Current Cardiovascular Imaging Reports

, Volume 5, Issue 4, pp 206–220

Optical Coherence Tomography: Potential Clinical Applications

  • Antonios Karanasos
  • Jurgen Ligthart
  • Karen Witberg
  • Gijs van Soest
  • Nico Bruining
  • Evelyn Regar
Open Access
Intravascular Imaging (U Landmesser, Section Editor)


Optical coherence tomography (OCT) is a novel intravascular imaging modality using near-infrared light. By OCT it is possible to obtain high-resolution cross-sectional images of the vascular wall structure and assess the acute and long-term effects of percutaneous coronary intervention. For the time being OCT has been mainly used in research providing new insights into the pathophysiology of the atheromatic plaque and of the vascular response to stenting, however, it seems that there is potential for clinical application of OCT in various fields, such as pre-interventional evaluation of coronary arteries, procedural guidance in coronary interventions, and follow-up assessment of vascular healing after stent implantation. This review will focus on the potential and advantages of OCT in the clinical practice of a catheterization laboratory.


Optical coherence tomography Intravascular imaging Percutaneous coronary intervention Stent coverage Restenosis Stent thrombosis Fractional flow reserve Intravascular ultrasound Procedural guidance Coronary angiography Stent Plaque Atheromatosis 


Since the introduction of percutaneous coronary intervention (PCI), coronary angiography has been the tool for assessing the need for revascularization, as well as for assessing the results of the interventions. The advent of intravascular ultrasound (IVUS) has opened a new chapter in PCI guidance, enabling the transition from assessment of the lumen to the direct assessment of plaque and vessel morphology and the evaluation of the vessel wall response to stenting. Utilizing this approach, IVUS studies have provided useful insights into the pathogenesis and prevention of stent failure [1, 2, 3] as well as the dynamic nature of atherosclerosis and the impact of medical therapy [4, 5, 6]. Despite, however, the enormous contribution of IVUS, it is limited by low axial resolution (100–150 μm) and poor capability to discriminate different plaque components that precludes assessment of specific plaque and stent characteristics. Technological advances have led to the development of new intravascular imaging methods. We will discuss the potential and advantages of optical coherence tomography (OCT) in the clinical practice of a catheterization laboratory. Table 1 summarizes some potential clinical applications of OCT.
Table 1

Potential clinical applications of optical coherence tomography (OCT)



Lesion evaluation

Assessment of culprit lesion in acute coronary syndromes: evaluation for plaque rupture and/or thrombus in patients without angiographically evident culprit lesion

Evaluation of lesions with angiographic haziness: differential diagnosis between thrombus, dissection, heavy calcification

Determination about presence or absence of plaque (e.g. in coronary spasm)

Pre-procedural assessment

Luminal measurements for selection of balloon and stent dimensions

Assessment of plaque morphology in order to guide therapeutic strategy and device selection (rotablation, cutting balloon, etc.)

Evaluation of the optimal location in the vessel for implantation of a coronary stent

Use for tracking the exact guidewire position (i.e. in chronic total occlusion or in bifurcation stenting)

Use in bifurcation intervention (assessment of carina, ostia of side-branches, stent cell geometry)

Post-procedural assessment

Assessment of stent expansion (detection of under-expansion, residual stenosis, incomplete stent apposition)

Assessment of vascular injury: detection of edge dissections, tissue protrusion, intra-stent thrombus

Assessment of intervention by adjunctive devices: measurement of luminal enlargement after cutting balloon angioplasty, assessment of the reduction of calcification after rotablation

Assessment of adjunctive therapies in acute coronary syndromes: evaluation of residual thrombus burden after thrombectomy or selective administration of IIb/IIIa antagonists

Follow-up stent assessment

Mid-term and long-term assessment of stent safety and efficacy: evaluation of stent restenosis (quantitative and qualitative), stent thrombosis, and stent coverage as a surrogate for vessel healing

Monitoring of the bioresorption and the healing response after implantation of bioresorbable scaffolds

Basic Principles of OCT Imaging

OCT is an intravascular imaging method capable of proving cross-sectional images of the vascular wall with a high axial resolution (5–15 μm) and a lateral resolution of approximately 25 μm. This high resolution, however, comes at a cost of reduced penetration depth caused by the rapid attenuation of light waves in the tissue, and of the need to temporarily displace blood during imaging, because of the high scattering of light caused by erythrocytes. OCT in contrast to IVUS is based on emission of near-infrared light rather than acoustic waves for imaging. These infrared light waves reflect off the vascular wall and are then received and processed by the OCT imaging system. As the wavelength of light waves is far greater than those of the intravascular ultrasound, OCT cannot directly interpret the signal, but uses instead a technique called low-coherence interferometry in order to process the reflected signal. By this technique, an interferogram is created that can be analyzed by the imaging system in order to interpret the reflection as temporal delay or as tissue length (A-line) [7••].

Time-Domain and Fourrier-Domain OCT Systems

There are two processing methods that are being used for intravascular OCT imaging: Time Domain OCT (TD-OCT), and the recently introduced Fourier Domain OCT (FD-OCT), which is also known as second generation OCT, Frequency Domain OCT, or Optical Frequency Domain Imaging (OFDI). FD-OCT systems can record A-lines at a very high speed, while improving noise-signal ratios resulting in greater penetration depth, without loss of vital detail or resolution. In this way, imaging acquisition time and contrast used is reduced, while longer pullbacks are acquired [8].

Intravascular FD-OCT Systems and Image Acquisition Technique

Currently available FD-OCT systems are utilizing a short rapid-exchange monorail catheter for mounting of the optical probe. The optical signal is transmitted by a single-mode fiber, automatically mounted on the catheter, the focus of which is approximately 1 mm outside the catheter. In order to scan the vessel lengthwise, the catheter imaging tip is pulled back while rotating, inside a transparent sheath, allowing for retrieval of consecutive cross-sectional images for a length of 50–70 mm from the coronary artery. Both rotary and pullback motion are driven proximally by a motor outside the patient. For image acquisition, the FD-OCT catheter is initially advanced with the aid of a conventional guidewire distally to the desired segment, while the catheter position is indicated by radio-opaque markers. In order to create a blood-free environment during the acquisition, contrast warmed to 37 °C is injected, either manually, or by a power injector at a rate of 3–4 mL/sec. Pullback of the optical fiber is being performed simultaneously with the contrast injection.

Safety and Efficacy of OCT Imaging

The first experimental and human studies of TD-OCT have shown the safety and feasibility of OCT imaging using a proximal occlusion balloon for blood clearance [9]. An alternative technique eliminating the need for proximal occlusion has also demonstrated a favorable safety profile [10]. In the first systematic attempt from a multicenter registry of 468 patients undergoing TD-OCT imaging either with the occlusive or the non-occlusive technique, to record the safety of optical coherence tomography, use of the non-occlusive technique was associated with a reduction in the rate of transient complications during image acquisition such as chest pain and ECG changes [11••]. The introduction of FD-OCT led to a significant improvement in the rate of images of usable quality by simultaneously reducing acquisition time and the rate of transient chest pain and ECG changes [8]. Furthermore, use of a FD-OCT system for guidance of intervention was associated with a favorable safety profile [12].

Plaque Characterization and Quantitative Measurements

OCT is an imaging method that can accurately measure lumen and stent dimensions with high agreement with histological specimens and characterize tissue with high sensitivity and specificity. By OCT, it is possible to visualize all three arterial layers in a normal coronary artery, in accordance with pathological specimens [13]. OCT allows differentiation of fibrous, fibrocalcific, and lipid-rich tissue by visual assessment of the standard intensity image [14]. Briefly, fibrous plaque is seen as a high-intensity, low-attenuation area, lipid as a low-intensity, high-attenuation area with diffuse borders, while calcium as low-intensity, low-attenuation area with sharp borders (Fig. 1) [14]. OCT can also detect thrombus with very high sensitivity and specificity, and allows for distinction between red (erythrocyte-rich) and white (platelet-rich) thrombus [15].
Fig. 1

Representative optical coherence tomography (OCT) cross-sectional images of a normal vessel with high-power view demonstrating the three layers of the vascular wall: b fibrous plaque; c lipid-rich plaque; d fibrocalcific plaque

Several studies have validated the ability of OCT to perform quantitative measurements of the lumen and stent area [7••, 16, 17]. Meanwhile, in vivo studies have confirmed that there is high correlation between OCT and IVUS measurements of vessel and stent dimensions, as well as that there is very low intra-observer and inter-observer variability in the assessment of stent and vessel area [18]. Measurements acquired by FD-OCT systems seem to be equally accurate and reproducible [19]. The recent introduction of algorithms allowing for the automated quantitative assessment of lumen dimensions enables the acceleration of the analysis process [20, 21, 22]. Various algorithms and software packages have been suggested for this approach [20], while the ability of these automatic quantification programs to detect with high correlation with histology and manual interpretation the luminal and stent borders allows for the rapid online assessment of the degree of stenosis, reference site diameter, and degree of neointimal hyperplasia [21, 22].

Role of OCT in Pre-interventional Decision Making

Intermediate Lesions

Accurate measurements of lumen area by OCT can be used for the evaluation of intermediate lesions. It has been shown in IVUS studies, that angiography often underestimates the plaque burden and the severity of stenosis [23]. Thus, evaluation of intermediate lesions has been a focus of invasive imaging. Functional assessment of intermediate lesions using fractional flow reserve (FFR) in patients with stable disease has been shown in large-scale studies to be linked with improved outcomes as it overcomes limitations of angiography [24]. Despite the existence of IVUS studies assessing quantitative indices of stenosis as a marker of the functional significance of a lesion, it remains questionable whether functional measurements can be replaced by anatomic measurements by IVUS or OCT. Taking into account, however, that various parameters, such as lesion length, lesion location, and plaque burden are factors also affecting the functional significance of a lesion, it is doubtful that the physiological significance of a lesion can be accurately assessed by measurement of minimal lumen area alone [25]. Moreover, a recent evaluation of IVUS and OCT to assess the physiological significance of a stenosis revealed that despite OCT measurements of minimal lumen area having greater diagnostic potential than IVUS for the assessment of the physiological significance of intermediate stenosis, anatomic lesion assessment by either modality correlates poorly to physiologic measurements performed by FFR [26]. Consequently, the current golden standard to assess hemodynamic relevance in a patient with stable angina is functional measurement by FFR (what to treat?), while OCT is helpful in guiding the procedure (how to treat?) or identification of the culprit and thrombosed lesion in acute coronary syndromes with intermediate lesions.

Angiographic Haziness

A field were OCT could substantially improve preprocedural assessment is in the evaluation of hazy lesions (Fig. 2). It is known that angiographic haziness could be due to a variety of morphological features such as thrombus, heavy calcification, extreme tortuosity, and intimal dissection. There have been several reports of utilizing OCT for the assessment of the nature of haziness, that have ranged from extreme vessel tortuosity to vessel dissection and recanalised thrombus [27, 28, 29]. Furthermore, the use of IVUS would be less helpful in such cases, as its diagnostic accuracy for complicated plaque and thrombus detection is limited [30].
Fig. 2

Evaluation by OCT of a patient with acute coronary syndrome and haziness in the coronary angiogram. OCT revealed the presence of thrombus

Evaluation of Coronary Spasm

Optical coherence tomography can also aid decision making in cases of acute coronary syndromes in patients where coronary spasm appears to be the culprit. Use of OCT in this subset of patients can exclude the presence of culprit atheromatic plaques and/or thrombus. The association of plaque morphology with coronary spasm has been evaluated by OCT, showing that the main underlying morphology is transient intima-media thickening [31]. Multiple lumen irregularities observed during the episode consisting of intimal bumps and intimal gathering disappear after intracoronary nitrate administration, giving place to normal vessel morphology [31].

Assessment of Plaque Morphology

One of the advantages of OCT is that it can assist in the preprocedural evaluation of coronary lesions by providing information about the morphology of the lesions. A small study recently evaluated the complementary use of FD-OCT with FFR in order to assess angiographically ambiguous lesions. In this study, FFR was used in order to provide information about the functional significance of these lesions, while FD-OCT was used in order to assess the presence of unstable plaques and guide decision making in cases of ACS and FFR values >0.80 [32]. Moreover, the underlying plaque type has been associated with the outcome of the intervention. The presence of lipid-rich plaques by OCT has been associated with greater incidence of non-reflow and greater rise in biomarkers of cardiac necrosis in several studies [33]. Additionally, patients with unstable angina compared to stable patients had greater rates of acute malapposition and tissue protrusion post PCI, while they had higher rates of malapposition and incomplete coverage at 9-month follow-up, implying an association between complicated plaque morphology—which was more common in the unstable angina group—with impaired vessel healing after stenting [34].

It remains to be proven whether qualitative assessment of non-culprit lesions can guide decision for treatment and improve patient-related outcomes. A recent intravascular ultrasound study suggested an association of the presence of a non-culprit lesion with small lumen area, large plaque burden and plaque morphology, as identified by radiofrequency ultrasound analysis, with subsequent re-hospitalizations and events [6]. However, the prognostic value of intravascular ultrasound with radiofrequency signal analysis for vulnerable plaque identification and risk stratification still needs to be established.

Preprocedural Guidance

Selection of PCI Strategy

OCT can be used in order to guide decisions about treatment before the procedure. As discussed above, OCT can provide precise area measurements not only of the minimal lumen, but of proximal and distal reference sites as well, and define the lesion length. Therefore, preprocedural measurements by OCT can aid in the proper selection of balloon and stent dimensions. Selection of appropriate balloon size using OCT measurements has been performed in a series of patients undergoing cutting balloon angioplasty for the treatment of in-stent restenosis [35]. Furthermore, OCT has also been used for selection of treatment strategy on the basis of lesion morphology. Given that OCT can quantify calcifications of the target site more accurately than IVUS [36], it could better assess the need for targeted therapies (Fig. 3). In a recent study, pre-interventional OCT assessment of plaque morphology guided the selection of dedicated treatments such as rotablation, thrombectomy, and cutting balloon in one third of patients [37•]. In the same study, decision to defer angioplasty was taken in 18 % of the patients using criteria of IVUS guidance [38], for assessing the severity of the lesion.
Fig. 3

a Angiogram of the right coronary artery of a patient with stable angina. b L-mode reconstruction of OCT images demonstrating the longitudinal morphology of the lesion. c, d Representative OCT cross-sections showing heavily superficially calcified plaque suggesting the need for targeted therapy such as rotablation. Asterisks represent calcific depositions

One of the advantages of OCT guidance is that it can help precisely identify the optimal segment for stent deployment, the so-called “landing zone” (Fig. 4). It has been shown that multiple plaque morphologies may be present in the culprit lesion of a patient with ACS [39]. Moreover, the longitudinal analysis of culprit lesions of ACS has demonstrated that in the majority of cases there is geographic mismatch of the minimal lumen site with the rupture site [40•], indicating the presence of necrotic core plaques in sites remote to the site of the greatest stenosis. Although there is not definitive evidence that stenting should also cover lipid-rich plaques located in shoulder areas, it has been shown that presence of such areas in the edge of the stent is associated with edge dissection, as is the presence of fibrocalcific plaques [41]. Additionally, pathologic studies have shown the association of late stent thrombosis with the presence of struts penetrating areas of necrotic core [42], while as mentioned earlier, possible stent-induced disruption of such areas could lead to impaired vascular healing or raise in cardiac necrosis biomarkers [33, 34].
Fig. 4

Registration of 3D QCA and OCT using qAngioOCT (Medis Medical Systems BV, Leiden, The Netherlands). a Fibrous cap at the minimal lumen area (red marker). Images at the right indicate proximal and distal landing zone. In the proximal landing zone there is a thin cap fibroatheroma. b If a shorter stent is selected, the proximal landing zone will be at a site with stable plaque. c, d Online three-dimensional reconstructions of the segment generated by the software

Co-registration of Invasive Imaging and Coronary Angiography

While invasive imaging generally offers high spatial resolution, it can be challenging to consolidate the information gained by invasive imaging technologies with the angiogram, and especially, to ensure correct spatial orientation. This is true for all angiographically silent lesions, whereas this phenomenon might be a consequence of vessel overlap, foreshortening or the inability to visualize a complex three-dimensional structure correctly in a two-dimensional image. Often operators use side branches as observed in both imaging modalities as landmarks. This approach is not always the optimal, as side branch ostia are not always clearly visible by angiography and also the assumed calibre of a particular side branch can be underestimated. Currently, a number of technical solutions to this problem are being developed, including the use of pulsed fluoroscopy to track the imaging catheter in real time (Siemens Medical prototype, Erlangen, Germany) [43] or alternatively, approaches for software enabled synchronization of three-dimensional angiography with invasive imaging pullbacks are being developed (Medis Medical Imaging Systems BV, Leiden, The Netherlands) (Fig. 4) [44]. The ultimate goal is an online co-registration of the invasive imaging modality with the coronary angiogram, allowing the operator to scroll through a synchronized dataset. Such information could be useful for planning of the most appropriate interventional strategy and for the longitudinal assessment of atherosclerotic lesions.

Guidance in Complex Procedures

OCT can also be a tool for guidance during complex procedures. There have been reports of OCT guidance in chronic total occlusions (CTOs) [45]. In such cases, OCT can be used to identify the entry point of the occlusion and to confirm that the guidewire is indeed in the true vessel lumen and has not entered a false lumen. The development of forward-looking OCT catheters will enable the guidance of a CTO crossing by continuous visualization of the position of the guidewire relative to the microchannels.

Bifurcation lesion stenting is another potential application of OCT guidance. By 3-dimensional reconstruction of OCT images it is possible to produce images that indicate the relative position of the main vessel and the side-branch and help select a suitable strategy [46]. Furthermore, three-dimensional models of coronary arteries can help identify the point of re-crossing of a guidewire in a side branch through the cells of a stent implanted in the main vessel, and evaluate possible presence of struts at the ostia of the side branches following kissing balloon dilation [47]. The development of online reconstructions that incorporate three-dimensional angiography and optical coherence tomography images could improve real-time guidance in these subsets of lesions [44, 48•].

Assessment of Acute Effects of PCI

Pathologic studies have indicated the association of implantation characteristics with late events following stent implantation [49]. Stent strut malapposition has been associated with very late stent thrombosis in IVUS studies [1]. Furthermore, postprocedural lesion assessment has shown that stent expansion, tissue protrusion, and dissection are associated with early stent thrombosis [2, 3], while restenosis is also associated with inadequate stent expansion [3]. Indeed, use of standardized criteria for stent expansion using IVUS guidance and additional treatment based on these criteria was associated with a low restenosis rate in the bare metal stent era [38].

OCT can accurately assess the acute vessel wall response to stent implantation. Due to the high resolution of OCT, tissue prolapse, malapposition, intra-stent thrombus formation, and edge dissection can be detected more accurately than with IVUS (Fig. 5), while stent and luminal measurements by the two modalities are not significantly different [7••, 9, 50]. In a study assessing the effects of stenting on vessel wall morphology, it was shown that the presence of dissections, either at the stent edge or inside the stent, and tissue protrusion was observed in almost all the cases, while in the majority of patients there was some degree of stent malapposition [51•]. Thrombus presence inside the stent was also common, both in stable and in ACS patients [51•]. Furthermore, optical coherence tomography is particularly useful in the assessment of malapposition, due to its superior resolution allowing the detection of small degrees of malapposition not detectable by IVUS with low variability between independent measurements. As OCT signal does not penetrate the surface of stent struts, it is important when calculating the distance of the stent strut from the vessel wall, to subtract the thickness of the strut and polymer from the total distance from strut surface to vessel wall. Acute malapposition has been assessed in a variety of studies, and was found to be associated with plaque and stent characteristics, clinical syndrome, and presence of overlapping stents (Fig. 6) [34, 52].
Fig. 5

Assessment of acute effects of intervention. a Patient with edge dissection after stent implantation at the bifurcation segment. b Intra-stent dissection following stent implantation at the left circumflex artery. c Tissue protrusion (9 to 10 o’clock) following stent implantation at the middle left anterior descending artery. d Stent protrusion to the diagonal branch following primary percutaneous intervention at the left anterior descending artery without kissing balloon dilation

Fig. 6

Correction of malapposition at the proximal LAD following stent implantation. a Angiographic result following the initial intervention. b OCT demonstrating malapposition at the proximal LAD. c Post-dilation was performed with a non-compliant balloon. d Final angiographic result. e OCT shows correction of malapposition (the distance of the strut surface from the vessel wall is lower than the thickness of the strut and polymer, as provided by the manufacturer)

The significance, however, and prognostic value of the detection of small degrees of malapposition, tissue protrusion, or thrombus that are detectable only with the high-resolution of OCT has not been precisely defined, as with IVUS. Small follow-up studies have tried to assess the impact of these findings with surrogate markers at follow-up [34, 50, 53]. Acute malapposition was more pronounced in implantation compared to follow-up in all of the studies [34, 50, 53]. Conversely, there were cases of initially well-apposed struts that were malapposed at follow-up, possibly due to changes in vessel remodelling [53]. In one of the studies, presence of malapposition was associated with impaired endothelialization and presence of thrombus on struts [53]. Dissections and tissue protrusion, detectable by OCT, tended to resolve at a 6-month follow-up period [50]. Nevertheless, unless larger prospective studies investigate the impact of OCT-detected markers of vessel injury and acute malapposition by OCT on clinical outcome, their role in decision making will remain uncertain.

Post-procedural OCT guidance has not been only used to evaluate vascular injury following stent implantation, but has also been used to assess the effects after PCI with other adjunctive devices such as cutting or scoring balloon and rotational atherectomy [54]. Furthermore, OCT can also be used in ACS in order to assess the role of adjunctive therapies in reducing thrombus burden (Fig. 7) [55, 56].
Fig. 7

a Coronary angiography of the right posterolateral branch of a patient with myocardial infarction. b OCT reveals significant thrombus burden (yellow arrow). c Angiography after manual thrombus aspiration. d OCT shows reduction of the thrombus burden, confirming the effectiveness of thrombus aspiration

There is only a handful of studies that have assessed the role of OCT guidance in PCI [12, 35, 37•]. Imola et al. [12] used post-implantation OCT imaging in 74 patients in order to assess the need for further intervention. In 24 patients, additional interventions were performed based on OCT assessment (15 patients with balloon metadilation and 9 patients with additional stent implantation), while in 50 patients the result of the interventions was judged satisfactory, leading to an event-free survival of 98 % at 6-month follow-up. Use of OCT in assessing luminal dimensions after cutting balloon angioplasty has led to the safe upsizing of luminal size in patients without coronary stent implantation [35]. Viceconte et al. [37] report on the outcomes of an OCT-guided strategy for procedural guidance, where in 207 cases, OCT suggested the need of a new stent implantation in 29 and further optimization in 64. No major complications were observed in this study, while serial OCT examinations increased procedural time by a mean of 15.4 ± 8.2 min. Thus, it seems that OCT can be safely used for procedural guidance, but the clinical significance of such an approach remains to be assessed in comparative studies.

Assessment of Long-Term Outcome After PCI

OCT can be a valuable tool for follow-up stent assessment. The association of the extent of stent endothelialization with stent thrombosis in pathologic studies have introduced the need for detailed assessment of stent coverage, as a surrogate marker for stent safety. The superior resolution of OCT allows for near-histology assessment of stent coverage, while the ability of OCT to assess and quantify neointimal hyperplasia with greater accordance with histology compared to IVUS, has clearly been documented (Fig. 8) [57]. Furthermore, the high reproducibility for measurements of neointimal hyperplasia makes OCT a reliable tool for objective evaluation of the degree of restenosis. In view of these advantages, OCT has been used for the assessment of the anti-restenotic efficacy of various devices.
Fig. 8

Various patterns of vessel response at the follow-up of stent implantation. a Homogeneous tissue coverage without compromise of the lumen. b Heterogeneous coverage with areas resembling lipid plaques 3 years after implantation of a drug-eluting stent. c Stent restenosis. d Presence of uncovered struts in another site of the stent shown in panel B. e Stent malapposition at follow-up, with tissue coverage probably corresponding either to fibrin or endothelial coverage

The assessment of neointimal coverage by OCT constitutes the subject of various studies trying to provide insights into subjects related to stent safety. Stent evaluation by OCT can be used to provide detailed information for stent coverage reported to be associated with stent thrombosis in post-mortem studies. It is important to mention that although OCT can detect even minimal tissue coverage at an order of 10 μm, which compares to analysis by optical microscopy, OCT detected coverage could correspond either to true endothelialization or to coverage by fibrin deposits [58]. Therefore, OCT has only about 80 % sensitivity and 95 % specificity for the detection of stent struts lacking endothelial coverage [59]. Nevertheless, due to different optical properties of these components, future developments with characterization based on optical properties [59] may be able to increase the sensitivity for detection of struts without endothelial coverage.

Assessment of tissue coverage has been extensively investigated in the case of the sirolimus-eluting stent, where there are reports from 3 months to 4 years post implantation [60, 61]. All these reports suggest that a small percentage of uncovered struts can be found even 4 years after implantation in sirolimus-eluting stents [61]. Sirolimus-eluting stents, as well as paclitaxel-eluting stents, demonstrate impaired healing compared to bare-metal stents [62, 63]. This does not seem to be the case for the zotarolimus-eluting stent with permanent polymer that is probably the stent with the highest extent of coverage, comparable to that of bare metal stents [64]. Furthermore, comparative studies between sirolimus-eluting and paclitaxel-eluting stents have demonstrated that the latter are associated with an enhanced healing response [65]. A recent OCT substudy of a randomized trial comparing a zotarolimus-stent with biocompatible polymer and the everolimus-eluting stent has shown comparable rates of coverage between these two second-generation stents [66]. Nonetheless, despite the presence of profound differences in vessel healing between different stents, these have not been shown yet to correspond to differences in stent thrombosis, underlining the complexity of mechanisms associated with this entity [67].

Pathologic evidence has shown that bare metal stents are sometimes associated with development of neointimal tissue with characteristics similar to de novo atherosclerosis [68]. Furthermore, recent observations have shown that this entity is also observed in drug-eluting stents at shorter follow-up intervals [69]. The fact that OCT allows for qualitative assessment of restenotic tissue can be used for elucidating the mechanisms behind late stent failure. Various morphological classifications of restenotic tissue have been proposed by OCT [59, 70, 71], however histologic validation was only available in the recent study by Nakano et al. [59], that proposed the use of a classification similar to the classification used for OCT assessment of de novo atheromatosis. According to this study, the differences in the optical properties of the various tissue components can be used for tissue characterization.

Whether such morphological features are implicated in the pathophysiology of very late stent thrombosis is a subject of investigation. Recent data from OCT studies suggest the existence of two discrete mechanisms associated with stent thrombosis: one involving impaired vessel healing after stent implantation with malapposition and incomplete strut coverage, and one associated with rupture of neoatherosclerotic tissue [72]. Histological examination of thrombus aspirates supports this theory by showing differences in the composition of thrombotic debris between these two mechanisms [72, 73]. However, little is known so far about the incidence and predictors of each mechanism, the “vulnerable” neointimal morphological characteristics, and the differences in clinical outcome in these cases. Future OCT studies will provide new insights into the role of each mechanism in the development of very late stent thrombosis and will assess the clinical significance of evaluation of these mechanisms.

OCT for the Assessment of New Stent Technologies

Due to its superior resolution and the ability to evaluate stent healing and quantify neointimal hyperplasia, OCT is becoming the standard for the assessment of new stent technologies. A new biolimus-eluting stent underwent OCT evaluation in a substudy of the LEADERS trial in order to assess the differences in healing response compared to a sirolimus-eluting stent and was shown to be associated with more complete coverage without increase in neointimal hyperplasia [74]. Moreover, various stents with improvements in release kinetics, coating or matrix design have been evaluated with OCT in order to assess if such improvements correspond to improved healing response as well [75, 76]. Likewise, OCT has been used in a number of studies to evaluate the healing response after treatment with drug-eluting balloons in de novo or in stent restenosis lesions [77].

One of the more fascinating aspects of OCT is the ability to monitor the absorption rate in bioabsorbable stents. OCT has been used for assessment of the biodegradation of the magnesium stent in porcine coronary arteries, as it can demonstrate the reduction in the width of stent struts that is associated with biodegradation [78]. In the case of the bioresorbable everolimus-eluting scaffold (Absorb™, Abbott Vascular, Santa Clara, CA) there have been more extensive animal and human studies [79, 80, 81]. Experimental studies have shown that OCT can assess the integration process of the scaffold in long-term observations [81]. In human studies, pilot trials have defined the OCT appearance of various stages of the resorption of the scaffold [79, 80], while OCT has been used for assessment of the vascular healing process and evaluation of differences in resorption and stent strut distribution between the first and the second generation of the scaffold [82], being the best method for measurement of stent length and luminal dimensions [83], as well as assessment of healing in side branches [84].

Future Research Directions

Intravascular OCT is a powerful and easily applicable tool for the assessment of the coronary artery. Today, OCT image interpretation and analysis is based on a color-coded intensity map. Algorithms enabling automated tissue characterization software will allow for a more objective assessment of plaque morphology [85]. New technologies such as polarization-sensitive OCT will enable the distinction of the collagen content of the coronary plaques [86], while the development of micro-OCT will help the better understanding of the pathophysiological mechanisms of acute coronary syndromes [87].

Despite the numerous clinical uses of OCT, and a wealth of case series and clinical observations illustrating potential use in a clinical setting, no clear indications have been established yet. Future studies, focusing either on unselected population or on specific patient and lesion subsets (i.e., acute coronary syndromes, calcified lesions, bifurcations), will determine the role of OCT in procedural guidance.

Furthermore, given that OCT can provide us with an enormous amount of information about plaque morphology and vessel healing following stent implantation, future research will elucidate which are the critical components of plaque and stent “vulnerability” on which we should focus. Finally, natural history studies investigating the impact of vessel morphology and acute procedural complications, as detected by OCT, on future clinical events need to be implemented. And if an association of such OCT findings with clinical outcome is demonstrated, it remains to be seen if treatment based on those findings can lead to an improvement in outcomes.


The introduction of OCT has not only provided new insights in the pathophysiology of the plaque and of the vascular response to stenting, but has also offered interventional cardiology a new tool for procedural guidance. Currently, there are no clear indications for OCT in a clinical setting; however, there are numerous fields where useful decision-guiding information could be provided by OCT. These include pre-interventional evaluation of coronary arteries, procedural guidance in coronary interventions, as well as follow-up assessment of vascular healing after stent implantation. The development of three-dimensional models reconstructed from OCT images could perhaps enhance the role of OCT in procedural guidance [44], while automated tissue characterization software will allow for more objective assessment of plaque morphology [85], strengthening the role of OCT as a tool for implementation of natural history studies. Studies aiming to show an association between OCT imaging and improvement in patient-related outcomes will ultimately define the role of OCT in interventional cardiology.



No potential conflicts of interest relevant to this article were reported.

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  1. 1.
    Garcia-Garcia HM, Gonzalo N, Kukreja N, Alfonso F. Greyscale intravascular ultrasound and IVUS-radiofrequency tissue characterisation to improve understanding of the mechanisms of coronary stent thrombosis in drug-eluting stents. EuroIntervention. 2008;4(Suppl C):C33–8.PubMedGoogle Scholar
  2. 2.
    Choi SY, Witzenbichler B, Maehara A, Lansky AJ, Guagliumi G, Brodie B, et al. Intravascular ultrasound findings of early stent thrombosis after primary percutaneous intervention in acute myocardial infarction: a Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) substudy. Circ Cardiovasc Interv. 2011;4(3):239–47.PubMedCrossRefGoogle Scholar
  3. 3.
    Liu X, Doi H, Maehara A, Mintz GS, de Ribamar Costa Jr J, Sano K, et al. A volumetric intravascular ultrasound comparison of early drug-eluting stent thrombosis versus restenosis. JACC Cardiovasc Interv. 2009;2(5):428–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Nissen SE, Nicholls SJ, Sipahi I, Libby P, Raichlen JS, Ballantyne CM, et al. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA. 2006;295(13):1556–65.PubMedCrossRefGoogle Scholar
  5. 5.
    Serruys PW, Garcia-Garcia HM, Buszman P, Erne P, Verheye S, Aschermann M, et al. Effects of the direct lipoprotein-associated phospholipase A(2) inhibitor darapladib on human coronary atherosclerotic plaque. Circulation. 2008;118(11):1172–82.PubMedCrossRefGoogle Scholar
  6. 6.
    Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011;364(3):226–35.PubMedCrossRefGoogle Scholar
  7. 7.
    •• Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the international working group for intravascular optical coherence tomography standardization and validation. J Am Coll Cardiol. 2012;59(12):1058–72. This is a consensus document that can be broadly used as a standard reference regarding the current state of the IVOCT imaging modality.PubMedCrossRefGoogle Scholar
  8. 8.
    Takarada S, Imanishi T, Liu Y, Ikejima H, Tsujioka H, Kuroi A, et al. Advantage of next-generation frequency-domain optical coherence tomography compared with conventional time-domain system in the assessment of coronary lesion. Catheter Cardiovasc Interv. 2010;75(2):202–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Bouma BE, Tearney GJ, Yabushita H, Shishkov M, Kauffman CR, DeJoseph Gauthier D, et al. Evaluation of intracoronary stenting by intravascular optical coherence tomography. Heart. 2003;89(3):317–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Prati F, Cera M, Ramazzotti V, Imola F, Giudice R, Albertucci M. Safety and feasibility of a new non-occlusive technique for facilitated intracoronary optical coherence tomography (OCT) acquisition in various clinical and anatomical scenarios. EuroIntervention. 2007;3(3):365–70.PubMedCrossRefGoogle Scholar
  11. 11.
    •• Barlis P, Gonzalo N, Di Mario C, Prati F, Buellesfeld L, Rieber J, et al. A multicentre evaluation of the safety of intracoronary optical coherence tomography. EuroIntervention. 2009;5(1):90–5. This is the first systematic attempt to evaluate the safety of OCT.PubMedCrossRefGoogle Scholar
  12. 12.
    Imola F, Mallus MT, Ramazzotti V, Manzoli A, Pappalardo A, Di Giorgio A, et al. Safety and feasibility of frequency domain optical coherence tomography to guide decision making in percutaneous coronary intervention. EuroIntervention. 2010;6(5):575–81.PubMedCrossRefGoogle Scholar
  13. 13.
    Kume T, Akasaka T, Kawamoto T, Watanabe N, Toyota E, Neishi Y, et al. Assessment of coronary intima–media thickness by optical coherence tomography: comparison with intravascular ultrasound. Circ J. 2005;69(8):903–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, et al. Characterization of human atherosclerosis by optical coherence tomography. Circulation. 2002;106(13):1640–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, et al. Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol. 2006;97(12):1713–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Murata A, Wallace-Bradley D, Tellez A, Alviar C, Aboodi M, Sheehy A, et al. Accuracy of optical coherence tomography in the evaluation of neointimal coverage after stent implantation. JACC Cardiovasc Imaging. 2010;3(1):76–84.PubMedCrossRefGoogle Scholar
  17. 17.
    Gonzalo N, Serruys PW, Garcia-Garcia HM, van Soest G, Okamura T, Ligthart J, et al. Quantitative ex vivo and in vivo comparison of lumen dimensions measured by optical coherence tomography and intravascular ultrasound in human coronary arteries. Rev Esp Cardiol. 2009;62(6):615–24.PubMedCrossRefGoogle Scholar
  18. 18.
    Gonzalo N, Garcia-Garcia HM, Serruys PW, Commissaris KH, Bezerra H, Gobbens P, et al. Reproducibility of quantitative optical coherence tomography for stent analysis. EuroIntervention. 2009;5(2):224–32.PubMedCrossRefGoogle Scholar
  19. 19.
    Tahara S, Bezerra HG, Baibars M, Kyono H, Wang W, Pokras S, et al. In vitro validation of new Fourier-domain optical coherence tomography. EuroIntervention. 2011;6(7):875–82.PubMedCrossRefGoogle Scholar
  20. 20.
    Okamura T, Gonzalo N, Gutierrez-Chico JL, Serruys PW, Bruining N, de Winter S, et al. Reproducibility of coronary Fourier domain optical coherence tomography: quantitative analysis of in vivo stented coronary arteries using three different software packages. EuroIntervention. 2010;6(3):371–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Sihan K, Botha C, Post F, de Winter S, Gonzalo N, Regar E, et al. Fully automatic three-dimensional quantitative analysis of intracoronary optical coherence tomography: method and Validation. Catheter Cardiovasc Interv. 2009;74(7):1058–65.PubMedCrossRefGoogle Scholar
  22. 22.
    Tanimoto S, Rodriguez-Granillo G, Barlis P, de Winter S, Bruining N, Hamers R, et al. A novel approach for quantitative analysis of intracoronary optical coherence tomography: high inter-observer agreement with computer-assisted contour detection. Catheter Cardiovasc Interv. 2008;72(2):228–35.PubMedCrossRefGoogle Scholar
  23. 23.
    Mintz GS, Painter JA, Pichard AD, Kent KM, Satler LF, Popma JJ, et al. Atherosclerosis in angiographically normal coronary-artery reference segments - an intravascular ultrasound study with clinical correlations. J Am Coll Cardiol. 1995;25(7):1479–85.PubMedCrossRefGoogle Scholar
  24. 24.
    Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360(3):213–24.PubMedCrossRefGoogle Scholar
  25. 25.
    Kang SJ, Lee JY, Ahn JM, Mintz GS, Kim WJ, Park DW, et al. Validation of intravascular ultrasound-derived parameters with fractional flow reserve for assessment of coronary stenosis severity. Circ Cardiovasc Interv. 2011;4(1):65–71.PubMedCrossRefGoogle Scholar
  26. 26.
    Gonzalo N, Escaned J, Alfonso F, Nolte C, Rodriguez V, Jimenez-Quevedo P, et al. Morphometric assessment of coronary stenosis relevance with optical coherence tomography: a comparison with fractional flow reserve and intravascular ultrasound. J Am Coll Cardiol. 2012;59(12):1080–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Toutouzas K, Karanasos A, Stathogiannis K, Synetos A, Tsiamis E, Papadopoulos D, et al. A honeycomb-like structure in the left anterior descending coronary artery: demonstration of recanalized thrombus by optical coherence tomography. JACC Cardiovasc Interv. 2012; (in press).Google Scholar
  28. 28.
    Toutouzas K, Karanasos A, Stefanadis C. Pitfalls of angiography in the assessment of atherosclerosis: The role of optical coherence tomography. J Invasive Cardiol. 2012; (in press).Google Scholar
  29. 29.
    Alfonso F, Paulo M, Gonzalo N, Dutary J, Jimenez-Quevedo P, Lennie V, et al. Diagnosis of spontaneous coronary artery dissection by optical coherence tomography. J Am Coll Cardiol. 2012;59(12):1073–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, et al. Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol. 2007;50(10):933–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Tanaka A, Shimada K, Tearney GJ, Kitabata H, Taguchi H, Fukuda S, et al. Conformational change in coronary artery structure assessed by optical coherence tomography in patients with vasospastic angina. J Am Coll Cardiol. 2011;58(15):1608–13.PubMedCrossRefGoogle Scholar
  32. 32.
    Stefano GT, Bezerra HG, Attizzani G, Chamie D, Mehanna E, Yamamoto H, et al. Utilization of frequency domain optical coherence tomography and fractional flow reserve to assess intermediate coronary artery stenoses: conciliating anatomic and physiologic information. Int J Cardiovasc Imaging. 2011;27(2):299–308.PubMedCrossRefGoogle Scholar
  33. 33.
    Porto I, Di Vito L, Burzotta F, Niccoli G, Trani C, Leone AM, et al. Predictors of periprocedural (Type IVa) myocardial infarction, as assessed by frequency-domain optical coherence tomography. Circ Cardiovasc Interv. 2012;5(1):89–96.PubMedCrossRefGoogle Scholar
  34. 34.
    Kubo T, Imanishi T, Kitabata H, Kuroi A, Ueno S, Yamano T, et al. Comparison of vascular response after sirolimus-eluting stent implantation between patients with unstable and stable angina pectoris: a serial optical coherence tomography study. JACC Cardiovasc Imaging. 2008;1(4):475–84.PubMedCrossRefGoogle Scholar
  35. 35.
    Secco GG, Foin N, Viceconte N, Borgia F, De Luca G, Di Mario C. Optical coherence tomography for guidance of treatment of in-stent restenosis with cutting balloons. EuroIntervention. 2011;7(7):828–34.PubMedCrossRefGoogle Scholar
  36. 36.
    Kume T, Okura H, Kawamoto T, Yamada R, Miyamoto Y, Hayashida A, et al. Assessment of the coronary calcification by optical coherence tomography. EuroIntervention. 2011;6(6):768–72.PubMedCrossRefGoogle Scholar
  37. 37.
    • Viceconte N, Chan PH, Barrero EA, Ghilencea L, Lindsay A, Foin N, et al. Frequency domain optical coherence tomography for guidance of coronary stenting. Int J Cardiol. 2011. in press. A report on the use of OCT for interventional guidance. Google Scholar
  38. 38.
    de Jaegere P, Mudra H, Figulla H, Almagor Y, Doucet S, Penn I, et al. Intravascular ultrasound-guided optimized stent deployment. Immediate and 6 months clinical and angiographic results from the Multicenter Ultrasound Stenting in Coronaries Study (MUSIC Study). Eur Heart J. 1998;19(8):1214–23.PubMedCrossRefGoogle Scholar
  39. 39.
    Toutouzas K, Karanasos A, Stefanadis C. Multiple plaque morphologies assessed by optical coherence tomography in a patient with acute coronary syndrome. Heart. 2010;96(16):1335–6.PubMedCrossRefGoogle Scholar
  40. 40.
    • Toutouzas K, Karanasos A, Tsiamis E, Riga M, Drakopoulou M, Synetos A, et al. New insights by optical coherence tomography into the differences and similarities of culprit ruptured plaque morphology in non-ST-elevation myocardial infarction and ST-elevation myocardial infarction. Am Heart J. 2011;161(6):1192–9. This study highlights the significance of the longitudinal assessment of coronary plaques with implications in the landing zone concept.PubMedCrossRefGoogle Scholar
  41. 41.
    Gonzalo N, Serruys PW, Okamura T, Shen ZJ, Garcia-Garcia HM, Onuma Y, et al. Relation between plaque type and dissections at the edges after stent implantation: an optical coherence tomography study. Int J Cardiol. 2011;150(2):151–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Joner M, Finn AV, Farb A, Mont EK, Kolodgie FD, Ladich E, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006;48(1):193–202.PubMedCrossRefGoogle Scholar
  43. 43.
    Hetterich H, Redel T, Lauritsch G, Rohkohl C, Rieber J. New X-ray imaging modalities and their integration with intravascular imaging and interventions. Int J Cardiovasc Imaging. 2010;26(7):797–808.PubMedCrossRefGoogle Scholar
  44. 44.
    Tu S, Holm NR, Koning G, Huang Z, Reiber JH. Fusion of 3D QCA and IVUS/OCT. Int J Cardiovasc Imaging. 2011;27(2):197–207.PubMedCrossRefGoogle Scholar
  45. 45.
    Schultz C, van der Ent M, Serruys PW, Regar E. Optical coherence tomography to guide treatment of chronic occlusions? JACC Cardiovasc Interv. 2009;2(4):366–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Farooq V, Serruys PW, Heo JH, Gogas BD, Okamura T, Gomez-Lara J, et al. New insights into the coronary artery bifurcation hypothesis-generating concepts utilizing 3-dimensional optical frequency domain imaging. JACC Cardiovasc Interv. 2011;4(8):921–31.PubMedCrossRefGoogle Scholar
  47. 47.
    Okamura T, Yamada J, Nao T, Suetomi T, Maeda T, Shiraishi K, et al. Three-dimensional optical coherence tomography assessment of coronary wire re-crossing position during bifurcation stenting. EuroIntervention. 2011;7(7):886–7.PubMedCrossRefGoogle Scholar
  48. 48.
    • Tu S, Xu L, Ligthart J, Xu B, Witberg K, Sun Z, et al. In vivo comparison of arterial lumen dimensions assessed by co-registered three-dimensional (3D) quantitative coronary angiography, intravascular ultrasound and optical coherence tomography. Int J Cardiovasc Imaging. 2012. This study introduces a new software package for registration of angiography and OCT and for the online reconstruction of three-dimensional models. Google Scholar
  49. 49.
    Farb A, Burke AP, Kolodgie FD, Virmani R. Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation. 2003;108(14):1701–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Kume T, Okura H, Miyamoto Y, Yamada R, Saito K, Tamada T, et al. Natural history of stent edge dissection, tissue protrusion and incomplete stent apposition detectable only on optical coherence tomography after stent implantation. Circ J. 2012. in press.Google Scholar
  51. 51.
    • Gonzalo N, Serruys PW, Okamura T, Shen ZJ, Onuma Y, Garcia-Garcia HM, et al. Optical coherence tomography assessment of the acute effects of stent implantation on the vessel wall: a systematic quantitative approach. Heart. 2009;95(23):1913–9. A detailed description of acute vascular wall response to stenting.PubMedCrossRefGoogle Scholar
  52. 52.
    Tanigawa J, Barlis P, Dimopoulos K, Dalby M, Moore P, Di Mario C. The influence of strut thickness and cell design on immediate apposition of drug-eluting stents assessed by optical coherence tomography. Int J Cardiol. 2009;134(2):180–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Ozaki Y, Okumura M, Ismail TF, Naruse H, Hattori K, Kan S, et al. The fate of incomplete stent apposition with drug-eluting stents: an optical coherence tomography-based natural history study. Eur Heart J. 2010;31(12):1470–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Attizzani GF, Patricio L, Bezerra HG. Optical coherence tomography assessment of calcified plaque modification after rotational atherectomy. Catheter Cardiovasc Interv. 2011.Google Scholar
  55. 55.
    Prati F, Capodanno D, Pawlowski T, Ramazzotti V, Albertucci M, La Manna A, et al. Local delivery versus intracoronary infusion of abciximab in patients with acute coronary syndromes. JACC Cardiovasc Interv. 2010;3(9):928–34.PubMedCrossRefGoogle Scholar
  56. 56.
    Van Mieghem NM, Kauer F, Regar E. Rheolytic versus aspiration thrombectomy in acute st-segment elevation myocardial infarction judged by OCT. EuroIntervention. 2010;5(8):994.PubMedCrossRefGoogle Scholar
  57. 57.
    Suzuki Y, Ikeno F, Koizumi T, Tio F, Yeung AC, Yock PG, et al. In vivo comparison between optical coherence tomography and intravascular ultrasound for detecting small degrees of in-stent neointima after stent implantation. JACC Cardiovasc Interv. 2008;1(2):168–73.PubMedCrossRefGoogle Scholar
  58. 58.
    Templin C, Meyer M, Muller MF, Djonov V, Hlushchuk R, Dimova I, et al. Coronary optical frequency domain imaging (OFDI) for in vivo evaluation of stent healing: comparison with light and electron microscopy. Eur Heart J. 2010;31(14):1792–801.PubMedCrossRefGoogle Scholar
  59. 59.
    Nakano M, Vorpahl M, Otsuka F, Taniwaki M, Yazdani SK, Finn AV, et al. Ex vivo assessment of vascular response to coronary stents by optical frequency domain imaging. JACC Cardiovasc Imaging. 2012;5(1):71–82.PubMedCrossRefGoogle Scholar
  60. 60.
    Takano M, Inami S, Jang IK, Yamamoto M, Murakami D, Seimiya K, et al. Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation. Am J Cardiol. 2007;99(8):1033–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Takano M, Yamamoto M, Mizuno M, Murakami D, Inami T, Kimata N, et al. Late vascular responses from 2 to 4 years after implantation of sirolimus-eluting stents: serial observations by intracoronary optical coherence tomography. Circ Cardiovasc Interv. 2010;3(5):476–83.PubMedCrossRefGoogle Scholar
  62. 62.
    Chen BX, Ma FY, Luo W, Ruan JH, Xie WL, Zhao XZ, et al. Neointimal coverage of bare-metal and sirolimus-eluting stents evaluated with optical coherence tomography. Heart. 2008;94(5):566–70.PubMedCrossRefGoogle Scholar
  63. 63.
    Guagliumi G, Costa MA, Sirbu V, Musumeci G, Bezerra HG, Suzuki N, et al. Strut coverage and late malapposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: optical coherence tomography substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial. Circulation. 2011;123(3):274–81.PubMedCrossRefGoogle Scholar
  64. 64.
    Guagliumi G, Sirbu V, Bezerra H, Biondi-Zoccai G, Fiocca L, Musumeci G, et al. Strut coverage and vessel wall response to zotarolimus-eluting and bare-metal stents implanted in patients with ST-segment elevation myocardial infarction: the OCTAMI (Optical Coherence Tomography in Acute Myocardial Infarction) Study. JACC Cardiovasc Interv. 2010;3(6):680–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Kim JS, Kim JS, Kim TH, Fan C, Lee JM, Kim W, et al. Comparison of neointimal coverage of sirolimus-eluting stents and paclitaxel-eluting stents using optical coherence tomography at 9 months after implantation. Circ J. 2010;74(2):320–6.PubMedCrossRefGoogle Scholar
  66. 66.
    Gutierrez-Chico JL, van Geuns RJ, Regar E, van der Giessen WJ, Kelbaek H, Saunamaki K, et al. Tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent vs. a fluoropolymer-coated everolimus-eluting stent at 13-month follow-up: an optical coherence tomography substudy from the RESOLUTE All Comers trial. Eur Heart J. 2011;32(19):2454–63.PubMedCrossRefGoogle Scholar
  67. 67.
    Synetos A, Toutouzas K, Karanasos A, Stathogiannis K, Triantafyllou G, Tsiamis E, et al. Differences in drug-eluting stents used in coronary artery disease. Am J Med Sci. 2011;342(5):402–8.PubMedCrossRefGoogle Scholar
  68. 68.
    Inoue K, Abe K, Ando K, Shirai S, Nishiyama K, Nakanishi M, et al. Pathological analyses of long-term intracoronary Palmaz-Schatz stenting; Is its efficacy permanent? Cardiovasc Pathol. 2004;13(2):109–15.PubMedCrossRefGoogle Scholar
  69. 69.
    Nakazawa G, Otsuka F, Nakano M, Vorpahl M, Yazdani SK, Ladich E, et al. The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol. 2011;57(11):1314–22.PubMedCrossRefGoogle Scholar
  70. 70.
    Gonzalo N, Serruys PW, Okamura T, van Beusekom HM, Garcia-Garcia HM, van Soest G, et al. Optical coherence tomography patterns of stent restenosis. Am Heart J. 2009;158(2):284–93.PubMedCrossRefGoogle Scholar
  71. 71.
    Tanimoto S, Aoki J, Serruys PW, Regar E. Paclitaxel-eluting stent restenosis shows three-layer appearance by optical coherence tomography. EuroIntervention. 2006;1(4):484.PubMedGoogle Scholar
  72. 72.
    Guagliumi G, Sirbu V, Musumeci G, Gerber R, Biondi-Zoccai G, Ikejima H, et al. Examination of the in vivo mechanisms of late drug-eluting stent thrombosis: findings from optical coherence tomography and intravascular ultrasound imaging. JACC Cardiovasc Interv. 2012;5(1):12–20.PubMedCrossRefGoogle Scholar
  73. 73.
    Yamaji K, Inoue K, Nakahashi T, Noguchi M, Domei T, Hyodo M, et al. Bare metal stent thrombosis and in-stent neoatherosclerosis. Circ Cardiovasc Interv. 2012;5(1):47–54.PubMedCrossRefGoogle Scholar
  74. 74.
    Barlis P, Regar E, Serruys PW, Dimopoulos K, van der Giessen WJ, van Geuns RJ, et al. An optical coherence tomography study of a biodegradable vs. durable polymer-coated limus-eluting stent: a LEADERS trial sub-study. Eur Heart J. 2010;31(2):165–76.PubMedCrossRefGoogle Scholar
  75. 75.
    Guagliumi G, Sirbu V, Musumeci G, Bezerra HG, Aprile A, Kyono H, et al. Strut coverage and vessel wall response to a new-generation paclitaxel-eluting stent with an ultrathin biodegradable abluminal polymer: Optical Coherence Tomography Drug-Eluting Stent Investigation (OCTDESI). Circ Cardiovasc Interv. 2010;3(4):367–75.PubMedCrossRefGoogle Scholar
  76. 76.
    Prati F, Stazi F, Dutary J, La Manna A, Di Giorgio A, Pawlosky T, et al. Detection of very early stent healing after primary angioplasty: an optical coherence tomographic observational study of chromium cobaltum and first-generation drug-eluting stents. The DETECTIVE study. Heart. 2011;97(22):1841–6.PubMedCrossRefGoogle Scholar
  77. 77.
    Gutierrez-Chico JL, van Geuns RJ, Koch KT, Koolen JJ, Duckers H, Regar E, et al. Paclitaxel-coated balloon in combination with bare metal stent for treatment of de novo coronary lesions: an optical coherence tomography first-in-human randomised trial, balloon first vs. stent first. EuroIntervention. 2011;7(6):711–22.PubMedCrossRefGoogle Scholar
  78. 78.
    Slottow TL, Pakala R, Okabe T, Hellinga D, Lovec RJ, Tio FO, et al. Optical coherence tomography and intravascular ultrasound imaging of bioabsorbable magnesium stent degradation in porcine coronary arteries. Cardiovasc Revasc Med. 2008;9(4):248–54.PubMedCrossRefGoogle Scholar
  79. 79.
    Serruys PW, Ormiston JA, Onuma Y, Regar E, Gonzalo N, Garcia-Garcia HM, et al. A bioabsorbable everolimus-eluting coronary stent system (ABSORB): 2-year outcomes and results from multiple imaging methods. Lancet. 2009;373(9667):897–910.PubMedCrossRefGoogle Scholar
  80. 80.
    Serruys PW, Onuma Y, Ormiston JA, de Bruyne B, Regar E, Dudek D, et al. Evaluation of the second generation of a bioresorbable everolimus drug-eluting vascular scaffold for treatment of de novo coronary artery stenosis: six-month clinical and imaging outcomes. Circulation. 2010;122(22):2301–12.PubMedCrossRefGoogle Scholar
  81. 81.
    Onuma Y, Serruys PW, Perkins LE, Okamura T, Gonzalo N, Garcia-Garcia HM, et al. 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: an attempt to decipher the human optical coherence tomography images in the ABSORB trial. Circulation. 2010;122(22):2288–300.PubMedCrossRefGoogle Scholar
  82. 82.
    Gomez-Lara J, Brugaletta S, Diletti R, Garg S, Onuma Y, Gogas BD, et al. A comparative assessment by optical coherence tomography of the performance of the first and second generation of the everolimus-eluting bioresorbable vascular scaffolds. Eur Heart J. 2011;32(3):294–304.PubMedCrossRefGoogle Scholar
  83. 83.
    Gutierrez-Chico JL, Serruys PW, Girasis C, Garg S, Onuma Y, Brugaletta S, et al. Quantitative multi-modality imaging analysis of a fully bioresorbable stent: a head-to-head comparison between QCA, IVUS and OCT. Int J Cardiovasc Imaging. 2011.Google Scholar
  84. 84.
    Okamura T, Serruys PW, Regar E. Cardiovascular flashlight. The fate of bioresorbable struts located at a side branch ostium: serial three-dimensional optical coherence tomography assessment. Eur Heart J. 2010;31(17):2179.PubMedCrossRefGoogle Scholar
  85. 85.
    van Soest G, Goderie T, Regar E, Koljenovic S, van Leenders GL, Gonzalo N, et al. Atherosclerotic tissue characterization in vivo by optical coherence tomography attenuation imaging. J Biomed Opt. 2010;15(1):011105.PubMedCrossRefGoogle Scholar
  86. 86.
    Giattina SD, Courtney BK, Herz PR, Harman M, Shortkroff S, Stamper DL, et al. Assessment of coronary plaque collagen with polarization sensitive optical coherence tomography (PS-OCT). Int J Cardiol. 2006;107(3):400–9.PubMedCrossRefGoogle Scholar
  87. 87.
    Liu L, Gardecki JA, Nadkarni SK, Toussaint JD, Yagi Y, Bouma BE, et al. Imaging the subcellular structure of human coronary atherosclerosis using micro-optical coherence tomography. Nat Med. 2011;17(8):1010–4.PubMedCrossRefGoogle Scholar

Copyright information

© The Author(s) 2012

Authors and Affiliations

  • Antonios Karanasos
    • 1
  • Jurgen Ligthart
    • 1
  • Karen Witberg
    • 1
  • Gijs van Soest
    • 1
  • Nico Bruining
    • 1
  • Evelyn Regar
    • 1
  1. 1.Department of CardiologyErasmus University Medical CenterRotterdamThe Netherlands

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