Intracoronary optical coherence tomography: state of the art and future directions

Abstract

Optical coherence tomography (OCT) has been increasingly utilised to guide percutaneous coronary intervention (PCI). Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited. Difficulty in transitioning from intravascular ultrasound (IVUS), complex image interpretation, lack of a standardised algorithm for PCI guidance, and paucity of data from prospective clinical trials have contributed to the modest adoption. Herein, we provide a comprehensive up-do-date overview on the utility of OCT in coronary artery disease, including technical details, device set-up, simplified OCT image interpretation, recognition of the imaging artefacts, and an algorithmic approach for using OCT in PCI guidance. We discuss the utility of OCT in acute coronary syndromes, provide a summary of the clinical trial data, list the work in progress, and discuss the future directions. KEYWORDS• ACS/NSTE-ACS • intravascular ultrasound • optical coherence tomography EuroIntervention 2021;17:e105-e123 e 106 Abbreviations ACS acute coronary syndromes BOOM bifurcation and ostial optical coherence tomography mapping DES drug-eluting stents IVUS intravascular ultrasound MI myocardial infarction MINOCA myocardial infarction with non-obstructive coronary arteries MLA minimal lumen area MLD MAX morphology, length, diameter, medial dissection, apposition, expansion MSA minimal stent area NSTEACS non-ST-segment elevation acute coronary syndromes NURD non-uniform rotational distortion OCT optical coherence tomography OFR optical flow ratio PCI percutaneous coronary intervention STEMI ST-segment elevation myocardial infarction TCFA thin-cap fibroatheroma

Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma

“…Compared to IVUS, OCT has greater axial and spatial resolution that might be helpful in CAE to assess atherosclerotic plaque features, thrombus burden and mechanisms of PCI failure. However, its application in large vessel is limited by the low penetration depth, with loss of image definition as the distance of the anatomical structures from the lens increases (62).…”

Procedure-Related Differences and Clinical Outcomes in Patients Treated with Percutaneous Coronary Intervention Assisted by Optical Coherence Tomography between New and Earlier Generation Software (Ultreon™ 1.0 Software vs. AptiVue™ Software)

“…It has been proved that an EEL-based strategy of stent sizing caused the minimal stent area to be similar to that in the case of IVUS-guided PCI. At the same time, a lower number of untreated post-PCI complications was observed [27].…”

“…Another issue is that distal EEL diameter, even with the use of modern software, may be visualized via OCT among 85% of the cases by the particular catheterization laboratory. In 95% of cases, this can be conducted by the OCT core laboratory within 5 mm of the original angiographically selected segment for reference [27].…”

Coronary orbital atherectomy treatment of Hispanic and Latino patients: A real‐world comparative analysis

“…Lastly, recent intravascular imaging studies indicate that calcified nodules are more likely found in the RCA, resulting in a higher risk of stent under expansion and more adverse events compared to calcified lesions without a calcified nodule 15,16 . Although optical coherence tomography and intravascular ultrasound imaging were not tracked in this analysis, previous studies have shown that imaging optimizes and improves PCI results regardless of lesion location and ethnicity 17,18 . However, we hypothesize that patients with RCA lesions, such as the HL patients in our retrospective analysis, may especially require intravascular imaging to better characterize the calcified lesions to properly plan for vessel preparation to obtain optimal results.…”