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Intracoronary Optical Coherence Tomography: A Comprehensive Review

Clinical and Research Applications

Hiram G. Bezerra, MD, PhD^_*, Marco A. Costa, MD, PhD^_*,_*, Giulio Guagliumi, MD, Andrew M. Rollins, PhD, Daniel I. Simon, MD^_*

^_* Harrington-McLaughlin Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio
Department of Biomedical Engineering, Case Western Reserve University School of Medicine, Cleveland, Ohio
Cardiovascular Department Ospedali Riuniti di Bergamo, Bergamo, Italy

^_* Reprint requests and correspondence: Dr. Marco A. Costa, Division of Cardiology, Heart & Vascular Institute, University Hospitals, Case Western Reserve University, 11100 Euclid Avenue, Lakeside 3001, Cleveland, Ohio 44106-5038 (Email: marco.costa{at}uhhospitals.org).

Cardiovascular optical coherence tomography (OCT) is a catheter-based invasive imaging system. Using light rather than ultrasound, OCT produces high-resolution in vivo images of coronary arteries and deployed stents. This comprehensive review will assist practicing interventional cardiologists in understanding the technical aspects of OCT based upon the physics of light and will also highlight the emerging research and clinical applications of OCT. Semi-automated imaging analyses of OCT systems permit accurate measurements of luminal architecture and provide insights regarding stent apposition, overlap, neointimal thickening, and, in the case of bioabsorbable stents, information regarding the time course of stent dissolution. The advantages and limitations of this new imaging modality will be discussed with emphasis on key physical and technical aspects of intracoronary image acquisition, current applications, definitions, pitfalls, and future directions.

Key Words: optical coherence tomography • coronary • stent • atherosclerosis

Abbreviations and Acronyms   A-line = axial line (scan)   FD-OCT = frequency or Fourier-domain optical coherence tomography   IEL/EEL = internal elastic lamina/external elastic lamina   IVUS = intravascular ultrasound   NIH = neointimal hyperplasia   OCT = optical coherence tomography   TD-OCT = time-domain optical coherence tomography