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The role of optical coherence tomography in coronary intervention.

Terashima M, Kaneda H, Suzuki T - Korean J. Intern. Med. (2012)

Bottom Line: Several OCT studies have demonstrated delayed neointimal coverage following drug-eluting stent (DES) implantation vs. bare metal stent (BMS) placement.While newer DESs promote more favorable vascular healing, the clinical implications remain unknown.Recent OCT studies have provided insights into restenotic tissue characteristics; DES restenotic morphologies differ from those with BMSs.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. mterashima-circ@umin.ac.jp

ABSTRACT
Optical coherence tomography (OCT) is an optical analog of intravascular ultrasound (IVUS) that can be used to examine the coronary arteries and has 10-fold higher resolution than IVUS. Based on polarization properties, OCT can differentiate tissue characteristics (fibrous, calcified, or lipid-rich plaque) and identify thin-cap fibroatheroma. Because of the strong attenuation of light by blood, OCT systems required the removal of blood during OCT examinations. A recently developed frequency-domain OCT system has a faster frame rate and pullback speed, making the OCT procedure more user-friendly and not requiring proximal balloon occlusion. During percutaneous coronary intervention (PCI), OCT can provide detailed information (dissection, tissue prolapse, thrombi, and incomplete stent apposition [ISA]). At follow-up examinations after stent implantation, stent strut coverage and ISA can be assessed. Several OCT studies have demonstrated delayed neointimal coverage following drug-eluting stent (DES) implantation vs. bare metal stent (BMS) placement. While newer DESs promote more favorable vascular healing, the clinical implications remain unknown. Recent OCT studies have provided insights into restenotic tissue characteristics; DES restenotic morphologies differ from those with BMSs. OCT is a novel, promising imaging modality; with more in-depth assessments of its use, it may impact clinical outcomes in patients with symptomatic coronary artery disease.

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Optical coherence tomographic patterns of restenotic tissue following drug-eluting stent implantation. Patchy (A), layered (B), and speckled (C) patterns.
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Figure 10: Optical coherence tomographic patterns of restenotic tissue following drug-eluting stent implantation. Patchy (A), layered (B), and speckled (C) patterns.

Mentions: OCT provides new insights into the characteristics of the tissue covering the stent struts. Several papers have reported OCT patterns of restenotic tissue components. A typical restenotic tissue of BMS at early follow-up (to 1 year), recognized as neointimal hyperplasia primarily composed of smooth muscle cells, is visualized as a homogeneous structure by OCT (Fig. 9A) [40]. We have, however, reported that the characteristics of restenotic tissue in the very late phase (> 5 years) is frequently demonstrated as a heterogeneous structure suggesting lipid accumulation/calcification (Fig. 9B and 9C), occasionally accompanied by disruption of the intima, microvessels within neointima, or intraluminal materials [41]. The restenotic tissue of DESs, even in an early phase, also demonstrates polymorphic patterns in structure, backscatter, and composition (Fig. 10) [42,43]. This variation in OCT images could be caused by diverse components, including mature/immature smooth muscle cells and persistent fibrin or extracellular matrix, such as proteoglycans [43]. Thus, OCT provides important information about the tissue covering the stent struts. However, few studies have sought to validate OCT findings in comparison with pathological findings, and further investigations should be conducted until the impact of these findings on clinical outcomes is known.


The role of optical coherence tomography in coronary intervention.

Terashima M, Kaneda H, Suzuki T - Korean J. Intern. Med. (2012)

Optical coherence tomographic patterns of restenotic tissue following drug-eluting stent implantation. Patchy (A), layered (B), and speckled (C) patterns.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3295975&req=5

Figure 10: Optical coherence tomographic patterns of restenotic tissue following drug-eluting stent implantation. Patchy (A), layered (B), and speckled (C) patterns.
Mentions: OCT provides new insights into the characteristics of the tissue covering the stent struts. Several papers have reported OCT patterns of restenotic tissue components. A typical restenotic tissue of BMS at early follow-up (to 1 year), recognized as neointimal hyperplasia primarily composed of smooth muscle cells, is visualized as a homogeneous structure by OCT (Fig. 9A) [40]. We have, however, reported that the characteristics of restenotic tissue in the very late phase (> 5 years) is frequently demonstrated as a heterogeneous structure suggesting lipid accumulation/calcification (Fig. 9B and 9C), occasionally accompanied by disruption of the intima, microvessels within neointima, or intraluminal materials [41]. The restenotic tissue of DESs, even in an early phase, also demonstrates polymorphic patterns in structure, backscatter, and composition (Fig. 10) [42,43]. This variation in OCT images could be caused by diverse components, including mature/immature smooth muscle cells and persistent fibrin or extracellular matrix, such as proteoglycans [43]. Thus, OCT provides important information about the tissue covering the stent struts. However, few studies have sought to validate OCT findings in comparison with pathological findings, and further investigations should be conducted until the impact of these findings on clinical outcomes is known.

Bottom Line: Several OCT studies have demonstrated delayed neointimal coverage following drug-eluting stent (DES) implantation vs. bare metal stent (BMS) placement.While newer DESs promote more favorable vascular healing, the clinical implications remain unknown.Recent OCT studies have provided insights into restenotic tissue characteristics; DES restenotic morphologies differ from those with BMSs.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. mterashima-circ@umin.ac.jp

ABSTRACT
Optical coherence tomography (OCT) is an optical analog of intravascular ultrasound (IVUS) that can be used to examine the coronary arteries and has 10-fold higher resolution than IVUS. Based on polarization properties, OCT can differentiate tissue characteristics (fibrous, calcified, or lipid-rich plaque) and identify thin-cap fibroatheroma. Because of the strong attenuation of light by blood, OCT systems required the removal of blood during OCT examinations. A recently developed frequency-domain OCT system has a faster frame rate and pullback speed, making the OCT procedure more user-friendly and not requiring proximal balloon occlusion. During percutaneous coronary intervention (PCI), OCT can provide detailed information (dissection, tissue prolapse, thrombi, and incomplete stent apposition [ISA]). At follow-up examinations after stent implantation, stent strut coverage and ISA can be assessed. Several OCT studies have demonstrated delayed neointimal coverage following drug-eluting stent (DES) implantation vs. bare metal stent (BMS) placement. While newer DESs promote more favorable vascular healing, the clinical implications remain unknown. Recent OCT studies have provided insights into restenotic tissue characteristics; DES restenotic morphologies differ from those with BMSs. OCT is a novel, promising imaging modality; with more in-depth assessments of its use, it may impact clinical outcomes in patients with symptomatic coronary artery disease.

Show MeSH
Related in: MedlinePlus