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Optical Coherence Tomography for Imaging the Vulnerable Plaque
Published in Robert J. Gropler, David K. Glover, Albert J. Sinusas, Heinrich Taegtmeyer, Cardiovascular Molecular Imaging, 2007
Guillermo J. Tearney, Ik-Kyung Jang, Brett E. Bouma
While our understanding of vulnerable coronary plaque is still at an early stage, the concept that certain types of plaques predispose patients to developing an AMI and sudden cardiac death continues to be at the forefront of cardiology research to improve the mortality of CAD. Intracoronary optical coherence tomography (OCT) has been developed to both identify and study these lesions due to its distinct resolution advantage over other imaging modalities. In this chapter, we summarize clinical research conducted at the Massachusetts General Hospital over the past decade to develop, validate, and utilize this technology to improve our understanding of vulnerable plaque. Our results show that intracoronary OCT may be safely conducted in patients and that it provides abundant information regarding plaque microscopic morphology, which is essential to the identification and study of high-risk lesions. Even though many basic biological, clinical, and technological challenges must be addressed prior to widespread use of this technology, the unique capabilities of OCT ensure that it will have a prominent role in shaping the future of cardiology.
OCT imaging acquisition
Published in Hiram G. Bezerra, Guilherme F. Attizzani, Marco A. Costa, OCT Made Easy, 2017
Manabu Kashiwagi, Takashi Kubo, Hironori Kitabata, Takashi Akasaka
Intracoronary optical coherence tomography (OCT) is a catheter-based imaging technology that employs near-infrared light.1–4 OCT can provide approximately 10–20 μm axial and 20–40 μm transverse resolutions in vivo. These detailed assessments enable us to detect the thin-capped fibroatheromas (TCFAs),5,6 known as vulnerable plaques,7 and to evaluate stent failure (e.g., apposition) immediately after coronary stenting and strut coverage at late follow-up.8–10 OCT has recently contributed to the evaluation of bioresorbable vascular scaffolds (BVSs), which are expected to be the next challenging therapeutic approach for coronary artery disease.11–13 To date, there are two types of OCT for coronary artery imaging. The first generation is called time-domain (TD) OCT, and the second-generation is called frequency-domain (FD) OCT, also known as optical frequency-domain imaging (OFDI), which has several advantages in interventional cardiology.14,15 OFDI is designed as a catheter type, like intravascular ultrasound (IVUS). Therefore, it is easier and more conventional compared with the first-generation OCT system. It is expected that detailed information from OFDI will allow us to make better decisions in coronary intervention.16,17 However, to obtain clear views, there are some matters that require careful attention. Unclear imaging has the potential to lead us to misunderstand the coronary lesions, and subsequently make wrong decisions, resulting in nonoptimized therapies. In this chapter, we focus on how to obtain clearer and more correct OFDI images in vivo.
The Cre8 amphilimus-eluting stent for the treatment of coronary artery disease: safety and efficacy profile
Published in Expert Review of Medical Devices, 2020
Carlo A. Pivato, Pier Pasquale Leone, Gennaro Petriello, Jorge Sanz-Sanchez, Mauro Chiarito, Giulio G. Stefanini
In the ranDomizEd coMparisOn betweeN novel Cre8 stent and BMS to assess neoinTimal coveRAge by OCT Evaluation (DEMONSTRATE) 3-month optical coherence tomography evaluation of Cre8 stent showed comparable strut coverage while preserving a greater efficacy in neointima formation reduction as compared to bare metal stents at 1 month (Table 1). The number of the patients enrolled was 38, 19 randomized to Cre8 stent and 19 randomized to bare metal stent [26]. Since incomplete endothelialization and delayed arterial healing represent a potential drawback of local antiproliferative agents elution, DEMONSTRATE findings are extremely reassuring with respect to vascular healing after implantation of Cre8 stents and have potential clinical implications regarding the required duration of DAPT in patients treated with Cre8. In the recent 6-month Intracoronary Optical Coherence Tomography Evaluation of Three New Generation Drug Eluting Stent (CREBX-OCT), 60 patients undergoing percutaneous revascularization were randomly allocated to implantation of Cre8 stent, biodegradable-polymer biolimus eluting Biomatrix stent (Biosensors, Switzerland) or durable-polymer everolimus-eluting Xience stent (Abbott Vascular, CA, USA) [27]. Six-month optical coherence tomography assessment showed a similarly complete strut coverage in all three stent types [27].