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{{Infobox medical intervention |
{{Infobox medical intervention |
Name = Intravascular optical coherence tomography |
Name = Endoscopic optical coherence tomography |
Image = Intracoronary_OCT_imaging.png |
Image = Intracoronary_OCT_imaging.png |
Caption = Example of intracoronary optical coherence tomography (OCT) image of atherosclerosis. Between 6 and 8 o'clock it is possible to observe a fibrocalcific [[atherosclerotic plaque]].
Caption = Example of intracoronary optical coherence tomography (OCT) image of atherosclerosis. Between 6 and 8 o'clock it is possible to observe a fibrocalcific [[atherosclerotic plaque]].
}}
}}
'''Intravascular optical coherence tomography''' ('''OCT''') is a [[catheter]]-based imaging application of [[optical coherence tomography]]. It is an endoscopic imaging technology capable of acquiring high-resolution images from inside a blood vessel using optical fibers and laser technology.
'''Endoscopic optical coherence tomography''', also '''intravascular optical coherence tomography''' is a [[catheter]]-based imaging application of [[optical coherence tomography]] (OCT).<ref name="Gora">{{cite journal | vauthors = Gora MJ, Suter MJ, Tearney GJ, Li X | title = Endoscopic optical coherence tomography: technologies and clinical applications [Invited] | journal = Biomedical Optics Express | volume = 8 | issue = 5 | pages = 2405–2444 | date = May 2017 | pmid = 28663882 | pmc = 5480489 | doi = 10.1364/BOE.8.002405 }}</ref> It is capable of acquiring high-resolution images from inside a blood vessel using [[optical fiber]]s and [[laser|laser technology]].


One of its main applications is for coronary arteries, which are often treated by endoscopic, minimally invasive surgical procedures. More recently, applications for peripheral arteries and for neurovascular procedures have been proposed and are being investigated. Neurovascular applications required significant technological developments, due to the highly tortuous anatomy of human cerebrovasculature.
One of its main applications is for [[coronary arteries]], which are often treated by [[endoscopic]], minimally invasive surgical procedures.<ref name="Kumar">{{cite journal | vauthors = Kumar A, Yadav N, Singh S, Chauhan N | title = Minimally invasive (endoscopic-computer assisted) surgery: Technique and review | journal = Annals of Maxillofacial Surgery | volume = 6 | issue = 2 | pages = 159–164 | date = July 2016 | pmid = 28299251 | pmc = 5343621 | doi = 10.4103/2231-0746.200348 | doi-access = free }}</ref> Other applications for peripheral arteries and for [[Neurovascular unit|neurovascular]] procedures have been proposed and are being investigated. Neurovascular applications required significant technological developments, due to the highly tortuous anatomy of the cerebrovasculature.


Intravascular OCT rapidly creates three-dimensional images at a resolution of approximately 15 micrometers, an order of magnitude improved resolution with respect to intravascular ultrasound and X-ray [[coronary angiogram]], the other imaging techniques adopted in clinical practice.<ref name="BezerraCosta2009">{{cite journal | vauthors = Bezerra HG, Costa MA, Guagliumi G, Rollins AM, Simon DI | title = Intracoronary optical coherence tomography: a comprehensive review clinical and research applications | journal = JACC. Cardiovascular Interventions | volume = 2 | issue = 11 | pages = 1035–1046 | date = November 2009 | pmid = 19926041 | pmc = 4113036 | doi = 10.1016/j.jcin.2009.06.019 }}</ref> This offers additional information that can be used to optimize treatment and management of patients suffering from vascular disease.
Intravascular OCT rapidly creates three-dimensional images at a resolution of approximately 15 micrometers, an improved resolution with respect to [[intravascular ultrasound]] and [[Angiography|coronary angiogram]], the other imaging techniques.<ref name="BezerraCosta2009">{{cite journal | vauthors = Bezerra HG, Costa MA, Guagliumi G, Rollins AM, Simon DI | title = Intracoronary optical coherence tomography: a comprehensive review clinical and research applications | journal = JACC. Cardiovascular Interventions | volume = 2 | issue = 11 | pages = 1035–1046 | date = November 2009 | pmid = 19926041 | pmc = 4113036 | doi = 10.1016/j.jcin.2009.06.019 }}</ref> This offers additional information that can be used to optimize the treatment and management of [[vascular disease]].


== Theory ==
== Theory ==
OCT is analogous to medical [[ultrasound]], measuring the backreflection of infrared light rather than sound. The time for light to be reflected back from the tissue under inspection is used to measure distances. However, due to the high speed of light, the backreflection time cannot be measured directly, but is instead measured using [[interferometry]].<ref name = "Brezinski_1996">{{cite journal | vauthors = Brezinski ME, Tearney GJ, Bouma BE, Izatt JA, Hee MR, Swanson EA, Southern JF, Fujimoto JG | title = Optical coherence tomography for optical biopsy. Properties and demonstration of vascular pathology | journal = Circulation | volume = 93 | issue = 6 | pages = 1206–1213 | date = March 1996 | pmid = 8653843 | doi = 10.1161/01.CIR.93.6.1206 }}</ref>
OCT is analogous to medical [[ultrasound]], measuring the backreflection of infrared light rather than sound. The time for light to be reflected back from the tissue under inspection is used to measure distances. However, due to the high speed of light, the backreflection time cannot be measured directly, but is instead measured using [[Interferometry#Biology and medicine|interferometry]].<ref>{{cite journal | vauthors = Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, Hee MR, Flotte T, Gregory K, Puliafito CA | title = Optical coherence tomography | journal = Science | volume = 254 | issue = 5035 | pages = 1178–1181 | date = November 1991 | pmid = 1957169 | pmc = 4638169 | doi = 10.1126/science.1957169 | bibcode = 1991Sci...254.1178H }}</ref>


OCT is measured using either time domain (TD-OCT) or frequency domain techniques (FD-OCT). Commercially available coronary OCT technology is based on Frequency domain techniques, resulting in a rapid acquisition procedures (1 to 2 seconds). Intracoronary OCT uses near-infrared light at 1300&nbsp;nm and can visualize the microstructure of the arterial wall, its size, and therapeutic devices with high accuracy.
OCT is measured using either [[time domain]] (TD-OCT) or [[frequency domain]] techniques (FD-OCT). Commercially available coronary OCT technology is based on frequency domain techniques, resulting in rapid acquisition procedures (1 to 2 seconds). Intracoronary OCT uses near-infrared light at 1300&nbsp;nm and can visualize the microstructure of the arterial wall, its size, and therapeutic devices with high accuracy.


== History ==
== History ==
Intravascular OCT was developed for the imaging of arterial disease at a resolution higher than the other techniques available, such as x-ray angiography and intravascular ultrasounds. OCT allows to assess atherosclerotic plaques characteristics at a resolution of approximately 15 μm (or better) and found applications for the guidance of catheter-based coronary interventions (ie, percutaneous coronary interventions). The first report of endoscopic OCT appeared in 1997 in the journal [[Science (journal)|''Science'']] exploring various applications including gastroenterology and airways.<ref>{{cite journal | vauthors = Tearney GJ, Brezinski ME, Bouma BE, Boppart SA, Pitris C, Southern JF, Fujimoto JG | title = In vivo endoscopic optical biopsy with optical coherence tomography | journal = Science | volume = 276 | issue = 5321 | pages = 2037–2039 | date = June 1997 | pmid = 9197265 | doi = 10.1126/science.276.5321.2037 }}</ref> The first intravascular in vivo use in a preclinical model was reported in 1994<ref>{{cite journal | vauthors = Fujimoto JG, Boppart SA, Tearney GJ, Bouma BE, Pitris C, Brezinski ME | title = High resolution in vivo intra-arterial imaging with optical coherence tomography | journal = Heart | volume = 82 | issue = 2 | pages = 128–133 | date = August 1999 | pmid = 10409522 | pmc = 1729132 | doi = 10.1136/hrt.82.2.128 }}</ref> and first in human, clinical imaging in 2003.<ref>{{cite journal | vauthors = Bouma BE, Tearney GJ, Yabushita H, Shishkov M, Kauffman CR, DeJoseph Gauthier D, MacNeill BD, Houser SL, Aretz HT, Halpern EF, Jang IK | title = Evaluation of intracoronary stenting by intravascular optical coherence tomography | journal = Heart | volume = 89 | issue = 3 | pages = 317–320 | date = March 2003 | pmid = 12591841 | pmc = 1767586 | doi = 10.1136/heart.89.3.317 }}</ref> The first OCT imaging catheter and system was commercialized by LightLab Imaging, Inc., a company based in Massachusetts formed following a technology transfer in 1997 from Fujimoto's lab (MIT).<ref>{{Cite web |title=Biomedical Optical Imaging and Biophotonics Group |url=https://www.rle.mit.edu/boib/#/ |access-date=2024-05-22 |website=www.rle.mit.edu}}</ref>
Intravascular OCT was developed for the imaging of arterial disease at a resolution higher than the other techniques available, such as x-ray angiography and intravascular ultrasounds. OCT allows to assess atherosclerotic plaques characteristics at a resolution of approximately 15 μm (or better) and found applications for the guidance of catheter-based coronary interventions (ie, percutaneous coronary interventions).


⚫
Early on, time-domain OCT technology required slow acquisitions (>10 seconds long) requiring the use of balloon occlusion techniques to displace the blood from the arterial lumen, opaque to near-infrared light. This prevented a broader adoption for several years. Aroun 2008-2009, the advent of rapid sweep source lasers allowed for the development of intravascular Fourier-Domain OCT (FD-OCT).<ref>{{cite journal | vauthors = de Boer JF, Cense B, Park BH, Pierce MC, Tearney GJ, Bouma BE | title = Improved signal-to-noise ratio in spectral-domain compared with time-domain optical coherence tomography | journal = Optics Letters | volume = 28 | issue = 21 | pages = 2067–2069 | date = November 2003 | pmid = 14587817 | doi = 10.1364/OL.28.002067 | bibcode = 2003OptL...28.2067D | url = https://research.vu.nl/en/publications/8596084e-22c8-40a3-801f-9719955645b0 }}</ref><ref>{{Cite journal | vauthors = Adler DC, Chen Y, Huber R, Schmitt J, Connolly J, Fujimoto JG |date=December 2007 |title=Three-dimensional endomicroscopy using optical coherence tomography |url=https://www.nature.com/articles/nphoton.2007.228 |journal=Nature Photonics |volume=1 |issue=12 |pages=709–716 |doi=10.1038/nphoton.2007.228 |bibcode=2007NaPho...1..709A |issn=1749-4885}}</ref> This enabled for the first-time rapid acquisitions of a long coronary segment in a couple of seconds, allowing non occlusive brief contrast injections to clear the arterial lumen from blood. Initial demonstration of FD-OCT for coronary imaging was achieved in 2008-2009<ref>{{cite journal | vauthors = Tearney GJ, Waxman S, Shishkov M, Vakoc BJ, Suter MJ, Freilich MI, Desjardins AE, Oh WY, Bartlett LA, Rosenberg M, Bouma BE | title = Three-dimensional coronary artery microscopy by intracoronary optical frequency domain imaging | journal = JACC. Cardiovascular Imaging | volume = 1 | issue = 6 | pages = 752–761 | date = November 2008 | pmid = 19356512 | pmc = 2852244 | doi = 10.1016/j.jcmg.2008.06.007 }}</ref><ref name="BezerraCosta2009"/> which significantly accelerated clinical adoption starting in 2009.
The first report of endoscopic OCT appeared in 1997 in [[Science (journal)]] exploring various applications including gastroenterology and airways.<ref>{{Cite journal |last=Tearney |first=Guillermo J. |last2=Brezinski |first2=Mark E. |last3=Bouma |first3=Brett E. |last4=Boppart |first4=Stephen A. |last5=Pitris |first5=Costas |last6=Southern |first6=James F. |last7=Fujimoto |first7=James G. |date=1997-06-27 |title=In Vivo Endoscopic Optical Biopsy with Optical Coherence Tomography |url=https://www.science.org/doi/10.1126/science.276.5321.2037 |journal=Science |volume=276 |issue=5321 |pages=2037–2039 |doi=10.1126/science.276.5321.2037 |issn=0036-8075}}</ref> The first intravascular in vivo use in a preclinical model was reported in 1994<ref>{{Cite journal |last=Fujimoto |first=J G |last2=Boppart |first2=S A |last3=Tearney |first3=G J |last4=Bouma |first4=B E |last5=Pitris |first5=C |last6=Brezinski |first6=M E |date=1999-08-01 |title=High resolution in vivo intra-arterial imaging with optical coherence tomography |url=https://heart.bmj.com/lookup/doi/10.1136/hrt.82.2.128 |journal=Heart |volume=82 |issue=2 |pages=128–133 |doi=10.1136/hrt.82.2.128 |issn=1355-6037 |pmc=1729132 |pmid=10409522}}</ref> and first in human, clinical imaging in 2003.<ref>{{cite journal |vauthors=Bouma BE, Tearney GJ, Yabushita H, Shishkov M, Kauffman CR, DeJoseph Gauthier D, MacNeill BD, Houser SL, Aretz HT, Halpern EF, Jang IK |date=March 2003 |title=Evaluation of intracoronary stenting by intravascular optical coherence tomography |journal=Heart |volume=89 |issue=3 |pages=317–320 |doi=10.1136/heart.89.3.317 |pmc=1767586 |pmid=12591841}}</ref>


⚫
== Cardiovascular applications ==
The first OCT imaging catheter and system was commercialized by LightLab Imaging, Inc., a company based in Massachusetts formed following a technology transfer in 1997 from Fujimoto's lab (MIT)<ref>{{Cite web |title=Biomedical Optical Imaging and Biophotonics Group |url=https://www.rle.mit.edu/boib/#/ |access-date=2024-05-22 |website=www.rle.mit.edu}}</ref>. The most important technical advance for cardiology was the need for a reliable catheter/endoscope and development of a "rotary joint", a device aligning two single-mode, optical fibers with a small optical core (~8 microns) rotating across free space.

⚫
Early on, time-domain OCT technology required slow acquisitions (>10 seconds long) requiring the use of balloon occlusion techniques to displace the blood from the arterial lumen, opaque to near-infrared light. This prevented a broader adoption for several years. Aroun 2008-2009, the advent of rapid sweep source lasers allowed for the development of intravascular Fourier-Domain OCT (FD-OCT).<ref>{{Cite journal |last=de Boer |first=Johannes F. |last2=Cense |first2=Barry |last3=Park |first3=B. Hyle |last4=Pierce |first4=Mark C. |last5=Tearney |first5=Guillermo J. |last6=Bouma |first6=Brett E. |date=2003-11-01 |title=Improved signal-to-noise ratio in spectral-domain compared with time-domain optical coherence tomography |url=https://opg.optica.org/abstract.cfm?URI=ol-28-21-2067 |journal=Optics Letters |volume=28 |issue=21 |pages=2067 |doi=10.1364/OL.28.002067 |issn=0146-9592}}</ref><ref>{{Cite journal |last=Adler |first=Desmond C. |last2=Chen |first2=Yu |last3=Huber |first3=Robert |last4=Schmitt |first4=Joseph |last5=Connolly |first5=James |last6=Fujimoto |first6=James G. |date=December 2007 |title=Three-dimensional endomicroscopy using optical coherence tomography |url=https://www.nature.com/articles/nphoton.2007.228 |journal=Nature Photonics |volume=1 |issue=12 |pages=709–716 |doi=10.1038/nphoton.2007.228 |issn=1749-4885}}</ref> This enabled for the first-time rapid acquisitions of a long coronary segment in a couple of seconds, allowing non occlusive brief contrast injections to clear the arterial lumen from blood. Initial demonstration of FD-OCT for coronary imaging was achieved in 2008-2009<ref>{{cite journal | vauthors = Tearney GJ, Waxman S, Shishkov M, Vakoc BJ, Suter MJ, Freilich MI, Desjardins AE, Oh WY, Bartlett LA, Rosenberg M, Bouma BE | title = Three-dimensional coronary artery microscopy by intracoronary optical frequency domain imaging | journal = JACC. Cardiovascular Imaging | volume = 1 | issue = 6 | pages = 752–761 | date = November 2008 | pmid = 19356512 | pmc = 2852244 | doi = 10.1016/j.jcmg.2008.06.007 }}</ref><ref name="BezerraCosta2009"/> which significantly accelerated clinical adoption starting in 2009.

⚫
== Cardiovascular Medicine Applications ==
Following regulatory clearances in the major geographies between 2009 and 2012 of fast acquisition Fourier domain OCT, the use of intracoronary OCT rapidly increased. It is used to help coronary disease diagnosis, planning of the intervention, assess procedural results, and prevent complications.
Following regulatory clearances in the major geographies between 2009 and 2012 of fast acquisition Fourier domain OCT, the use of intracoronary OCT rapidly increased. It is used to help coronary disease diagnosis, planning of the intervention, assess procedural results, and prevent complications.


In the last decade, clinical benefits of coronary OCT have been systematically investigated. Several studies have linked the use of intravascular imaging such as IVUS and OCT to better stent expansion, a metric strongly correlated to better clinical outcomes in patients suffering from coronary artery disease and myocardial infarction.<ref name="Wijns_2015">{{cite journal | vauthors = Wijns W, Shite J, Jones MR, Lee SW, Price MJ, Fabbiocchi F, Barbato E, Akasaka T, Bezerra H, Holmes D | title = Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study | journal = European Heart Journal | volume = 36 | issue = 47 | pages = 3346–3355 | date = December 2015 | pmid = 26242713 | pmc = 4677272 | doi = 10.1093/eurheartj/ehv367 }}</ref><ref>{{cite journal | vauthors = Habara M, Nasu K, Terashima M, Kaneda H, Yokota D, Ko E, Ito T, Kurita T, Tanaka N, Kimura M, Ito T, Kinoshita Y, Tsuchikane E, Asakura K, Asakura Y, Katoh O, Suzuki T | title = Impact of frequency-domain optical coherence tomography guidance for optimal coronary stent implantation in comparison with intravascular ultrasound guidance | journal = Circulation. Cardiovascular Interventions | volume = 5 | issue = 2 | pages = 193–201 | date = April 2012 | pmid = 22456026 | doi = 10.1161/CIRCINTERVENTIONS.111.965111 | s2cid = 3025748 | doi-access = free }}</ref><ref name="Wijns_2015"/><ref name="Wijns_2015" /><ref>{{cite journal | vauthors = Vergallo R, Porto I, D'Amario D, Annibali G, Galli M, Benenati S, Bendandi F, Migliaro S, Fracassi F, Aurigemma C, Leone AM, Buffon A, Burzotta F, Trani C, Niccoli G, Liuzzo G, Prati F, Fuster V, Jang IK, Crea F | title = Coronary Atherosclerotic Phenotype and Plaque Healing in Patients With Recurrent Acute Coronary Syndromes Compared With Patients With Long-term Clinical Stability: An In Vivo Optical Coherence Tomography Study | journal = JAMA Cardiology | volume = 4 | issue = 4 | pages = 321–329 | date = April 2019 | pmid = 30865212 | pmc = 6484796 | doi = 10.1001/jamacardio.2019.0275 }}</ref>
In the last decade, clinical benefits of coronary OCT have been systematically investigated. Several studies have linked the use of intravascular imaging such as IVUS and OCT to better stent expansion, a metric strongly correlated to better clinical outcomes in patients suffering from coronary artery disease and myocardial infarction.<ref name="Wijns_2015">{{cite journal | vauthors = Wijns W, Shite J, Jones MR, Lee SW, Price MJ, Fabbiocchi F, Barbato E, Akasaka T, Bezerra H, Holmes D | title = Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study | journal = European Heart Journal | volume = 36 | issue = 47 | pages = 3346–3355 | date = December 2015 | pmid = 26242713 | pmc = 4677272 | doi = 10.1093/eurheartj/ehv367 }}</ref><ref>{{cite journal | vauthors = Habara M, Nasu K, Terashima M, Kaneda H, Yokota D, Ko E, Ito T, Kurita T, Tanaka N, Kimura M, Ito T, Kinoshita Y, Tsuchikane E, Asakura K, Asakura Y, Katoh O, Suzuki T | title = Impact of frequency-domain optical coherence tomography guidance for optimal coronary stent implantation in comparison with intravascular ultrasound guidance | journal = Circulation: Cardiovascular Interventions | volume = 5 | issue = 2 | pages = 193–201 | date = April 2012 | pmid = 22456026 | doi = 10.1161/CIRCINTERVENTIONS.111.965111 | s2cid = 3025748 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Vergallo R, Porto I, D'Amario D, Annibali G, Galli M, Benenati S, Bendandi F, Migliaro S, Fracassi F, Aurigemma C, Leone AM, Buffon A, Burzotta F, Trani C, Niccoli G, Liuzzo G, Prati F, Fuster V, Jang IK, Crea F | title = Coronary Atherosclerotic Phenotype and Plaque Healing in Patients With Recurrent Acute Coronary Syndromes Compared With Patients With Long-term Clinical Stability: An In Vivo Optical Coherence Tomography Study | journal = JAMA Cardiology | volume = 4 | issue = 4 | pages = 321–329 | date = April 2019 | pmid = 30865212 | pmc = 6484796 | doi = 10.1001/jamacardio.2019.0275 }}</ref>


Recently, larger randomized clinical trials have been undertaken. In 2023, a double-blind prospective trial demonstrated improvement in morbidity and mortality in coronary bifurcation interventions: "Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI."<ref>{{cite journal | vauthors = Holm NR, Andreasen LN, Neghabat O, Laanmets P, Kumsars I, Bennett J, Olsen NT, Odenstedt J, Hoffmann P, Dens J, Chowdhary S, O'Kane P, Bülow Rasmussen SH, Heigert M, Havndrup O, Van Kuijk JP, Biscaglia S, Mogensen LJ, Henareh L, Burzotta F, H Eek C, Mylotte D, Llinas MS, Koltowski L, Knaapen P, Calic S, Witt N, Santos-Pardo I, Watkins S, Lønborg J, Kristensen AT, Jensen LO, Calais F, Cockburn J, McNeice A, Kajander OA, Heestermans T, Kische S, Eftekhari A, Spratt JC, Christiansen EH | title = OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions | journal = The New England Journal of Medicine | volume = 389 | issue = 16 | pages = 1477–1487 | date = October 2023 | pmid = 37634149 | doi = 10.1056/NEJMoa2307770 | s2cid = 261231045 | url = https://portal.findresearcher.sdu.dk/da/publications/e7e19002-2f77-47ed-9b15-11f306b01cb0 }}</ref> Although not every study showed significant results,<ref>{{cite journal | vauthors = Ali ZA, Landmesser U, Maehara A, Matsumura M, Shlofmitz RA, Guagliumi G, Price MJ, Hill JM, Akasaka T, Prati F, Bezerra HG, Wijns W, Leistner D, Canova P, Alfonso F, Fabbiocchi F, Dogan O, McGreevy RJ, McNutt RW, Nie H, Buccola J, West NE, Stone GW | title = Optical Coherence Tomography-Guided versus Angiography-Guided PCI | journal = The New England Journal of Medicine | volume = 389 | issue = 16 | pages = 1466–1476 | date = October 2023 | pmid = 37634188 | doi = 10.1056/NEJMoa2305861 }}</ref> to date, several studies demonstrated the benefits in patient outcomes of using intravascular imaging during coronary arteries interventions.<ref>{{cite journal | vauthors = Kang DY, Ahn JM, Yun SC, Hur SH, Cho YK, Lee CH, Hong SJ, Lim S, Kim SW, Won H, Oh JH, Choe JC, Hong YJ, Yoon YH, Kim H, Choi Y, Lee J, Yoon YW, Kim SJ, Bae JH, Park DW, Park SJ | title = Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial | journal = Circulation | volume = 148 | issue = 16 | pages = 1195–1206 | date = October 2023 | pmid = 37634092 | doi = 10.1161/CIRCULATIONAHA.123.066429 }}</ref><ref>{{cite journal | vauthors = Stone GW, Christiansen EH, Ali ZA, Andreasen LN, Maehara A, Ahmad Y, Landmesser U, Holm NR | title = Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis | journal = Lancet | volume = 403 | issue = 10429 | pages = 824–837 | date = March 2024 | pmid = 38401549 | doi = 10.1016/S0140-6736(23)02454-6 }}</ref> The use of intravascular imaging for coronary intervention is reported on the current cardiology guidelines.
Larger randomized clinical trials have been undertaken. In 2023, a double-blind prospective trial demonstrated improvement in morbidity and mortality in coronary bifurcation interventions: "Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI."<ref>{{cite journal | vauthors = Holm NR, Andreasen LN, Neghabat O, Laanmets P, Kumsars I, Bennett J, Olsen NT, Odenstedt J, Hoffmann P, Dens J, Chowdhary S, O'Kane P, Bülow Rasmussen SH, Heigert M, Havndrup O, Van Kuijk JP, Biscaglia S, Mogensen LJ, Henareh L, Burzotta F, H Eek C, Mylotte D, Llinas MS, Koltowski L, Knaapen P, Calic S, Witt N, Santos-Pardo I, Watkins S, Lønborg J, Kristensen AT, Jensen LO, Calais F, Cockburn J, McNeice A, Kajander OA, Heestermans T, Kische S, Eftekhari A, Spratt JC, Christiansen EH | title = OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions | journal = The New England Journal of Medicine | volume = 389 | issue = 16 | pages = 1477–1487 | date = October 2023 | pmid = 37634149 | doi = 10.1056/NEJMoa2307770 | s2cid = 261231045 | url = https://portal.findresearcher.sdu.dk/da/publications/e7e19002-2f77-47ed-9b15-11f306b01cb0 }}</ref> Although not every study showed significant results,<ref>{{cite journal | vauthors = Ali ZA, Landmesser U, Maehara A, Matsumura M, Shlofmitz RA, Guagliumi G, Price MJ, Hill JM, Akasaka T, Prati F, Bezerra HG, Wijns W, Leistner D, Canova P, Alfonso F, Fabbiocchi F, Dogan O, McGreevy RJ, McNutt RW, Nie H, Buccola J, West NE, Stone GW | title = Optical Coherence Tomography-Guided versus Angiography-Guided PCI | journal = The New England Journal of Medicine | volume = 389 | issue = 16 | pages = 1466–1476 | date = October 2023 | pmid = 37634188 | doi = 10.1056/NEJMoa2305861 }}</ref> to date, several studies demonstrated the benefits in patient outcomes of using intravascular imaging during coronary arteries interventions.<ref>{{cite journal | vauthors = Kang DY, Ahn JM, Yun SC, Hur SH, Cho YK, Lee CH, Hong SJ, Lim S, Kim SW, Won H, Oh JH, Choe JC, Hong YJ, Yoon YH, Kim H, Choi Y, Lee J, Yoon YW, Kim SJ, Bae JH, Park DW, Park SJ | title = Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial | journal = Circulation | volume = 148 | issue = 16 | pages = 1195–1206 | date = October 2023 | pmid = 37634092 | doi = 10.1161/CIRCULATIONAHA.123.066429 }}</ref><ref>{{cite journal | vauthors = Stone GW, Christiansen EH, Ali ZA, Andreasen LN, Maehara A, Ahmad Y, Landmesser U, Holm NR | title = Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis | journal = Lancet | volume = 403 | issue = 10429 | pages = 824–837 | date = March 2024 | pmid = 38401549 | doi = 10.1016/S0140-6736(23)02454-6 }}</ref> The use of intravascular imaging for coronary intervention is reported on the current cardiology guidelines.


Data published in late 2016 showed that over 150,000 intracoronary optical coherence tomography procedures are performed every year, and its adoption is rapidly growing at a rate of ~10-20% every year.<ref>{{cite journal | vauthors = Swanson EA, Fujimoto JG | title = The ecosystem that powered the translation of OCT from fundamental research to clinical and commercial impact [Invited] | journal = Biomedical Optics Express | volume = 8 | issue = 3 | pages = 1638–1664 | date = March 2017 | pmid = 28663854 | pmc = 5480569 | doi = 10.1364/BOE.8.001638 }}</ref>
Data published in late 2016 showed that over 150,000 intracoronary optical coherence tomography procedures are performed every year, and its adoption is rapidly growing at a rate of ~10-20% every year.<ref>{{cite journal | vauthors = Swanson EA, Fujimoto JG | title = The ecosystem that powered the translation of OCT from fundamental research to clinical and commercial impact [Invited] | journal = Biomedical Optics Express | volume = 8 | issue = 3 | pages = 1638–1664 | date = March 2017 | pmid = 28663854 | pmc = 5480569 | doi = 10.1364/BOE.8.001638 }}</ref>


Assessment of artery lumen morphology is the cornerstone of [[intravascular imaging]] criteria to evaluate disease severity and guide intervention. The high-resolution of OCT imaging allows to assess with high accuracy vessel [[lumen (anatomy)|lumen]] area, wall microstructure, intracoronary stent apposition and expansion.<ref>{{cite journal | vauthors = Ughi GJ, Adriaenssens T, Onsea K, Kayaert P, Dubois C, Sinnaeve P, Coosemans M, Desmet W, D'hooge J | title = Automatic segmentation of in-vivo intra-coronary optical coherence tomography images to assess stent strut apposition and coverage | journal = The International Journal of Cardiovascular Imaging | volume = 28 | issue = 2 | pages = 229–241 | date = February 2012 | pmid = 21347593 | doi = 10.1007/s10554-011-9824-3 }}</ref><ref>{{cite journal | vauthors = Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, Kauffman CR, Shishkov M, Kang DH, Halpern EF, Tearney GJ | title = Characterization of human atherosclerosis by optical coherence tomography | journal = Circulation | volume = 106 | issue = 13 | pages = 1640–1645 | date = September 2002 | pmid = 12270856 | doi = 10.1161/01.CIR.0000029927.92825.F6 }}</ref> OCT has an improved ability with respect to intravascular ultrasound to penetrate and delineate calcium in the vessel wall that makes it well suited to guide complex interventional strategies in vessels with superficial calcification. OCT has the capability of visualize coronary plaque erosion and fibrotic caps overlying atheromas.<ref name = "Brezinski_1996" />
Assessment of artery lumen morphology is the cornerstone of [[intravascular imaging]] criteria to evaluate disease severity and guide intervention. The high-resolution of OCT imaging allows to assess with high accuracy vessel [[lumen (anatomy)|lumen]] area, wall microstructure, intracoronary stent apposition and expansion.<ref>{{cite journal | vauthors = Ughi GJ, Adriaenssens T, Onsea K, Kayaert P, Dubois C, Sinnaeve P, Coosemans M, Desmet W, D'hooge J | title = Automatic segmentation of in-vivo intra-coronary optical coherence tomography images to assess stent strut apposition and coverage | journal = The International Journal of Cardiovascular Imaging | volume = 28 | issue = 2 | pages = 229–241 | date = February 2012 | pmid = 21347593 | doi = 10.1007/s10554-011-9824-3 }}</ref><ref>{{cite journal | vauthors = Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, Kauffman CR, Shishkov M, Kang DH, Halpern EF, Tearney GJ | title = Characterization of human atherosclerosis by optical coherence tomography | journal = Circulation | volume = 106 | issue = 13 | pages = 1640–1645 | date = September 2002 | pmid = 12270856 | doi = 10.1161/01.CIR.0000029927.92825.F6 }}</ref> OCT has an improved ability with respect to intravascular ultrasound to penetrate and delineate calcium in the vessel wall that makes it well suited to guide complex interventional strategies in vessels with superficial calcification. OCT has the capability of visualize coronary plaque erosion and fibrotic caps overlying lipid plaques.<ref>{{cite journal | vauthors = Kini AS, Vengrenyuk Y, Yoshimura T, Matsumura M, Pena J, Baber U, Moreno P, Mehran R, Maehara A, Sharma S, Narula J | title = Fibrous Cap Thickness by Optical Coherence Tomography In Vivo | journal = Journal of the American College of Cardiology | volume = 69 | issue = 6 | pages = 644–657 | date = February 2017 | pmid = 27989887 | doi = 10.1016/j.jacc.2016.10.028 }}</ref>

== Neurovascular applications ==
⚫
In the last decade, significant advances have been made in the endovascular treatment of stroke, including brain aneurysms, intracranial atherosclerosis and ischemic stroke.<ref>{{cite journal | vauthors = Nogueira RG, Ribó M | title = Endovascular Treatment of Acute Stroke | journal = Stroke | volume = 50 | issue = 9 | pages = 2612–2618 | date = September 2019 | pmid = 31340728 | doi = 10.1161/STROKEAHA.119.023811 }}</ref> Intravascular OCT has been proposed has a key technology that can improve current procedure and treatments.<ref>{{cite journal | vauthors = Chen CJ, Kumar JS, Chen SH, Ding D, Buell TJ, Sur S, Ironside N, Luther E, Ragosta M, Park MS, Kalani MY, Liu KC, Starke RM | title = Optical Coherence Tomography: Future Applications in Cerebrovascular Imaging | journal = Stroke | volume = 49 | issue = 4 | pages = 1044–1050 | date = April 2018 | pmid = 29491139 | doi = 10.1161/STROKEAHA.117.019818 }}</ref> However, current intracoronary OCT catheters are not designed for navigation and reliable imaging of tortuous cerebrovascular arteries.<ref>{{cite journal | vauthors = Gounis MJ, Ughi GJ, Marosfoi M, Lopes DK, Fiorella D, Bezerra HG, Liang CW, Puri AS | title = Intravascular Optical Coherence Tomography for Neurointerventional Surgery | journal = Stroke | volume = 50 | issue = 1 | pages = 218–223 | date = January 2019 | pmid = 30580737 | doi = 10.1161/STROKEAHA.118.022315 | pmc = 6541539 }}</ref>

⚫
Recently, different (wire-like) OCT catheters have been proposed and were specifically designed for the human cerebrovasculature,<ref>{{cite journal | vauthors = Ughi GJ, Marosfoi MG, King RM, Caroff J, Peterson LM, Duncan BH, Langan ET, Collins A, Leporati A, Rousselle S, Lopes DK, Gounis MJ, Puri AS | title = A neurovascular high-frequency optical coherence tomography system enables in situ cerebrovascular volumetric microscopy | journal = Nature Communications | volume = 11 | issue = 1 | pages = 3851 | date = July 2020 | pmid = 32737314 | doi = 10.1038/s41467-020-17702-7 | pmc = 7395105 | bibcode = 2020NatCo..11.3851U }}</ref> named neuro optical coherence tomography (''n''OCT). A first clinical study to investigate safety, feasibility, and clinical potential has been conducted.<ref>{{cite journal | vauthors = Pereira VM, Lylyk P, Cancelliere N, Lylyk PN, Lylyk I, Anagnostakou V, Bleise C, Nishi H, Epshtein M, King RM, Shazeeb MS, Puri AS, Liang CW, Hanel RA, Spears J, Marotta TR, Lopes DK, Gounis MJ, Ughi GJ | title = Volumetric microscopy of cerebral arteries with a miniaturized optical coherence tomography imaging probe | journal = Science Translational Medicine | volume = 16 | issue = 747 | pages = eadl4497 | date = May 2024 | pmid = 38748771 | doi = 10.1126/scitranslmed.adl4497 }}</ref> Initial applications for the treatment of brain aneurysms and intracranial atherosclerosis have been demonstrated<ref>{{cite journal | vauthors = King RM, Peker A, Anagnostakou V, Raskett CM, Arends JM, Dixit HG, Ughi GJ, Puri AS, Gounis MJ, Shazeeb MS | title = High-frequency optical coherence tomography predictors of aneurysm occlusion following flow diverter treatment in a preclinical model | journal = Journal of NeuroInterventional Surgery | volume = 15 | issue = 9 | pages = 919–923 | date = September 2023 | pmid = 36002288 | doi = 10.1136/jnis-2022-019275 }}</ref><ref>{{cite journal | vauthors = Anagnostakou V, Epshtein M, Ughi GJ, King RM, Valavanis A, Puri AS, Gounis MJ | title = Transvascular in vivo microscopy of the subarachnoid space | journal = Journal of NeuroInterventional Surgery | volume = 14 | issue = 5 | pages = 420–428 | date = May 2022 | pmid = 35115394 | doi = 10.1136/neurintsurg-2021-018544 }}</ref><ref>{{cite journal | vauthors = Caroff J, King RM, Ughi GJ, Marosfoi M, Langan ET, Raskett C, Puri AS, Gounis MJ | title = Longitudinal Monitoring of Flow-Diverting Stent Tissue Coverage After Implant in a Bifurcation Model Using Neurovascular High-Frequency Optical Coherence Tomography | journal = Neurosurgery | volume = 87 | issue = 6 | pages = 1311–1319 | date = November 2020 | pmid = 32463884 | pmc = 7666887 | doi = 10.1093/neuros/nyaa208 }}</ref> showing future potential.<ref>{{Cite journal |last1=Siddiqui |first1=Adnan H |last2=Andersson |first2=Tommy |date=2024-09-26 |title=Shining light on neurovascular disease |journal=Interventional Neuroradiology |language=en |pages=15910199241285962 |doi=10.1177/15910199241285962 |issn=1591-0199 |pmc=11559757 |pmid=39324217}}</ref><ref>{{Cite web | vauthors = Cooney E |date=2024-05-15 |title=To detect risk of stroke, tiny probe acts 'like a microscope' inside brain's blood vessels |url=https://www.statnews.com/2024/05/15/stroke-cardiovascular-disease-detection-tomography/ |access-date=2024-05-17 |website=STAT }}</ref>


== Technology ==
== Technology ==
Line 44: Line 45:
State-of-the-art intracoronary [[optical coherence tomography]] uses a swept-source laser to make OCT images at high-speed (i.e., approximately 80,000&nbsp;kHz - A-scan lines per second) to complete acquisition of a 3D OCT volume of coronary segments in a few-seconds.<ref>{{cite journal | vauthors = Yun SH, Tearney G, de Boer J, Bouma B | title = Pulsed-source and swept-source spectral-domain optical coherence tomography with reduced motion artifacts | journal = Optics Express | volume = 12 | issue = 23 | pages = 5614–5624 | date = November 2004 | pmid = 19488195 | pmc = 2713045 | doi = 10.1364/opex.12.005614 | bibcode = 2004OExpr..12.5614Y }}</ref> The first intravascular FD-OCT was introduced to the market in 2009 (EU and Asia) and in 2012 (US). In 2018, two intracoronary OCT catheters are clinically available for use in the coronary arteries, having a size in diameter between 2.4F and 2.7F. {{citation needed|date=March 2021}}
State-of-the-art intracoronary [[optical coherence tomography]] uses a swept-source laser to make OCT images at high-speed (i.e., approximately 80,000&nbsp;kHz - A-scan lines per second) to complete acquisition of a 3D OCT volume of coronary segments in a few-seconds.<ref>{{cite journal | vauthors = Yun SH, Tearney G, de Boer J, Bouma B | title = Pulsed-source and swept-source spectral-domain optical coherence tomography with reduced motion artifacts | journal = Optics Express | volume = 12 | issue = 23 | pages = 5614–5624 | date = November 2004 | pmid = 19488195 | pmc = 2713045 | doi = 10.1364/opex.12.005614 | bibcode = 2004OExpr..12.5614Y }}</ref> The first intravascular FD-OCT was introduced to the market in 2009 (EU and Asia) and in 2012 (US). In 2018, two intracoronary OCT catheters are clinically available for use in the coronary arteries, having a size in diameter between 2.4F and 2.7F. {{citation needed|date=March 2021}}


The axial resolution of state-of-the-art commercial systems is less than 20 micrometers, which is decoupled from the catheter lateral resolution. The highest resolution of OCT allows for the ''in vivo'' imaging of vessel microstructural features at an unprecedented level, enabling visualization of vessel wall atherosclerosis, pathology, and interaction with therapeutic devices at a microscopic level.<ref name="Brezinski_1996"/>{{citation needed|date=March 2021}}
The axial resolution of state-of-the-art commercial systems is less than 20 micrometers, which is decoupled from the catheter lateral resolution. The highest resolution of OCT allows for the ''in vivo'' imaging of vessel microstructural features at an unprecedented level, enabling visualization of vessel wall atherosclerosis, pathology, and interaction with therapeutic devices at a microscopic level.<ref>{{cite journal | vauthors = Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Falk E, Feldman MD, Fitzgerald P, Garcia-Garcia HM, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CC, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Räber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PW, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Uemura S, Ughi GJ, van Beusekom HM, van der Steen AF, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G | title = Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation | journal = Journal of the American College of Cardiology | volume = 59 | issue = 12 | pages = 1058–1072 | date = March 2012 | pmid = 22421299 | doi = 10.1016/j.jacc.2011.09.079 }}</ref>


Recent developments included the combination of OCT with spectroscopy and fluorescence in a single imaging catheter<ref>{{cite journal | vauthors = Fard AM, Vacas-Jacques P, Hamidi E, Wang H, Carruth RW, Gardecki JA, Tearney GJ | title = Optical coherence tomography--near infrared spectroscopy system and catheter for intravascular imaging | journal = Optics Express | volume = 21 | issue = 25 | pages = 30849–30858 | date = December 2013 | pmid = 24514658 | doi = 10.1364/OE.21.030849 | pmc = 3926541 | bibcode = 2013OExpr..2130849F }}</ref><ref>{{cite journal | vauthors = Ughi GJ, Wang H, Gerbaud E, Gardecki JA, Fard AM, Hamidi E, Vacas-Jacques P, Rosenberg M, Jaffer FA, Tearney GJ | title = Clinical Characterization of Coronary Atherosclerosis With Dual-Modality OCT and Near-Infrared Autofluorescence Imaging | journal = JACC. Cardiovascular Imaging | volume = 9 | issue = 11 | pages = 1304–1314 | date = November 2016 | pmid = 26971006 | doi = 10.1016/j.jcmg.2015.11.020 | pmc = 5010789 }}</ref> and miniaturization of the imaging catheter.<ref>{{cite journal | vauthors = Bezerra HG, Quimby DL, Matar F, Mohanty BD, Bassily E, Ughi GJ | title = High-Frequency Optical Coherence Tomography (HF-OCT) for Preintervention Coronary Imaging: A First-in-Human Study | journal = JACC. Cardiovascular Imaging | volume = 16 | issue = 7 | pages = 982–984 | date = July 2023 | pmid = 37407126 | doi = 10.1016/j.jcmg.2023.01.013 }}</ref>
Recent developments included the combination of OCT with spectroscopy and fluorescence in a single imaging catheter<ref>{{cite journal | vauthors = Fard AM, Vacas-Jacques P, Hamidi E, Wang H, Carruth RW, Gardecki JA, Tearney GJ | title = Optical coherence tomography--near infrared spectroscopy system and catheter for intravascular imaging | journal = Optics Express | volume = 21 | issue = 25 | pages = 30849–30858 | date = December 2013 | pmid = 24514658 | doi = 10.1364/OE.21.030849 | pmc = 3926541 | bibcode = 2013OExpr..2130849F }}</ref><ref>{{cite journal | vauthors = Ughi GJ, Wang H, Gerbaud E, Gardecki JA, Fard AM, Hamidi E, Vacas-Jacques P, Rosenberg M, Jaffer FA, Tearney GJ | title = Clinical Characterization of Coronary Atherosclerosis With Dual-Modality OCT and Near-Infrared Autofluorescence Imaging | journal = JACC. Cardiovascular Imaging | volume = 9 | issue = 11 | pages = 1304–1314 | date = November 2016 | pmid = 26971006 | doi = 10.1016/j.jcmg.2015.11.020 | pmc = 5010789 }}</ref> and miniaturization of the imaging catheter.<ref>{{cite journal | vauthors = Bezerra HG, Quimby DL, Matar F, Mohanty BD, Bassily E, Ughi GJ | title = High-Frequency Optical Coherence Tomography (HF-OCT) for Preintervention Coronary Imaging: A First-in-Human Study | journal = JACC. Cardiovascular Imaging | volume = 16 | issue = 7 | pages = 982–984 | date = July 2023 | pmid = 37407126 | doi = 10.1016/j.jcmg.2023.01.013 }}</ref>


== Safety ==
== Safety ==
Safety of intravascular imaging, including intracoronary OCT and [[intravascular ultrasound]], has been investigated by several studies. Recent clinical trials reported a very low rate of self-limiting, minor complications on over 3,000 patients where in all cases no harm or prolongation of hospital stay was observed. Intracoronary optical coherence tomography was demonstrated to be safe among heterogeneous groups of patients presenting varying clinical setting.<ref>{{cite journal | vauthors = van der Sijde JN, Karanasos A, van Ditzhuijzen NS, Okamura T, van Geuns RJ, Valgimigli M, Ligthart JM, Witberg KT, Wemelsfelder S, Fam JM, Zhang B, Diletti R, de Jaegere PP, van Mieghem NM, van Soest G, Zijlstra F, van Domburg RT, Regar E | title = Safety of optical coherence tomography in daily practice: a comparison with intravascular ultrasound | journal = European Heart Journal. Cardiovascular Imaging | volume = 18 | issue = 4 | pages = 467–474 | date = April 2017 | pmid = 26992420 | doi = 10.1093/ehjci/jew037 | doi-access = free }}</ref>
Safety of intravascular imaging, including intracoronary OCT and [[intravascular ultrasound]], has been investigated by several studies. Recent clinical trials reported a very low rate of self-limiting, minor complications on over 3,000 patients where in all cases no harm or prolongation of hospital stay was observed. Intracoronary optical coherence tomography was demonstrated to be safe among heterogeneous groups of patients presenting varying clinical setting.<ref>{{cite journal | vauthors = van der Sijde JN, Karanasos A, van Ditzhuijzen NS, Okamura T, van Geuns RJ, Valgimigli M, Ligthart JM, Witberg KT, Wemelsfelder S, Fam JM, Zhang B, Diletti R, de Jaegere PP, van Mieghem NM, van Soest G, Zijlstra F, van Domburg RT, Regar E | title = Safety of optical coherence tomography in daily practice: a comparison with intravascular ultrasound | journal = European Heart Journal - Cardiovascular Imaging | volume = 18 | issue = 4 | pages = 467–474 | date = April 2017 | pmid = 26992420 | doi = 10.1093/ehjci/jew037 | doi-access = free }}</ref>

== Other intravascular applications: Neurovascular ==
⚫
In the last decade, significant advances have been made in the endovascular treatment of stroke, including brain aneurysms, intracranial atherosclerosis and ischemic stroke.<ref>{{cite journal | vauthors = Nogueira RG, Ribó M | title = Endovascular Treatment of Acute Stroke | journal = Stroke | volume = 50 | issue = 9 | pages = 2612–2618 | date = September 2019 | pmid = 31340728 | doi = 10.1161/STROKEAHA.119.023811 }}</ref> Intravascular OCT has been proposed has a key technology that can improve current procedure and treatments.<ref>{{cite journal | vauthors = Chen CJ, Kumar JS, Chen SH, Ding D, Buell TJ, Sur S, Ironside N, Luther E, Ragosta M, Park MS, Kalani MY, Liu KC, Starke RM | title = Optical Coherence Tomography: Future Applications in Cerebrovascular Imaging | journal = Stroke | volume = 49 | issue = 4 | pages = 1044–1050 | date = April 2018 | pmid = 29491139 | doi = 10.1161/STROKEAHA.117.019818 }}</ref> However, current intracoronary OCT catheters are not designed for navigation and reliable imaging of tortuous cerebrovascular arteries.<ref>{{cite journal | vauthors = Gounis MJ, Ughi GJ, Marosfoi M, Lopes DK, Fiorella D, Bezerra HG, Liang CW, Puri AS | title = Intravascular Optical Coherence Tomography for Neurointerventional Surgery | journal = Stroke | volume = 50 | issue = 1 | pages = 218–223 | date = January 2019 | pmid = 30580737 | doi = 10.1161/STROKEAHA.118.022315 | pmc = 6541539 }}</ref>

⚫
Recently, different (wire-like) OCT catheters have been proposed and were specifically designed for the human cerebrovasculature,<ref>{{cite journal | vauthors = Ughi GJ, Marosfoi MG, King RM, Caroff J, Peterson LM, Duncan BH, Langan ET, Collins A, Leporati A, Rousselle S, Lopes DK, Gounis MJ, Puri AS | title = A neurovascular high-frequency optical coherence tomography system enables in situ cerebrovascular volumetric microscopy | journal = Nature Communications | volume = 11 | issue = 1 | pages = 3851 | date = July 2020 | pmid = 32737314 | doi = 10.1038/s41467-020-17702-7 | pmc = 7395105 | bibcode = 2020NatCo..11.3851U }}</ref> named neuro optical coherence tomography (''n''OCT). A first clinical study to investigate safety, feasibility, and clinical potential has been conducted.<ref>{{cite journal | vauthors = Pereira VM, Lylyk P, Cancelliere N, Lylyk PN, Lylyk I, Anagnostakou V, Bleise C, Nishi H, Epshtein M, King RM, Shazeeb MS, Puri AS, Liang CW, Hanel RA, Spears J, Marotta TR, Lopes DK, Gounis MJ, Ughi GJ | title = Volumetric microscopy of cerebral arteries with a miniaturized optical coherence tomography imaging probe | journal = Science Translational Medicine | volume = 16 | issue = 747 | pages = eadl4497 | date = May 2024 | pmid = 38748771 | doi = 10.1126/scitranslmed.adl4497 }}</ref> Initial applications for the treatment of brain aneurysms and intracranial atherosclerosis have been demonstrated<ref>{{cite journal | vauthors = King RM, Peker A, Anagnostakou V, Raskett CM, Arends JM, Dixit HG, Ughi GJ, Puri AS, Gounis MJ, Shazeeb MS | title = High-frequency optical coherence tomography predictors of aneurysm occlusion following flow diverter treatment in a preclinical model | journal = Journal of Neurointerventional Surgery | volume = 15 | issue = 9 | pages = 919–923 | date = September 2023 | pmid = 36002288 | doi = 10.1136/jnis-2022-019275 }}</ref><ref>{{cite journal | vauthors = Anagnostakou V, Epshtein M, Ughi GJ, King RM, Valavanis A, Puri AS, Gounis MJ | title = Transvascular in vivo microscopy of the subarachnoid space | journal = Journal of Neurointerventional Surgery | volume = 14 | issue = 5 | pages = 420–428 | date = May 2022 | pmid = 35115394 | doi = 10.1136/neurintsurg-2021-018544 }}</ref><ref>{{cite journal | vauthors = Caroff J, King RM, Ughi GJ, Marosfoi M, Langan ET, Raskett C, Puri AS, Gounis MJ | title = Longitudinal Monitoring of Flow-Diverting Stent Tissue Coverage After Implant in a Bifurcation Model Using Neurovascular High-Frequency Optical Coherence Tomography | journal = Neurosurgery | volume = 87 | issue = 6 | pages = 1311–1319 | date = November 2020 | pmid = 32463884 | pmc = 7666887 | doi = 10.1093/neuros/nyaa208 }}</ref> showing future potential.<ref>{{Cite web | vauthors = Cooney E |date=2024-05-15 |title=To detect risk of stroke, tiny probe acts 'like a microscope' inside brain's blood vessels |url=https://www.statnews.com/2024/05/15/stroke-cardiovascular-disease-detection-tomography/ |access-date=2024-05-17 |website=STAT }}</ref>


== See also ==
== See also ==
* [[Fractional flow reserve]]
* [[Fractional flow reserve]]
* [[Intravascular ultrasound]]
* [[Intravascular fluorescence]]
* [[Intravascular fluorescence]]


Latest revision as of 14:46, 17 December 2024

Endoscopic optical coherence tomography
Example of intracoronary optical coherence tomography (OCT) image of atherosclerosis. Between 6 and 8 o'clock it is possible to observe a fibrocalcific atherosclerotic plaque.

Endoscopic optical coherence tomography, also intravascular optical coherence tomography is a catheter-based imaging application of optical coherence tomography (OCT).[1] It is capable of acquiring high-resolution images from inside a blood vessel using optical fibers and laser technology.

One of its main applications is for coronary arteries, which are often treated by endoscopic, minimally invasive surgical procedures.[2] Other applications for peripheral arteries and for neurovascular procedures have been proposed and are being investigated. Neurovascular applications required significant technological developments, due to the highly tortuous anatomy of the cerebrovasculature.

Intravascular OCT rapidly creates three-dimensional images at a resolution of approximately 15 micrometers, an improved resolution with respect to intravascular ultrasound and coronary angiogram, the other imaging techniques.[3] This offers additional information that can be used to optimize the treatment and management of vascular disease.

Theory

[edit]

OCT is analogous to medical ultrasound, measuring the backreflection of infrared light rather than sound. The time for light to be reflected back from the tissue under inspection is used to measure distances. However, due to the high speed of light, the backreflection time cannot be measured directly, but is instead measured using interferometry.[4]

OCT is measured using either time domain (TD-OCT) or frequency domain techniques (FD-OCT). Commercially available coronary OCT technology is based on frequency domain techniques, resulting in rapid acquisition procedures (1 to 2 seconds). Intracoronary OCT uses near-infrared light at 1300 nm and can visualize the microstructure of the arterial wall, its size, and therapeutic devices with high accuracy.

History

[edit]

Intravascular OCT was developed for the imaging of arterial disease at a resolution higher than the other techniques available, such as x-ray angiography and intravascular ultrasounds. OCT allows to assess atherosclerotic plaques characteristics at a resolution of approximately 15 μm (or better) and found applications for the guidance of catheter-based coronary interventions (ie, percutaneous coronary interventions). The first report of endoscopic OCT appeared in 1997 in the journal Science exploring various applications including gastroenterology and airways.[5] The first intravascular in vivo use in a preclinical model was reported in 1994[6] and first in human, clinical imaging in 2003.[7] The first OCT imaging catheter and system was commercialized by LightLab Imaging, Inc., a company based in Massachusetts formed following a technology transfer in 1997 from Fujimoto's lab (MIT).[8]

Early on, time-domain OCT technology required slow acquisitions (>10 seconds long) requiring the use of balloon occlusion techniques to displace the blood from the arterial lumen, opaque to near-infrared light. This prevented a broader adoption for several years. Aroun 2008-2009, the advent of rapid sweep source lasers allowed for the development of intravascular Fourier-Domain OCT (FD-OCT).[9][10] This enabled for the first-time rapid acquisitions of a long coronary segment in a couple of seconds, allowing non occlusive brief contrast injections to clear the arterial lumen from blood. Initial demonstration of FD-OCT for coronary imaging was achieved in 2008-2009[11][3] which significantly accelerated clinical adoption starting in 2009.

Cardiovascular applications

[edit]

Following regulatory clearances in the major geographies between 2009 and 2012 of fast acquisition Fourier domain OCT, the use of intracoronary OCT rapidly increased. It is used to help coronary disease diagnosis, planning of the intervention, assess procedural results, and prevent complications.

In the last decade, clinical benefits of coronary OCT have been systematically investigated. Several studies have linked the use of intravascular imaging such as IVUS and OCT to better stent expansion, a metric strongly correlated to better clinical outcomes in patients suffering from coronary artery disease and myocardial infarction.[12][13][14]

Larger randomized clinical trials have been undertaken. In 2023, a double-blind prospective trial demonstrated improvement in morbidity and mortality in coronary bifurcation interventions: "Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI."[15] Although not every study showed significant results,[16] to date, several studies demonstrated the benefits in patient outcomes of using intravascular imaging during coronary arteries interventions.[17][18] The use of intravascular imaging for coronary intervention is reported on the current cardiology guidelines.

Data published in late 2016 showed that over 150,000 intracoronary optical coherence tomography procedures are performed every year, and its adoption is rapidly growing at a rate of ~10-20% every year.[19]

Assessment of artery lumen morphology is the cornerstone of intravascular imaging criteria to evaluate disease severity and guide intervention. The high-resolution of OCT imaging allows to assess with high accuracy vessel lumen area, wall microstructure, intracoronary stent apposition and expansion.[20][21] OCT has an improved ability with respect to intravascular ultrasound to penetrate and delineate calcium in the vessel wall that makes it well suited to guide complex interventional strategies in vessels with superficial calcification. OCT has the capability of visualize coronary plaque erosion and fibrotic caps overlying lipid plaques.[22]

Neurovascular applications

[edit]

In the last decade, significant advances have been made in the endovascular treatment of stroke, including brain aneurysms, intracranial atherosclerosis and ischemic stroke.[23] Intravascular OCT has been proposed has a key technology that can improve current procedure and treatments.[24] However, current intracoronary OCT catheters are not designed for navigation and reliable imaging of tortuous cerebrovascular arteries.[25]

Recently, different (wire-like) OCT catheters have been proposed and were specifically designed for the human cerebrovasculature,[26] named neuro optical coherence tomography (nOCT). A first clinical study to investigate safety, feasibility, and clinical potential has been conducted.[27] Initial applications for the treatment of brain aneurysms and intracranial atherosclerosis have been demonstrated[28][29][30] showing future potential.[31][32]

Technology

[edit]

The most critical technological advance was the catheter and the development of fast wavelength sweeping near-infrared lasers. The fiber optic catheter/endoscope required rapid alignment of two optical fibers with 8 μm cores (one rotating) across free space. The distal end has a focusing component (GRIN or ball lens, typically).

State-of-the-art intracoronary optical coherence tomography uses a swept-source laser to make OCT images at high-speed (i.e., approximately 80,000 kHz - A-scan lines per second) to complete acquisition of a 3D OCT volume of coronary segments in a few-seconds.[33] The first intravascular FD-OCT was introduced to the market in 2009 (EU and Asia) and in 2012 (US). In 2018, two intracoronary OCT catheters are clinically available for use in the coronary arteries, having a size in diameter between 2.4F and 2.7F. [citation needed]

The axial resolution of state-of-the-art commercial systems is less than 20 micrometers, which is decoupled from the catheter lateral resolution. The highest resolution of OCT allows for the in vivo imaging of vessel microstructural features at an unprecedented level, enabling visualization of vessel wall atherosclerosis, pathology, and interaction with therapeutic devices at a microscopic level.[34]

Recent developments included the combination of OCT with spectroscopy and fluorescence in a single imaging catheter[35][36] and miniaturization of the imaging catheter.[37]

Safety

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Safety of intravascular imaging, including intracoronary OCT and intravascular ultrasound, has been investigated by several studies. Recent clinical trials reported a very low rate of self-limiting, minor complications on over 3,000 patients where in all cases no harm or prolongation of hospital stay was observed. Intracoronary optical coherence tomography was demonstrated to be safe among heterogeneous groups of patients presenting varying clinical setting.[38]

See also

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References

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