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Abstract
Optical coherence tomography (OCT) has emerged as a powerful intravascular imaging modality in recent years. The introduction of frequency-domain OCT has simplified the procedure and enabled its safe utilisation in different clinical settings including acute coronary syndromes, where it can determine the mechanism of plaque disruption, thrombus burden, and guide percutaneous coronary intervention. In patients presenting with stent failure (stent thrombosis and instent restenosis), OCT can also be very useful in determining the underlying mechanism and guiding therapy thereafter. This article aims to review the role of OCT in acute coronary syndromes as well as its potential clinical applications.
Highlights
The vast majority of acute coronary syndromes (ACS) are of atherosclerotic aetiology.[1]
Postmortem studies in the last 25 years revealed that in some patients presenting with myocardial infarction (MI), coronary thrombosis occurred without physical disruption of the plaque fibrous cap.[3,4,5]
In a study involving 72 consecutive anterior AMI patients, MIs induced by plaque rupture were found to cause more myocardial damage and poorer functional recovery compared to those caused by plaque erosions, even after successful primary angioplasty.[41]
Summary
The vast majority of acute coronary syndromes (ACS) are of atherosclerotic aetiology.[1]. IVUS and CAS have higher spatial resolution (150–200 μm and 50 μm respectively) At this resolution, characterization of plaque morphology and fibrous cap integrity remains challenging.[21] On the other. It is important to recognize that the current resolution of OCT is still insufficient to visualize endothelial cells and detect such denudation For this reason, the term ‘‘disrupted plaque with intact fibrous plaque (IFC)’’ rather than plaque erosion is preferable.[40]. Page 10 of 14 Samir & ElGuindy, GCSP 2016:36 despite the major advances in coronary imaging, which remains an important area for future research
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