Abstract
OCT has been reported as a high-resolution imaging tool for characterizing plaque in the coronary arteries. The present study aimed to evaluate the ability of OCT to visualize carotid artery plaques compared with that of IVUS in asymptomatic and symptomatic patients. OCT was performed for 34 plaques (17 symptomatic, 17 asymptomatic) in 30 patients during CAS under a proximal cerebral protection method. OCT was performed before balloon angioplasty and after stent placement. IVUS was also performed just after OCT. No technical or neurologic complications were encountered by using OCT. An inner catheter was used in 12 of 34 procedures (35.3%) for advancing the OCT image wire beyond the site of stenosis. OCT clearly visualized intraluminal thrombus in 15 of 34 plaques (44.1%), whereas IVUS detected a thrombus in 1 plaque (2.9%, P < .001). Neovascularization was demonstrated in 13 of 34 plaques (38.2%) by OCT, but not by IVUS (0%, P < .001). Intraluminal thrombus was more frequently observed in symptomatic plaques (13 of 17, 76.5%) than in asymptomatic plaques (2 of 17, 11.8%; P < .001). Interobserver and intraobserver variability with OCT diagnosis was excellent for thrombus, ulceration, neovascularization, and lipid pool. The present findings suggest that OCT can safely and precisely visualize human carotid plaques during CAS and that intraluminal thrombus and neovascularization are more frequently detected in symptomatic plaques.
Highlights
MethodsOCT was performed for 34 plaques (17 symptomatic, 17 asymptomatic) in 30 patients during CAS under a proximal cerebral protection method
AND PURPOSE: OCT has been reported as a high-resolution imaging tool for characterizing plaque in the coronary arteries
OCT clearly visualized intraluminal thrombus in 15 of 34 plaques (44.1%), whereas IVUS detected a thrombus in 1 plaque (2.9%, P Ͻ .001)
Summary
OCT was performed for 34 plaques (17 symptomatic, 17 asymptomatic) in 30 patients during CAS under a proximal cerebral protection method. OCT and IVUS were performed for 34 lesions in 30 patients during the CAS procedure, with 4 patients undergoing bilateral CAS. Plaques were defined as “asymptomatic” if they did not cause truly ipsilateral ischemic lesions or had not caused ipsilateral ischemic lesions within the past 180 days.[10] Grade of carotid stenosis was assessed by using angiography,[11] and indications for CAS were based on the SAPPHIRE trial.[12] OCT examination was performed only when CAS was planned under proximal protection methods, due to the need for continuous injection of saline through the guiding catheter to remove blood from the FOV. Because OCT is approved only for coronary arteries, the application to human carotid arteries was approved by our institutional ethics committee (No 21-108), and the study protocol was submitted to an open-access
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