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14.4 Optical coherence tomography
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Published:July 2018
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This version:April 2020
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Abstract
Frequency domain optical coherence tomography (FD-OCT) uses infrared light waves, providing intracoronary images at a high resolution and enabling the characterization of the structure and extent of coronary artery disease in unprecedented detail. OCT can study plaque components such as fibrous tissue, calcium, and lipids with high accuracy. Furthermore, the technique is potentially able to depict inflammatory cells, crystals of cholesterol, and intimal vasculature, and can clarify the mechanism of acute coronary syndromes. OCT is therefore the most promising technique to study plaque vulnerability. FD-OCT, with its ability to distinguish fresh thrombus from other tissues, can also identify culprit lesions in patients with acute coronary syndromes. Some studies are encouraging the adoption of an OCT-guided approach of stent deployment, showing the superiority versus an angiography-guided strategy. The assessment of plaque composition pre-intervention is instrumental for device selection. Identification and quantification of calcium is key in deciding whether to perform direct stenting or to proceed with tissue ablation in the presence of massive calcifications. Furthermore, FD-OCT can be used to size stent length and diameter. After intervention, recent data established the OCT metrics to be adopted to fine-tune stenting procedures.
Update:
Results of the CLIMA study have been added, recently published in the European Heart Journal, addressing how optical coherence tomography ...More
Update:
Results of the CLIMA study have been added, recently published in the European Heart Journal, addressing how optical coherence tomography (OCT) can assess features of plaque vulnerability responsible for the hard cardiac end-point during the first year of follow-up.
OCT can also guide stent implantation in challenging procedures with the use of techniques for calcium removal (rotational atherectomy, ShockWave, and Laser).
Results of the OPINION and ILLUMIEN III trials have been added, two studies showing the non-inferiority of OCT with respect to intravascular ultrasound for percutaneous coronary intervention guidance.
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