The Ability of Optical Coherence Tomography to Monitor PCI
Background. We investigated the usefulness of optical coherence tomography (OCT) to evaluate vessel response after stent implantation by comparing with that of intravascular ultrasound (IVUS).
Methods and Results. Eighteen cases undergoing percutaneous coronary intervention (PCI) who provided consent for both IVUS and OCT usage pre- and post-PCI procedure were enrolled. The lumen area at the distal site of the culprit lesion was smaller on OCT images than on IVUS images due to proximal vessel occlusion, whereas the lumen area at the proximal site of the lesion did not differ between OCT and IVUS images (distal site: 4.6 ± 2.0 vs. 5.0 ± 1.8 mm; p = 0.0004; proximal site: 5.5 ± 2.3 vs. 5.6 ± 2.3 mm; p = 0.8160). Stent malapposition was more frequently observed by OCT (30%) than by IVUS (5%, p = 0.0381). Stent edge dissection was not detected by IVUS, but was detected in 10% by OCT. Tissue prolapse was identified in all stents by OCT and in 5% by IVUS. Thrombus was observed in 15% by OCT and in 5% by IVUS.
Conclusions. Proximal coronary occlusion during OCT imaging was possibly related to underestimation of vessel sizing at distal reference. Our data suggested that OCT might provide more detailed information on the presence of tissue prolapse, thrombus formation and edge dissection than IVUS. Further study is warranted to assess its clinical utility.
Intravascular ultrasound (IVUS) has been used to understand coronary structures in clinical practice. IVUS provides useful information on vessel size, plaque area, and other important morphological changes after stent implantation. Also, several studies have shown that IVUS guidance improves clinical outcome after bare-metal and drug-eluting stent placement. The resolution of IVUS (100–150 μm), however, limits its ability to detect detailed structures, such as intimal tears, thrombus, stent malapposition, and tissue prolapse during stent strut insertion.
Optical coherence tomography (OCT) is a novel intracoronary diagnostic technique that has an axial resolution of 10 to 20 μm, approximately ten times greater than that of IVUS. Although OCT has its well-known disadvantage in its relatively poor penetration depth, the high resolution of OCT allows for visualization of microstructural features such as intimal tears, thrombus, stent malapposition, and tissue prolapse before and after PCI. Therefore, OCT may be useful for optimizing stenting procedures in clinical practice.
Recently, a new generation OCT; frequency-domain OCT (FD-OCT) has been developed. Although FD-OCT offers faster image acquisition speeds and greater scan depth without sacrificing its resolution, the FD-OCT system is not available in Japan for clinical use. Therefore, in this study, we evaluated usefulness of clinically available TD-OCT for the assessment of vessel response after stent deployment by comparing with that of IVUS.
Abstract and Introduction
Abstract
Background. We investigated the usefulness of optical coherence tomography (OCT) to evaluate vessel response after stent implantation by comparing with that of intravascular ultrasound (IVUS).
Methods and Results. Eighteen cases undergoing percutaneous coronary intervention (PCI) who provided consent for both IVUS and OCT usage pre- and post-PCI procedure were enrolled. The lumen area at the distal site of the culprit lesion was smaller on OCT images than on IVUS images due to proximal vessel occlusion, whereas the lumen area at the proximal site of the lesion did not differ between OCT and IVUS images (distal site: 4.6 ± 2.0 vs. 5.0 ± 1.8 mm; p = 0.0004; proximal site: 5.5 ± 2.3 vs. 5.6 ± 2.3 mm; p = 0.8160). Stent malapposition was more frequently observed by OCT (30%) than by IVUS (5%, p = 0.0381). Stent edge dissection was not detected by IVUS, but was detected in 10% by OCT. Tissue prolapse was identified in all stents by OCT and in 5% by IVUS. Thrombus was observed in 15% by OCT and in 5% by IVUS.
Conclusions. Proximal coronary occlusion during OCT imaging was possibly related to underestimation of vessel sizing at distal reference. Our data suggested that OCT might provide more detailed information on the presence of tissue prolapse, thrombus formation and edge dissection than IVUS. Further study is warranted to assess its clinical utility.
Introduction
Intravascular ultrasound (IVUS) has been used to understand coronary structures in clinical practice. IVUS provides useful information on vessel size, plaque area, and other important morphological changes after stent implantation. Also, several studies have shown that IVUS guidance improves clinical outcome after bare-metal and drug-eluting stent placement. The resolution of IVUS (100–150 μm), however, limits its ability to detect detailed structures, such as intimal tears, thrombus, stent malapposition, and tissue prolapse during stent strut insertion.
Optical coherence tomography (OCT) is a novel intracoronary diagnostic technique that has an axial resolution of 10 to 20 μm, approximately ten times greater than that of IVUS. Although OCT has its well-known disadvantage in its relatively poor penetration depth, the high resolution of OCT allows for visualization of microstructural features such as intimal tears, thrombus, stent malapposition, and tissue prolapse before and after PCI. Therefore, OCT may be useful for optimizing stenting procedures in clinical practice.
Recently, a new generation OCT; frequency-domain OCT (FD-OCT) has been developed. Although FD-OCT offers faster image acquisition speeds and greater scan depth without sacrificing its resolution, the FD-OCT system is not available in Japan for clinical use. Therefore, in this study, we evaluated usefulness of clinically available TD-OCT for the assessment of vessel response after stent deployment by comparing with that of IVUS.
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