CLINICAL APPLICATIONS OF OPTICAL COHERENCE TOMOGRAPHY Konstantina P. Bouki, FESC 2 nd Department of Cardiology General Hospital Of Nikea, Pireaus
OPTICAL COHERENCE TOMOGRAPHY (OCT)
IVUS and OCT IVUS OCT Scan area 10-15 mm 7.0 mm Max. depth of penetration 4-8 mm 1.5 2.0 mm Blood clearing Not required Required
OPTICAL COHERENCE TOMOGRAPHY
OPTICAL COHERENCE TOMOGRAPHY Time domain OCT
Comparison of Time Domain OCT vs. Fourier Domain OCT Systems Gonzalo N et al. Rev Esp Cardiol. 2010;63:893-903
OCT-Current Clinical Applications Assessment of atherosclerosis (plaque characterization) Stent evaluation (immediate after implantation and during follow up)
Characterization of Human Atherosclerosis by Optical Coherence Tomography Hiroshi Yabushita et al. Circulation. 2002;106:1640-1645 Sensitivity Specificity Fibrous 71-79% 97-98% Fibrocalcific 95-96% 97% Lipid rich 90-94% 90-92% overall agreement: κ= 0.83-0.84
Diagnostic Accuracy of Optical Coherence Tomography and Integrated Backscatter Intravascular Ultrasound Images for Tissue Characterization of Human Coronary Plaques Kawasaki M,et al. J Am Coll Cardiol 2006;48:81 8 Sensitivity Specificity OCT Fibrous 98% 94% Calcific. 100% 100% Lipid pool 95% 98% Cohen s κ= 0.92 IVUS-IB Fibrous 94% 84% Calcific. 100% 99% Lipid pool 84% 97% Cohen s κ= 0.80
OCT imaging of Thrombus Kubo et al. Circulation 2006;114:II-645
Culprit Lesion Morphology Assessed By OCT. Bouki et al. Int J Cardiol. 2012;154:287-92
Assessment of culprit lesion morphology in acute myocardial infarction Kubo et al. JACC 2007;50:933-9 Plaque Rupture Plaque Erosion
Assessment of culprit lesion morphology in acute myocardial infarction Kubo et al. JACC 2007;50:933-9 Thrombus Incidence 100% Incidence 100% Incidence 33%
OCT imaging of Culprit ruptured plaque morphology in non STEMI and STEMI Toutouzas K et al. Am Heart J 2011;161:1192-9. Patients with STEMI have greater plaque disruption and smaller minimal lumen area than patients with NSTEMI
Stent Evaluation By OCT Stent expansion, apposition Acute vessel injury after stent implantation Detection of tissue prolapse (thickness, area, distribution, structural quality, thrombus) Assessment in tissue coverage over time
OPTICAL COHERENCE TOMOGRAPHY (OCT) vs IVUS T. Kubo et al JACC: Cardiovascular Imaging, vol.1 N 4, July 2008:475-84
Optical coherence tomography assessment of the acute effects of stent implantation on the vessel wall: a systematic quantitative approach. N Gonzalo, et al. Heart 2009;95:1913 1919.
OCT assessment of vessel trauma after stent implantation with long term outcomes. 43,9% (18/41) stent edge dissection were detected Stent edge dissection length: 2,2±0,7mm Dissections > 1mm are associated with worse prognosis. Bouki et al. EUROPCR 2011
OCT and histology detected a similar proportion of uncovered struts mean neointimal thickness However histology showed difference in neointimal composition, while OCT was unable to distinguish between fibrin, giant cells, granulomatous reaction, and degree of endothelialization.
Electron microscopy OCT
OFDI is a highly promising tool for accurate evaluation of coronary stent strut coverage. Optical density measurements can provide additional information with respect to the type of stent strut coverage, i.e. fibrin vs. neointimal coverage. European Heart Journal 2010; 31: 1792 1801
Vascular Healing Response 5 Years After Implantation of SES vs. PES SIRTAX-LATE, EuroPCR 2011
Neointima within the BMS often transforms into atherosclerotic tissue in the extended late phase
Case example 1: male, 76 yrs old with nonstemi and intermediate stenosis in CX
Case example 2 : 67 yrs., male, 7 years after successful implantation of a Cypher stent 3,0/28mm in proximal LAD because of an acute coronary syndrome
Conclusions OCT with its unique image resolution can accurately characterize coronary plaque components identify vulnerable plaque assess stent strut apposition assess vascular response after PCI
Future Clinical implications Need of prospective clinical trials to estimate the prognostic value of OCT findings and their impact on clinical outcome.