CARA Lab – Amsterdam

A collaboration between Abbott, Radboud University Medical Center, and Amsterdam University Medical Center.

CARA Lab researches automated segmentation and characterization of intravascular structures and lesions, optimizing OCT-based algorithms to assess physiologic characteristics, high-risk plaque identification, and predicting stent-related complications, with the goal of increasing the usability, reliability, and applicability of intravascular OCT in interventional cardiology through the use of trustworthy AI. The lab is a collaboration between Abbott, Radboud University Medical Center, and Amsterdam University Medical Center.

CARA Lab aims to address two challenges that are common in many real-world AI applications: (1) developing accurate AI models that can analyze high-resolution data streams in real-time and (2) deriving accurate and safe models from these data streams that can make long-term predictions with a limited number of training samples. Our focus is on using optical coherence tomography (OCT) pullbacks, which are high-resolution data streams that are critical for decision-making during cardiac interventions. Our goal is to identify patients at risk for future cardiac events so that preventative treatment and enhanced monitoring can be applied to those individuals. We aim to substantially enhance the usability, reliability, and applicability of intravascular OCT in interventional cardiology through the use of trustworthy AI.

To achieve these goals, CARA Lab is focusing on automated segmentation and characterization of intravascular structures and lesions, optimizing OCT-based algorithms to assess physiologic characteristics, high-risk plaque identification, and predicting stent-related complications. Indicators here are publications about the accuracy and repeatability of the developed algorithms. We consider algorithms accurate when they fall within the interobserver variability of human analysts in core laboratory assessment.

The major assumption is that AI-aided interpretation of OCT images will result in increased use of OCT in revascularization decision-making, which will be tested through the evaluation of patient outcomes and surveys. Another assumption is that the OCT interpretation by a core laboratory used to develop and validate the algorithms is accurate. Initial research showed that there is a good overall correlation between OCT findings and histopathological findings, but there are some limitations that can be addressed through comparison with other imaging modalities such as computed tomography (CT). It is also assumed that treating vulnerable plaques could have a clinical benefit for patients, though this has not yet been formally demonstrated in a clinical trial.

CARA Lab will test the impact of AI-driven OCT on (1) decision-making and (2) trust within the catheterization laboratory for both physicians and patients.

Sustainable Development Goals

Research projects

Automated OCT-assessment: aims to develop efficient annotation strategies for individual frames and for multi-frame (pullback) analysis.

End-to-end learning for vulnerable plaque features: aims to develop methods to assess high-risk plaques and to predict plaque rupture or dissection.

Optimising OCT-derived physiological measures: aims to develop algorithms to indicate physiologic coronary artery features and stent-related hemodynamic changes to original OCT-pullback.

Prediction of stent failure: aims to develop algorithms to identify OCT-based predictors of stent failure and predict risk of stent failure.

AI-driven OCT guidance in coronary revascularisation: aims to investigate ethical issues of AI-driven revascularisation strategies.

Publications

CARA Lab

2025

Volleberg, R. H. J. A.; Shin, D.; Saitta, S.; Shlofmitz, R. A.; Shlofmitz, E.; Jeremias, A.; Waerden, R. G. A.; Thannhauser, J.; Royen, N.; Ali, Z. A.

Deep Learning-Derived Plaque Burden for Intracoronary Optical Coherence Tomography: An Intravascular Ultrasound-Based Validation Study Journal Article

In: JACC. Cardiovascular interventions, vol. 18, no. 19, pp. 2432–2434, 2025, ISSN: 1876-7605.

Links | BibTeX

Volleberg, R. H. J. A.; Luttikholt, T. J.; Waerden, R. G. A.; Cancian, P.; Zande, J. L.; Gu, X.; Mol, J. Q.; Roleder, T.; Prokop, M.; Sánchez, C. I.; Ginneken, B.; Išgum, I.; Saitta, S.; Thannhauser, J.; Royen, N.

Artificial intelligence-based identification of thin-cap fibroatheromas and clinical outcomes: the PECTUS-AI study Journal Article

In: European Heart Journal, pp. ehaf595, 2025, ISSN: 0195-668X.

Abstract | Links | BibTeX

Luttikholt, T. J.; Thannhauser, J.; Royen, N.

Detection of large areas of thin-cap fibroatheroma in a recurrent STEMI patient using a novel artificial intelligence algorithm: moving from 2D to 3D Journal Article

In: European Heart Journal, vol. 46, no. 27, pp. 2712, 2025, ISSN: 0195-668X.

Abstract | Links | BibTeX

Volleberg, R. H. J. A.; Waerden, R. G. A.; Luttikholt, T. J.; Zande, J. L.; Cancian, P.; Gu, X.; Mol, J. Q.; Quax, S.; Prokop, M.; Sánchez, C. I.; Ginneken, B.; Išgum, I.; Thannhauser, J.; Saitta, S.; Nishimiya, K.; Roleder, T.; Royen, N.

Comprehensive full-vessel segmentation and volumetric plaque quantification for intracoronary optical coherence tomography using deep learning Journal Article

In: European Heart Journal - Digital Health, vol. 6, no. 3, pp. 404–416, 2025, ISSN: 2634-3916.

Abstract | Links | BibTeX

Volleberg, R.; Cancian, P.; Royen, N.

Optical Coherence Tomography in Motion: Potential Cause for Artifacts Journal Article

In: JACC: Cardiovascular Interventions, vol. 18, no. 5, pp. 680–681, 2025, ISSN: 1936-8798.

Links | BibTeX

Cancian, P.; Saitta, S.; Gu, X.; Herten, R. L. M.; Luttikholt, T. J.; Thannhauser, J.; Volleberg, R. H. J. A.; Waerden, R. G. A.; Zande, J. L.; Sánchez, C. I.; Ginneken, B.; Royen, N.; Išgum, I.

Attenuation artifact detection and severity classification in intracoronary OCT using mixed image representations Journal Article

In: 2025, (arXiv:2503.05322 [cs]).

Abstract | Links | BibTeX

Waerden, R. G. A.; Volleberg, R. H. J. A.; Luttikholt, T. J.; Cancian, P.; Zande, J. L.; Stone, G. W.; Holm, N. R.; Kedhi, E.; Escaned, J.; Pellegrini, D.; Guagliumi, G.; Mehta, S. R.; Pinilla-Echeverri, N.; Moreno, R.; Räber, L.; Roleder, T.; Ginneken, B.; Sánchez, C. I.; Išgum, I.; Royen, N.; Thannhauser, J.

Artificial intelligence for the analysis of intracoronary optical coherence tomography images: a systematic review Journal Article

In: European Heart Journal. Digital Health, vol. 6, no. 2, pp. 270–284, 2025, ISSN: 2634-3916.

Abstract | Links | BibTeX

Volleberg, R.; Luttikholt, T.; Zande, J.; Waerden, R.; Heil, L.; Cancian, P.; Gu, X.; Saitta, S.; Sánchez, C.; Ginneken, B.

TCT-1251 Artificial intelligence-based volumetric evaluation of the fibrous cap: the maximum thin-cap index within 4 mm Journal Article

In: Journal of the American College of Cardiology, vol. 86, no. 17_Supplement, pp. B537–B538, 2025.

BibTeX

Waerden, R.; Zande, J.; Cancian, P.; Luttikholt, T.; Heil, L.; Gu, X.; Thannhauser, J.; Saitta, S.; Sánchez, C.; Ginneken, B.

TCT-1259 Artificial Intelligence-Based Volumetric Analysis of Coronary Calcifications and the Association with Plaque Vulnerability Journal Article

In: Journal of the American College of Cardiology, vol. 86, no. 17_Supplement, pp. B541–B541, 2025.

BibTeX

Volleberg, R.; Shin, D.; Waerden, R.; Saitta, S.; Thannhauser, J.; Zande, J.; Luttikholt, T.; Cancian, P.; Gu, X.; Heil, L.

TCT-1260 Deep Learning-Derived Plaque Burden for Intracoronary Optical Coherence Tomography: an Intravascular Ultrasound-Based Validation Study Journal Article

In: Journal of the American College of Cardiology, vol. 86, no. 17_Supplement, pp. B541–B542, 2025.

BibTeX

Luttikholt, T.; Volleberg, E.; Waerden, R.; Zande, J.; Heil, L.; Cancian, P.; Gu, X.; Saitta, S.; Sánchez, C.; Ginneken, B.

TCT-1263 Spatial Relationship Between Artificial Intelligence-Identified Thinnest Fibrous Cap Region and the Minimum Lumen Area Journal Article

In: Journal of the American College of Cardiology, vol. 86, no. 17_Supplement, pp. B543–B543, 2025.

BibTeX

Waerden, R.; Volleberg, R.; Luttikholt, T.; Heil, L.; Cancian, P.; Gu, X.; Saitta, S.; Sánchez, C.; Ginneken, B; Išgum, I.

TCT-1266 High-Risk Plaque Features in Non-Culprit Vessels of ACS Patients: Insights from AI-Driven OCT Analysis Journal Article

In: Journal of the American College of Cardiology, vol. 86, no. 17_Supplement, pp. B544–B544, 2025.

BibTeX

Volleberg, R. H. J. A.; Rroku, A.; Mol, J. Q.; Hermanides, R. S.; van Leeuwen, M.; Berta, B.; Meuwissen, M.; Alfonso, F.; Wojakowski, W.; Belkacemi, A.

Impact of clinical risk characteristics on the prognostic value of high-risk plaques Journal Article

In: EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, vol. 21, no. 19, pp. e1147–e1158, 2025.

BibTeX

Volleberg, R. H. J. A.; Rroku, A.; Mol, J. Q.; Hermanides, R. S.; van Leeuwen, M.; Berta, B.; Meuwissen, M.; Alfonso, F.; Wojakowski, W.; Belkacemi, A.

FFR-negative nonculprit high-risk plaques and clinical outcomes in high-risk populations: an individual patient-data pooled analysis from COMBINE (OCT-FFR) and PECTUS-obs Journal Article

In: Circulation: Cardiovascular Interventions, vol. 18, no. 2, pp. e014667, 2025.

BibTeX

2024

Mézquita, A. J. V.; Biavati, F.; Falk, V.; Alkadhi, H.; Hajhosseiny, R.; Maurovich-Horvat, P.; Manka, R.; Kozerke, S.; Stuber, M.; Derlin, T.

Clinical quantitative coronary artery stenosis and coronary atherosclerosis imaging: a Consensus Statement from the Quantitative Cardiovascular Imaging Study Group Journal Article

In: Quantification of biophysical parameters in medical imaging, pp. 569–600, 2024.

BibTeX

Volleberg, R.; Damman, P.; Royen, N.

Dissection-like appearance of focal catheter-induced vasospasm in intracoronary optical coherence tomography Journal Article

In: European Heart Journal, vol. 45, no. 30, pp. 2793–2793, 2024.

BibTeX

Los, J.; Mensink, F. B.; Mohammadnia, N.; Opstal, T. S. J.; Damman, P.; Volleberg, R. H. J. A.; Peeters, D. A. M.; Royen, N.; Garcia, H. M.; Cornel, J. H.

Invasive coronary imaging of inflammation to further characterize high-risk lesions: what options do we have? Journal Article

In: Frontiers in Cardiovascular Medicine, vol. 11, pp. 1352025, 2024.

BibTeX

Föllmer, B.; Williams, M. C.; Dey, D.; Arbab-Zadeh, A.; Maurovich-Horvat, P.; Volleberg, R. H. J. A.; Rueckert, D.; Schnabel, J. A.; Newby, D. E.; Dweck, M. R.

Roadmap on the use of artificial intelligence for imaging of vulnerable atherosclerotic plaque in coronary arteries Journal Article

In: Quantification of Biophysical Parameters in Medical Imaging, pp. 547–568, 2024.

BibTeX

2023

Mol, J. Q.; Volleberg, R. H. J. A.; Belkacemi, A.; Hermanides, R. S.; Meuwissen, M.; Protopopov, A. V.; Laanmets, P.; Krestyaninov, O. V.; Dennert, R.; Oemrawsingh, R. M.

Fractional flow reserve–negative high-risk plaques and clinical outcomes after myocardial infarction Journal Article

In: JAMA cardiology, vol. 8, no. 11, pp. 1013–1021, 2023.

BibTeX

Volleberg, R.; Mol, J. Q.; Heijden, D.; Meuwissen, M.; Leeuwen, M.; Escaned, J.; Holm, N.; Adriaenssens, T.; Geuns, R. J.; Tu, S.

Optical coherence tomography and coronary revascularization: from indication to procedural optimization Journal Article

In: Trends in Cardiovascular Medicine, vol. 33, no. 2, pp. 92–106, 2023.

BibTeX

2022

Volleberg, R.; Oord, S.; van Geuns, R. J.

Hangover after side branch stenting: The discomfort comes afterwards Journal Article

In: Interventional Cardiology: Reviews, Research, Resources, vol. 17, pp. e08, 2022.

BibTeX

2021

Mol, J. Q.; Belkacemi, A.; Volleberg, R. H. J. A.; Meuwissen, M.; Protopopov, A. V.; Laanmets, P.; Krestyaninov, O. V.; Dennert, R.; Oemrawsingh, R. M.; Kuijk, J. P.

Identification of anatomic risk factors for acute coronary events by optical coherence tomography in patients with myocardial infarction and residual nonflow limiting lesions: rationale and design of the PECTUS-obs study Journal Article

In: BMJ open, vol. 11, no. 7, pp. e048994, 2021.

BibTeX

People

Partners

Abbott, the Radboud University Medical Center, and the Amsterdam University Medical Center, will all be responsible for obtaining sufficient data for the development and validation of the intended algorithms. Development, testing, and validation will mostly be performed by members of the radiology and cardiology departments of the Radboud University Medical Center and Amsterdam University Medical Center. Abbott will have the leading role in implementing the final product within a readily available OCT system. To enable this, Abbott will also be involved in the development phase by means of half-yearly meetings and all researchers will spend time at Abbott R&D in Norwood, Massachusetts, e.g. via internships.

Abbott Laboratories is an American multinational medical devices and health care company

The Radboud University Medical Center (Radboudumc) is the teaching hospital affiliated with the Radboud University, in the city of Nijmegen in the eastern-central part of the Netherlands.

Amsterdam University Medical Centers (AUMC): AUMC is a leading medical center that combines complex high-quality patient care, innovative scientific research, and education of the next generation health care professionals.

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