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Cardiology
Optical Coherence Tomography
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
17 sections · 123 slides
Overview
- Scope of this presentation
Introduction and historical development
- Definition and origin of optical coherence tomography
- Translation of OCT to the coronary circulation
- Evolution of intravascular coronary imaging
- Resolution and acquisition speed compared with IVUS
- Limitations of coronary angiography addressed by OCT
- First-generation time-domain OCT
- Frequency-domain OCT
- Capabilities of current OCT systems
Fundamentals of image formation
- Light source and wavelength
- Formation of the OCT image
- Interferometry and the need for a blood-free lumen
- From time-domain to frequency-domain acquisition
Normal vessel wall and plaque morphology
- Trilaminar appearance of the normal coronary wall
- Layers of the normal arterial wall on OCT
- Normal wall and plaque types on cross-sectional OCT
- Fibrous plaque
- Calcified plaque
- Calcium arc and depth as predictors of stent underexpansion
- Lipid plaque
- Discriminating calcified from lipid plaque
Intravascular ultrasound versus optical coherence tomography
- Comparing the two intravascular modalities
- Comparison of Intravascular Ultrasound and Optical Coherence Tomography
- Comparison of IVUS and OCT: remaining catheters
Equipment and imaging technique
- Available OCT systems
- Catheter and drive-shaft construction
- Flush media for nonocclusive imaging
- Guide catheter position and wire selection
- Contrast injection and pullback parameters
- Sequence of an OCT pullback run
- Precautions in critical lesions and single remaining vessels
- Display modes of the acquired image
Indications and guideline recommendations
- Value of OCT added to coronary angiography
- Guideline recommendations for intracoronary OCT
- Diagnostic applications of high-resolution imaging
Atherosclerotic plaque composition
- Plaque composition and the risk of destabilisation
- Diagnostic accuracy of OCT for plaque type
- Reproducibility of OCT plaque assessment
- Validation against histology and against IVUS
- Plaque appearance across clinical presentations
- Assessment of coronary calcification
Visualisation of macrophage accumulation
- Appearance of macrophages on OCT
- Macrophage density in unstable versus stable disease
- Macrophages, systemic inflammation and prognosis
Thickness of the fibrous cap
- Thin-cap fibroatheroma as the substrate of sudden death
- Fibrous cap thickness thresholds and event risk
- Measurement of fibrous cap thickness
- Fibrous cap findings in acute myocardial infarction
- Layered plaque and rapid plaque progression
- Thin-cap fibroatheroma, lipid pool, neovascularisation and macrophages
Intracoronary thrombus
- Recognition of thrombus on OCT
- Red thrombus versus white thrombus
- Recanalised chronic thrombus
- Honeycomb appearance of recanalised chronic coronary thrombus
Plaque rupture, erosion and calcified nodule
- Diagnostic algorithm for ACS plaque phenotypes
- The three culprit plaque phenotypes
- Predictors of plaque erosion
- Detection of intraluminal thrombus
- EROSION study: antithrombotic therapy without stenting
- EROSION III: OCT-guided reperfusion in STEMI
- Underlying plaque morphologies in ST-elevation myocardial infarction
Cardiac allograft vasculopathy
- OCT in cardiac allograft vasculopathy
- Layered fibrotic plaque
- Morphological patterns of cardiac allograft vasculopathy
Clinical evidence for OCT-guided PCI
- ILUMIEN I: impact on physician decision-making
- OCTACS: strut coverage after NSTEMI
- ILUMIEN III: OCT, IVUS and angiography compared
- DOCTORS: design and primary result
- DOCTORS: post-PCI findings on OCT
- OPINION: OCT versus IVUS guidance
- ILUMIEN IV: high-risk patients and complex lesions
- OCTOBER: complex bifurcation lesions
- OCCUPI: complex lesions with drug-eluting stents
- Pattern across the randomised evidence
- Clinical Evidence for OCT Use in Coronary Interventions
- OCT trials: clinical presentation and lesion type
- OCT trials: primary endpoint and major adverse cardiac events
- OCT trials: key findings
- OCT trials: key findings (continued)
- OCT trials: key findings (continued)
Limitations of optical coherence tomography
- Limited penetration depth
- Haemodynamic risk of the blood-free requirement
- Vessel-related and access limitations
- Contrast, cost and training constraints
- Constraints on the routine use of OCT
Artefacts in OCT imaging
- Classification of OCT artefacts
- Residual blood
- Guidewire shadow and gas bubbles
- Ghost lines and pseudo thin-cap fibroatheroma
- Poor calibration
- Non-uniform rotational distortion
- Sew-up and fold-over artefacts
- Stent strut artefacts: blooming and saturation
- Merry-go-round and sunflower artefacts
- Catalogue of common OCT artefacts
Conclusions
- Summary of the role of OCT
- Future directions
- Key numbers to remember
- References
- References (continued)
- References (continued)
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- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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