Optical Coherence Tomography for the Assessment of Coronary Artery Disease

Abstract

Angiography remains the gold standard for assessment of atherosclerotic impairment of coronary arteries and for guidance of coronary intervention. Angiography, as a main limitation, only depicts the luminal narrowings caused by coronary plaques, without showing the structures located beneath, such as the atherosclerotic lesions or the vessel wall. Intravascular imaging modalities are currently adopted to circumvent angiographic limitations. Optical coherence tomography (OCT)) is a novel imaging technique that uses infrared lights and can study atherosclerotic plaques and stented segments with extreme accuracy. Compared to intravascular ultrasound (IVUS) , OCT has a much higher resolution; this is at the expense of the penetration depth. This chapter reviews the role of OCT in atherosclerotic plaque assessment and the clinical outcome of OCT-guided percutaneous coronary interventions (PCI). A detailed visualization of the superficial lipid pool, thin fibrous cap, and inflammatory cells allows OCT to precisely identify vulnerable plaque with thin-cap fibroatheroma . Recent data support the potential clinical role of an OCT-guided strategy of coronary interventions that may lead to a reduction in the incidence of acute coronary events.