Frequency-Domain Optical Coherence Tomography for Intracranial Atherosclerotic Stenosis: Feasibility, Safety, and Preliminary Experience

Abstract

Background: Despite advances in non-invasive imaging, the characterization of atherosclerotic plaque remains superior with frequency-domain optical coherence tomography (FD-OCT) in the clinical coronary and experimental cerebrovascular literature. An assessment of the feasibility and safety of FD-OCT for intracranial atherosclerotic stenosis (ICAS) is desirable.Methods: We analyzed a cohort of all consecutive FD-OCT evaluations for ICAS performed at our institution from April 2017 to August 2018 (16 months) in patients who suffered from transient ischemic attack (TIA) or non-disabling stroke despite optimal medical management within 90 days of admission attributable to angiographically verified 70–99% stenosis of an intracranial artery.Results: Thirty-three patients harboring 36 lesions with an average age of (57.6 ± 7.1) years (male sex 27 cases) comprising nine cases of lesions located within the anterior circulation and 24 cases within the posterior circulation were identified. Of the 33 patients with 36 lesions, the FD-OCT imaging catheter detected 35/36 (97%) lesions except in one case in which the FD-OCT catheter failed to navigate excessively tortuous vessels, and FD-OCT images in 27 patients (81.8%) were finally obtained successful, where the target lesion was fully visible, and image quality under at least one pullback was graded 2 or 3. There were no symptomatic complications. Blood flow was the most common artifact encountered (51.9%).Conclusion: FD-OCT is safe and feasible for the assessment of ICAS in the anterior and posterior circulation. The use of diagnostic interferometry will have to be weighed against its cost, and these preliminary findings should be verified by prospective large-scale studies.

Role of optical coherence tomography in pipeline embolization device for the treatment of vertebral–basilar artery dissecting aneurysms

“…One subarachnoid hemorrhage (2.0%) and two dissections (4.1%) were reported in a cohort of 49 patients with intracranial vertebral artery V4 segment stenosis 18. In another cohort of 33 consecutive patients who underwent OCT evaluation for intracranial atherosclerotic stenosis, iatrogenic dissection occurred in two patients (8.3%) 19…”

Case report: Late in-stent thrombosis in a patient with vertebrobasilar dolichoectasia after stent-assisted coil embolization due to the discontinuation of antiplatelet therapy

“…Nevertheless, there were still some limitations to using OCT in the neurovascular field. Stiff catheters and tortuous intracranial arteries may result in iatrogenic dissection and poor imaging quality ( 19 , 20 ).…”

Intracranial atherosclerosis update for neurointerventionalists

“…During DSA, intravascular imaging such as OCT and IVUS may be performed to assess the luminal wall and characteristics of the atherosclerotic plaque. 8 Similarly, FFR measurement has been described in the cerebral circulation using a pressure sensor monitoring wire proximal and distal to the stenotic ICAD lesion to assess pressure gradient and blood flow compromise. 9 How this would be used to affect intracranial stenting decisions has not been well studied.…”