Optical coherence tomography (OCT) is an emerging high-resolution intravascular imaging modality that can provide physicians with critical information, thereby enabling precise characterization of plaque morphology and luminal geometry and facilitating pre-intervention lesion assessment. As OCT has a higher sensitivity for lipid-rich plaque characterization than intravascular ultrasound, vulnerable plaque detection by OCT has thus been investigated. By evaluating both the calcium thickness and arc, OCT can be the ideal method for determining both the indication and endpoint of rotational atherectomy for calcified lesions prior to stent implantation. OCT has become applicable for the optimization of stent implantation with immediate and semi-automatic quantification of stent apposition and expansion to achieve potentially better clinical outcomes. In bifurcation lesions, OCT allows the visualization of the stent-link location overhanging the side-branch ostium and the guidewire recrossing point prior to the final kissing balloon inflation through three-dimensional reconstructed OCT images, providing us with deep insights into the mechanical optimization of stent struts. Furthermore, recent studies have reported several OCT-derived predictors of adverse clinical events. Important limitations of OCT, including the excessive contrast volume needed and observation of aorto-ostial lesions, may partially be overcome through the use of low-molecular-weight dextran and a guide extension catheter. The clinical applications of OCT have been expanding, and evidence on its clinical utility has been accumulating.
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Bezerra HG, Costa MA, Guagliumi G, Rollins AM, Simon DI. Intracoronary optical coherence tomography: a comprehensive review clinical and research applications. JACC Cardiovasc Interv. 2009;2:1035–46.
Ali ZA, Maehara A, Généreux P, Shlofmitz RA, Fabbiocchi F, Nazif TM, et al. Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial. Lancet. 2016;388:2618–28.
Kubo T, Shinke T, Okamura T, Hibi K, Nakazawa G, Morino Y, et al. Optical frequency domain imaging vs. intravascular ultrasound in percutaneous coronary intervention (OPINION trial): one-year angiographic and clinical results. Eur Heart J. 2017;38:3139–47.
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;59:1058–72.
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.
Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death. Arterioscler Thromb Vasc Biol. 2000;20:1262–75.
Fujii K, Hao H, Shibuya M, Imanaka T, Fukunaga M, Miki K, et al. Accuracy of OCT, grayscale IVUS, and their combination for the diagnosis of coronary TCFA: an ex vivo validation study. JACC Cardiovasc Imaging. 2015;8:451–60.
Ndrepepa G, Tiroch K, Fusaro M, Keta D, Seyfarth M, Byrne RA, et al. 5-Year prognostic value of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction. J Am Coll Cardiol. 2010;55:2383–9.
Wu X, Mintz GS, Xu K, Lansky AJ, Witzenbichler B, Guagliumi G, et al. The relationship between attenuated plaque identified by intravascular ultrasound and no-reflow after stenting in acute myocardial infarction: the HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial. JACC Cardiovasc Interv. 2011;4:495–502.
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.
Stone GW, Webb J, Cox DA, Brodie BR, Qureshi M, Kalynych A, et al. Distal microcirculatory protection during percutaneous coronary intervention in acute ST-segment elevation myocardial infarction: a randomized controlled trial. J Am Med Assoc. 2005;293:1063–72.
Stone GW, Maehara A, Muller JE, Rizik DG, Shunk KA, Ben-Yehuda O, et al. Plaque characterization to inform the prediction and prevention of periprocedural myocardial infarction during percutaneous coronary intervention: the CANARY trial (Coronary Assessment by Near-infrared of Atherosclerotic Rupture-prone Yellow). JACC Cardiovasc Interv. 2015;8:927–36.
Onuma Y, Tanimoto S, Ruygrok P, Neuzner J, Piek JJ, Seth A, et al. Efficacy of everolimus eluting stent implantation in patients with calcified coronary culprit lesions: two-year angiographic and three-year clinical results from the SPIRIT II study. Catheter Cardiovasc Interv. 2010;76:634–42.
Kastrati A, Schömig A, Elezi S, Schühlen H, Dirschinger J, Hadamitzky M, et al. Predictive factors of restenosis after coronary stent placement. J Am Coll Cardiol. 1997;30:1428–36.
Kawamoto H, Latib A, Ruparelia N, Ielasi A, D’Ascenzo F, Pennacchi M, et al. In-hospital and midterm clinical outcomes of rotational atherectomy followed by stent implantation: the ROTATE multicentre registry. EuroIntervention. 2016;12:1448–56.
Saito Y, Kobayashi Y, Fujii K, Sonoda S, Tsujita K, Hibi K, et al. Clinical expert consensus document on standards for measurements and assessment of intravascular ultrasound from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther. 2020;35:1–12.
Sharma SK, Tomey MI, Teirstein PS, Kini AS, Reitman AB, Lee AC, et al. North American expert review of rotational atherectomy. Circ Cardiovasc Interv. 2019;12:e007448.
Barbato E, Carrié D, Dardas P, Fajadet J, Gaul G, Haude M, et al. European expert consensus on rotational atherectomy. EuroIntervention. 2015;11:30–6.
Safian RD, Feldman T, Muller DWM, Mason D, Schreiber T, Haik B, et al. Coronary Angioplasty and Rotablator Atherectomy Trial (CARAT): immediate and late results of a prospective multicenter randomized trial. Catheter Cardiovasc Interv. 2001;53:213–20.
Whitlow PL, Bass TA, Kipperman RM, Sharaf BL, Ho KKL, Cutlip DE, et al. Results of the study to determine rotablator and transluminal angioplasty strategy (STRATAS). Am J Cardiol. 2001;87:699–705.
Mehanna E, Bezerra HG, Prabhu D, Brandt E, Chamié D, Yamamoto H, et al. Volumetric characterization of human coronary calcification by frequency-domain optical coherence tomography. Circ J. 2013;77:2334–40.
Fujino A, Mintz G, Matsumura M, Yamamoto MH, Lee C, Hoshino M, et al. TCT-28: a new optical coherence tomography-based calcium scoring system to predict stent underexpansion. EuroIntervention. 2018;70:B12–3.
Kobayashi N, Ito Y, Yamawaki M, Araki M, Obokata M, Sakamoto Y, et al. Optical coherence tomography-guided versus intravascular ultrasound-guided rotational atherectomy in patients with calcified coronary lesions. EuroIntervention. 2020;16:e313–21.
Kubo T, Shimamura K, Ino Y, Yamaguchi T, Matsuo Y, Shiono Y, et al. Superficial calcium fracture after PCI as assessed by OCT. JACC Cardiovasc Imaging. 2015;8:1228–9.
Maejima N, Hibi K, Saka K, Akiyama E, Konishi M, Endo M, et al. Relationship between thickness of calcium on optical coherence tomography and crack formation after balloon dilatation in calcified plaque requiring rotational atherectomy. Circ J. 2016;80:1413–9.
Hahn JY, Chun WJ, Kim JH, Song YB, Oh JH, Koo BK, et al. Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions: results from the COBIS II registry (coronary bifurcation stenting). J Am Coll Cardiol. 2013;62:1654–9.
Kini AS, Vengrenyuk Y, Pena J, Yoshimura T, Panwar SR, Motoyama S, et al. Plaque morphology predictors of side branch occlusion after provisional stenting in coronary bifurcation lesion: results of optical coherence tomography bifurcation study (ORBID). Catheter Cardiovasc Interv. 2017;89:259–68.
Watanabe M, Uemura S, Sugawara Y, Ueda T, Soeda T, Takeda Y, et al. Side branch complication after a single-stent crossover technique: prediction with frequency domain optical coherence tomography. Coron Artery Dis. 2014;25:321–9.
Burzotta F, Trani C, Sianos G. Jailed balloon protection: a new technique to avoid acute side-branch occlusion during provisional stenting of bifurcated lesions. Bench test report and first clinical experience. EuroIntervention. 2010;5:809–13.
Saito S, Shishido K, Moriyama N, Ochiai T, Mizuno S, Yamanaka F, et al. Modified jailed balloon technique for bifurcation lesions. Catheter Cardiovasc Interv. 2018;92:E218–26.
Numasawa Y, Sakakura K, Yamamoto K, Yamamoto S, Taniguchi Y, Fujita H, et al. A novel side branch protection technique in coronary stent implantation: jailed Corsair technique. Cardiovasc Revasc Med. 2017;18:295–8.
Fujii K, Kubo T, Otake H, Nakazawa G, Sonoda S, Hibi K, et al. Expert consensus statement for quantitative measurement and morphological assessment of optical coherence tomography. Cardiovasc Interv Ther. 2020;35:13–8.
Attizzani GF, Capodanno D, Ohno Y, Tamburino C. Mechanisms, pathophysiology, and clinical aspects of incomplete stent apposition. J Am Coll Cardiol. 2014;63:1355–67.
Shimamura K, Kubo T, Akasaka T, Kozuma K, Kimura K, Kawamura M, et al. Outcomes of everolimus-eluting stent incomplete stent apposition: a serial optical coherence tomography analysis. Eur Heart J Cardiovasc Imaging. 2015;16:23–8.
Soeda T, Uemura S, Park SJ, Jang Y, Lee S, Cho JM, et al. Incidence and clinical significance of poststent optical coherence tomography findings: one-year follow-up study from a multicenter registry. Circulation. 2015;132:1020–9.
Prati F, Romagnoli E, Burzotta F, Limbruno U, Gatto L, La Manna A, et al. Clinical impact of OCT findings during PCI: the CLI-OPCI II study. JACC Cardiovasc Imaging. 2015;8:1297–305.
Im E, Kim BK, Ko YG, Shin DH, Kim JS, Choi D, et al. Incidences, predictors, and clinical outcomes of acute and late stent malapposition detected by optical coherence tomography after drug-eluting stent implantation. Circ Cardiovasc Interv. 2014;7:88–96.
Romagnoli E, Gatto L, La Manna A, Burzotta F, Taglieri N, Saia F, et al. Role of residual acute stent malapposition in percutaneous coronary interventions. Catheter Cardiovasc Interv. 2017;90:566–75.
Hong YJ, Jeong MH, Ahn Y, Sim DS, Chung JW, Cho JS, et al. Plaque prolapse after stent implantation in patients with acute myocardial infarction: an intravascular ultrasound analysis. JACC Cardiovasc Imaging. 2008;1:489–97.
Hong YJ, Jeong MH, Choi YH, Song JA, Kim DH, Lee KH, et al. Impact of tissue prolapse after stent implantation on short- and long-term clinical outcomes in patients with acute myocardial infarction: an intravascular ultrasound analysis. Int J Cardiol. 2013;166:646–51.
Maehara A, Matsumura M, Ali ZA, Mintz GS, Stone GW. IVUS-guided versus OCT-guided coronary stent implantation: a critical appraisal. JACC Cardiovasc Imaging. 2017;10:1487–503.
Nakano M, Yahagi K, Otsuka F, Sakakura K, Finn AV, Kutys R, et al. Causes of early stent thrombosis in patients presenting with acute coronary syndrome: an ex vivo human autopsy study. J Am Coll Cardiol. 2014;63:2510–20.
Fujii K, Carlier SG, Mintz GS, Yang YM, Moussa I, Weisz G, et al. Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J Am Coll Cardiol. 2005;45:995–8.
Hong MK, Mintz GS, Lee CW, Park DW, Choi BR, Park KH, et al. Intravascular ultrasound predictors of angiographic restenosis after sirolimus-eluting stent implantation. Eur Heart J. 2006;27:1305–10.
Sonoda S, Morino Y, Ako J, Terashima M, Hassan AH, Bonneau HN, et al. Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the SIRIUS trial. J Am Coll Cardiol. 2004;43:1959–63.
Doi H, Maehara A, Mintz GS, Yu A, Wang H, Mandinov L, et al. Impact of post-intervention minimal stent area on 9-month follow-up patency of paclitaxel-eluting stents: an integrated intravascular ultrasound analysis from the TAXUS IV, V, and VI and TAXUS ATLAS Workhorse, Long Lesion, and Direct Stent Trials. JACC Cardiovasc Interv. 2009;2:1269–75.
Hong SJ, Kim BK, Shin DH, Nam CM, Kim JS, Ko YG, et al. Effect of intravascular ultrasound-guided vs angiography-guided everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial. JAMA. 2015;314:2155–63.
Nakamura D, Wijns W, Price MJ, Jones MR, Barbato E, Akasaka T, et al. New volumetric analysis method for stent expansion and its correlation with final fractional flow reserve and clinical outcome: an ILUMIEN I Substudy. JACC Cardiovasc Interv. 2018;11:1467–78.
Okamura T, Onuma Y, Yamada J, Iqbal J, Tateishi H, Nao T, et al. 3D optical coherence tomography: new insights into the process of optimal rewiring of side branches during bifurcational stenting. EuroIntervention. 2014;10:907–15.
Okamura T, Nagoshi R, Fujimura T, Murasato Y, Yamawaki M, Ono S, et al. Impact of guidewire recrossing point into stent jailed side branch for optimal kissing balloon dilatation: core lab 3D optical coherence tomography analysis. EuroIntervention. 2018;13:e1785–93.
Nagoshi R, Okamura T, Murasato Y, Fujimura T, Yamawaki M, Ono S, et al. Feasibility and usefulness of three-dimensional optical coherence tomography guidance for optimal side branch treatment in coronary bifurcation stenting. Int J Cardiol. 2018;250:270–4.
Nishimura T, Okamura T, Fujimura T, Miyazaki Y, Mochizuki M, Oda T, et al. TCT-347 frequency of incomplete stent apposition at side-branch ostium after kissing balloon inflation predicted from pre-operative appearance of coronary artery bifurcation on 3-dimensional optical coherence tomograms. J Am Coll Cardiol. 2019;74:B344.
Hikichi Y, Umezu M, Node K, Iwasaki K. Reduction in incomplete stent apposition area caused by jailed struts after single stenting at left main bifurcation lesions: micro-CT analysis using a three-dimensional elastic bifurcated coronary artery model. Cardiovasc Interv Ther. 2017;32:12–7.
Yamawaki M, Muramatsu T, Ashida K, Kishi K, Morino Y, Kinoshita Y, et al. Randomized comparison between 2-link cell design biolimus A9-eluting stent and 3-link cell design everolimus-eluting stent in patients with de novo true coronary bifurcation lesions: the BEGIN trial. Heart Vessels. 2019;34:1297–308.
Habara M, Nasu K, Terashima M, Kaneda H, Yokota D, Ko E, et al. Impact of frequency-domain optical coherence tomography guidance for optimal coronary stent implantation in comparison with intravascular ultrasound guidance. Circ Cardiovasc Interv. 2012;5:193–201.
Prati F, Di Vito L, Biondi-Zoccai G, Occhipinti M, La Manna A, Tamburino C, et al. Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l’Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study. EuroIntervention. 2012;8:823–9.
James MT, Samuel SM, Manning MA, Tonelli M, Ghali WA, Faris P, et al. Contrast-induced acute kidney injury and risk of adverse clinical outcomes after coronary angiography: a systematic review and meta-analysis. Circ Cardiovasc Interv. 2013;6:37–43.
Kurogi K, Ishii M, Sakamoto K, Komaki S, Marume K, Kusaka H, et al. Persistent renal dysfunction in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. J Am Heart Assoc. 2019;8:e014096.
Ozaki Y, Kitabata H, Tsujioka H, Hosokawa S, Kashiwagi M, Ishibashi K, et al. Comparison of contrast media and low-molecular-weight dextran for frequency-domain optical coherence tomography. Circ J. 2012;76:922–7.
Kurogi K, Ishii M, Sakamoto K, Komaki S, Kusaka H, Yamamoto N, et al. Optical coherence tomography-guided percutaneous coronary intervention with low-molecular-weight dextran – effect on renal function. Circ J. 2020;84:917–25.
Kurogi K, Ishii M, Sakamoto K, Kusaka H, Yamamoto N, Takashio S, et al. Minimum-contrast percutaneous coronary intervention guided by optical coherence tomography using low–molecular weight dextran. JACC Cardiovasc Interv. 2020;13:1270–2.
Kurogi K, Ishii M, Sakamoto K, Tusjita K. Observing an aorto-ostial lesion using TELESCOPE® in optical coherence tomography-guided percutaneous coronary intervention. PCROnline. 2020. https://www.pcronline.com/Cases-resources-images/Images-interventional-cardiology/EuroIntervention-images/Aorto-ostial-lesion-observation-by-OCT.
Conflict of interest
Dr. Tsujita has received remuneration for lecture from Amgen Astellas BioPharma K.K., Kowa Pharmaceutical Co. Ltd., Daiichi Sankyo Co., Ltd., Takeda Pharmaceutical Co., Ltd., Bayer Yakuhin, Ltd., Pfizer Japan Inc., Bristol-Myers K.K., MSD K.K.; has received trust research/joint research funds from Bristol-Myers K.K., Sugi Bee Garden Co., Ltd., Kowa Pharmaceutical Co. Ltd.; and has received scholarship fund from ITI Co., Ltd., Abbott Medical Japan L.L.C, Abbott Vascular Japan Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Cardinal Health Japan, Kaneka Medix Co., Ltd., Takeda Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma, Chugai Pharmaceutical Co., Ltd., TERUMO Co., Ltd., NIPRO CORPORATION, NIHON KOHDEN CORPORATION, Medtronic Japan Co., Ltd., Japan Lifeline Co., Ltd., Fides-One, Inc., Fukuda Denshi Co., Ltd., and Boston Scientific Japan K.K. All the other authors have nothing to disclose.
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Kurogi, K., Ishii, M., Yamamoto, N. et al. Optical coherence tomography-guided percutaneous coronary intervention: a review of current clinical applications. Cardiovasc Interv and Ther (2021). https://doi.org/10.1007/s12928-020-00745-4
- Intravascular imaging
- Optical coherence tomography
- Percutaneous coronary intervention