Optical coherence tomography imaging: current status and future perspectives

Current and future developments in OCT
Review Article


Optical coherence tomography (OCT) is an optical analogue of intravascular ultrasound that provides high-resolution (10–20 μm) cross-sectional images of coronary arteries. The micron-scale resolution of OCT has an ability to capture in vivo what was previously seen only through a pathologist’s microscope. OCT can differentiate three types of atherosclerotic plaque components (fibrous, fibrocalcific and lipid-rich) with high sensitivity and specificity. Early in vitro and in vivo studies have demonstrated a possibility of OCT for identifying vulnerable plaque features, in particular the quantification of plaque rupture, intracoronary thrombus, thin-capped fibroatheroma and the distribution of macrophages within the fibrous cap. In addition, OCT has shown its effectiveness in imaging the short-term and long-term results of percutaneous coronary intervention. OCT can precisely assess stent strut malapposition, tissue protrusion, coronary artery dissection, and neointimal hyperplasia following stent implantation. Recently, next-generation OCT, called Fourier-domain OCT, has already been shown to be a powerful enabling technology for coronary imaging. The novel developments with high frame rate and fast pullback speed simplifies procedural requirements and will eventually eliminate limitations of current OCT systems such as need for proximal vessel balloon occlusion during image acquisition. This report details current and future developments in OCT imaging, which include exciting technological advancements that will consolidate the position of OCT as a key diagnostic tool to complement the armamentarium of the cardiologist well into the future.


Optical coherence tomography Coronary artery disease Vulnerable plaque Percutaneous coronary intervention Imaging 


  1. 1.
    Kubo T, Akasaka T. Recent advances in intracoronary imaging techniques: focus on optical coherence tomography. Expert Rev Med Devices. 2008;5:691–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Kubo T, Akasaka T. OCT-ready for prime time? : clinical applications of optical coherence tomography. Cardiac Interve Today. 2009;4:35–7.Google Scholar
  3. 3.
    Raffel OC, Akasaka T, Jang IK. Cardiac optical coherence tomography. Heart. 2008;94:1200–10.CrossRefPubMedGoogle Scholar
  4. 4.
    Yamaguchi T, Terashima M, Akasaka T, Hayashi T, Mizuno K, Muramatsu T, et al. Safety and feasibility of an intravascular optical coherence tomography image wire system in the clinical setting. Am J Cardiol. 2008;101:562–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Kataiwa H, Tanaka A, Kitabata H, Imanishi T, Akasaka T. Safety and usefulness of non-occlusion image acquisition technique for optical coherence tomography. Circ J. 2008;72:1536–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Prati F, Cera F, 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;3:365–70.PubMedGoogle Scholar
  7. 7.
    Prati F, Cera M, Ramazzotti V, Imola F, Giudice R, Giudice M, et al. From bench to bedside: a novel technique of acquiring OCT images. Circ J. 2008;72:839–43.CrossRefPubMedGoogle Scholar
  8. 8.
    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;5:90–5.PubMedGoogle Scholar
  9. 9.
    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;69:903–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Kume T, Akasaka T, Kawamoto T, Watanabe N, Toyota E, Neishi Y, et al. Assessment of coronary arterial plaque by optical coherence tomography. Am J Cardiol. 2006;97:1172–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Jang IK, Bouma BE, Kang DH, Park SJ, Park SW, Seung KB, et al. Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound. J Am Coll Cardiol. 2002;39:604–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, et al. Characterization of human atherosclerosis by optical coherence tomography. Circulation. 2002;106:1640–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Kawasaki M, Bouma BE, Bressner J, Houser SL, Nadkarni SK, MacNeill BD, et al. Diagnostic accuracy of optical coherence tomography and integrated backscatter intravascular ultrasound images for tissue characterization of human coronary plaques. J Am Coll Cardiol. 2006;48:81–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Kitabata H, Kubo T, Akasaka T. Identification of multiple plaque ruptures by optical coherence tomography in a patient with acute myocardial infarction: a three-vessel study. Heart. 2008;94:544.CrossRefPubMedGoogle Scholar
  15. 15.
    Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Tanimoto T, et al. Morphology of exertion-triggered plaque rupture in patients with acute coronary syndrome: an optical coherence tomography study. Circulation. 2008;118:2368–73.CrossRefPubMedGoogle Scholar
  16. 16.
    Tanimoto T, Imanishi T, Tanaka A, Yamano T, Kitabata H, Takarada S, et al. Various types of plaque disruption in a culprit coronary artery visualized by optical coherence tomography in a patient with unstable angina. Circ J. 2009;73:187–9.CrossRefPubMedGoogle Scholar
  17. 17.
    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;50:933–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, et al. Implication of plaque color classification for assessing plaque vulnerability: a coronary angioscopy and optical coherence tomography investigation. JACC Cardiovasc Interv. 2008;1:74–80.CrossRefPubMedGoogle Scholar
  19. 19.
    Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Kataiwa H, et al. Distribution and frequency of thin-capped fibroatheromas and ruptured plaques in the entire culprit coronary artery in patients with acute coronary syndrome as determined by optical coherence tomography. Am J Cardiol. 2008;102:975–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Kume T, Okura H, Yamada R, Kawamoto T, Watanabe N, Neishi Y, et al. Frequency and spatial distribution of thin-cap fibroatheroma assessed by 3-vessel intravascular ultrasound and optical coherence tomography. Circ J. 2009;73:1086–91.CrossRefPubMedGoogle Scholar
  21. 21.
    Kume T, Akasaka T, Kawamoto T, Okura H, Watanabe N, Toyota E, et al. Measurement of the thickness of the fibrous cap by optical coherence tomography. Am Heart J. 2006;152:e1–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Sawada T, Shite J, Garcia-Garcia HM, Shinke T, Watanabe S, Otake H, et al. Feasibility of combined use of intravascular ultrasound radiofrequency data analysis and optical coherence tomography for detecting thin-cap fibroatheroma. Eur Heart J. 2008;29:1136–46.CrossRefPubMedGoogle Scholar
  23. 23.
    Jang IK, Tearney GJ, MacNeill B, Takano M, Moselewski F, Iftima N, et al. In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation. 2005;111:1551a–5a.Google Scholar
  24. 24.
    Fujii K, Masutani M, Okumura T, Kawasaki D, Akagami T, Ezumi A, et al. Frequency and predictor of coronary thin-cap fibroatheroma in patients with acute myocardial infarction and stable angina pectoris a 3-vessel optical coherence tomography study. J Am Coll Cardiol. 2008;52:787–8.Google Scholar
  25. 25.
    Takarada S, Imanishi T, Kubo T, Tanimoto T, Kitabata H, et al. Effect of statin therapy on coronary fibrous-cap thickness in patients with acute coronary syndrome: assessment by optical coherence tomography study. Atherosclerosis. 2009;202:491–7.CrossRefPubMedGoogle Scholar
  26. 26.
    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;97:1713–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Tearney GJ, Yabushita H, Houser SL, Aretz HT, Jang IK, Schlendorf KH, et al. Quantification of macrophage content in atherosclerotic plaques by optical coherence tomography. Circulation. 2003;107:113–9.CrossRefPubMedGoogle Scholar
  28. 28.
    MacNeill BD, Jang IK, Bouma BE, Iftimia N, Takano M, Yabushita H, et al. Focal and multi-focal plaque macrophage distributions in patients with acute and stable presentations of coronary artery disease. J Am Coll Cardiol. 2004;44:972–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, et al. Comparison of vascular response after sirolimus-eluting stent implantation between unstable angina pectoris and stable angina pectoris: a serial optical coherence tomography study. JACC Cardiovasc Imaging. 2008;1:475–84.CrossRefPubMedGoogle Scholar
  30. 30.
    Kubo T, Akasaka T. Reply Letter to: optical coherence tomography to diagnose under-expansion of a drug eluting stent. JACC Cardiovasc Imaging. 2009;2:246.CrossRefGoogle Scholar
  31. 31.
    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;89:317–20.CrossRefPubMedGoogle Scholar
  32. 32.
    Takeda Y, Katoh D. OCT guided winning technique for chronic total occlusion. In: Regar E, van Leeuwen AMGJ, Serruys PW, editors. Optical coherence tomography in cardiovascular research. 1st ed. United Kingdom: Informa Healthcare, 2007:45.Google Scholar
  33. 33.
    Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Tanimoto T, et al. Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study. Eur Heart J. 2009;30:1348–55.CrossRefPubMedGoogle Scholar
  34. 34.
    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;99:1033–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Matsumoto D, Shite J, Shinke T, Otake H, Tanino Y, Ogasawara D, et al. Neointimal coverage of sirolimus-eluting stents at six-month follow-up: evaluated by optical coherence tomography. Eur Heart J. 2007;28:961–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Takano M, Yamamoto M, Inami S, Murakami D, Seimiya K, Ohba T, et al. Long-term follow-up evaluation after sirolimus-eluting stent implantation by optical coherence tomography: do uncovered struts persist? J Am Coll Cardiol. 2008;51:968–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Matsumoto H, Arita Y, et al. Relationship between coronary arterial remodeling, fibrous cap thickness and high-sensitivity c-reactive protein levels in patients with acute coronary syndrome. Circ J. 2009;73:1291–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Tearney GJ, Waxman S, Shishkov M, Vakoc BJ, Suter MJ, Freilich MI, et al. Three-dimensional coronary artery microscopy by intracoronary optical frequency domain imaging. JACC Cardiovasc Imaging. 2008;1:752–61.CrossRefPubMedGoogle Scholar
  39. 39.
    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;107:400–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Nadkarni SK, Pierce MC, Park BH, de Boer JF, Whittaker P, Bouma BE, et al. Measurement of collagen and smooth muscle cell content in atherosclerotic plaques using polarization-sensitive optical coherence tomography. J Am Coll Cardiol. 2007;49:1474–81.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2009

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineWakayama Medical UniversityWakayamaJapan

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