Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures

Prati, Francesco; Guagliumi, Giulio; Mintz, Gary S.; Costa, Marco A.; Regar, Evelyn; Akasaka, Takashi; Barlis, Peter; Tearney, Guillermo J.; Jang, Ik Kyung; Arbustini, Eloisa; Bezerra, Hiram G.; Ozaki, Yukio; Bruining, Nico; Dudek, Darius; Radu, Maria; Ērglis, Andrejs; Motreff, Pascale; Alfonso, Fernándo; Toutouzas, Kostas; Gonzalo, Nieves; Tamburino, Corrado; Adriaenssens, Tom; Pinto, Fausto J.; Serruys, Patrick W.; Mario, Carlo Di

doi:10.1093/eurheartj/ehs095

Cited by 362 publications

(284 citation statements)

References 56 publications

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“…When PCI with stenting was performed, OCT was used to assess the final stent result including for stent malapposition, defined as a strut/wall distance greater than the thickness of the strut (including polymer if any) 22,23 , significant intra-stent thrombotic protrusion (intraluminal tissue protrusion forming an arch between the stent struts 22,23 , considered moderate when less than and significant when more than 500 µm thick) or proximal/distal edge dissection (upstream or downstream: edge dissection).…”

Section: Medical Management Protocolmentioning

confidence: 99%

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Amabile¹,

Combaret²,

Hammas³

et al. 2015

EuroIntervention

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2 STRUCTURED ABSTRACT Aims:To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe. Methods and results:We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB.Among 852 ACS patients who had undergone invasive coronary angiography, 101(11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI-3 flow without stenting. All of these patients then had repeat angiography with OCT (Day 0-2 (Group1), Day 3-6 (Group2) or Day 7-30 (Group3)).No adverse events occurred between the initial and second angiograms. Residual thrombus was detected in 68% of patients with OCT (respectively, 94%, 79% and 32% in Group1, Group2 and Group3) and 20% of cases with angiography. Plaque rupture was detected by OCT in 65% of cases. Minimal lumen area was 2.81mm 2 , 3.40mm 2 and 4.89mm 2 in Group1, Group2 and Group3, respectively. 62% of patients were stented (respectively, 76%, 61% and 50%). During a minimum follow-up period of 12 months in all patients, 1 non-fatal MI occurred and 1 PCI was performed for angina. Conclusions:Medical management without stents is safe and feasible in selected ACS patients with LTB.OCT revealed culprit lesion characteristics that were not disclosed by angiography and facilitated treatment decisions. 3 KEY WORDSAcute coronary syndrome, optical coherence tomography, coronary thrombosis, myocardial infarction, percutaneous coronary intervention. 4 CONDENSED ABSTRACTWe assessed the feasibility and safety of invasive management and selected stenting or not, as guided by angiography and OCT, in ACS patients with LTB. In a 2-stage strategy, angiography was used to select patients for delayed stenting, and in the second procedure angiography and OCT were used to decide on stenting or not. OCT improved the assessment of culprit lesion characteristics and thrombus burden. Of 101 STEMI patients, 38% did not receive a stent. There were no adverse events related to OCT and only 2 non-fatal MACEs occurred during 12 months of follow-up. 5 ABBREVIATIONS LIST

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Section: Medical Management Protocolmentioning

confidence: 99%

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Amabile¹,

Combaret²,

Hammas³

et al. 2015

EuroIntervention

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“…63) These studies suggest that OCT can identify patients at high risk in the future. and tissue protrusion 70,71) in higher frequency compared to IVUS. 72,73) OCT is capable of detecting smaller stent edge dissection (Fig.…”

Section: Evaluation Of Non-culprit Plaque Characteristicsmentioning

confidence: 97%

Optical Coherence Tomography for Study of <i>In Vivo</i> Pathobiology and for Optimization of Percutaneous Coronary Intervention

Sugiyama

Jang

2017

Angioscopy

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Intravascular optical coherence tomography (OCT) is an imaging modality uniquely characterized by its high resolution. OCT can visualize in vivo plaque characteristics and detect vulnerable plaque, such as thin-cap fibroatheroma, which has a large lipid pool with overlying thin fibrous cap. OCT can also help the clinicians to identify the underlying pathology of acute coronary syndrome: plaque rupture, plaque erosion, and calcified nodule. The OCT system enables automated measurement of the lumen diameter, lumen area, and lesion length, which is useful to determine appropriate reference sites, stent size and stent length during percutaneous coronary intervention (PCI). Evaluation of underlying plaque characteristics is helpful in predicting possible complications after PCI. OCT-guided PCI may acquire comparable angiographical and clinical outcomes to intravascular ultrasound-guided PCI. OCT can be used to evaluate characteristics of non-culprit plaque and efficacy of lipidlowering therapy on plaque stabilization. OCT also clearly visualizes mechanical vessel injury after stent implantation. Notably, the presence of irregular tissue protrusion has been shown to be associated with the occurrence of device-oriented clinical events. Recent studies suggest that OCT is feasible for the selection of conservative management without stenting in patients with acute coronary syndrome caused by plaque erosion.

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“…21 IVUS can also accurately identify calcium, but it is unable to quantify its thickness. 22 The raw signals appearing from the reflection of ultrasound waves present a color-coded structure of plaque characteristics. In the last years, IVUS was frequently used and validated.…”

Section: Intravascular Ultrasoundmentioning

confidence: 99%

“…The acquisition rate can be set up in a series between 5 and 40 mm/s. 22 The applied energies in OCT are low and do not cause damage at the level of structural or functional tissue. OCT can penetrate calcium deposits that are located superficially, but penetration through superficial necrotic lipid pools is known to be less than through fibrous tissue or through calcified tissue.…”

Section: Optical Coherence Tomographymentioning

confidence: 99%

“…It is important to know that the degradation process is characterized by empty spaces that replace the stent column; however, this phenomenon was described in the first generation of bioresorbable stents, and in the second-generation model the degradation process was not visible. 22 OCT is indicated for evaluating vague angiographic lesions and focal vessel spasm. It has the ability to identify coronary thrombosis in the presence of haziness on the angiography.…”

Section: Optical Coherence Tomographymentioning

confidence: 99%

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Imaging Techniques for the Assessment of Coronary Arteries in Diabetic Patients Undergoing PCI with Bioresorbable Vascular Scaffolds

Cordunean¹,

Hodaş²,

Benedek³

et al. 2017

Journal of Interdisciplinary Medicine

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Patients who suffer from diabetes mellitus and present coronary artery disease are at a higher risk of cardiovascular events. The coronary arteries of diabetic patients present a diffuse process of atherosclerosis with frequent distal involvement, being prone to acute cardiovascular events. Diabetics present an increased rate of developing coronary artery remodeling, negative remodeling being representative for this class of patients; this process is characterized by vessel shrinkage and an increased rate of coronary calcium accumulation that is a predictor for cardiovascular risk. Currently, it is desired to improve the treatment of diabetic patients with bioresorbable vascular scaffolds (BVS), because of their reduced risk of restenosis and the ability to restore coronary function, including vasomotion, adaptive shear stress, and expansive remodeling. Optical coherence tomography, intravascular ultrasound and multi-slice computed tomography are imaging techniques used for a high accuracy of diagnosis in coronary artery disease. This manuscript is a review that aims to highlight imaging techniques used for evaluating the functional impact of coronary lesions in diabetic patients who underwent coronary PCI with bioresorbable scaffolds and to describe the functional markers that show the specificity for predicting coronary artery disease.

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Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures

Cited by 362 publications

References 56 publications

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Optical Coherence Tomography for Study of <i>In Vivo</i> Pathobiology and for Optimization of Percutaneous Coronary Intervention

Imaging Techniques for the Assessment of Coronary Arteries in Diabetic Patients Undergoing PCI with Bioresorbable Vascular Scaffolds

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