The Ability of Optical Coherence Tomography to Monitor Percutaneous Coronary Intervention: Detailed Comparison With Intravascular Ultrasound

OBJECTIVES: We investigated the usefulness of optical coherence tomography (OCT) to evaluate vessel response after stent implantation by comparing with that of intravascular ultrasound (IVUS).

METHODS: Eighteen cases undergoing percutaneous coronary intervention (PCI) who provided consent for both IVUS and OCT usage pre- and post-PCI procedure were enrolled.

RESULTS: The lumen area at the distal site of the culprit lesion was smaller on OCT images than on IVUS images due to proximal vessel occlusion, whereas the lumen area at the proximal site of the lesion did not differ between OCT and IVUS images (distal site: 4.6 ± 2.0 vs. 5.0 ± 1.8 mm²; p = 0.0004; proximal site: 5.5 ± 2.3 vs. 5.6 ± 2.3 mm²; p = 0.8160). Stent malapposition was more frequently observed by OCT (30%) than by IVUS (5%, p = 0.0381). Stent edge dissection was not detected by IVUS, but was detected in 10% by OCT. Tissue prolapse was identified in all stents by OCT and in 5% by IVUS. Thrombus was observed in 15% by OCT and in 5% by IVUS.

CONCLUSIONS: Proximal coronary occlusion during OCT imaging was possibly related to underestimation of vessel sizing at distal reference. Our data suggested that OCT might provide more detailed information on the presence of tissue prolapse, thrombus formation and edge dissection than IVUS. Further study is warranted to assess its clinical utility.

PMID: 21041851

Posted in Invasive Imaging and tagged , , , , .

9 Comments

  1. See also:

    In vivo assessment of high-risk coronary plaques at bifurcations with combined intravascular ultrasound and optical coherence tomography.
    Gonzalo N, Garcia-Garcia HM, Regar E, Barlis P, Wentzel J, Onuma Y, Ligthart J, Serruys PW.
    JACC Cardiovasc Imaging. 2009 Apr;2(4):473-82.
    PMID: 19580731

  2. See also:

    Quantitative ex vivo and in vivo comparison of lumen dimensions measured by optical coherence tomography and intravascular ultrasound in human coronary arteries.
    Gonzalo N, Serruys PW, García-García HM, van Soest G, Okamura T, Ligthart J, Knaapen M, Verheye S, Bruining N, Regar E.
    Rev Esp Cardiol. 2009 Jun;62(6):615-24.
    PMID: 19480757

  3. See also:

    Combined use of optical coherence tomography and intravascular ultrasound during percutaneous coronary intervention in patients with coronary artery disease.
    Hou JB, Meng LB, Jing SH, Han ZG, Yu H, Yu B.
    Zhonghua Xin Xue Guan Bing Za Zhi. 2008 Nov;36(11):980-4. Chinese.
    PMID: 19102909

  4. See also:

    Comparison of nonuniform rotational distortion between mechanical IVUS and OCT using a phantom model.
    Kawase Y, Suzuki Y, Ikeno F, Yoneyama R, Hoshino K, Ly HQ, Lau GT, Hayase M, Yeung AC, Hajjar RJ, Jang IK.
    Ultrasound Med Biol. 2007 Jan;33(1):67-73.
    PMID: 21041851

  5. It is interesting to compare similar research in different countries. However, the number of these cases is limited for the financial reasons to use both IVUS and OCT. What’s more, to add CT and MRI ?

    Patients may ask: What did you see in my heart, doctor? Can you see it clear with echo, IVUS and OCT and CT and MRI and nuclear and ….? What should I do next? To be or not to be?

    Doctors: We compared echo, IVUS and OCT and CT and MRI and nuclear and ….. We are going to invent more and better examinations. You just wait to pay the bill or not to pay.

  6. Another interesting paper just published:

    Intracoronary Optical Coherence Tomography and Histology at 1 Month and 2, 3, and 4 Years After Implantation of Everolimus-Eluting Bioresorbable Vascular Scaffolds in a Porcine Coronary Artery Model.
    Circulation. 2010;122:2288-2300 [link]

    In this study, the authors show that at 3 and 4 years, both OCT and histology confirm complete integration of the everolimus-eluting bioresorbable vascular scaffold (BVS) struts into the arterial wall.

  7. Stent mal-apposition and tissue prolapse were observed more often with OCT images than with IVUS…how does this translate to clinical outcomes. Are this real differences or just trivial minutia?

  8. I don’t know what the other experts think, but to me this is not a surprise finding at all; because the resolution of the OCT is almost 10 times better than IVUS, that’s why we should able to detect those “small” stent mal-apposition and tissue prolepses that are not possible to be detected by IVUS. However, whether these findings are able to translate to clinical outcomes, honestly nobody knows, we need more and big studies to show it; otherwise these findings are only for academic interest but with not much “practical” values at all.

    For those stent mal-apposition detected by IVUS, we already knows it’s going to cause more problems. But for those detected by OCT not IVUS, whether it’s going to cause problem, to me most likely not, but still we need data.

    Regards,

    William Hau PhD
    Institute of Cardiovascular Medicine and Research,
    LiKaShing Faculty of Medicine,
    The University of Hong Kong

  9. See also:

    Comparison of plaque prolapse in consecutive patients treated with Xience V and Taxus Liberte stents.
    Zhu Jun Shen, Salvatore Brugaletta, Hector M. Garcia-Garcia, Jurgen Ligthart and Josep Gomez-Lara, et al.
    Int J Cardiovasc Imaging. 2010 Dec 21.
    PMID: 21174151

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>