Optical Coherence Tomography—OCT for Characterization of Non-Atherosclerotic Coronary Lesions in Acute Coronary Syndromes

Abstract

Cardiovascular diseases are the main cause of death worldwide, with coronary artery disease being the predominant underlying etiology. The most prevalent coronary lesions are represented by the atherosclerotic plaques, in more than 85% of cases, but there are several other non-atherosclerotic lesions such as spontaneous coronary artery dissection and/or hematoma and spontaneous recanalization of coronary thrombus, which are less common, approximately 5% of cases, but with similar clinical manifestations as well as complications. There are insufficient data regarding the pathological mechanism, true prevalence and optimal treatment of these kind of coronary lesions. Optical coherence tomography (OCT) is an intracoronary imaging technique, developed in order to overcome the diagnostic limitations of a standard coronary angiography and has an extremely high resolution, similar to that of a usual histological evaluation of a biopsy sample, thus, OCT provides a histological-like information, but in a in vivo environment. The aim of this article is to review the current knowledge regarding non-atherosclerotic coronary lesions, with an emphasis on the importance of OCT for optimal identification, characterization of pathogenic mechanisms and optimal treatment selection.

Diagnosis and treatment of angiographically unclear coronary lesions

“…10,25,29 Using OCT in PCI lesions avoids suboptimal treatment results such as malposition, dissection, insufficient stent expansion, and later consequences related to major adverse cardiac and cerebrovascular events. 2,30 Conclusion "Honeycomb-like" structures are rarely encountered in clinical practice because of the difficulty of diagnosis based on coronary angiography findings and the nonspecific clinical symptoms and signs. Coronary angiography is insufficient for recognition of these structures because the true canaliculi are often not recognized and unclear filling defects are often mistaken for dissections.…”

A.I. Pipeline for Accurate Retinal Layer Segmentation Using OCT 3D Images

“…The technique provides time-dependent topographical structures of the deep retina in micrometre order. Besides ocular imaging, it is also used to study cardiovascular, dermatological lesions, and sub-surface cerebral activities [2][3][4]. Phase variance of OCT data can be correlated with dynamic structure thus providing a blood vessel map.…”

Validation of the detection of ischemia using 12 lead smartphone based electrocardiography - a non-randomized, single blinded, cross-sectional, multicenter study

“…2 Moreover, silent ambulatory ST-segment depression is associated with an increased incidence of coronary events in asymptomatic men, so routine assessment of such ST-segment depression could be used to better stratify populations are risk. 3 The 12-lead electrocardiogram is the primary screening tool for myocardial ischemia. 4 ECG signs suggestive of ischemia, and include ST-depression, T wave abnormalities, the development of pathological Q waves and at times new conduction disturbances.…”