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Optical coherence tomography-guided percutaneous coronary intervention: a review of current clinical applications

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Abstract

Optical coherence tomography (OCT) is an emerging high-resolution intravascular imaging modality that can provide physicians with critical information, thereby enabling precise characterization of plaque morphology and luminal geometry and facilitating pre-intervention lesion assessment. As OCT has a higher sensitivity for lipid-rich plaque characterization than intravascular ultrasound, vulnerable plaque detection by OCT has thus been investigated. By evaluating both the calcium thickness and arc, OCT can be the ideal method for determining both the indication and endpoint of rotational atherectomy for calcified lesions prior to stent implantation. OCT has become applicable for the optimization of stent implantation with immediate and semi-automatic quantification of stent apposition and expansion to achieve potentially better clinical outcomes. In bifurcation lesions, OCT allows the visualization of the stent-link location overhanging the side-branch ostium and the guidewire recrossing point prior to the final kissing balloon inflation through three-dimensional reconstructed OCT images, providing us with deep insights into the mechanical optimization of stent struts. Furthermore, recent studies have reported several OCT-derived predictors of adverse clinical events. Important limitations of OCT, including the excessive contrast volume needed and observation of aorto-ostial lesions, may partially be overcome through the use of low-molecular-weight dextran and a guide extension catheter. The clinical applications of OCT have been expanding, and evidence on its clinical utility has been accumulating.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Miyazaki, Japan

    Kazumasa Kurogi, Masanobu Ishii & Nobuyasu Yamamoto

  2. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Kenshi Yamanaga & Kenichi Tsujita

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  1. Kazumasa Kurogi
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  2. Masanobu Ishii
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  3. Nobuyasu Yamamoto
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Correspondence to Kenichi Tsujita.

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Conflict of interest

Dr. Tsujita has received remuneration for lecture from Amgen Astellas BioPharma K.K., Kowa Pharmaceutical Co. Ltd., Daiichi Sankyo Co., Ltd., Takeda Pharmaceutical Co., Ltd., Bayer Yakuhin, Ltd., Pfizer Japan Inc., Bristol-Myers K.K., MSD K.K.; has received trust research/joint research funds from Bristol-Myers K.K., Sugi Bee Garden Co., Ltd., Kowa Pharmaceutical Co. Ltd.; and has received scholarship fund from ITI Co., Ltd., Abbott Medical Japan L.L.C, Abbott Vascular Japan Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Cardinal Health Japan, Kaneka Medix Co., Ltd., Takeda Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma, Chugai Pharmaceutical Co., Ltd., TERUMO Co., Ltd., NIPRO CORPORATION, NIHON KOHDEN CORPORATION, Medtronic Japan Co., Ltd., Japan Lifeline Co., Ltd., Fides-One, Inc., Fukuda Denshi Co., Ltd., and Boston Scientific Japan K.K. All the other authors have nothing to disclose.

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Kurogi, K., Ishii, M., Yamamoto, N. et al. Optical coherence tomography-guided percutaneous coronary intervention: a review of current clinical applications. Cardiovasc Interv and Ther 36, 169–177 (2021). https://doi.org/10.1007/s12928-020-00745-4

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