Intravascular optical coherence tomography (IVOCT) is used to assess stent tissue coverage and malapposition in stent evaluation trials. We developed the OCT Image Visualization and Analysis Toolkit for Stent (OCTivat-Stent), for highly automated analysis of IVOCT pullbacks. Algorithms automatically detected the guidewire, lumen boundary, and stent struts; determined the presence of tissue coverage for each strut; and estimated the stent contour for comparison of stent and lumen area. Strut-level tissue thickness, tissue coverage area, and malapposition area were automatically quantified. The software was used to analyze 292 stent pullbacks. The concordance-correlation-coefficients of automatically measured stent and lumen areas and independent manual measurements were 0.97 and 0.99, respectively. Eleven percent of struts were missed by the software and some artifacts were miscalled as struts giving 1% false-positive strut detection. Eighty-two percent of uncovered struts and 99% of covered struts were labeled correctly, as compared to manual analysis. Using the highly automated software, analysis was harmonized, leading to a reduction of inter-observer variability by 30%. With software assistance, analysis time for a full stent analysis was reduced to less than 30 minutes. Application of this software to stent evaluation trials should enable faster, more reliable analysis with improved statistical power for comparing designs.

Cardiovascular Imaging Core Laboratory Harrington Heart and Vascular Institute University Hospitals Cleveland Medical Center Cleveland OH 44106 USA

Department of Biomedical Engineering Case Western Reserve University Cleveland OH 44106 USA

Department of Cardiology Krajska zdravotni a s Masaryk Hospital UJEP Usti nad Labem Usti nad Labem Czech Republic

Department of Electrical Engineering and Computer Science Research Laboratory of Electronics Massachusetts Institute of Technology Cambridge MA 02139 USA

Department of Radiology Case Western Reserve University Cleveland OH 44106 USA

Microsoft Azure Global Cambridge MA 02142 USA

University of Defense Faculty of Military Health Sciences Hradec Kralove Czech Republic

Sci Rep. 2020 Oct 23;10(1):18491. doi: 10.1038/s41598-020-74850-y. PubMed

See more in PubMed

Bezerra HG, Costa MA, Guagliumi G, Rollins AM, Simon DI. Intracoronary optical coherence tomography: a comprehensive review clinical and research applications. JACC Cardiovasc. Interv. 2009;2:1035–1046. doi: 10.1016/j.jcin.2009.06.019. PubMed DOI PMC

Lim JW, et al. Effects of lowest-dose vs. highest-dose pitavastatin on coronary neointimal hyperplasia at 12-month follow-up in type 2 diabetic patients with non-ST elevation acute coronary syndrome: an optical coherence tomography analysis. Heart Vessel. 2019;34:62–73. doi: 10.1007/s00380-018-1227-0. PubMed DOI

Seung-Yul L, et al. Early Follow-Up Optical Coherence Tomographic Findings of Significant Drug-Eluting Stent Malapposition. Circulation: Cardiovascular Interventions. 2018;11:e007192. PubMed

Gatto L, et al. Role of optical coherence tomography in identifying sub-optimal stent positioning and predicting major adverse cardiac events in a comparative study with angiography: a CLIO-OPCI II sub-study. Coron. Artery Dis. 2018;29:384. doi: 10.1097/MCA.0000000000000633. PubMed DOI

Suzuki Y, et al. In vivo comparison between optical coherence tomography and intravascular ultrasound for detecting small degrees of in-stent neointima after stent implantation. JACC Cardiovasc. Interv. 2008;1:168–173. doi: 10.1016/j.jcin.2007.12.007. PubMed DOI

Capodanno D, et al. Comparison of optical coherence tomography and intravascular ultrasound for the assessment of in-stent tissue coverage after stent implantation. EuroIntervention. 2009;5:538–543. doi: 10.4244/EIJV5I5A88. PubMed DOI

Lüscher TF, et al. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation. 2007;115:1051–1058. doi: 10.1161/CIRCULATIONAHA.106.675934. PubMed DOI

Pfisterer Matthias E. Late Stent Thrombosis After Drug-Eluting Stent Implantation for Acute Myocardial Infarction. Circulation. 2008;118:1117–1119. doi: 10.1161/CIRCULATIONAHA.108.803627. PubMed DOI

Finn Aloke V, et al. Vascular Responses to Drug Eluting Stents. Arteriosclerosis, Thrombosis, Vasc. Biol. 2007;27:1500–1510. doi: 10.1161/ATVBAHA.107.144220. PubMed DOI

Guagliumi G, et al. Optical Coherence Tomography Assessment of In Vivo Vascular Response After Implantation of Overlapping Bare-Metal and Drug-Eluting Stents. JACC: Cardiovascular Interventions. 2010;3:531–539. PubMed

Tahara S, Chamié D, Baibars M, Alraies C, Costa M. Optical coherence tomography endpoints in stent clinical investigations: strut coverage. Int. J. Cardiovasc. Imaging. 2011;27:271–287. doi: 10.1007/s10554-011-9796-3. PubMed DOI PMC

Giulio G, et al. Strut Coverage and Vessel Wall Response to a New-Generation Paclitaxel-Eluting Stent With an Ultrathin Biodegradable Abluminal Polymer. Circulation: Cardiovascular Interventions. 2010;3:367–375. PubMed

Guagliumi G, et al. Strut coverage and late malapposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: optical coherence tomography substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial. Circulation. 2011;123:274–281. doi: 10.1161/CIRCULATIONAHA.110.963181. PubMed DOI

Guagliumi G, et al. Strut Coverage and Vessel Wall Response to Zotarolimus-Eluting and Bare-Metal Stents Implanted in Patients With ST-Segment Elevation Myocardial Infarction: The OCTAMI (Optical Coherence Tomography in Acute Myocardial Infarction) Study. JACC: Cardiovascular Interventions. 2010;3:680–687. PubMed

Kauffmann C, Motreff P, Sarry L. In Vivo Supervised Analysis of Stent Reendothelialization From Optical Coherence Tomography. IEEE Trans. Med. Imaging. 2010;29:807–818. doi: 10.1109/TMI.2009.2037755. PubMed DOI

Bruining, N., Sihan, K., Ligthart, J., Winter, S. de & Regar, E. Automated three-dimensional detection of intracoronary stent struts in optical coherence tomography images. In 2011 Computing in Cardiology 221–224 (2011).

Adriaenssens T, et al. Automated detection and quantification of clusters of malapposed and uncovered intracoronary stent struts assessed with optical coherence tomography. Int. J. Cardiovasc. Imaging. 2014;30:839–848. PubMed

Xu C, Schmitt JM, Akasaka T, Kubo T, Huang K. Automatic detection of stent struts with thick neointimal growth in intravascular optical coherence tomography image sequences. Phys. Med. Biol. 2011;56:6665–6675. doi: 10.1088/0031-9155/56/20/010. PubMed DOI

Ughi GJ, et al. Automatic segmentation of in-vivo intra-coronary optical coherence tomography images to assess stent strut apposition and coverage. Int. J. Cardiovasc. Imaging. 2012;28:229–241. doi: 10.1007/s10554-011-9824-3. PubMed DOI

Ughi GJ, et al. Automatic assessment of stent neointimal coverage by intravascular optical coherence tomography. Eur. Heart J. - Cardiovascular Imaging. 2014;15:195–200. doi: 10.1093/ehjci/jet134. PubMed DOI

Bonnema GT, Cardinal KO, Williams SK, Barton JK. An automatic algorithm for detecting stent endothelialization from volumetric optical coherence tomography datasets. Phys. Med. Biol. 2008;53:3083–3098. doi: 10.1088/0031-9155/53/12/001. PubMed DOI

Gurmeric S, Isguder GG, Carlier S, Unal G. A new 3-D automated computational method to evaluate in-stent neointimal hyperplasia in in-vivo intravascular optical coherence tomography pullbacks. Med. Image Comput. Comput Assist. Interv. 2009;12:776–785. PubMed

Wang A, et al. Automatic stent strut detection in intravascular optical coherence tomographic pullback runs. Int. J. Cardiovasc. Imaging. 2013;29:29–38. doi: 10.1007/s10554-012-0064-y. PubMed DOI PMC

Tsantis S, et al. Automatic vessel lumen segmentation and stent strut detection in intravascular optical coherence tomography. Med. Phys. 2012;39:503–513. doi: 10.1118/1.3673067. PubMed DOI

Lu H, et al. Automatic stent detection in intravascular OCT images using bagged decision trees. Biomed. Opt. Express, BOE. 2012;3:2809–2824. doi: 10.1364/BOE.3.002809. PubMed DOI PMC

Nam HS, et al. Automated detection of vessel lumen and stent struts in intravascular optical coherence tomography to evaluate stent apposition and neointimal coverage. Med. Phys. 2016;43:1662. doi: 10.1118/1.4943374. PubMed DOI

Lu H, et al. Automated stent coverage analysis in intravascular OCT (IVOCT) image volumes using a support vector machine and mesh growing. Biomed. Opt. Express, BOE. 2019;10:2809–2828. doi: 10.1364/BOE.10.002809. PubMed DOI PMC

Wang Z, et al. Semiautomatic segmentation and quantification of calcified plaques in intracoronary optical coherence tomography images. J. Biomed. Opt. 2010;15:061711. doi: 10.1117/1.3506212. PubMed DOI

Wang Z, et al. Volumetric quantification of fibrous caps using intravascular optical coherence tomography. Biomed. Opt. Express. 2012;3:1413–1426. doi: 10.1364/BOE.3.001413. PubMed DOI PMC

Shalev, R., Bezerra, H. G., Ray, S., Prabhu, D. & Wilson, D. L. Classification of calcium in intravascular OCT images for the purpose of intervention planning. Proc SPIE Int Soc Opt Eng9786 (2016). PubMed PMC

Kolluru, C., Prabhu, D., Gharaibeh, Y., Wu, H. & Wilson, D. L. Voxel-based plaque classification in coronary intravascular optical coherence tomography images using decision trees. Proc SPIE Int Soc Opt Eng10575 (2018). PubMed PMC

Kolluru C, et al. Deep neural networks for A-line-based plaque classification in coronary intravascular optical coherence tomography images. J. Med. Imaging. 2018;5:044504. doi: 10.1117/1.JMI.5.4.044504. PubMed DOI PMC

Prabhu, D. et al. 3D registration of intravascular optical coherence tomography and cryo-image volumes for microscopic-resolution validation. Proc SPIE Int Soc Opt Eng9788 (2016). PubMed PMC

Shalev, R. et al. Intravascular optical coherence tomography image analysis method. In 2015 41st Annual Northeast Biomedical Engineering Conference (NEBEC) 1–2, doi:10.1109/NEBEC.2015.7117058(2015).

Prabhu DS, et al. Automated A-line coronary plaque classification of intravascular optical coherence tomography images using handcrafted features and large datasets. JBO. 2019;24:106002. PubMed PMC

Hong, L. et al. Automated stent coverage analysis in intravascular OCT (IVOCT) image volumes using support vector machine and mesh growing. Biomedical Optics Express, Submitted (2019). PubMed PMC

Wang Z, et al. 3-D Stent Detection in Intravascular OCT Using a Bayesian Network and Graph Search. IEEE Trans. Med. Imaging. 2015;34:1549–1561. doi: 10.1109/TMI.2015.2405341. PubMed DOI PMC

Kala P, et al. OCT guidance during stent implantation in primary PCI: A randomized multicenter study with nine months of optical coherence tomography follow-up. Int. J. Cardiology. 2018;250:98–103. doi: 10.1016/j.ijcard.2017.10.059. PubMed DOI

Jakl, M. et al. P3176Stent malapposition is associated with unfavorable long-term outcomes in patients treated by primary coronary angioplasty: six-year follow-up of ROBUST study. Eur Heart J39 (2018).

Taniwaki Masanori, et al. Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography. Circulation. 2016;133:650–660. doi: 10.1161/CIRCULATIONAHA.115.019071. PubMed DOI

Attizzani GF, Bezerra HG. Contemporary assessment of stent strut coverage by OCT. Int. J. Cardiovasc. Imaging. 2013;29:23–27. doi: 10.1007/s10554-012-0046-0. PubMed DOI

Tearney GJ, et al. Consensus Standards for Acquisition, Measurement, and Reporting of Intravascular Optical Coherence Tomography Studies. J. Am. Coll. Cardiology. 2012;59:1058–1072. doi: 10.1016/j.jacc.2011.09.079. PubMed DOI

Lu H, et al. Automatic stent detection in intravascular OCT images using bagged decision trees. Biomed. Opt. Express. 2012;3:2809–2824. doi: 10.1364/BOE.3.002809. PubMed DOI PMC

Bonnema GT, Cardinal KO, Williams SK, Barton JK. An automatic algorithm for detecting stent endothelialization from volumetric optical coherence tomography datasets. Phys. Med. Biol. 2008;53:3083–3098. doi: 10.1088/0031-9155/53/12/001. PubMed DOI

Ughi GJ, et al. Automatic segmentation of in-vivo intra-coronary optical coherence tomography images to assess stent strut apposition and coverage. Int. J. Cardiovasc. Imaging. 2012;28:229–241. doi: 10.1007/s10554-011-9824-3. PubMed DOI

Mandelias K, et al. Automatic quantitative analysis of in-stent restenosis using FD-OCT in vivo intra-arterial imaging. Med. Phys. 2013;40:063101. doi: 10.1118/1.4803461. PubMed DOI

Wang A, et al. Automatic stent strut detection in intravascular optical coherence tomographic pullback runs. Int. J. Cardiovasc. Imaging. 2013;29:29–38. doi: 10.1007/s10554-012-0064-y. PubMed DOI PMC

Nam HS, et al. Automated detection of vessel lumen and stent struts in intravascular optical coherence tomography to evaluate stent apposition and neointimal coverage. Med. Phys. 2016;43:1662–1675. doi: 10.1118/1.4943374. PubMed DOI