Efficacy of a new generation intracoronary optical coherence tomography imaging system with fast pullback

Abstract

Objectives We sought to investigate whether a novel, fast‐pullback, high‐frequency optical coherence tomography (HF‐OCT) imaging system enables data acquisition with a reduced amount of contrast agents while retaining the same qualitative and quantitative lesion assessment to conventional OCT. Background The increased amount of administered contrast agents is a major concern when performing intracoronary OCT. Methods The present study is a single‐center, prospective, observational study including 10 patients with stable coronary artery disease. A total of 28 individual coronary arteries were assessed by both fast‐pullback HF‐OCT and by conventional OCT. Results The contrast volume used in each OCT run for the HF‐OCT system was significantly lower than for the conventional OCT system (5.0 ± 0.0 mL vs. 7.8 ± 0.7 mL, respectively, with a mean difference of −2.84 [95% confidence interval [CI]: −3.10 to −2.58]). No significant difference was found in the median value of the clear image length between the two OCT systems (74 mm [interquartile range [IQR]; 63, 81], 74 mm [IQR; 71, 75], p = 0.89). Fast‐pullback HF‐OCT showed comparable measurements to conventional OCT, including minimum lumen area (3.27 ± 1.53 mm2 vs. 3.21 ± 1.53 mm2, p = 0.27), proximal reference area (7.03 ± 2.28 mm2 vs. 7.03 ± 2.34 mm2, p = 0.96), and distal reference area (5.93 ± 1.96 mm2 vs. 6.03 ± 2.02 mm2, p = 0.23). Qualitative OCT findings were comparable between the fast‐pullback HF‐OCT runs and conventional OCT with respect to identifying lipid‐rich plaques, calcifications, layered plaques, macrophages, and cholesterol crystals. Conclusion With the fast pullback function of a novel HF‐OCT imaging system, we acquired OCT images using a significantly lower amount of contrast volume while retaining a comparable qualitative and quantitative lesion assessment to conventional OCT.

Experience with a novel high frequency optical coherence tomography device for intracoronary imaging: a case series

“…In both series, the global pullback quality of HF-OCT remained good with an overall CIL% ≥ 80%. Similarly, our results are in line with those of another study that compared HF-OCT with OCT, which had a global CIL for HF-OCT of 74 mm (71–75) ( 14 ).…”

“…Although OCT offers better accuracy in plaque morphology and measurement of stent expansion than IVUS ( 6 ), the latter is more commonly used for imaging the LMCA ( 18 ), because of the better-studied nature of IVUS for LMCA, its deeper image penetration, and its reduced susceptibility to artefacts at the ostium as it does not require blood clearance ( 19 ). However, the extended scan range and faster pullback of HF-OCT, which reduce time needed of blood clearance ( 13 , 14 ), could potentially offer an advantage in imaging the LMCA ostium, although this is purely speculative and requires evaluation in a dedicated study.…”

“…The first intra-human study for coronary imaging has recently been published, showing the ability to image long, severely stenotic coronary segments without any preparation, and a preservation of image quality even in stenotic lesions ( 13 ). A comparison between HF-OCT and conventional OCT in identical vessels indicated that HF-OCT provides similar imaging quality but requires less contrast ( 14 ). The clinical benefits of the HF-OCT catheter lie in its enhanced ability to cross extremely narrow lesions inaccessible to standard OCT catheters, its greater flexibility in navigating through tortuous arterial pathways, and its capacity to scan a broader spectrum of vessel diameters while offering faster pullback, which could reduce the bias caused by cardiac movements ( 12 ).…”

Intraplaque hematoma with focal intimal disruption in a right coronary artery lesion: differential diagnosis of intraplaque hemorrhage

“…Intraplaque hemorrhage is typically characterized by active bleeding or blood leakage from the microvasculature within the plaque, or from the vasa vasorum into the atherosclerotic plaque. OCT findings indicative of intraplaque hemorrhage often include areas of low intensity and attenuation [1]. However, the presence of a proximal intimal microtear, in this case, suggests a pathophysiological deviation from typical intraplaque hemorrhage.…”

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“…Although OCT offers better accuracy in plaque morphology and measurement of stent expansion than IVUS (6), the latter is more commonly used for imaging the LMCA (18), because of the better-studied nature of IVUS for LMCA, its deeper image penetration, and its reduced susceptibility to artefacts at the ostium as it does not require blood clearance (19). However, the extended scan range and faster pullback of HF-OCT, which reduce time needed of blood clearance (13,14), could potentially offer an advantage in imaging the LMCA ostium, although this is purely speculative and requires evaluation in a dedicated study. Our data suggests that increasing tortuosity is negatively associated with image quality, with a significantly lower CIL for moderate or severe tortuosity compared with no tortuosity.…”