Inter-Scan Reproducibility of Geometric Coronary Artery Measurements Using Frequency-Domain Optical Coherence Tomography

Abstract

SummaryFrequency-domain optical coherence tomography (FD-OCT) is a novel technology which provides high-resolution cross-sectional images of coronary arteries. The aim of this study was to evaluate the inter-scan reproducibility of geometric FD-OCT measurements in the clinical setting. We examined 20 coronary lesions using FD-OCT. Following the FD-OCT image acquisition (1 st pullback), and after the disengagement and re-engagement of the guiding catheter, an additional acquisition (2 nd pullback) was performed using a new FD-OCT catheter. There was excellent correlation for minimum lumen area (r = 0.99, P < 0.001), lesion length (r = 0.99, P < 0.001) and lumen volume (r = 0.99, P < 0.001) between the 1 st pullback and the 2 nd pullback. The Bland-Altman test demonstrated good agreement between the 1 st pullback and the 2 nd pullback: the mean difference for minimum lumen area, lesion length, and lumen volume was 0.05 mm High frame rate (100 frame/sec) and fast pull-back speed (20 mm/s) of FD-OCT allow for a clear visualization of coronary lumens and vessel walls.2,3) Various factors such as location of the image catheter, heart motion, timing of image acquisition (systole/diastole) and manual zero-offset may affect the OCT assessment. 1) In vitro phantom models have demonstrated the accuracy of quantitative OCT measurement for luminal size and length. 4) In a Corelab setting, several studies have disclosed excellent intra-and inter-observer agreement of OCT measurements.5,6) However, the inter-scan reproducibility of geometric OCT measurements remains unclear. Such information in regard to measurement consistency between the scans should be required to design longitudinal OCT studies. The aim of the present study was to assess the inter-scan agreement for geometric FD-OCT measurements in a clinical setting. MethodsStudy population: We enrolled consecutive 20 patients who underwent percutaneous coronary intervention with a single stent for a native coronary artery lesion. Patients were excluded if they had congestive heart failure with a left ventricular ejection fraction < 30 %, renal insufficiency with baseline serum creatinine > 2.0 mg/dL, or required primary angioplasty. In addition, those with left main coronary artery stenting, ostial right coronary artery stenting, or bifurcation stenting were excluded because of expected difficulty in FD-OCT analysis. This protocol was approved by the Wakayama Medical University Ethics Committee, and all patients provided informed consent before participation.

Optical frequency domain imaging vs. intravascular ultrasound in percutaneous coronary intervention (OPINION trial): Study protocol for a randomized controlled trial

“…The spatial resolution of OCT is 10-20 mm, and it is approximately 10 times greater than that of IVUS. An excellent contrast between lumen and vessel wall in OCT allows accurate lumen measurements, which might be helpful in determining appropriate balloon or stent size [9][10][11][12]. Compared with IVUS, OCT is more sensitive in detecting suboptimal lesion morphologies after PCI, such as intrastent tissue protrusion, incomplete stent apposition, stent edge dissection, and intra-stent thrombus [9,13,14].…”

Incidence and potential mechanism of resolved, persistent and newly acquired malapposition three days after implantation of self-expanding or balloon-expandable stents in a STEMI population: insights from optical coherence tomography in the APPOSITION II study

“…Mechanical change of a stent, stent recoil and enlargement were defined by the sequential difference of mean stent area in corresponding segments. According to the range of reproducibility measurements between inter-/intra-observer and inter-scan 15,16 , Tanimoto et al reported that the standard deviation of absolute interobserver difference in the stent area analysis was 0.68 mm 2 . Jamil et al demonstrated that the 95% confidence interval of absolute inter-pullback difference in the stent area analysis was 0.9 mm 2 .…”

Noninvasive Measurement of Coronary Fractional Flow Reserve

“…FD-OCT merges to be another novel noninvasive method for the quantitative measure of stenosis severity, which provides cross-sectional images of coronary arteries and deployed stents with micron resolution and measures lumen dimensions with excellent reproducibility. [ 29 30 ] It also provides information about plaque vulnerability, calcification, estimates the blood flow resistance and microvascular resistance of the vessel segments imaged. Through the volumetric analysis of FD-OCT images, FFR was calculated from the blood flow resistance and the microvascular resistance.…”