcium, dissection, etc.
Stent apposition and malappostion
Tissue protrusion after stenting
Neointimal hyperplasia
All done with OCT with the side arm of wireless FFR (FAME STUDY) on the system

7. ILUMIEN INSIGHT FOR WORK
FFR
Determine if blood flow is sufficiently before and after PCI
FFR allows accurate data of hemodynamically significant stenoses
FFR-guided PCI reduces mortality, procedural time, healthcare costs in the cath lab
Wi-Box provides a wireless connection to ILUMIEN, and is permanently installed between AO-transducer and hemodynamic recording system
FFR is always available in all labs anytime.
OCT
The ILUMIEN system uses the OCT technology for enhanced lesion assessment and PCI optimization
Optimize stent implantation , strut coverage, expansion and apposition
Differentiate and classify plaque
Evaluate lumen area quickly, with accurate and automated measurements
The system has 10 times better resolution and is 20 times faster than IVUS pullback rate (pullbacks in under 5 seconds)

8. ILUMIEN™ PCI Optimization System
First to combine fractional flow reserve (FFR) and optical coherence tomography (OCT) technologies in one unit
ILUMIEN represents a giant step forward in optimizing percutaneous coronary intervention (PCI)/research
Offers the physician the ability to identify culprit lesion or lesions and clarify treatment strategies

9. ILUMIEN Mobile Integration For FFR
ILUMIEN Offers :
Fast and Easy
Wireless, FFR set up in one or multiple labs
Move between FFR and OCT modalities with one touch
The ease of use of an integrated system with the flexibility and cost effectiveness of a mobile unit
Quick and easy movement between multiple labs
Easy on-screen guide simplifies ILUMIEN FFR and OCT procedures with a new, seamless user interface
Flexible
Easy patient ID information retrieval for review
Accommodates future updates and technology for the future

10. ILUMIEM SYSTEM

11. Make Every Call With Confidence
IVUS documents your decisions at every stage and is clinically relevant — choose IVUS.
Pre-therapy Understanding
• Determining lesion significance
• Morphological assessment
• Interventional sizing
Stent Optimization
• Stent apposition
• Stent expansion
• Geographic miss
• Edge dissection
Clinical Outcomes
• TLR and TVF
• Death and MI
• Thrombosis
PC BASE SYSTEMS
STATE OF THE ART DESIGN
UPGRADABLE
EASY TO USE
LIGHTWEIGHT CARTS
SUPER FEATURES
SAVE TO ALL MEDIA AND REVIEW
SMALL UNITS
PLUG & PLAY

12. Install IVUS Imaging Systems
Support MHz IVUS catheters and FFR pressure wires
Chroma-Flo technology for the blood flow
Measurements – vessel/lumen diameter, surface area and percentage
User friendly, PC base
Lightweight, maneuverable, easy to use
All S5i™, IVUS is always ready and always on and plug/play
No need to install transport a console from lab to lab
Install
IVUS Imaging Systems
Volcano s5 Imaging System

13. Volcano s5 Imaging SystemS

14. INFRAREDX TVC Imaging system
Intravascular imaging system has the ability to assess vessel composition and structure using integrated NIRS (near infrared spectroscopy) lipid core plaque detection and enhanced IVUS
The TVC Imaging System enables identification and location of vessel's LCP or LCB (lipid core plaques or burden)
The TVC IVUS Imaging System provides information about vessel structure, including lumen dimensions, degree of stenosis, and plaque burden, etc.
The TVC Imaging System is the first and only FDA-cleared device for the detection of lipid core plaques (LCP)
The CANARY clinical study is a randomized pilot trial of the use of a distal protection device to prevent peri-procedural MI during dilation of coronary stenoses caused by plaques with large lipid cores

15. INFRAREDX TVC Imaging system
TVC or True vessel characterization is the accurate, reliable, and rapid assessment of vessel composition and structure for treatment strategies.
True vessel characterization may have value in:
Improved stentting therapy and treatment strategies of coronary artery disease
Detailed risk stratification of CAD
Adjustment of pharmaceutical therapy

16. InfraReDx LipiScan IVUS Coronary Imaging System
TVC/Pre LAD: LCBI 113
TVC RCA: LCBI 0

17. How to read a chemogram

18. Determining Lesion Significance
IVUS can help
Identify large plaque burden and can help assess whether the lesion is flow-limiting.
“IVUS and FFR can both be used to assess intermediate lesions. IVUS helps me facilitate optimal stent expansion and apposition.”
Michael Lee, MD
Ronald Reagan UCLA Medical Center

19. SHOWCASE THE GOLD STANDARDS OF IVUS AT WHC

20. ILab Ultrasound Imaging System
Convenient to Use
Installed system reduces set up time
Control the case from imaging to measurement from the sterile field
Enhanced Clinical Value
Provides full cross-section IVUS images alone or in combination with measurement of lesion length on a LongView™ Image
Automatically determines vessel and lumen borders, which gives plaque burden and percent area stenosis measurement for clinical decision making
Additional Software Features
Trace Assist : Automatic detection lumen and vessel borders
Dynamic Review : Animates IVUS images for image interpretation
Archives complete cases: on CD, DVD, removable hard drive or DICOM network
iReview : Offline DICOM viewing software allows for post-procedure case viewing
Continuous Upgradable:
software development efforts to improve the clinical value of the IVUS image.
Intuitive Hardware
Installed Systems and multiple monitor-mounting into the cath lab procedure rooms
Tableside Controller: Provides sterile field control of IVUS measurement and playback of IVUS runs
Touch Panel: Intuitive user interface and simplified display
iLab 1.3 – 2.7 System Software
iSize : preview device sizing decisions by displaying area and length measurement graphics*
iColor: Enhances image interpretation by adding color to the cross-sectional IVUS view, coloring plaque and lumen based on Trace Assist™
iTint: Provides uniform tint to IVUS screen with color ( red, blue, yellow or green)
Icon Magnifier: Zoom feature that enlarges icons on the main IVUS screen
New Run Icon: to start a new run from the main screen

21. Install
IVUS Imaging Systems

22. Conclusion All of the diagnostic tools used in the
Washington Hospital Center’s Cath. Lab are state
of the art technologies. Each tool is designed to
make our job easier, and to provide the
information necessary to help patients have
the best outcome possible.

23. THANK YOU!
DLH