Optical coherence tomography: Role in percutaneous coronary intervention

Abstract

Optical coherence tomography (OCT) is an imaging modality that utilizes back-reflection of near-infrared light. Superior resolution intra-coronary imaging, including assessment of plaque morphology and characteristics as well as imaging stents and post-stent complications have made OCT a powerful research tool, and more recently a clinical tool for guidance of PCI. Visualization of coronary lesions with OCT and their characterization as lipid-rich, fibrous, or fibro-calcific plaque can influence percutaneous coronary intervention (PCI) procedural planning. OCT has contributed significantly to the understanding of culprit lesion pathophysiology in acute coronary syndromes (ACS). ACS culprit lesions have been categorized by OCT features as resulting from plaque rupture, calcific nodule, or plaque erosion. Finally, OCT has proven to be an ideal imaging modality for ensuring optimal results after PCI. OCT can be used to assess for appropriate stent expansion and apposition of the stent with the vessel wall, and is an effective modality for the detection and assessment of stent-edge dissection, incomplete stent apposition, and in-stent tissue protrusion. The resolution of OCT allows for detection and assessment of in-stent neointima proliferation and neoatherosclerosis. A demonstrated safe and effective research instrument, OCT has shown great potential in this clinical role as an adjunctive imaging modality for PCI.