Current and future developments in intracoronary optical coherence tomography imaging

The Northern Hospital, Department of Cardiology, University of Melbourne, Victoria, Australia.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (Impact Factor: 3.77). 02/2009; 4(4):529-33. DOI: 10.4244/EIJV4I4A89
Source: PubMed


Optical coherence tomography (OCT) has become a key intracoronary imaging modality able to traverse some of the limitations of angiography and intravascular ultrasound. In vivo imaging with high resolution (around 15 micrometres) has given unique insights into not only atherosclerotic plaque, but also to the understanding of tissue responses underlying stent implantation. Novel developments with faster OCT pullback speeds will further simplify the procedural requirements and eventually eliminate the need for proximal vessel balloon occlusion during image acquisition. This report explores the current and future developments in OCT technology that will see this unique imaging modality become a key player in both the clinical and research arena for the interventional cardiologist.

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    • "Most clinical imaging techniques have been applied to detect blockages in blood flow and locate narrowed sections of vessels and as such, they are suited to detecting stenotic lesions and aid in the management of patients with acute blockages. Intravascular ultrasound (IVUS) and more recently optical coherence tomography are imaging technologies that are available to clinicians to visualize plaque structure in the vessel wall (Hodgson et al. 1993; Yock and Fitzgerald 1998; Jang et al. 2005; Barlis et al. 2008a, b; Sun et al. 2008; Barlis and Schmitt 2009). Recent studies have shown the potential of fluorescence lifetime imaging to differentiate thin plaques from thick plaques and thick-cap fibroatheroma based on UV-excited fluorescence lifetime data (Suhling et al. 2005; Jo et al. 2006; Marcu et al. 2009; Phipps et al. 2009; Thomas et al. 2010). "
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    ABSTRACT: Pathological understanding of arterial diseases is mainly attributable to histological observations based on conventional tissue staining protocols. The emerging development of nonlinear optical microscopy (NLOM), particularly in second-harmonic generation, two-photon excited fluorescence and coherent Raman scattering, provides a new venue to visualize pathological changes in the extracellular matrix caused by atherosclerosis progression. These techniques in general require minimal tissue preparation and offer rapid three-dimensional imaging. The capability of label-free microscopic imaging enables disease impact to be studied directly on the bulk artery tissue, thus minimally perturbing the sample. In this review, we look at recent progress in applications related to arterial disease imaging using various forms of NLOM.
    Biophysical Reviews 12/2012; 4(4). DOI:10.1007/s12551-012-0077-8
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    • "This mechanical scanning process limits the rate at which images can be acquired (Fig. 1A). To overcome this limitation, a new generation of OCT systems that employ frequency-domain OCT imaging methods has been developed [5,6]. These systems are known as frequency-domain OCT (FD-OCT), Fourier-domain OCT, swept-source OCT (SS-OCT), or optical frequency-domain imaging (OFDI). "
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    ABSTRACT: Optical coherence tomography (OCT) is an optical analog of intravascular ultrasound (IVUS) that can be used to examine the coronary arteries and has 10-fold higher resolution than IVUS. Based on polarization properties, OCT can differentiate tissue characteristics (fibrous, calcified, or lipid-rich plaque) and identify thin-cap fibroatheroma. Because of the strong attenuation of light by blood, OCT systems required the removal of blood during OCT examinations. A recently developed frequency-domain OCT system has a faster frame rate and pullback speed, making the OCT procedure more user-friendly and not requiring proximal balloon occlusion. During percutaneous coronary intervention (PCI), OCT can provide detailed information (dissection, tissue prolapse, thrombi, and incomplete stent apposition [ISA]). At follow-up examinations after stent implantation, stent strut coverage and ISA can be assessed. Several OCT studies have demonstrated delayed neointimal coverage following drug-eluting stent (DES) implantation vs. bare metal stent (BMS) placement. While newer DESs promote more favorable vascular healing, the clinical implications remain unknown. Recent OCT studies have provided insights into restenotic tissue characteristics; DES restenotic morphologies differ from those with BMSs. OCT is a novel, promising imaging modality; with more in-depth assessments of its use, it may impact clinical outcomes in patients with symptomatic coronary artery disease.
    The Korean Journal of Internal Medicine 03/2012; 27(1):1-12. DOI:10.3904/kjim.2012.27.1.1 · 1.43 Impact Factor
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    • "Recently optical coherence tomography (OCT) and Raman spectroscopy were also reported to be useful in detecting and characterizing atherosclerotic lesions. Intravascular OCT shows particular promise and several research groups have demonstrated its potential [10–13] by characterizing plaque morphology at much higher resolution (~10 µm) than IVUS. Raman spectroscopy is ideal for identifying gross biochemical changes in tissue and has great potential to discriminate between lipid-rich, calcified and fibrotic plaques [14–18]. "
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    ABSTRACT: A femtosecond CARS-based nonlinear optical microscope was used to simultaneously image extracellular structural proteins and lipid-rich structures within intact aortic tissue obtained from myocardial infarction-prone Watanabe heritable hyperlipidemic rabbits (WHHLMI). Clear differences in the NLO microscopic images were observed between healthy arterial tissue and regions dominated by atherosclerotic lesions. In the current ex-vivo study, we present a single parameter based on intensity changes derived from multi-channel NLO image to classify plaque burden within the vessel. Using this parameter we were able to differentiate between healthy regions of the vessel and regions with plaque, as well as distinguish plaques relative to the age of the WHHLMI rabbit.
    Biomedical Optics Express 08/2010; 1(1):59-73. DOI:10.1364/BOE.1.000059 · 3.65 Impact Factor
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