Optical coherence tomography guidance during bioresorbable vascular scaffold implantation

Abstract

In the last decades angiography has been the keystone to assess coronary anatomy, leading to a rapid development of percutaneous revascularisation techniques. Despite the widespread dissemination and high reproducibility, angiography provides a limited analysis of arterial lumen profile without the possibility to disclose vessel wall characteristics and composition of coronary plaques. Intracoronary imaging techniques have been developed to overcome these limitations. Intravascular ultrasound (IVUS) was the first technique introduced in interventional cardiology in the early 90ies (1), followed more than a decade after by optical coherence tomography (OCT). OCT is a light-based technology that similar to IVUS provides information about intravascular anatomy that far exceeds the level of detail obtained from conventional angiography (2). The use of near-infrared light rather than ultrasound reflectance allows OCT to have greater resolution at the price of lower penetration power. Moreover, near-infrared light is scattered by red blood cells, and therefore OCT use for guidance of intervention is limited by the need of prolonged crystalloid infusion during imaging (3,4). In so forth, the penetrance of OCT in daily clinical practice was limited and the technology was mainly employed as a research tool to investigate plaque morphology and strut endothelialisation (5). The frequency domain OCT system (FD-OCT) has the advantage of a more rapid image acquisition due to the fast-scanning laser systems minimising the contrast use and increasing imaging speed while delivering an improved image quality than with the earlier time domain systems (TD-OCT) (6). This The high-resolution power together with the lack of shadowing observed beyond polymer struts makes optical coherence tomography (OCT) the optimal imaging technique to guide BRS implantation and identifies eventually scaffolds failures.

Three-year outcomes of bioresorbable vascular scaffolds versus second-generation drug-eluting stents

“…The use of optical coherence tomography allows the physician to accurately assess the condition of the stent and vessels after implantation, reducing the occurrence of adverse events. [ 24 ]…”

Long-Term Outcomes After Implantation of Magnesium-Based Bioresorbable Scaffolds—Insights From an All-Comer Registry

“…On one hand, this might implicate that implantation of this device should not solely rely on angiographic measures, but rather intravascular imaging needs to be involved to ensure that the device is well-apposed and its integrity is not distorted ( 43 ). In fact, there is evidence that supports the liberal use of intravascular imaging whenever one considers implanting a BRS ( 43 ). On the other hand, it suggests that there may be some specific patient or lesion characteristics that detrimentally affect the performance of the Mg-BRS.…”

Imaging during percutaneous coronary intervention for optimizing outcomes

“…Other subgroups in which intravascular imaging guidance during PCI has the potential to improve clinical outcomes are acute coronary syndromes, small vessel disease, bypass graft occlusions, bioresorbable vascular scaffolds, and so on. Ongoing research will provide us with more evidence to successfully use IVUS and OCT guidance to optimize clinical outcomes in these difficult-to-treat subgroups 120, 121, 122…”