Preliminary experience with optical coherence tomography imaging to evaluate carotid artery stents: safety, feasibility and techniques

Abstract

Intravascular OCT under occlusive proximal protection appears feasible and safe to assess stent implantation in carotid arteries.

Frequency-Domain Optical Coherence Tomography Assessment of Human Carotid Atherosclerosis Using Saline Flush for Blood Clearance without Balloon Occlusion

“…3,19 Previous studies of carotid OCT imaging have reported using either iodinated contrast material with FD-OCT or saline and balloon occlusion with TD-OCT to achieve satisfactory blood clearance for "diagnostic" quality images. [10][11][12][13][14] We hypothesized that the carotid vasculature would accommodate significantly higher volumes of flush media compared with the coronary arteries, allowing for effective blood clearance with saline injections during FD-OCT imaging. Although heparinized saline required larger volumes at higher injection rates (compared with the iodinated contrast material), these injection rates were within acceptable ranges for carotid angiography.…”

“…[4][5][6][7][8][9] Although OCT imaging of carotid artery plaque is currently in its infancy, previous case series suggest that the pathologic features of "vulnerable" plaques validated in the coronary arteries are similar to those seen in the carotid vasculature. [10][11][12][13] Although a detailed technical description of OCT performance is beyond the scope of this case series, it should be noted that the earliest published descriptions of carotid OCT imaging used TD-OCT, [11][12][13][14] an early iteration of OCT that requires proximal balloon occlusion to effectively "clear" light-attenuating red blood cells during image acquisition. The newest iteration of OCT-FD-OCT-allows very rapid data acquisition (up to 25 mm/s), thus obviating the need for balloon occlusion, with image acquisition carried out during iodinated contrast injection.…”

“…10,15 Nevertheless, although FD-OCT solves the hurdle of balloon occlusion posed by TD-OCT, contrast injection for clearance of red blood cells is still a potential concern, particularly in patients at higher risk for contrastinduced nephropathy. 10,13 We report, for the first time, the successful use of FD-OCT in vivo to evaluate carotid artery disease by using only saline flush to clear red blood cells during image acquisition. This latest variation of FD-OCT imaging allows for image acquisition without the need for balloon occlusion or iodinated contrast material.…”

Intravascular Frequency-Domain Optical Coherence Tomography Assessment of Atherosclerosis and Stent-Vessel Interactions in Human Carotid Arteries

“…More recently, the use of OCT to evaluate carotid artery stent placement was reported in 7 patients for whom the authors emphasized the necessity of proximal balloon occlusion (complicated by symptomatic cerebral ischemia in 1 patient) to obtain acceptable images. 37 Furthermore, an early experience with OCT in carotid plaque characterization was reported in a brief communication that compared OCT with other imaging modalities. 38 Most recently, a 30-patient cohort undergoing scheduled carotid artery stent placement was studied before and following stent placement with TDOCT.…”

Dynamic Assessment of the Endothelialization of Tissue-Engineered Blood Vessels Using an Optical Coherence Tomography Catheter-Based Fluorescence Imaging System

“…In recent years, intravascular catheters have been developed for intravascular OCT imaging to monitor the state of coronary as well as peripheral arteries and to evaluate microstructure of plaques. 17,18 OCT can be used to monitor the development of a bioengineered vascular graft through high-resolution imaging as well as through extraction of its geometrical and optical properties, and thus can aid with improving the design of engineered tissues. We recently demonstrated the ability of OCT to image a developing tissue-engineered blood vessel within a bioreactor using either free-space OCT imaging or a vascular OCT endoscope.…”