Author + information
- Takashi Kubo, MD, PhD and
- Takashi Akasaka, MD, PhD⁎ ()
- ↵⁎Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
Developments of drug-eluting stent and intravascular coronary imaging have dramatically changed interventional cardiology. The case reported by Drs. Motreff and Souteyrand demonstrated the contribution of optical coherence tomography (OCT) to precise diagnosis during coronary intervention.
In the past decade, intravascular ultrasound (IVUS) has played an important role in understanding failure and optimizing outcome in stent treatment. However, due to its relatively low resolution, IVUS does not provide detailed structural information. The OCT uses advanced photonics and fiberoptics to obtain images and tissue characterization on a microscopic scale. The resolution of the OCT is 10 to 20 μm, which is approximately 10 times higher than that of IVUS. Compared with conventional imaging modalities, OCT has a superior ability to visualize stent malapposition, tissue protrusion, and vessel injury after stenting as well as thin tissue coverage of individual stent struts at follow-up (1). Nevertheless, the clinical relevance of these small, detailed features identified by OCT has not been determined yet. Assessment for the clinical reliability of OCT guidance in coronary intervention warrants further investigation.
An inherent limitation of OCT is the need to occlude coronary artery by balloon catheter and to flush Ringer's lactate solution for image acquisition. The coronary occlusion limits evaluation of left main or ostial lesions of the major coronary arteries. And the time constraint imposed by blood flow interruption limits assessment of long coronary segments. To overcome the vessel occlusion blood removal technique, an alternative method based on nonocclusive infusion of isosmolar contrast media has been proposed as a safe and effective method (2). The newly proposed method simplifies the previous complex occlusive technique, leading to a marked reduction of procedural time.
Recently, the second-generation OCT system has been shown to be an enabling technology with 15 to 50 times faster image acquisition rate than that of the currently available OCT system. This capability is made possible by a new detection method called Fourier-domain OCT, frequency-domain OCT, or spectral-domain OCT. In combination with a short, non-occlusive saline flush and rapid spiral pullback, the higher frame rates generated by second-generation OCT enable imaging of the 3-dimensional microstructure of long segments of coronary arteries (3). Moreover, the use of this method facilitates the acquisition of spectroscopic and polarization data for tissue characterization. When the second-generation OCT system is fully exploited, it might provide new insights into the treatment of coronary artery disease.
- American College of Cardiology Foundation
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