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Background Coronary artery calcification (CAC) presents unique challenges for percutaneous coronary intervention. Calcium appears as a signal-poor region with well-defined borders by FD-OCT, which might enable full quantification of CAC. The objective of this study was to demonstrate the accuracy of intravascular frequency-domain optical coherence tomography (FD-OCT) to determine distribution of CAC. Methods and Results Cadaveric coronary arteries were imaged using FD-OCT at 100Dm frame interval. Arteries were subsequently frozen, sectioned and imaged in their entire length at 20Dm intervals using the Case Cryo-Imaging automated system™. Full volumetric co-registration between FD-OCT and cryo-images was performed. Calcium area, distance from lumen and angle were traced on every cross-section and volumetric quantification was performed offline using a dedicated algorithm. Thirty left anterior descending (LAD) arteries were imaged by both FD-OCT and cryo-imaging. Of these, 13 vessels had a total of 55 plaques with calcification by cryo-imaging and FD-OCT identified 47 (85%) of these plaques. Quantitative analyses of 1285 cryo-images were compared with corresponding co-registered 257 FD-OCT images. Calcium distribution, represented by the calcium-lumen distance (depth) and the mean calcium angle, was similar with excellent correlation between FD-OCT and cryo-imaging respectively (calcium-lumen distance: 0.25±0.09mm vs. 0.26±0.12mm, p=0.742; R=0.90), (mean calcium angle: 35.33±21.86° vs. 39.68±26.61°, p=0.207; R=0.88). Volumetric quantification of CAC was possible by OCT; calcium volume was underestimated in large calcifications in which the abluminal plaque border could not be well visualized (3.11±2.14mm3 vs. 4.58±3.39mm3, p=0.001) in OCT vs. cryo respectively. Conclusion Intravascular FD-OCT can accurately characterize CAC distribution. OCT can quantify absolute calcium volume, but may underestimate calcium burden in large plaques with poorly defined abluminal borders.

The combined use of IVUS-VH and OCT is a reliable tool to serially assess plaque progression and regression, and in the present study it was demonstrated to be safe and feasible. At 6-month follow-up, in this post-percutaneous coronary intervention patient population, most high-risk plaques remained unchanged, retaining their imaging classifications, nevertheless appearing to have remained clinically silent.

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This article discusses the current value of optical coherence tomography (OCT) for the assessment of stable coronary lesions. OCT generates intracoronary images with unprecedented image resolution, namely a 10‐fold higher image resolution compared to conventional intravascular ultrasound. OCT is able to visualize a variety of atherosclerotic plaques features that have been associated with rapid lesion progression and clinical events. There is broad agreement that the detailed, easy accessible, and interpretable information of OCT on the presence of atherosclerosis, its extent, lumen narrowing, as well as on the result of any interventional measure can be of clinical value, at least in individual patients and in specific clinical scenarios. Preliminary data indicate that OCT can change the operator's intention‐to‐treat and modify the overall revascularization strategy, potentially avoiding unnecessary interventional procedures. OCT might be efficient in complex interventions including treatment of long lesions, diffuse disease, bifurcations, as well as in all cases of angiographically ambiguous lesions. As such, OCT might emerge, next to its undisputed position in research, as tool of choice in all clinical scenarios where angiography is limited by its nature as two‐dimensional luminogram. Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/4279893/Activity.aspx

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