1. Near Infrared Spectroscopy: Case Studies and Clinical Relevance
Brijeshwar Maini MD, FACC
Chair
Structural Heart Division
Cardiovascular Research Division
Pinnacle Health Cardiovascular Institute
Harrisburg, PA

2. I have no real or apparent conflicts of interest to report.
Brijeshwar S. Maini, MD
I have no real or apparent conflicts of interest to report.

3. NIRS

4. In vivo characterization of coronary plaques: novel findings from comparing greyscale and virtual histology intravascular ultrasound and near-infrared spectroscopy: Eur Heart J (2012) 33 (3):
Pu, Maini, Stone, Maehara et al
A positive relationship between VH-derived %NC and NIRS-derived lipid core burden index was found in non-calcified plaques, but not in calcified plaques.

5. Brijeshwar Maini, MD‡, Larisa Buyantseva, MD‡, Avneep Dhanju, MS†,
In Vivo Tissue Characterization of Coronary Lipid Plaques: Novel Findings from Comparing Optical Coherence Tomography and Near-Infrared Spectroscopy.
Brijeshwar Maini, MD‡, Larisa Buyantseva, MD‡, Avneep Dhanju, MS†,
Gregg W Stone, MD*
 *Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY; †Pennsylvania State University, Harrisburg, PA; ‡PinnacleHealth Cardiovascular Institute, Harrisburg, PA

10. What is their distribution
LARGE LIPID POOL
SMALL LIPID POOL
What is their distribution

12. Stent Thrombosis
STENOSIS

19. RESTENOSIS LAD
STENOSIS

20. Stent
edge

21. RESTENOSIS LCX
STENOSIS

22. Nouveau Atherosclerosis

23. Nouveau Atherosclerosis

24. PLAQUE PROTRUSION

25. X I E N C V

26. PLAQUE PROTRUSION AND EXTENSIVE LIPID BEHIND STENT IN PROXIMAL LAD
LCX LM
XIENCE V
LAD

30. Analysis of saphenous vein graft lesion composition using near-infrared spectroscopy and intravascular ultrasonography with virtual histology: Atherosclerosis Oct;212(2): Wood FO, Badhey N, Garcia B, Abdel-karim AR, Maini B, Banerjee S, Brilakis ES.
NIRS-measured lipid core plaque in SVGs increases with increasing SVG age and is infrequent in anastomotic lesions.

31. Detection of lipid-core plaques by intracoronary near-infrared spectroscopy identifies high risk of periprocedural myocardial infarction: Goldstein JA, Maini B et al Circ Cardiovasc Interv Oct 1;4(5):429-37
NIRS provides rapid, automated detection of extensive LCPs that are associated with a high risk of periprocedural MI, presumably due to embolization of plaque contents during coronary intervention

32. QUESTIONS ? HOW BIG IS BIG?
WHEN DOES A LIPID POOL REACH A POINT OF NO RETURN?
WILL WE BE ABLE TO PREVENT DISTAL EMBOLIZATION DUE TO INSTRUMENTATION?
ARE LARGE LIPID POOLS RESISTANT TO STATIN THERAPY?

33. SHOULD THESE PATIENTS WITH LARGE LIPID POOLS BE ON LIFELONG DAPT?
IS RESIDUAL LIPID BEHIND THE STENT/PLAQUE PROTRUSION A POOR PROGNOSTIC MARKER?
SHOULD WE BE SCAFFOLDING THEM WITH BIOABSORBABLE STENTS?
WOULD CETP INHIBITORS HOLD ANY PROMISE?

34. IS THIS VULNERABLE PLAQUE?