Research and Clinical Applications of Optical Coherence Tomography in Invasive Cardiology: A Review (original) (raw)
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Current applications of optical coherence tomography for coronary intervention
International journal of cardiology, 2013
Optical coherence tomography (OCT) is the 'new kid on the block' in coronary imaging. This technology offers clinicians a high resolution (approximately 15 μm), that is ten times higher than the currently accepted gold standard of intravascular ultrasound and has emerged as the ideal imaging tool for the assessment of superficial components of coronary plaques and stent struts. Novel OCT systems can perform quick and safe scanning of coronary arteries with a non-occlusive technique. A brief summary containing the key physical principles of OCT technology with particular attention to the novel Fourier domain system is presented. This review will focus on clinical and research applications of OCT in interventional cardiology. The two main fields of OCT in vivo: coronary atherosclerosis assessment and the study of vessel wall response to stent implantation in terms of strut coverage and apposition will be delineated. Limitations and future perspectives of the technique are pres...
Optical Coherence Tomography: An Eye Into the Coronary Artery
Frontiers in Cardiovascular Medicine
Optical coherence tomography (OCT) is slowly but surely gaining a foothold in the hands of interventional cardiologists. Intraluminal and transmural contents of the coronary arteries are no longer elusive to the cardiologist's probing eye. Although the graduation of an interventionalist in imaging techniques right from naked eye angiographies to ultrasound-based coronary sonographies to the modern light-based OCT has been slow, with the increasing regularity of complex coronary cases in practice, such a transition is inevitable. Although intravascular ultrasound (IVUS) due to its robust clinical data has been the preferred imaging modality in recent years, OCT provides a distinct upgrade over it in many imaging and procedural aspects. Better image resolution, accurate estimation of the calcified lesion, and better evaluation of acute and chronic stent failure are the distinct advantages of OCT over IVUS. Despite the obvious imaging advantages of OCT, its clinical impact remains ...
Journal of Clinical Medicine, 2022
Cardiovascular diseases are the main cause of death worldwide, with coronary artery disease being the predominant underlying etiology. The most prevalent coronary lesions are represented by the atherosclerotic plaques, in more than 85% of cases, but there are several other non-atherosclerotic lesions such as spontaneous coronary artery dissection and/or hematoma and spontaneous recanalization of coronary thrombus, which are less common, approximately 5% of cases, but with similar clinical manifestations as well as complications. There are insufficient data regarding the pathological mechanism, true prevalence and optimal treatment of these kind of coronary lesions. Optical coherence tomography (OCT) is an intracoronary imaging technique, developed in order to overcome the diagnostic limitations of a standard coronary angiography and has an extremely high resolution, similar to that of a usual histological evaluation of a biopsy sample, thus, OCT provides a histological-like informat...
Archives of Cardiovascular Diseases, 2010
Background. -Optical coherence tomography is an imaging method that enables cardiologists to study atheromatous plaques, and to check the implantation and evolution of coronary stents. It is an invasive technique, providing high-resolution (10 m) in vivo images, but with limitations and artefacts that need to be understood before the field of application can be extended. Aim. -To determine the feasibility and limitations of optical coherence tomography coronary imaging from a single-centre experience.
Application of Optical Coherence Tomography in Percutaneous Coronary Intervention
Circulation Journal, 2012
ptical coherence tomography (OCT) is a novel intravascular imaging modality that uses near-infrared light. The distinct advantage of OCT over conventional intravascular ultrasound (IVUS) is its ultra-high resolution (10-20 μm). OCT provides new opportunities to perform detailed analysis of the coronary artery wall, including plaque characterization, identification of unstable plaque, and assessment of the vascular response in relation to percutaneous coronary intervention (PCI). 1,2 This review focuses on the usefulness of OCT in PCI. OCT System and Technique The OCT system consists of a light source, reference mirror, and photodetector. Compared with the initial time-domain (TD) OCT, newer generations of intravascular OCT systems, termed frequency-domain (FD) OCT, use a fixed mirror with a variable frequency light source, which makes image acquisition significantly faster. The pullback speed of the OCT catheter is up to 20 mm/s, and the scanning length reaches 50 mm. In addition, FD-OCT imaging can be achieved during contrast injection from a guiding catheter (<15 ml, 3-4 ml/s). The fast scanning speed of FD-OCT could be related to its clinical utility and patient safety. FD-OCT has a shorter procedure time and less ischemic symptoms during OCT image acquisition as compared to TD-OCT. 3,4 Quantitative Measurements OCT provides robust and reproducible measurements of the vessel lumen. The high resolution of OCT images allows accurate recognition of the luminal boundary. When OCT was performed in a plexiglass phantom manufactured with a precision of 10 μm, the OCT measurement correlated extremely well with the real luminal dimension (relative standard deviation 1.8%, r=1.000, intercept 0.01, slope 1.02). 5 In addition, the correlation between the measurements of OCT and IVUS was highly significant (R 2 =0.82, P<0.001). 6 However, the luminal area measured by OCT seems to be smaller than that with IVUS, and the relative difference is approximately 11-22%. 6,7 The difference between the 2 methods could be related to the specific backscattering of either light or sound. The recognition of the luminal boundary might be inherently different because of the physical characteristics of the wave length used by these technologies. Moreover, the Z-offset, which is a manually adjustable calibration of OCT, is critical for accurate measurements. A 1% change in the magnitude of the ideal Z-offset can result in a 12-14% error in area measurements by OCT. 8 The measurement bias in OCT may influence the assessment of lesion severity and device selection for PCI.
From Patient to Plaque. Contemporary Coronary ImagingPart 2: Optical Coherence Tomography
British journal of …, 2010
I ntra-coronary imaging has become a cornerstone of visualising atherosclerotic coronary artery disease and also to guide the therapy in selected high-risk cases. Optical coherence tomography (OCT) is an imaging modality quite similar to intravascular ultrasound (IVUS), but uses light instead of sound. In the second article on contemporary coronary imaging, the potential of OCT is discussed. Tissue type OCT image characteristics Fibrous Homogenous High reflectivity Low attenuation Calcium Sharp edges Low reflectivity Low attenuation Lipid Diffuse edges High reflectivity High attenuation Red thrombus Medium reflectivity High attenuation White thrombus Medium reflectivity Low attenuation
Optical coherence tomography as a tool for percutaneous coronary interventions
Catheterization and Cardiovascular Interventions, 2005
This study was performed to demonstrate the ability of intravascular optical coherence tomography (OCT) to identify characteristic vascular responses to percutaneous coronary interventions (PCI). OCT provides cross-sectional images of tissue in situ at approximately 10 mm, rendering detailed structural information. Intravascular ultrasound and OCT images were obtained from 10 patients before and after PCI. Images were evaluated to identify balloon-induced dissections/disruptions, thrombus, cutting balloon-induced vascular changes, tissue protrusion, stent apposition and symmetry, and intimal hyperplasia. The disrupted intima, intraluminal thrombus, depth of ballooninduced dissections, cutting balloon cuts, tissue prolapse, underdeployed struts, and intimal hyperplasia were all noticed with OCT. This is the first report of the use of OCT to identify in vivo human intracoronary pathology after PCI.
Autopsy studies suggest that acute myocardial infarction is provoked by sudden disruption of thin-cap fibroatheromas, known as vulnerable plaques followed by subsequent thrombosis 1-3 . The pathological characteristics of vulnerable plaques include a thin fibrous cap with macrophage infiltration and a large lipid pool1 1-3 . These findings are based largely on postmortem studies because it has previously not been possible to accurately define coronary plaque morphology in vivo.
The basics of intravascular optical coherence tomography
Advances in Interventional Cardiology, 2015
Optical coherence tomography (OCT) has opened new horizons for intravascular coronary imaging. It utilizes near-infrared light to provide a microscopic insight into the pathology of coronary arteries in vivo. Optical coherence tomography is also capable of identifying the chemical composition of atherosclerotic plaques and detecting traits of their vulnerability. At present it is the only tool to measure the thickness of the fibrous cap covering the lipid core of the atheroma, and thus it is an exceptional modality to detect plaques that are prone to rupture (thin fibrous cap atheromas). Moreover, it facilitates distinguishing between plaque rupture and plaque erosion as a cause of acute intracoronary thrombosis. Optical coherence tomography is applied to guide angioplasties of coronary lesions and to assess outcomes of percutaneous coronary interventions broadly. It identifies stent malapposition, dissections, and thrombosis with unprecedented precision. Furthermore, OCT helps to monitor vessel healing after stenting. It evaluates the coverage of stent struts by the neointima and detects in-stent neoatherosclerosis. With so much potential, new studies are warranted to determine OCT's clinical impact. The following review presents the technical background, basics of OCT image interpretation, and practical tips for adequate OCT imaging, and outlines its established and potential clinical application.