Abstract
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been developed and improved as both diagnostic and guidance tools for interventional procedures over the past three decades. IVUS has a resolution of 100 μm with a high tissue penetration and capability of assessing the entire structure of a coronary artery including the external elastic membrane, whereas OCT has a higher resolution of 10–20 μm to assess endoluminal structures with a limited tissue penetration compared to IVUS. Recently, two companies, CONAVI and TERUMO, integrated IVUS and OCT into a single catheter system. With their inherent strength and limitations, the combined IVUS and OCT probes are complementary and work synergistically to enable a comprehensive depiction of coronary artery. In this review, we summarize the performance of the two intracoronary imaging modalities—IVUS and OCT—and discuss the expected potential of the novel hybrid IVUS–OCT catheter system in the clinical field.
Highlights
History of Intracoronary Imaging ModalitiesThe history of percutaneous coronary intervention (PCI) started with the first coronary balloon angioplasty performed by Andreas Grüntzig in 1977 [1]
In 2011, Stone et al reported the results of the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, demonstrating that a large plaque burden (≥70%) (HR: 5.03, 95% CI: 2.51–10.11) and a thin-cap fibroatheroma (TCFA) (HR: 3.35, 95% CI: 1.77– 6.36) detected by Intravascular ultrasound (IVUS)-RF as well as a minimal lumen area
In the OPTIMUM trial, Onuma et al reported that 3D optical coherence tomography (OCT)-guided PCI and re-crossing through the optimal strut cell after stent implantation followed by kissing-balloon technique (KBT) significantly reduced acute incomplete stent apposition (ISA) at the bifurcation compared to angiography-guided PCI (19.5 vs. 27.5%, p = 0.008) in patients with bifurcation lesion including left main coronary artery (LMCA) disease [136, 137]
Summary
Perspective of Novel Hybrid Catheter System in Coronary Imaging. IVUS has a resolution of 100 μm with a high tissue penetration and capability of assessing the entire structure of a coronary artery including the external elastic membrane, whereas OCT has a higher resolution of 10–20 μm to assess endoluminal structures with a limited tissue penetration compared to IVUS. Two companies, CONAVI and TERUMO, integrated IVUS and OCT into a single catheter system. With their inherent strength and limitations, the combined IVUS and OCT probes are complementary and work synergistically to enable a comprehensive depiction of coronary artery. We summarize the performance of the two intracoronary imaging modalities—IVUS and OCT—and discuss the expected potential of the novel hybrid IVUS–OCT catheter system in the clinical field
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