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Technology Insight: optical coherence tomography—current status and future development

Abstract

The understanding of concepts in coronary artery disease, such as the vulnerable or high-risk plaque, which accounts for many acute coronary events arising from non-flow-limiting coronary lesions, has advanced remarkably. Although coronary angiography is an established imaging technique for visualizing atherosclerotic disease, it is limited by its two-dimensional imaging aspect and a low sensitivity for identifying lesions in the presence of positive remodeling and diffuse disease. Moreover, coronary atherosclerotic plaques cannot be characterized. Although intravascular ultrasound is currently the most commonly employed adjunctive method to better define lesions, it is limited by low resolution. The development of new technologies for improved coronary plaque characterization has, thus, been desired. Optical coherence tomography is a developing technique that uses near-infrared light for the cross-sectional visualization of the vessel wall at the microscopic level. It enables excellent resolution of coronary architecture and precise characterization of plaque architecture. Quantification of macrophages within the plaque is also possible. These capabilities allow precise identification of the most common type of vulnerable plaque, the thin-cap fibroatheroma. Here, we discuss results from clinical studies which indicate that optical coherence tomography is a promising imaging technique for improved characterization of the coronary atherosclerotic plaque.

Key Points

  • Optical coherence tomography is an optical analog of intravascular ultrasound, but with a much higher resolution

  • This new imaging modality allows in vivo study of coronary vascular structures at the microscopic level, which include plaque characteristics, fibrous cap thickness, and macrophage density

  • The results of optical coherence tomography might help us to understand the vascular response to percutaneous intervention and might eventually improve clinical outcome

  • Current limitations, such as red-blood-cell interference and limited penetration depth, might be overcome in the near future by optical frequency domain imaging

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Figure 1: Histology of vulnerable coronary plaques seen on Movat's pentachrome staining.
Figure 2: Schematic of optical coherence tomography system.
Figure 3: In vivo optical coherence tomography images of different coronary plaque types compared with intravascular ultrasonography of the corresponding sites.
Figure 4: Low and high magnification of optical coherence tomography and corresponding histology images.
Figure 5: Selected optical coherence tomography images of clinically relevant atherosclerosis-related situations.

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Acknowledgements

We thank our research staff at the Cardiovascular Clinical Research Office, and nurses and technologists at the cardiac catheterization laboratories of the Massachusetts General Hospital, MA, USA. Funding for work described was provided by the Center for Integration of Medicine and Innovative Technology, the National Institutes of Health and through a generous gift from Mr and Mrs John and Marilee Polmonari. AF Low is the recipient of a Health Manpower Development Program Fellowship funded by the Ministry of Health, Singapore.

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Correspondence to Ik-Kyung Jang.

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Low, A., Tearney, G., Bouma, B. et al. Technology Insight: optical coherence tomography—current status and future development. Nat Rev Cardiol 3, 154–162 (2006). https://doi.org/10.1038/ncpcardio0482

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