Endoscopic optical coherence tomography imaging: Difference between revisions

Intracoronary optical coherence tomography
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.
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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]

History

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]

However, time-domain OCT required slow acquisitions 20-30 second long which required the use of balloon occlusion techniques, preventing for several years a broader adoption. Faster sweep source laser allowed for the development of Fourier-Domain OCT (FD-OCT). Initial demonstration of FD-OCT for coronary imaging was achieved in 2008-2009^[11]^[12] which significantly accelerated clinical adoption.

Cardiovascular Medicine Applications

Following regulatory clearances in the major geographies between 2009 and 2012, the use of intracoronary OCT rapidly increased. In the last decade, clinical benefits of coronary OCT images have been investigated. Several studies have correlated 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.^[13] ^[14] ^[15] ^[13] ^[16]

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."^[17] Although not every study showed significant results^[18], to date, several studies demonstrated the benefits in patient outcomes of using intravascular imaging during coronary arteries interventions.^[19]^[20]

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.^[21]

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.^[22]^[23] 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.^[24]

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.^[25] 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.^[26]^{[citation needed]}

Recent developments included the combination of OCT with spectroscopy and fluorescence in a single imaging catheter^[27]^[28] and miniaturization of the imaging catheter.^[29]

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.^[30]

References

^ 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.
^ ^a ^b ^c 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.
^ ^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.
^ 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.
^ Brezinski ME (2006). Optical Coherence Tomography: Principles and Applications. Amsterdam, Boston: Academic Press. ISBN 978-0-12-133570-0.
^ 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.
^ 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.
^ 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.
^ Brezinski M, Saunders K, Jesser C, Li X, Fujimoto J (April 2001). "Index matching to improve optical coherence tomography imaging through blood". Circulation. 103 (15): 1999–2003. doi:10.1161/01.CIR.103.15.1999. PMID 11306530. S2CID 40845181.
^ Bouma BE, Tearney GJ, Yabushita H, Shishkov M, Kauffman CR, DeJoseph Gauthier D, et al. (March 2003). "Evaluation of intracoronary stenting by intravascular optical coherence tomography". Heart. 89 (3): 317–320. doi:10.1136/heart.89.3.317. PMC 1767586. PMID 12591841.
^ Tearney GJ, Waxman S, Shishkov M, Vakoc BJ, Suter MJ, Freilich MI, et al. (2008-11-01). "Three-Dimensional Coronary Artery Microscopy by Intracoronary Optical Frequency Domain Imaging". JACC: Cardiovascular Imaging. 1 (6): 752–761. doi:10.1016/j.jcmg.2008.06.007. ISSN 1936-878X. PMC 2852244. PMID 19356512.{{cite journal}}: CS1 maint: PMC format (link)
^ Bezerra HG, Costa MA, Guagliumi G, Rollins AM, Simon DI (2009-11). "Intracoronary Optical Coherence Tomography: A Comprehensive Review". JACC: Cardiovascular Interventions. 2 (11): 1035–1046. doi:10.1016/j.jcin.2009.06.019. PMC 4113036. PMID 19926041. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
^ ^a ^b Wijns W, Shite J, Jones MR, Lee SW, Price MJ, Fabbiocchi F, et al. (December 2015). "Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study". European Heart Journal. 36 (47): 3346–3355. doi:10.1093/eurheartj/ehv367. PMC 4677272. PMID 26242713.
^ Habara M, Nasu K, Terashima M, Kaneda H, Yokota D, Ko E, et al. (April 2012). "Impact of frequency-domain optical coherence tomography guidance for optimal coronary stent implantation in comparison with intravascular ultrasound guidance". Circulation. Cardiovascular Interventions. 5 (2): 193–201. doi:10.1161/CIRCINTERVENTIONS.111.965111. PMID 22456026. S2CID 3025748.
^ Wijns W, Shite J, Jones MR, Lee SW, Price MJ, Fabbiocchi F, et al. (2015-12-14). "Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study". European Heart Journal. 36 (47): 3346–3355. doi:10.1093/eurheartj/ehv367. ISSN 0195-668X. PMC 4677272. PMID 26242713.
^ Vergallo R, Porto I, D'Amario D, Annibali G, Galli M, Benenati S, et al. (April 2019). "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". JAMA Cardiology. 4 (4): 321–329. doi:10.1001/jamacardio.2019.0275. PMC 6484796. PMID 30865212.
^ Holm NR, Andreasen LN, Neghabat O, Laanmets P, Kumsars I, Bennett J, et al. (October 2023). "OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions" (PDF). The New England Journal of Medicine. 389 (16): 1477–1487. doi:10.1056/NEJMoa2307770. PMID 37634149. S2CID 261231045.
^ Ali ZA, Landmesser U, Maehara A, Matsumura M, Shlofmitz RA, Guagliumi G, et al. (2023-10-19). "Optical Coherence Tomography–Guided versus Angiography-Guided PCI". New England Journal of Medicine. 389 (16): 1466–1476. doi:10.1056/NEJMoa2305861. ISSN 0028-4793.
^ Kang DY, Ahn JM, Yun SC, Hur SH, Cho YK, Lee CH, et al. (2023-10-17). "Optical Coherence Tomography–Guided or Intravascular Ultrasound–Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial". Circulation. 148 (16): 1195–1206. doi:10.1161/CIRCULATIONAHA.123.066429. ISSN 0009-7322.
^ Stone GW, Christiansen EH, Ali ZA, Andreasen LN, Maehara A, Ahmad Y, et al. (2024-03). "Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis". The Lancet. 403 (10429): 824–837. doi:10.1016/S0140-6736(23)02454-6. {{cite journal}}: Check date values in: |date= (help)
^ Swanson EA, Fujimoto JG (2017-03-01). "The ecosystem that powered the translation of OCT from fundamental research to clinical and commercial impact [Invited]". Biomedical Optics Express. 8 (3): 1638. doi:10.1364/BOE.8.001638. ISSN 2156-7085. PMC 5480569. PMID 28663854.{{cite journal}}: CS1 maint: PMC format (link)
^ Ughi GJ, Adriaenssens T, Onsea K, Kayaert P, Dubois C, Sinnaeve P, et al. (2012-02). "Automatic segmentation of in-vivo intra-coronary optical coherence tomography images to assess stent strut apposition and coverage". The International Journal of Cardiovascular Imaging. 28 (2): 229–241. doi:10.1007/s10554-011-9824-3. ISSN 1569-5794. {{cite journal}}: Check date values in: |date= (help)
^ Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, et al. (2002-09-24). "Characterization of Human Atherosclerosis by Optical Coherence Tomography". Circulation. 106 (13): 1640–1645. doi:10.1161/01.CIR.0000029927.92825.F6. ISSN 0009-7322.
^ Martin S, Rashidifard C, Norris D, Goncalves A, Vercollone C, Brezinski M (December 2022). "Minimally Invasive Polarization Sensitive Optical Coherence Tomography (PS-OCT) for assessing Pre-OA, a pilot study on technical feasibility". Osteoarthritis and Cartilage Open. 4 (4): 100313. doi:10.1016/j.ocarto.2022.100313. ISSN 2665-9131. PMC 9576017. PMID 36263247.
^ Yun SH, Tearney G, de Boer J, Bouma B (November 2004). "Pulsed-source and swept-source spectral-domain optical coherence tomography with reduced motion artifacts". Optics Express. 12 (23): 5614–5624. Bibcode:2004OExpr..12.5614Y. doi:10.1364/opex.12.005614. PMC 2713045. PMID 19488195.
^ Brezinski ME, Tearney GJ, Bouma BE, Izatt JA, Hee MR, Swanson EA, et al. (1996-03-15). "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. ISSN 0009-7322. PMID 8653843.
^ Fard AM, Vacas-Jacques P, Hamidi E, Wang H, Carruth RW, Gardecki JA, et al. (2013-12-16). "Optical coherence tomography – near infrared spectroscopy system and catheter for intravascular imaging". Optics Express. 21 (25): 30849. doi:10.1364/OE.21.030849. ISSN 1094-4087.
^ Ughi GJ, Wang H, Gerbaud E, Gardecki JA, Fard AM, Hamidi E, et al. (2016-11). "Clinical Characterization of Coronary Atherosclerosis With Dual-Modality OCT and Near-Infrared Autofluorescence Imaging". JACC: Cardiovascular Imaging. 9 (11): 1304–1314. doi:10.1016/j.jcmg.2015.11.020. {{cite journal}}: Check date values in: |date= (help)
^ Bezerra HG, Quimby DL, Matar F, Mohanty BD, Bassily E, Ughi GJ (2023-07-01). "High-Frequency Optical Coherence Tomography (HF-OCT) for Preintervention Coronary Imaging: A First-in-Human Study". JACC: Cardiovascular Imaging. 16 (7): 982–984. doi:10.1016/j.jcmg.2023.01.013. ISSN 1936-878X.
^ van der Sijde JN, Karanasos A, van Ditzhuijzen NS, Okamura T, van Geuns RJ, Valgimigli M, et al. (April 2017). "Safety of optical coherence tomography in daily practice: a comparison with intravascular ultrasound". European Heart Journal. Cardiovascular Imaging. 18 (4): 467–474. doi:10.1093/ehjci/jew037. PMID 26992420.

[BezerraCosta2009-1] 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.

[Brezinski_1996-2] 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.

[Zheng_2008-3] 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.

[Brezinski_2006-5] 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.

[9] Brezinski M, Saunders K, Jesser C, Li X, Fujimoto J (April 2001). "Index matching to improve optical coherence tomography imaging through blood". Circulation. 103 (15): 1999–2003. doi:10.1161/01.CIR.103.15.1999. PMID 11306530. S2CID 40845181.

[10] Bouma BE, Tearney GJ, Yabushita H, Shishkov M, Kauffman CR, DeJoseph Gauthier D, et al. (March 2003). "Evaluation of intracoronary stenting by intravascular optical coherence tomography". Heart. 89 (3): 317–320. doi:10.1136/heart.89.3.317. PMC 1767586. PMID 12591841.

[11] Tearney GJ, Waxman S, Shishkov M, Vakoc BJ, Suter MJ, Freilich MI, et al. (2008-11-01). "Three-Dimensional Coronary Artery Microscopy by Intracoronary Optical Frequency Domain Imaging". JACC: Cardiovascular Imaging. 1 (6): 752–761. doi:10.1016/j.jcmg.2008.06.007. ISSN 1936-878X. PMC 2852244. PMID 19356512.{{cite journal}}: CS1 maint: PMC format (link)

[12] Bezerra HG, Costa MA, Guagliumi G, Rollins AM, Simon DI (2009-11). "Intracoronary Optical Coherence Tomography: A Comprehensive Review". JACC: Cardiovascular Interventions. 2 (11): 1035–1046. doi:10.1016/j.jcin.2009.06.019. PMC 4113036. PMID 19926041. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)

[Wijns_2015-13] Wijns W, Shite J, Jones MR, Lee SW, Price MJ, Fabbiocchi F, et al. (December 2015). "Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study". European Heart Journal. 36 (47): 3346–3355. doi:10.1093/eurheartj/ehv367. PMC 4677272. PMID 26242713.

[14] Habara M, Nasu K, Terashima M, Kaneda H, Yokota D, Ko E, et al. (April 2012). "Impact of frequency-domain optical coherence tomography guidance for optimal coronary stent implantation in comparison with intravascular ultrasound guidance". Circulation. Cardiovascular Interventions. 5 (2): 193–201. doi:10.1161/CIRCINTERVENTIONS.111.965111. PMID 22456026. S2CID 3025748.

[15] Wijns W, Shite J, Jones MR, Lee SW, Price MJ, Fabbiocchi F, et al. (2015-12-14). "Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study". European Heart Journal. 36 (47): 3346–3355. doi:10.1093/eurheartj/ehv367. ISSN 0195-668X. PMC 4677272. PMID 26242713.

[16] Vergallo R, Porto I, D'Amario D, Annibali G, Galli M, Benenati S, et al. (April 2019). "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". JAMA Cardiology. 4 (4): 321–329. doi:10.1001/jamacardio.2019.0275. PMC 6484796. PMID 30865212.

[17] Holm NR, Andreasen LN, Neghabat O, Laanmets P, Kumsars I, Bennett J, et al. (October 2023). "OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions" (PDF). The New England Journal of Medicine. 389 (16): 1477–1487. doi:10.1056/NEJMoa2307770. PMID 37634149. S2CID 261231045.

[18] Ali ZA, Landmesser U, Maehara A, Matsumura M, Shlofmitz RA, Guagliumi G, et al. (2023-10-19). "Optical Coherence Tomography–Guided versus Angiography-Guided PCI". New England Journal of Medicine. 389 (16): 1466–1476. doi:10.1056/NEJMoa2305861. ISSN 0028-4793.

[19] Kang DY, Ahn JM, Yun SC, Hur SH, Cho YK, Lee CH, et al. (2023-10-17). "Optical Coherence Tomography–Guided or Intravascular Ultrasound–Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial". Circulation. 148 (16): 1195–1206. doi:10.1161/CIRCULATIONAHA.123.066429. ISSN 0009-7322.

[20] Stone GW, Christiansen EH, Ali ZA, Andreasen LN, Maehara A, Ahmad Y, et al. (2024-03). "Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis". The Lancet. 403 (10429): 824–837. doi:10.1016/S0140-6736(23)02454-6. {{cite journal}}: Check date values in: |date= (help)

[21] Swanson EA, Fujimoto JG (2017-03-01). "The ecosystem that powered the translation of OCT from fundamental research to clinical and commercial impact [Invited]". Biomedical Optics Express. 8 (3): 1638. doi:10.1364/BOE.8.001638. ISSN 2156-7085. PMC 5480569. PMID 28663854.{{cite journal}}: CS1 maint: PMC format (link)

[22] Ughi GJ, Adriaenssens T, Onsea K, Kayaert P, Dubois C, Sinnaeve P, et al. (2012-02). "Automatic segmentation of in-vivo intra-coronary optical coherence tomography images to assess stent strut apposition and coverage". The International Journal of Cardiovascular Imaging. 28 (2): 229–241. doi:10.1007/s10554-011-9824-3. ISSN 1569-5794. {{cite journal}}: Check date values in: |date= (help)

[23] Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, et al. (2002-09-24). "Characterization of Human Atherosclerosis by Optical Coherence Tomography". Circulation. 106 (13): 1640–1645. doi:10.1161/01.CIR.0000029927.92825.F6. ISSN 0009-7322.

[24] Martin S, Rashidifard C, Norris D, Goncalves A, Vercollone C, Brezinski M (December 2022). "Minimally Invasive Polarization Sensitive Optical Coherence Tomography (PS-OCT) for assessing Pre-OA, a pilot study on technical feasibility". Osteoarthritis and Cartilage Open. 4 (4): 100313. doi:10.1016/j.ocarto.2022.100313. ISSN 2665-9131. PMC 9576017. PMID 36263247.

[25] Yun SH, Tearney G, de Boer J, Bouma B (November 2004). "Pulsed-source and swept-source spectral-domain optical coherence tomography with reduced motion artifacts". Optics Express. 12 (23): 5614–5624. Bibcode:2004OExpr..12.5614Y. doi:10.1364/opex.12.005614. PMC 2713045. PMID 19488195.

[26] Brezinski ME, Tearney GJ, Bouma BE, Izatt JA, Hee MR, Swanson EA, et al. (1996-03-15). "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. ISSN 0009-7322. PMID 8653843.

[27] Fard AM, Vacas-Jacques P, Hamidi E, Wang H, Carruth RW, Gardecki JA, et al. (2013-12-16). "Optical coherence tomography – near infrared spectroscopy system and catheter for intravascular imaging". Optics Express. 21 (25): 30849. doi:10.1364/OE.21.030849. ISSN 1094-4087.

[28] Ughi GJ, Wang H, Gerbaud E, Gardecki JA, Fard AM, Hamidi E, et al. (2016-11). "Clinical Characterization of Coronary Atherosclerosis With Dual-Modality OCT and Near-Infrared Autofluorescence Imaging". JACC: Cardiovascular Imaging. 9 (11): 1304–1314. doi:10.1016/j.jcmg.2015.11.020. {{cite journal}}: Check date values in: |date= (help)

[29] Bezerra HG, Quimby DL, Matar F, Mohanty BD, Bassily E, Ughi GJ (2023-07-01). "High-Frequency Optical Coherence Tomography (HF-OCT) for Preintervention Coronary Imaging: A First-in-Human Study". JACC: Cardiovascular Imaging. 16 (7): 982–984. doi:10.1016/j.jcmg.2023.01.013. ISSN 1936-878X.

[30] van der Sijde JN, Karanasos A, van Ditzhuijzen NS, Okamura T, van Geuns RJ, Valgimigli M, et al. (April 2017). "Safety of optical coherence tomography in daily practice: a comparison with intravascular ultrasound". European Heart Journal. Cardiovascular Imaging. 18 (4): 467–474. doi:10.1093/ehjci/jew037. PMID 26992420.

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 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://openaccess.sgul.ac.uk/id/eprint/115791/1/nejmoa2307770.pdf }}</ref>  Although not every study showed significant results<ref>{{Cite journal |last=Ali |first=Ziad A. |last2=Landmesser |first2=Ulf |last3=Maehara |first3=Akiko |last4=Matsumura |first4=Mitsuaki |last5=Shlofmitz |first5=Richard A. |last6=Guagliumi |first6=Giulio |last7=Price |first7=Matthew J. |last8=Hill |first8=Jonathan M. |last9=Akasaka |first9=Takashi |last10=Prati |first10=Francesco |last11=Bezerra |first11=Hiram G. |last12=Wijns |first12=William |last13=Leistner |first13=David |last14=Canova |first14=Paolo |last15=Alfonso |first15=Fernando |date=2023-10-19 |title=Optical Coherence Tomography–Guided versus Angiography-Guided PCI |url=http://www.nejm.org/doi/10.1056/NEJMoa2305861 |journal=New England Journal of Medicine |language=en |volume=389 |issue=16 |pages=1466–1476 |doi=10.1056/NEJMoa2305861 |issn=0028-4793}}</ref>, to date, several studies demonstrated the benefits in patient outcomes of using intravascular imaging during coronary arteries interventions.<ref>{{Cite journal |last=Kang |first=Do-Yoon |last2=Ahn |first2=Jung-Min |last3=Yun |first3=Sung-Cheol |last4=Hur |first4=Seung-Ho |last5=Cho |first5=Yun-Kyeong |last6=Lee |first6=Cheol Hyun |last7=Hong |first7=Soon Jun |last8=Lim |first8=Subin |last9=Kim |first9=Sang-Wook |last10=Won |first10=Hoyoun |last11=Oh |first11=Jun-Hyok |last12=Choe |first12=Jeong Cheon |last13=Hong |first13=Young Joon |last14=Yoon |first14=Yong-Hoon |last15=Kim |first15=Hoyun |date=2023-10-17 |title=Optical Coherence Tomography–Guided or Intravascular Ultrasound–Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial |url=https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066429 |journal=Circulation |language=en |volume=148 |issue=16 |pages=1195–1206 |doi=10.1161/CIRCULATIONAHA.123.066429 |issn=0009-7322}}</ref><ref>{{Cite journal |last=Stone |first=Gregg W |last2=Christiansen |first2=Evald H |last3=Ali |first3=Ziad A |last4=Andreasen |first4=Lene N |last5=Maehara |first5=Akiko |last6=Ahmad |first6=Yousif |last7=Landmesser |first7=Ulf |last8=Holm |first8=Niels R |date=2024-03 |title=Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis |url=https://linkinghub.elsevier.com/retrieve/pii/S0140673623024546 |journal=The Lancet |language=en |volume=403 |issue=10429 |pages=824–837 |doi=10.1016/S0140-6736(23)02454-6}}</ref>
-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.{{cn|date=January 2024}}
+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.<ref>{{Cite journal |last=Swanson |first=Eric A. |last2=Fujimoto |first2=James G. |date=2017-03-01 |title=The ecosystem that powered the translation of OCT from fundamental research to clinical and commercial impact [Invited] |url=https://opg.optica.org/abstract.cfm?URI=boe-8-3-1638 |journal=Biomedical Optics Express |language=en |volume=8 |issue=3 |pages=1638 |doi=10.1364/BOE.8.001638 |issn=2156-7085 |pmc=PMC5480569 |pmid=28663854}}</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. 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 |last=Ughi |first=G. J. |last2=Adriaenssens |first2=T. |last3=Onsea |first3=K. |last4=Kayaert |first4=P. |last5=Dubois |first5=C. |last6=Sinnaeve |first6=P. |last7=Coosemans |first7=M. |last8=Desmet |first8=W. |last9=D’hooge |first9=J. |date=2012-02 |title=Automatic segmentation of in-vivo intra-coronary optical coherence tomography images to assess stent strut apposition and coverage |url=http://link.springer.com/10.1007/s10554-011-9824-3 |journal=The International Journal of Cardiovascular Imaging |language=en |volume=28 |issue=2 |pages=229–241 |doi=10.1007/s10554-011-9824-3 |issn=1569-5794}}</ref><ref>{{Cite journal |last=Yabushita |first=Hiroshi |last2=Bouma |first2=Brett E. |last3=Houser |first3=Stuart L. |last4=Aretz |first4=H. Thomas |last5=Jang |first5=Ik-Kyung |last6=Schlendorf |first6=Kelly H. |last7=Kauffman |first7=Christopher R. |last8=Shishkov |first8=Milen |last9=Kang |first9=Dong-Heon |last10=Halpern |first10=Elkan F. |last11=Tearney |first11=Guillermo J. |date=2002-09-24 |title=Characterization of Human Atherosclerosis by Optical Coherence Tomography |url=https://www.ahajournals.org/doi/10.1161/01.CIR.0000029927.92825.F6 |journal=Circulation |language=en |volume=106 |issue=13 |pages=1640–1645 |doi=10.1161/01.CIR.0000029927.92825.F6 |issn=0009-7322}}</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" />
 == Technology ==
@@ Line 42: / Line 42: @@
 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 |last1=Brezinski |first1=Mark E. |last2=Tearney |first2=Guillermo J. |last3=Bouma |first3=Brett E. |last4=Izatt |first4=Joseph A. |last5=Hee |first5=Michael R. |last6=Swanson |first6=Eric A. |last7=Southern |first7=James F. |last8=Fujimoto |first8=James G. |date=1996-03-15 |title=Optical Coherence Tomography for Optical Biopsy: Properties and Demonstration of Vascular Pathology |url=https://www.ahajournals.org/doi/10.1161/01.CIR.93.6.1206 |journal=Circulation |language=en |volume=93 |issue=6 |pages=1206–1213 |doi=10.1161/01.CIR.93.6.1206 |pmid=8653843 |issn=0009-7322}}</ref>{{citation needed|date=March 2021}}
+Recent developments included the combination of OCT with spectroscopy and fluorescence in a single imaging catheter<ref>{{Cite journal |last=Fard |first=Ali M. |last2=Vacas-Jacques |first2=Paulino |last3=Hamidi |first3=Ehsan |last4=Wang |first4=Hao |last5=Carruth |first5=Robert W. |last6=Gardecki |first6=Joseph A. |last7=Tearney |first7=Guillermo J. |date=2013-12-16 |title=Optical coherence tomography – near infrared spectroscopy system and catheter for intravascular imaging |url=https://opg.optica.org/oe/abstract.cfm?uri=oe-21-25-30849 |journal=Optics Express |language=en |volume=21 |issue=25 |pages=30849 |doi=10.1364/OE.21.030849 |issn=1094-4087}}</ref><ref>{{Cite journal |last=Ughi |first=Giovanni J. |last2=Wang |first2=Hao |last3=Gerbaud |first3=Edouard |last4=Gardecki |first4=Joseph A. |last5=Fard |first5=Ali M. |last6=Hamidi |first6=Ehsan |last7=Vacas-Jacques |first7=Paulino |last8=Rosenberg |first8=Mireille |last9=Jaffer |first9=Farouc A. |last10=Tearney |first10=Guillermo J. |date=2016-11 |title=Clinical Characterization of Coronary Atherosclerosis With Dual-Modality OCT and Near-Infrared Autofluorescence Imaging |url=https://linkinghub.elsevier.com/retrieve/pii/S1936878X16000383 |journal=JACC: Cardiovascular Imaging |language=en |volume=9 |issue=11 |pages=1304–1314 |doi=10.1016/j.jcmg.2015.11.020}}</ref> and miniaturization of the imaging catheter.<ref>{{Cite journal |last=Bezerra |first=Hiram G. |last2=Quimby |first2=Donald L. |last3=Matar |first3=Fadi |last4=Mohanty |first4=Bibhu D. |last5=Bassily |first5=Emmanuel |last6=Ughi |first6=Giovanni J. |date=2023-07-01 |title=High-Frequency Optical Coherence Tomography (HF-OCT) for Preintervention Coronary Imaging: A First-in-Human Study |url=https://www.sciencedirect.com/science/article/pii/S1936878X23000852 |journal=JACC: Cardiovascular Imaging |volume=16 |issue=7 |pages=982–984 |doi=10.1016/j.jcmg.2023.01.013 |issn=1936-878X}}</ref>
 == Safety ==