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== Cardiological applications ==
== Cardiological applications ==


In 1993, after OCT had been unsuccessful in imaging non-transparent tissue, researchers proposed imaging at 1300&nbsp;nm rather than 830&nbsp;nm used in the eye (after analyzing a 1989 scattering/absorption study by Parsa et al. in liver).<ref>{{cite journal | vauthors = Parsa P, Jacques SL, Nishioka NS | title = Optical properties of rat liver between 350 and 2200 nm | language = EN | journal = Applied Optics | volume = 28 | issue = 12 | pages = 2325–2330 | date = June 1989 | pmid = 20555519 | doi = 10.1364/AO.28.002325 | bibcode = 1989ApOpt..28.2325P }}</ref> The goal was to image vulnerable plaque (where better than 20&nbsp;μm resolution is needed based on histology and stress studies) and guide stent placement. A collaboration was established between Brezinski and James Fujimoto and they successfully imaged artery as well as other scattering tissue in 1993 (initially chicken and fish).<ref name = "Brezinski_1996" /> The first demonstration of endoscopic OCT was reported in 1997, by researchers at the Massachusetts Institute of Technology and Massachusetts General Hospital. Team members include prof. James Fujimoto, Mark Brezinski, pathologist James Southern MD, PhD, [[Guillermo James Tearney]], Micheal Hee, Joe Izatt, and [[Brett Bouma]].
In 1993, after OCT had been unsuccessful in imaging non-transparent tissue, researchers proposed imaging at 1300&nbsp;nm rather than 830&nbsp;nm used in the eye (after analyzing a 1989 scattering/absorption study by Parsa et al. in liver).<ref>{{cite journal | vauthors = Parsa P, Jacques SL, Nishioka NS | title = Optical properties of rat liver between 350 and 2200 nm | language = EN | journal = Applied Optics | volume = 28 | issue = 12 | pages = 2325–2330 | date = June 1989 | pmid = 20555519 | doi = 10.1364/AO.28.002325 | bibcode = 1989ApOpt..28.2325P }}</ref> The goal was to image atherosclerotic plaque characteristics in high resolution at 20&nbsp;μm or better (to ascertain characteristics otherwise only available with histological techniques) and guide stent placement.<ref name = "Brezinski_1996" /> The first demonstration of endoscopic OCT was reported in 1997, by researchers at the Massachusetts Institute of Technology and Massachusetts General Hospital. Team members included prof. James Fujimoto, Mark Brezinski, pathologist James Southern MD, PhD, [[Guillermo James Tearney]], Micheal Hee, Joe Izatt, and [[Brett Bouma]].


The superior resolution to IVUS was demonstrated.<ref>{{cite journal | vauthors = Brezinski ME, Tearney GJ, Weissman NJ, Boppart SA, Bouma BE, Hee MR, Weyman AE, Swanson EA, Southern JF, Fujimoto JG | title = Assessing atherosclerotic plaque morphology: comparison of optical coherence tomography and high frequency intravascular ultrasound | journal = Heart | volume = 77 | issue = 5 | pages = 397–403 | date = May 1997 | pmid = 9196405 | doi = 10.1136/hrt.77.5.397 | pmc = 484757 }}</ref> The first TD-OCT imaging catheter and system was commercialized by [[LightLab Imaging, Inc.]], a company based in Massachusetts formed in 1997 by Fujimoto, Swanson, and Brezinski. Technical advances over the ophthamologic system were needed beyond wavelength, particularly the catheter and acquisition rate. The most important technical advance for cardiology and other nontransparent tissue was likely the catheter/endoscope. The fiber optic catheter/endoscope required rapid alignment of two optical fibers with 8&nbsp;μm cores (one rotating) across free space. The first intravascular imaging was in rabbit but blood needed to be pushed out of the field in 1998.<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 | doi = 10.1136/hrt.82.2.128 | pmc = 1729132 }}</ref> Index matching was proposed to make the red cells invisible to infrared light.<ref>{{cite journal | vauthors = Brezinski M, Saunders K, Jesser C, Li X, Fujimoto J | title = Index matching to improve optical coherence tomography imaging through blood | journal = Circulation | volume = 103 | issue = 15 | pages = 1999–2003 | date = April 2001 | pmid = 11306530 | doi = 10.1161/01.CIR.103.15.1999 | s2cid = 40845181 | doi-access = free }}</ref> The initial few years of the millineum did not see in vivo human imaging as only a few groups were capable. The Brezinski and Fujimoto groups could not because of COI, owning Lightlab and IP. Lightlab had not moved this forward. The Tearney and Bouma group finally achieved it in 2003 looking at stents.<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 superior resolution to intravascular ultrasound, the only intravascular imaging technology available at the time, was demonstrated.<ref>{{cite journal | vauthors = Brezinski ME, Tearney GJ, Weissman NJ, Boppart SA, Bouma BE, Hee MR, Weyman AE, Swanson EA, Southern JF, Fujimoto JG | title = Assessing atherosclerotic plaque morphology: comparison of optical coherence tomography and high frequency intravascular ultrasound | journal = Heart | volume = 77 | issue = 5 | pages = 397–403 | date = May 1997 | pmid = 9196405 | doi = 10.1136/hrt.77.5.397 | pmc = 484757 }}</ref> The first TD-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). Technical advances over the ophthamologic system were needed beyond wavelength, particularly the catheter and acquisition rate. The most important technical advance for cardiology was the need for a reliable catheter/endoscope. The fiber optic catheter/endoscope required rapid alignment of two optical fibers with 8&nbsp;μm cores (one rotating) across free space.
The first intravascular imaging was in rabbit, but blood (opaque to infrared light) needed to be pushed out of the field in 1998.<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 | doi = 10.1136/hrt.82.2.128 | pmc = 1729132 }}</ref> Index matching media (such as saline or contrast) was proposed to displace blood (i.e., red blood cells) from the arterial lumen.<ref>{{cite journal | vauthors = Brezinski M, Saunders K, Jesser C, Li X, Fujimoto J | title = Index matching to improve optical coherence tomography imaging through blood | journal = Circulation | volume = 103 | issue = 15 | pages = 1999–2003 | date = April 2001 | pmid = 11306530 | doi = 10.1161/01.CIR.103.15.1999 | s2cid = 40845181 | doi-access = free }}</ref> The initial few years of the millennium did not see in vivo human imaging as only a few groups were capable. The Tearney and Bouma at Massachusetts General Hospital achieved first in human in vivo imaging in 2003 looking at stents.<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 last two decade have seen consensus groups and registries but a lack of prospective trials with MACE endpoints for unclear reasons.<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> Part was related to only several groups having access to cardiovascular systems early (Brezinski at Harvard, Fujimoto at MIT, LightLab, and former MIT trainees at MGH (Bouma/Tearney), with at least the first two having COI for intravascular studies. A study in 2012 concluded IVUS led to better stent expansion, but experience with OCT may have been limited.<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> This conclusion is supported by more recent studies.<ref>{{Cite journal |last1=Wijns |first1=William |last2=Shite |first2=Junya |last3=Jones |first3=Michael R. |last4=Lee |first4=Stephen W.-L. |last5=Price |first5=Matthew J. |last6=Fabbiocchi |first6=Franco |last7=Barbato |first7=Emanuele |last8=Akasaka |first8=Takashi |last9=Bezerra |first9=Hiram |last10=Holmes |first10=David |date=2015-12-14 |title=Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study |journal=European Heart Journal |language=en |volume=36 |issue=47 |pages=3346–3355 |doi=10.1093/eurheartj/ehv367 |issn=0195-668X |pmc=4677272 |pmid=26242713}}</ref> A study in 2015 showed OCT influenced physician decisions, but it is unclear if their changed decision was for the better or worse<ref name="Wijns_2015" /> Studies on plaque healing had conflicting results, though not surprising being primarily registry studies with little basic work on what a healed plaque (or even thrombus) appear on OCT.<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><ref>{{cite journal | vauthors = Yin WJ, Jing J, Zhang YQ, Tian F, Zhang T, Zhou SS, Chen YD | title = Association between non-culprit healed plaque and plaque progression in acute coronary syndrome patients: an optical coherence tomography study | journal = Journal of Geriatric Cardiology | volume = 18 | issue = 8 | pages = 631–644 | date = August 2021 | pmid = 34527029 | pmc = 8390931 | doi = 10.11909/j.issn.1671-5411.2021.08.001 }}</ref> Some authors have found these registry data is core length in ACS patients.<ref>{{cite journal | vauthors = Brezinski ME | title = Comparing the Risk Factors of Plaque Rupture and Failed Plaque Healing in Acute Coronary Syndrome | journal = JAMA Cardiology | volume = 4 | issue = 4 | pages = 329–331 | date = April 2019 | pmid = 30865209 | doi = 10.1001/jamacardio.2019.0312 | s2cid = 76667373 }}</ref> A major change occurred in 2023 with prospective trials, as Abbott acquiring LightLab in 2017. In 2023, after double blind prospective trails were ultimately performed demonstrating morbidity and mortality benefits "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://openaccess.sgul.ac.uk/id/eprint/115791/1/nejmoa2307770.pdf }}</ref> Several other studies are expected out in 2023.
The last two decade have seen consensus groups and registries but a lack of prospective trials with MACE endpoints for unclear reasons.<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> Part was related to only several groups having access to cardiovascular systems early (Brezinski at Harvard, Fujimoto at MIT, LightLab, and former MIT trainees at MGH (Bouma/Tearney), with at least the first two having COI for intravascular studies. A study in 2012 concluded IVUS led to better stent expansion, but experience with OCT may have been limited.<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> This conclusion is supported by more recent studies.<ref>{{Cite journal |last1=Wijns |first1=William |last2=Shite |first2=Junya |last3=Jones |first3=Michael R. |last4=Lee |first4=Stephen W.-L. |last5=Price |first5=Matthew J. |last6=Fabbiocchi |first6=Franco |last7=Barbato |first7=Emanuele |last8=Akasaka |first8=Takashi |last9=Bezerra |first9=Hiram |last10=Holmes |first10=David |date=2015-12-14 |title=Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study |journal=European Heart Journal |language=en |volume=36 |issue=47 |pages=3346–3355 |doi=10.1093/eurheartj/ehv367 |issn=0195-668X |pmc=4677272 |pmid=26242713}}</ref> A study in 2015 showed OCT influenced physician decisions, but it is unclear if their changed decision was for the better or worse<ref name="Wijns_2015" /> Studies on plaque healing had conflicting results, though not surprising being primarily registry studies with little basic work on what a healed plaque (or even thrombus) appear on OCT.<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><ref>{{cite journal | vauthors = Yin WJ, Jing J, Zhang YQ, Tian F, Zhang T, Zhou SS, Chen YD | title = Association between non-culprit healed plaque and plaque progression in acute coronary syndrome patients: an optical coherence tomography study | journal = Journal of Geriatric Cardiology | volume = 18 | issue = 8 | pages = 631–644 | date = August 2021 | pmid = 34527029 | pmc = 8390931 | doi = 10.11909/j.issn.1671-5411.2021.08.001 }}</ref> Some authors have found these registry data is core length in ACS patients.<ref>{{cite journal | vauthors = Brezinski ME | title = Comparing the Risk Factors of Plaque Rupture and Failed Plaque Healing in Acute Coronary Syndrome | journal = JAMA Cardiology | volume = 4 | issue = 4 | pages = 329–331 | date = April 2019 | pmid = 30865209 | doi = 10.1001/jamacardio.2019.0312 | s2cid = 76667373 }}</ref> A major change occurred in 2023 with prospective trials, as Abbott acquiring LightLab in 2017. In 2023, after double blind prospective trails were ultimately performed demonstrating morbidity and mortality benefits "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://openaccess.sgul.ac.uk/id/eprint/115791/1/nejmoa2307770.pdf }}</ref> Several other studies are expected out in 2023.

Revision as of 14:30, 17 May 2024

Intracoronary 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.

Intracoronary optical coherence tomography (OCT) (or, more generally, intravascular optical coherence tomography) is a catheter-based imaging application of optical coherence tomography. Currently prospective trials demonstrate OCT alters morbidity and/or mortality in coronary stenting as discussed below.

Intracoronary OCT creates images at a resolution of approximately 15 micro-meters, an order of magnitude improved resolution with respect to intravascular ultrasound and X-ray coronary angiogram.[1]

Theory

OCT is analogous to 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. The backreflection intensity with depth plots the structure of the tissue. An A-scan (a 1-dimension scan as opposed to a 2 dimensional B-scan) [clarification needed] can be taken (1-dimension) or the beam can scanned to produce two- and three-dimensional data sets. Due the high speed associated with light propagation, the backreflection time cannot be measured directly, but is instead measured using interferometry.[2]

OCT is measured using either time domain (TD-OCT) and frequency domain techniques (SS-OCT/FD-OCT/Spectral OCT). TD-OCT can be considered like ultrasound, directly measuring the time for the photon make the round-trip from the source to the tissue and back to the detector. Frequency domain OCT collects all the frequencies from an A-scan and ascertains backreflection depth using Fourier analysis.[3] Time domain and frequency domain OCT both existed by 1981. TD-OCT was initially used in cardiology but frame rates at the time were too slow. The ultimate maximum acquisition rate for TD-OCT remains unknown as work in this field stopped before later advances in data acquisition techniques were available. FD-OCT is faster but is believed to have lower dynamic range, which can affect imaging quality such as penetration.[3] Some groups dispute this, though they appear to be talking about SNR and not dynamic range.[4]

OCT needs to image at 1300 nm in cardiovascular tissue, but those could damage the eye. On the other hand, ophthalmologic systems image at 830 nm, which would only image a few hundred microns in arteries. The eye effectively has no scattering, but imaging to the retina occurs over a range of several centimeters, so water absorption becomes significant. The coronary application needs a wavelength with low scattering and preferably low absorption (though imaging is only over a range of a few millimeters). The light also had to have a broad bandwidth, significant power at high acquisition rates, and a Gaussian spectrum.[5]

Cardiological applications

In 1993, after OCT had been unsuccessful in imaging non-transparent tissue, researchers proposed imaging at 1300 nm rather than 830 nm used in the eye (after analyzing a 1989 scattering/absorption study by Parsa et al. in liver).[6] The goal was to image atherosclerotic plaque characteristics in high resolution at 20 μm or better (to ascertain characteristics otherwise only available with histological techniques) and guide stent placement.[2] The first demonstration of endoscopic OCT was reported in 1997, by researchers at the Massachusetts Institute of Technology and Massachusetts General Hospital. Team members included prof. James Fujimoto, Mark Brezinski, pathologist James Southern MD, PhD, Guillermo James Tearney, Micheal Hee, Joe Izatt, and Brett Bouma.

The superior resolution to intravascular ultrasound, the only intravascular imaging technology available at the time, was demonstrated.[7] The first TD-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). Technical advances over the ophthamologic system were needed beyond wavelength, particularly the catheter and acquisition rate. The most important technical advance for cardiology was the need for a reliable catheter/endoscope. The fiber optic catheter/endoscope required rapid alignment of two optical fibers with 8 μm cores (one rotating) across free space.

The first intravascular imaging was in rabbit, but blood (opaque to infrared light) needed to be pushed out of the field in 1998.[8] Index matching media (such as saline or contrast) was proposed to displace blood (i.e., red blood cells) from the arterial lumen.[9] The initial few years of the millennium did not see in vivo human imaging as only a few groups were capable. The Tearney and Bouma at Massachusetts General Hospital achieved first in human in vivo imaging in 2003 looking at stents.[10]

The last two decade have seen consensus groups and registries but a lack of prospective trials with MACE endpoints for unclear reasons.[11] Part was related to only several groups having access to cardiovascular systems early (Brezinski at Harvard, Fujimoto at MIT, LightLab, and former MIT trainees at MGH (Bouma/Tearney), with at least the first two having COI for intravascular studies. A study in 2012 concluded IVUS led to better stent expansion, but experience with OCT may have been limited.[12] This conclusion is supported by more recent studies.[13] A study in 2015 showed OCT influenced physician decisions, but it is unclear if their changed decision was for the better or worse[11] Studies on plaque healing had conflicting results, though not surprising being primarily registry studies with little basic work on what a healed plaque (or even thrombus) appear on OCT.[14][15] Some authors have found these registry data is core length in ACS patients.[16] A major change occurred in 2023 with prospective trials, as Abbott acquiring LightLab in 2017. In 2023, after double blind prospective trails were ultimately performed demonstrating morbidity and mortality benefits "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."[17] Several other studies are expected out in 2023.

Data published in late 2016 showed that approximately 100,000 intracoronary optical coherence tomography procedures are performed every year, and its adoption is rapidly growing at a rate of ~ 20% every year.[citation needed]

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. 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.[2]

Technology

The technology of most interest to clinicians and non-physicians are the catheter, technology for faster imaging (SS-OCT versus TD-OCT), the light source, and the potential for a guidewire. The most critical technological advance (besides identifying the optimal wavelength) was the catheter. The fiber optic catheter/endoscope required rapid alignment of two optical fibers with 8 μm cores (one rotating) across free space. The fiber itself is 120 microns so can be made into a guidewire unlike IVUS. The distal end has a focusing component (GRIN lens typically) and light directing component (usually prism). The fiber is fragile and needs external casing as a recent study using a Lightlab catheter in a joint had a high breakage rate.[18]

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.[19] 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.[20][citation needed]

Basic research

The field, and current clinical trials are limited by the need for more basic research, particularly characterizing plaque necrotic cores. A core to much of the basic research done and to be done is micron scale matching of OCT images to histopathology, covered in the Optical Coherence Tomography: Principles and Applications chapter 12.[5] There are only a small number of groups which have this capability. For the retina, micron scale matching was not performed but as prospective trials are being finally considered, more refined interpretation of images is needed.[21] Micron scale matching was performed in the first OCT artery paper, where pathologist James Southern MD,PhD of MGH played a major role.[2]

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.[22]

See also

References

  1. ^ Bezerra HG, Costa MA, Guagliumi G, Rollins AM, Simon DI (November 2009). "Intracoronary optical coherence tomography: a comprehensive review clinical and research applications". JACC. Cardiovascular Interventions. 2 (11): 1035–1046. doi:10.1016/j.jcin.2009.06.019. PMC 4113036. PMID 19926041.
  2. ^ a b c d Brezinski ME, Tearney GJ, Bouma BE, Izatt JA, Hee MR, Swanson EA, et al. (March 1996). "Optical coherence tomography for optical biopsy. Properties and demonstration of vascular pathology". Circulation. 93 (6): 1206–1213. doi:10.1161/01.CIR.93.6.1206. PMID 8653843.
  3. ^ a b Zheng K, Liu B, Huang C, Brezinski ME (November 2008). "Experimental confirmation of potential swept source optical coherence tomography performance limitations". Applied Optics. 47 (33): 6151–6158. Bibcode:2008ApOpt..47.6151Z. doi:10.1364/AO.47.006151. PMC 2640108. PMID 19023378.
  4. ^ Choma M, Sarunic M, Yang C, Izatt J (September 2003). "Sensitivity advantage of swept source and Fourier domain optical coherence tomography". Optics Express. 11 (18): 2183–2189. Bibcode:2003OExpr..11.2183C. doi:10.1364/OE.11.002183. PMID 19466106.
  5. ^ a b Brezinski ME (2006). Optical Coherence Tomography: Principles and Applications. Amsterdam, Boston: Academic Press. ISBN 978-0-12-133570-0.
  6. ^ Parsa P, Jacques SL, Nishioka NS (June 1989). "Optical properties of rat liver between 350 and 2200 nm". Applied Optics. 28 (12): 2325–2330. Bibcode:1989ApOpt..28.2325P. doi:10.1364/AO.28.002325. PMID 20555519.
  7. ^ Brezinski ME, Tearney GJ, Weissman NJ, Boppart SA, Bouma BE, Hee MR, et al. (May 1997). "Assessing atherosclerotic plaque morphology: comparison of optical coherence tomography and high frequency intravascular ultrasound". Heart. 77 (5): 397–403. doi:10.1136/hrt.77.5.397. PMC 484757. PMID 9196405.
  8. ^ Fujimoto JG, Boppart SA, Tearney GJ, Bouma BE, Pitris C, Brezinski ME (August 1999). "High resolution in vivo intra-arterial imaging with optical coherence tomography". Heart. 82 (2): 128–133. doi:10.1136/hrt.82.2.128. PMC 1729132. PMID 10409522.
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