In this fourth book in the series on quantitative coronary arteriography (QCA) with the earlier three volumes published in 1986, 1988 and 1991, the latest developments in this exciting field are covered. Both the methodolog ical and clinical application aspects of these advances are presented in a comprehensive manner in a total of 37 chapters by world renowned experts. The book is subdivided into a total of eight parts, beginning with the more methodological issues, such as QCA and other modalities (3 chapters), cine film versus digital arteriography (3 chapters), quality control in QCA (4 chapters), and coronary blood flow and flow reserve (3 chapters). Since QCA has been well established as the technique for the assessment of regression and progression in atherosclerotic disease, and of restenosis after recanaliz ation procedures, major clinical trials in both groups are described extensively by their principal investigators in a total of 11 chapters. In addition, the QCA results after the application of various recanalization techniques are presented in another eight chapters. In the last part the experiences with various intracoronary prostheses with the emphasis on QCA are discussed in five chapters. This large increase in application oriented chapters means that QCA is well alive and gaining momentum. Although the accuracy and precision of the analytical methods steadily improve with the increasing complexity of the algorithms, there is still always the human factor involved in these processes in terms of frame selection, segment definition, etc.

Quantitative coronary angiography has become an invaluable tool for the interventional cardiologist, providing objective and reproducible measurements of coronary artery dimensions, which can be used to study progression or regression of coronary atherosclerosis, as well as the immediate and long term effects of percutaneous interventions. Until recently, this powerful imaging technology was confined to a small number of so-called high level institutions. Fortunately, with the development of digital cardiac imaging equipment and adaptation of cine-angiographically based computer software for on-line use in the catheterization room, quantitative coronary angiography is now available to all interventionalists. This book is a timely guide for the impending QCA user, providing practical as well as theoretical and scientific information. A comprehensive evaluation of the clinical usefulness of QCA is covered, from the fundamental principles through experimental validation studies, application to clinical trials of a wide range of pharmacological and interventional therapies in the full spectrum of clinical presentation of coronary disease syndromes, evaluation of the therapeutic efficacy of various new devices for coronary intervention, together with extensive presentation of its physiological, functional and anatomical correlations, by comparison with other intracoronary measurement and imaging techniques. In addition, evolving theories and concepts in the ever topical `restenosis phenomenon' after percutaneous intervention, based on serial QCA studies, are presented and discussed and a potentially unifying methodological approach to further study of this ubiquitous problem is offered. This book, thanks to the collaboration of many experts in the field of intracoronary imaging and measurement, provides stimulating, interesting and practical information, both for the academic scientist and practising clinician.

In June 1989, a third conference concentrating on the progress in quantita tive coronary angiography and related techniques was held in Rotterdam, again very successful as the two preceding events in 1985 and 1987. Tech nical as well as clinical aspects of digital and digitized coronarography, morphometry, parametric imaging and functional quantification of the human coronary circulation were presented and discussed by prominent exponents of those groups who have been active in this particular field for many years. This book contains the chapters representing the lectures held by leading experts during the symposium that update the knowledge currently available, including most recent aspects in angioscopy and intravascular ultrasound imaging. It also includes a historical review on the development of angiogra phic techniques from the very early days on to our times given by one of the pioneers in heart catheterization and angiography, Dr. Kurt Amplatz. Those who had the chance to listen to his talk, will surely remember his impressive, humorous lecture as one of the highlights of this meeting.

There are few techniques that have influenced therapeutic strategies in modem cardiology to a similar extent as coronary arteriography. Bypass surgery as well as transluminal coronary angioplasty would not have been possible without coronary angiography serving as a 'midwife' in their evolu tion. Despite the widespread and long-standing use in clinical practice, however, the interpretation of coronary angiograms has not changed very much since the early days. Most angiogr~s are still reviewed in a visual and semi-quantitative and thus often very subjective way. In the face of an almost exploding field for interventional catheterization including thrombolysis, balloon dilatation, and other rapidly evolving techniques for transluminal revascularization or recanalization, a more detailed and quantitative analysis of coronary arteriograms is urgently required. In addition to the delineation of coronary morphology, we need dynamic and functional information about flow and perfusion to understand the physiological significance of anatomic abnormalities. Coronary arteriography contains and can provide most of this information. With the application of appropriate techniques, it can be made available in the catheterization laboratory even during the patient's investiga tion, thus facilitating and improving clinical decision making. Objective and reproducible analysis will furthermore enhance our understanding about the pathophysiology of coronary disease.

In this fourth book in the series on quantitative coronary arteriography (QCA) with the earlier three volumes published in 1986, 1988 and 1991, the latest developments in this exciting field are covered. Both the methodolog ical and clinical application aspects of these advances are presented in a comprehensive manner in a total of 37 chapters by world renowned experts. The book is subdivided into a total of eight parts, beginning with the more methodological issues, such as QCA and other modalities (3 chapters), cine film versus digital arteriography (3 chapters), quality control in QCA (4 chapters), and coronary blood flow and flow reserve (3 chapters). Since QCA has been well established as the technique for the assessment of regression and progression in atherosclerotic disease, and of restenosis after recanaliz ation procedures, major clinical trials in both groups are described extensively by their principal investigators in a total of 11 chapters. In addition, the QCA results after the application of various recanalization techniques are presented in another eight chapters. In the last part the experiences with various intracoronary prostheses with the emphasis on QCA are discussed in five chapters. This large increase in application oriented chapters means that QCA is well alive and gaining momentum. Although the accuracy and precision of the analytical methods steadily improve with the increasing complexity of the algorithms, there is still always the human factor involved in these processes in terms of frame selection, segment definition, etc.

This is the fifth volume in this series on quantitative coronary arteriography (QCA) published over the last nine years. Research and applications in this exciting, field are covered in a total of 26 chapters by world renowned experts. This book is subdivided into a total of 6 parts, each emphasizing the latest progress in these respective fields. In Part One a comprehensive overview is given of the current knowledge and research in endothelial function, which is of eminent importance for the further understanding of the pathophysiology of coronary artery disease in patients. Fortunately, the use of QCA tools is not limited anymore to leading research institutes; over the last several years these tools have been installed in many cardiology centers world wide. To understand the current possibili ties, limitations and future expectations of QCA, several relevant topics are presented in Part Two. First of all, the questions about why and how QCA systems should be validated both at the development site and at the appli cation sites, and whether data from different vendors and core laboratories can be pooled, are discussed. As the X-ray cardiovascular world steadily moves into the digital imaging era, differences and similarities between the conventional cinefilm and the modern digital approaches are presented. Cur rently. the widespread use of digital imaging is still hindered by the lack of proper archival and exchange media. Requirements and possible solutions for this problem are handled in this section as well.

Atherosclerotic Plaque Characterization Methods Based on Coronary Imaging provides a complete review of computer methods for atherosclerotic plaque reconstruction and characterization. The authors, with their expertise from biomedical engineering, computer science, and cardiology, offer a holistic view. The focus of the book is on the presentation of major imaging techniques, including their limitations. It includes details on the mechanical characterization and properties of plaques and appropriate constitutive models to describe the mechanical behavior of plaques. The authors explore the challenges of using multiple coronary imaging technologies, and provide the pros and cons of invasive vs. non-invasive techniques. Methods for plaque characterization and 3D reconstruction of coronary arteries using IVUS, OCT, and CT images are described. This book will help readers study new trends in image processing analysis and plaque characterization, implement automated plaque characterization methodologies, understand coronary imaging drawbacks, and comprehend 3 dimensional coronary artery and plaque reconstruction methods. - Describes the multimodality imaging techniques that are commonly used in the diagnosis of arterial diseases, including intravascular ultrasound, optical coherence tomography, angiography, computed tomography angiography, and magnetic resonance angiography - Discusses in-depth the computational methods which can be used for the detection of different plaque types - Explores plaque in 3D reconstruction methods and plaque modeling approaches