Cardiovascular optical coherence tomography

Abstract

The potential of optical coherence tomography (OCT) for intravascular imaging and assessing the microstructure of atherosclerosis was suggested already by Huang et al. at the very beginning of OCT [1]. For ophthalmology, the eye provides a natural window for OCT to image the retinal microstructure, and OCT has rapidly become the standard imaging modality to diagnose retinal disease and assess disease progression and response to therapy [1, 2]. Intravascular imaging is more invasive by nature and requires imaging through a catheter probe. This has triggered the development of advanced fiber-optic OCT systems with compact, rotating fiber probes, to image the vessel by circumferentially scanning the luminal wall [3, 4]. In 1998, we established the first cardiac OCT research group at the Massachusetts General Hospital to explore the clinical applications of OCT. The first imaging of rabbit aorta was reported by Fujimoto et al. [5], followed by the first swine measurements in vivo by Tearney et al. [6], and finally the first assessment of coronary arteries in patients by Jang et al. [7]. The scope of this chapter is to highlight the steps taken to bring intravascular OCT from bench to bedside over the last 15 years. We will give a general description of atherosclerosis and its pathophysiology and the specific technical implementation of OCT for intravascular imaging through a fiber-optic probe. The motivation is to provide sufficient medical details to provide a basic introduction to the terminology, principles, and challenges of intracoronary imaging.