The role of IVUS and OCT in the patients with Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Abstract

The work presented describes what is meant by the term MINOCA and the causes that lead to the onset of this acute event, responsible for myocardial ischemic necrosis. Diagnosis with coronary angiography alone cannot be made since MINOCA is characterized in half of cases by the absence of hemodynamically significant lesions and therefore invasive coronary imaging performed through IVUS and OCT plays an important role. The two imaging techniques have peculiar characteristics that differentiate them from each other. IVUS uses ultrasound while OCT uses infrared light, but they are also distinguished in terms of spatial resolution, which is greater for OCT thus allowing better tissue characterization, and tissue penetration capacity which is greater for IVUS. In MINOCA patients, coronary artery imaging could help identify pathological changes that are not visible by coronary angiography such as plaque rupture, coronary dissection, coronary thromboembolism, coronary spasm, and coronary artery disease in patients presenting with Takotsubo syndrome. The use of intracoronary imaging (IVUS or OCT) can give us important information regarding the diagnosis and optimization of the treatment of patients with MINOCA, improving their prognosis. The medical radiology technician, within the Hemodynamics Team, must have a role of responsibility in the management of diagnostic images.