Optical Coherence Tomography Group Research Articles

Intracoronary Imaging for Changing Therapeutic Decisions in Patients with Multivascular Coronary Artery Disease.

Background and Objectives: Atherosclerotic disease is a major contributor to heart failure, stroke, and myocardial infarction, significantly lowering the quality of life and life expectancy and placing a significant burden on healthcare. Not all lesions deemed non-significant are benign, and conversely, not all significant lesions are causative of ischemia. Fractional flow reserve (FFR) provides a functional assessment of coronary lesions, while optical coherence tomography (OCT) offers detailed imaging of plaque morphology, aiding in therapeutic decision-making. The objective of this study was to evaluate the utility of OCT and FFR as adjunctive tools in the catheterization laboratory for guiding therapeutic decisions in patients with multivessel disease for non-culprit vessels. Specifically, we aimed to assess how OCT and FFR influence therapeutic decision-making in patients with multivessel coronary artery disease. Materials and Methods: A total of 36 patients with acute coronary syndrome (ACS) and multivessel disease were randomized 1:1 into two groups: one guided by FFR alone and the other by a combination of FFR and OCT. For the FFR group, revascularization decisions for non-culprit lesions were based solely on FFR measurements. If the FFR was >0.8, the procedure was concluded, and the patient received maximal medical treatment. If the FFR was ≤0.8, a stent was placed. For the FFR + OCT group, if the FFR was >0.8, the revascularization decision was based on OCT findings. If there were no vulnerable plaques (VP), the procedure was concluded, and the patient received maximal medical treatment. If OCT imaging indicated VP, then the patient underwent revascularization. If the FFR was ≤0.8, the patient underwent revascularization regardless of OCT findings. Results: OCT imaging altered the therapeutic decision in 11 cases where FFR measurements were above 0.8, but the lesions were characterized as VP. Analyzing the total change in the decision to stent, 4 cases in the FFR group and 15 cases in the FFR and OCT groups (4 based on FFR and 11 on OCT) revealed a statistically significant difference (p = 0.0006; Relative Risk = 0.2556; 95% CI: 0.1013 to 0.5603). When analyzing the change in the total decision both to stent and not to stent, we observed a statistically significant difference, with Group 1 having 7 cases and Group 2 having 15 cases (p = 0.0153; Relative Risk = 0.4050; 95% CI: 0.2004 to 0.7698. Conclusions: Based on the findings of this study, OCT significantly increases the percentage of stenting procedures by identifying vulnerable lesions. The use of intracoronary imaging facilitates the timely identification and treatment of these vulnerable lesions. This underscores the crucial role of OCT in enhancing the precision of coronary interventions by ensuring timely intervention for vulnerable lesions, thereby potentially improving patient outcomes.

Importance of optical coherence tomography before cataract surgery

PurposeTo determine the importance of optical coherence tomography (OCT) in patients scheduled for cataract surgery who present with no pathologies in biomicroscopic fundus examination.DesignRetrospective study.MethodsIn this study, the routine ophthalmologic examination of patients who were recommended cataract surgery was performed.Occult retinal pathologies were evaluated using OCT in patients without any pathologies in biomicroscopic fundus examination.According to whether retinal pathologies were detected on OCT, the patients were divided into two groups: normal and abnormal OCT.The findings of patients with retinal pathologies on OCT and their distribution according to age were also evaluated.ResultsA total of 271 eyes from 271 patients were evaluated.The number of patients with retinal pathologies on OCT despite normal fundoscopic examination findings was 38(14.0%).Of these patients,15(39.4%) had an epiretinal membrane,10(26.3%) had age-related macular degeneration, eight(21%) had vitreomacular traction, two(5.2%) had a lamellar hole, and 1(2.6%) patient each had a full-thickness macular hole, an intraretinal cyst, and photoreceptor layer damage.The age distribution of the patients with retinal pathologies was as follows: two patients,<60 years; six patients,60–70 years;14 patients,70–80 years; and 16 patients,>80 years.The rate of patients aged > 70 years and above was 78.9%.There was no statistically significant difference between the normal and abnormal OCT groups in terms of age, gender, the presence of systemic diseases, visual acuity, central macular thickness, and cataract type or density(p > 0.05 for all).ConclusionIn one of seven patients evaluated, retinal pathologies were detected on OCT despite normal fundoscopic examination findings.OCT can be used to detect occult retinal pathologies that cannot be detected by biomicroscopic fundus examination before cataract surgery.

Imaging the Area of Internal Limiting Membrane Peeling after Macular Hole Surgery.

Background: The aim of this study was to compare en-face optical coherence tomography (OCT) imaging and confocal scanning laser ophthalmoscopy (cSLO) imaging at different wavelengths to identify the internal limiting membrane (ILM) peeling area after primary surgery with vitrectomy and ILM peeling for macular hole (MH). Methods: In total, 50 eyes of 50 consecutive patients who underwent primary surgery with vitrectomy and ILM peeling for MH were studied. The true ILM rhexis based on intraoperative color fundus photography was compared to the presumed ILM rhexis identified by a blinded examiner using en-face OCT imaging and cSLO images at various wavelengths. To calculate the fraction of overlap (FoO), the common intersecting area and the total of both areas were measured. Results: The FoO for the measured areas was 0.93 ± 0.03 for en-face OCT, 0.76 ± 0.06 for blue reflectance (BR; 488 nm), 0.71 ± 0.09 for green reflectance (GR; 514 nm), 0.56 ± 0.07 for infrared reflectance (IR; 815 nm) and 0.73 ± 0.06 for multispectral (MS). The FoO in the en-face OCT group was significantly higher than in all other groups, whereas the FoO in the IR group was significantly lower compared to all other groups. No significant differences were observed in FoO among the MS, BR, and GR groups. In en-face OCT, there was no significant change in the ILM peeled area measured intraoperatively and postoperatively (8.37 ± 3.01 vs. 8.24 ± 2.81 mm2; p = 0.8145). Nasal-inferior foveal displacement was observed in 38 eyes (76%). Conclusions: En-face OCT imaging demonstrates reliable postoperative visualization of the ILM peeled area. Although the size of the ILM peeling remains stable after one month, our findings indicate a notable inferior-nasal shift of the overall ILM peeling area towards the optic disc.

Tensor Ring Decomposition Guided Dictionary Learning for OCT Image Denoising.

Optical coherence tomography (OCT) is a non-invasive and effective tool for the imaging of retinal tissue. However, the heavy speckle noise, resulting from multiple scattering of the light waves, obscures important morphological structures and impairs the clinical diagnosis of ocular diseases. In this paper, we propose a novel and powerful model known as tensor ring decomposition-guided dictionary learning (TRGDL) for OCT image denoising, which can simultaneously utilize two useful complementary priors, i.e., three-dimensional low-rank and sparsity priors, under a unified framework. Specifically, to effectively use the strong correlation between nearby OCT frames, we construct the OCT group tensors by extracting cubic patches from OCT images and clustering similar patches. Then, since each created OCT group tensor has a low-rank structure, to exploit spatial, non-local, and its temporal correlations in a balanced way, we enforce the TR decomposition model on each OCT group tensor. Next, to use the beneficial three-dimensional inter-group sparsity, we learn shared dictionaries in both spatial and temporal dimensions from all of the stacked OCT group tensors. Furthermore, we develop an effective algorithm to solve the resulting optimization problem by using two efficient optimization approaches, including proximal alternating minimization and the alternative direction method of multipliers. Finally, extensive experiments on OCT datasets from various imaging devices are conducted to prove the generality and usefulness of the proposed TRGDL model. Experimental simulation results show that the suggested TRGDL model outperforms state-of-the-art approaches for OCT image denoising both qualitatively and quantitatively.

Total variation regularized tensor ring decomposition for OCT image denoising and super-resolution

This paper suggests a novel hybrid tensor-ring (TR) decomposition and first-order tensor-based total variation (FOTTV) model, known as the TRFOTTV model, for super-resolution and noise suppression of optical coherence tomography (OCT) images. OCT imaging faces two fundamental problems undermining correct OCT-based diagnosis: significant noise levels and low sampling rates to speed up the capturing process. Inspired by the effectiveness of TR decomposition in analyzing complicated data structures, we suggest the TRFOTTV model for noise suppression and super-resolution of OCT images. Initially, we extract the nonlocal 3D patches from OCT data and group them to create a third-order low-rank tensor. Subsequently, using TR decomposition, we extract the correlations among all modes of the grouped OCT tensor. Finally, FOTTV is integrated into the TR model to enhance spatial smoothness in OCT images and conserve layer structures more effectively. The proximal alternating minimization and alternative direction method of multipliers are applied to solve the obtained optimization problem. The effectiveness of the suggested method is verified by four OCT datasets, demonstrating superior visual and numerical outcomes compared to state-of-the-art procedures.

Glaucoma awareness, anxiety and its impact on patients undergoing visual field testing and optical coherence tomography.

To assess the effect of Glaucoma awareness, knowledge, and anxiety on patients under visual field analysis by Humphrey's visual field analyzer (HFA) and optical coherence tomography(OCT). This prospective comparative cohort study included glaucoma patients undergoing HFA (Group A)(n = 150) and OCT(Group B) (n = 150). Each group consisted of 75 newly diagnosed patients and 75 patients who were on follow-up. Participants completed State trait anxiety inventory form Y2(STAI) before and after the test to assess pre-test and intra-test anxiety. Another validated and structured questionnaire was used to assess patient awareness and knowledge of glaucoma. Anxiety scores were used to make correlations and comparisons between the two groups and also against visual field reliability indices. The impact of awareness on anxiety scores and its correlation with reliability indices were also determined. Overall pretest and intratest anxiety scores in patients undergoing HFA were 52.39(9.5) and 52.45(8.6)and OCT 53.04(8.0) and 53.83(8.2) respectively.Pretest anxiety was less in follow-up patients of both groups(Group A-51.04,Group B-52.72).There was no statistically significant difference between the groups(pretest p = 0.52,Intratest p = 0.15). Anxiety score was found to be significantly high in female participants(54.07,p = 0.01)and those without awareness(p < 0.001). Patients with education of graduation and above in group B had significantly lower anxiety scores(p = 0.007). Anxiety levels induced by both diagnostic modalities HFA and OCT appear to be similar and it does not affect the reliability indices.Anxiety score was higher in female participants and participants lacking disease awareness.

One-Year Clinical Outcomes in Acute ST-Segment Elevation Myocardial Infarction Patients Undergoing Optical Coherence Tomography-Guided Primary Percutaneous Coronary Intervention: A Comparative Study.

BACKGROUND Percutaneous coronary intervention (PCI) with angiography guidance is a common procedure. Optical coherence tomography (OCT) is a non-invasive imaging method that uses light waves. This study from a single center aimed to compare 1-year outcomes in 75 patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent OCT-guided primary PCI, with 163 patients with acute STEMI who underwent PCI without OCT guidance from February 2019 to July 2021. MATERIAL AND METHODS Patients with acute STEMI were enrolled from February 2019 to July 2021. Seventy-five patients underwent OCT-guided PCI (OCT group), while 163 underwent PCI without OCT (control group). Baseline characteristics, in-hospital mortality, target lesion revascularization, post-MI heart failure, and 1-year all-cause mortality were compared between groups. RESULTS The OCT group had lower diabetes mellitus and hyperlipidemia prevalence. Additionally, they experienced longer procedures (OCT: 50.45&plusmn;21.75 min; control: 33.80&plusmn;14.44 min; P<0.001). After PCI, the control group had lower left ventricular ejection fractions (OCT: 53.4%&plusmn;10.5%; control: 47.8%&plusmn;12.4%; P<0.001) and higher post-MI heart failure rates (OCT: 2.7%; control: 11.0%; P=0.030). Notably, the 1-year all-cause mortality rate was significantly lower in the OCT group (OCT: 1.3%; control: 8.0%; P=0.043). CONCLUSIONS During the 1-year follow-up, patients who received OCT-guided primary PCI experienced a notably lower rate of post-MI heart failure than did those who underwent primary PCI without OCT guidance. Importantly, the application of OCT in primary PCI procedures did not result in a higher incidence of distal embolism, even in cases with a significant thrombus burden.

Optical coherence tomography-guided versus intravascular ultrasound-guided percutaneous coronary intervention in patients with acute myocardial infarction

Introduction and objectivesOptical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) yields clinical outcomes comparable to intravascular ultrasound (IVUS)-guided PCI in patients with stable ischemic heart disease. However, there is a scarcity of data comparing the clinical outcomes of OCT-guided and IVUS-guided PCI in the setting of acute myocardial infarction (AMI). We sought to compare the clinical outcomes of OCT-guided vs IVUS-guided PCI for patients with AMI in the era of second-generation drug-eluting stent (DES). MethodsWe identified 5260 consecutive patients who underwent PCI with a second-generation DES for AMI under IVUS or OCT guidance from pooled data derived from a series of Korean AMI registries between 2011 and 2020. The primary endpoint was the 1-year rate of target lesion failure, defined as a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization. ResultsA total of 535 (10.2%) and 4725 (89.8%) patients were treated under OCT and IVUS guidance, respectively. The 1-year target lesion failure rates were comparable between the OCT and IVUS groups before and after propensity score matching (hazard ratio, 0.92; 95%CI, 0.42-2.05, P=.84). The OCT utilization rate did not exceed 5% of total patients treated with second-generation DES implantation during the study period. The primary factors for the selection of OCT over IVUS were the absence of chronic kidney disease, non-left main vessel disease, single-vessel disease, stent diameter <3mm, and stent length ≤ 25mm. ConclusionsOCT-guided PCI in patients with AMI treated with a second-generation DES provided comparable clinical outcomes for 1-year target lesion failure compared with IVUS-guided PCI.

Hemoglobin Genotype, Hemolytic Activity, Fetal Hemoglobin and Retinal Changes on Optic Coherence Tomography in Children with Sickle Cell Disease

Introduction: Sickle cell disease (SCD) affects multiple organs, including the eye. Optical coherence tomography (OCT) is a quick, noncontact test that provides high-resolution images of distinctive retinal layers. OCT has revolutionized ophthalmology examination and offers valuable new information on retinal damage in SCD. Our earlier studies show that OCT has a higher detection rate for retinal changes in SCD, offering earlier diagnosis than fundoscopy alone. Additionally, abnormal retinal OCT correlates with cerebrovascular disease (CVD) strongly suggesting that retinal OCT may aid in detecting and monitoring SCD related brain injury. One of the characteristics of SCD is the marked variability in patients' clinical manifestations. SCD genotype impacts the presentation of sickle cell retinopathy (SCR). Though OCT has revealed a higher frequency of SCR and more extensive retinal changes associated with the more severe SCD genotypes SS and Sβ0 as compared to SC, significant heterogeneity remains even among patients with the same genotype. Early identification of factors predictive of organ damage, such as SCR and CVD, will allow initiation of individualized disease-modifying treatment before organ systems suffer repeated hypoxic-ischemic events, thus improving long-term outcomes. Degree of hemolysis and fetal hemoglobin (FHb) are among the most important factors affecting SCD severity. There have been limited studies on their effect on ocular health in children with SCD. Methods: The Delaware Comprehensive Sickle Cell Research Center performed a prospective longitudinal cohort study in which all participants underwent complete ophthalmologic examination and OCT imaging. Posterior pole volume scans centered at approximately 3 mm temporal to the foveal were obtained. Areas of retinal thinning were identified using the thickness map. Medical history, brain imaging and laboratory data were collected. All available FHb values were recorded to examine the changing trend with age. Retinal findings were correlated with brain imaging and clinical data. Analysis was performed using IBM SPSS Statistics 27 (IBM, Armonk, NY). The Chi-square test was used for categorical data, and the nonparametric test for continuous variable analysis. The relationship between FHb, age at FHb testing and OCT was examined using multiple regression analysis. Results: From July 2015 to April 2023, 181 (88 males) patients aged 5.35 - 20.39 (12.72 ± 4.29) years with SCD (108 SS, 56 SC, 10 Sβ+ thalassemia, 5 Sβ0 thalassemia and 2 other) enrolled in the study. Visual acuity ranged 20/20 - 20/40. On funduscopic exams, 23 of 181 (12.71%) showed signs of SCR, whereas 107 (59.12%) had retinal injuries on OCT. Seventy-six patients with SS/Sβ0 genotype had brain MRI, and 28 had abnormal findings (Table). Twenty-four of the 28 patients (85.71%) also had abnormal OCT (p = 0.021). Children with SC and SS/Sβ0 disease with normal retinal OCT had FHb values significantly higher than those with abnormal OCT (Z =-2.61 and -4.16, p = 0.009 and 0.000). Children with SS/Sβ0 disease, abnormal OCT had more elevated reticulocyte counts than those with normal OCT (Z = -2.848, p = 0.004). SS genotype were evaluated for FHb values. As expected, FHb levels decline with age, and the rate of descent diminishes (i.e., more rapid fall at an early age). Interestingly, the decrease in FHb is significantly more profound before age 15 for patients with abnormal OCT than those with normal OCT (Figure). The effect of hydroxyurea (HU) in preventing SCR is inconclusive. Children with normal OCT had similar FHb levels without and with HU. However, HU raises FHb levels among those with abnormal OCT. Conclusions: 1) Retinal and brain injury correlates in SS/Sβ0, and OCT may help to select patients for MRI. 2) Abnormal OCT is associated with increased reticulocyte count, indicating heightened hemolysis. While AST and indirect bilirubin levels are not significantly different between normal and abnormal OCT groups in the current dataset, we will repeat the analysis of these hemolytic markers with a larger sample. 3) Early serial measurement of FHb levels throughout childhood can identify patients at high risk for subsequent severe complications such as SCR and CVD who might benefit from early disease modifying treatments. These important findings and the impact of hydroxyurea require further study in a larger patient population undergoing serial exams.

A comprehensive network meta-analysis: comparison of long-term outcomes between intravascular ultrasound, optical coherence tomography, and angiography-guided stent implantation

Abstract Background Intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) guided stent implantations are alternative techniques that are adjunct to angiography-guided (ANG) percutaneous coronary interventions in patients with coronary artery disease (CAD), especially for optimal stent deployment. We aimed to conduct a network meta-analysis including studies comparing those three techniques. Methods We searched PubMed, Scopus, and Cochrane libraries for eligible studies that compared IVUS, OCT, and angiography-guided stent implantation in patients with CAD. After excluding studies, which were irrelevant, duplicated, and had inappropriate results, 54 randomized, propensity-score matched, and observational studies with 232.181 patients were included in this meta-analysis. Results Number of studies compared ANG and IVUS was higher than the other two comparisons. Indirect evidence of network estimates between OCT and IVUS was higher than direct estimate (60% vs. 40%). Minimal parallelism and mean path length of each estimation was suitable with numbers low than 2 for both for comparisons. ANG had higher MACE (RR =1.30; 1.22-1.39, p&amp;lt;0.001), all cause-death (RR=1.45;1.30-1.61, p&amp;lt;0.001), cardiac death (RR=1.72;1.54-1.92, p&amp;lt;0.001), myocardial infarction (RR=1.34; 1.23-1.45, p&amp;lt;0.001), target lesion revascularization (RR=1.20; 1.13-1.26, p&amp;lt;0.001), and stent thrombosis (RR=1.58;1.34-1.85, p&amp;lt;0.001) risks compared to IVUS. There was no difference between OCT and IVUS regarding all outcomes. MACE (RR=1.51;1.26-1.81, p&amp;lt;0.001), cardiac death (RR=2.13;1.41-3.21, p&amp;lt;0.001), and myocardial infarction (RR=1.42;1.05-1.93, p&amp;lt;0.001) risks were higher in ANG groups than in OCT group. Highest benefit was established with OCT for MACE (p-score = 0.973), with IVUS for all-cause death (p-score= 0.792), with OCT for cardiac death (p-score=0.921), with OCT for myocardial infarction (p-score =0.823), with IVUS for target lesion revascularization (p-score=0.865), and with IVUS for stent thrombosis (p-score=0.930). Heterogeneity was appropriate for all outcomes (I2 &amp;lt;70%). There was no publication bias for all outcomes. Conclusion This comprehensive network meta-analysis indicated that angiography-guided stent implantation had higher risk of MACE, cardiac death, myocardial infarction, target lesion-revascularization, and stent thrombosis when compared to IVUS and had higher risk of MACE, cardiac death, and myocardial infarction than OCT.

Outcomes With Intravascular Ultrasound and Optical Coherence Tomography Guidance in Percutaneous Coronary Intervention

Intracoronary imaging has become an important tool in the treatment of complex lesions with percutaneous coronary intervention (PCI). This retrospective cohort study identified 1,118,475 patients with PCI from the Nationwide Readmissions Database from 2017 to 2019. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) were identified with appropriate International Classification of Diseases, Tenth Revision codes. The primary outcome was major adverse cardiac events. The secondary outcomes include net adverse clinical events (NACEs), all-cause mortality, myocardial infarction (MI) readmission, admission for stroke, and emergency revascularization. The multivariate Cox proportional hazard regression was used to adjust for demographic and co-morbid confounders. Of 1,118,475 PCIs, 86,140 (7.7%) used IVUS guidance and 5,617 (0.5%) used OCT guidance. The median follow-up time was 184days. The primary outcome of major adverse cardiac events was significantly lower for the IVUS (6.5% vs 7.6%; hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.86 to 0.91, p <0.001) and OCT (4.4% vs 7.6%; HR 0.69, 95% CI 0.61 to 0.79, p <0.001) groups. IVUS was associated with significantly lower rates of NACEs (8.4% vs 9.4%; HR 0.92, 95% CI 0.89 to 0.94, p <0.001), all-cause mortality (3.5% vs 4.3%; HR 0.85, 95% CI 0.82 to 0.88, p <0.001), readmission for MI (2.7% vs 3.0%; HR 0.95, 95% CI 0.91 to 0.99, p=0.012), and admission for stroke (0.5% vs 0.6%; HR 0.86, 95% CI 0.78 to 0.95, p=0.002). OCT was associated with significantly lower rates of NACEs (6.6% vs 9.4%; HR 0.81, 95% CI 0.73 to 0.89, p <0.001) and all-cause mortality (1.8% vs 4.3%; HR 0.51, 95% CI 0.42 to 0.63, p <0.001). Emergency revascularization was not significantly different with IVUS guidance. Readmission for MI, stroke, and emergency revascularization were not significantly different with OCT guidance. A subgroup analysis of patients with ST-elevation MI and non-ST-elevation MI showed similar results. In conclusion, the use of IVUS and OCT guidance with PCI were associated with significantly lower rates of morbidity and mortality in real-world practice.

Trans-synaptic degeneration in the optic pathway: Exploring the role of lateral geniculate nucleus in early stages of relapsing-remitting multiple sclerosis.

Optic pathway is considered an ideal model to study the interaction between inflammation and neurodegeneration in multiple sclerosis (MS). Optical Coherence Tomography (OCT) and 3.0 T magnetic resonance imaging (MRI) were acquired in 92 relapsing remitting (RR) MS at clinical onset. Peripapillary RNFL (pRNFL) and macular layers were measured. White matter (WM) and gray matter (GM) lesion volumes (LV), lateral geniculate nucleus (LGN) volume, optic radiations (OR) WM LV, thickness of pericalcarine cortex were evaluated. OCT and MRI control groups (healthy controls [HC]-OCT and HC-MRI) were included. A significant thinning of temporal pRNFL and papillo-macular bundle (PMB) was observed (p<0.001) in 16 (17%) patients presented with monocular optic neuritis (MSON+), compared to 76 MSON- and 30 HC (-15μm). In MSON-, PMB was reduced (-3μm) compared to HC OCT (p<0.05). INL total volume was increased both in MSON+ (p<0.001) and MSON- (p=0.033). Inner retinal layers volumes (macular RNFL, GCL and IPL) were significantly decreased in MSON+ compared to HC (p<0.001) and MSON- (p<0.001). Reduced GCL volume in the parafoveal ring was observed in MSON- compared to HCOCT (p < 0.05). LGN volume was significantly reduced only in MSON+ patients compared to HC-MRI (p<0.001) and MSON- (p<0.007). GCL, IPL and GCIP volumes associated with ipsilateral LGN volume in MSON+ and MSON-. Finally, LGN volume associated with visual cortex thickness with no significant difference between MSON+ and MSON-. Anterograde trans-synaptic degeneration is early detectable in RRMS presenting with optic neuritis but does not involve LGN.

Optical Coherence Tomography–Guided versus Angiography-Guided PCI

BackgroundData regarding clinical outcomes after optical coherence tomography (OCT)–guided percutaneous coronary intervention (PCI) as compared with angiography-guided PCI are limited.MethodsIn this prospective, randomized, single-blind trial, we randomly assigned patients with medication-treated diabetes or complex coronary-artery lesions to undergo OCT-guided PCI or angiography-guided PCI. A final blinded OCT procedure was performed in patients in the angiography group. The two primary efficacy end points were the minimum stent area after PCI as assessed with OCT and target-vessel failure at 2 years, defined as a composite of death from cardiac causes, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization. Safety was also assessed.ResultsThe trial was conducted at 80 sites in 18 countries. A total of 2487 patients underwent randomization: 1233 patients were assigned to undergo OCT-guided PCI, and 1254 to undergo angiography-guided PCI. The minimum stent area after PCI was 5.72±2.04 mm2 in the OCT group and 5.36±1.87 mm2 in the angiography group (mean difference, 0.36 mm2; 95% confidence interval [CI], 0.21 to 0.51; P<0.001). Target-vessel failure within 2 years occurred in 88 patients in the OCT group and in 99 patients in the angiography group (Kaplan–Meier estimates, 7.4% and 8.2%, respectively; hazard ratio, 0.90; 95% CI, 0.67 to 1.19; P=0.45). OCT-related adverse events occurred in 1 patient in the OCT group and in 2 patients in the angiography group. Stent thrombosis within 2 years occurred in 6 patients (0.5%) in the OCT group and in 17 patients (1.4%) in the angiography group.ConclusionsAmong patients undergoing PCI, OCT guidance resulted in a larger minimum stent area than angiography guidance, but there was no apparent between-group difference in the percentage of patients with target-vessel failure at 2 years. (Funded by Abbott; ILUMIEN IV: OPTIMAL PCI ClinicalTrials.gov number, NCT03507777.)

IVUS-guided versus OCT-guided PCI among patients presenting with acute coronary syndrome

BackgroundIntravascular imaging modalities such as intravascular ultrasound (IVUS) and, more recently, optical coherence tomography (OCT) improved the visualization of coronary anatomy and plaque pathology. We aimed to compare the procedural and short-term outcomes between IVUS-guided and OCT-guided percutaneous coronary interventions (PCIs) in patients with acute coronary syndrome (ACS).MethodsIn the present retrospective study, we reviewed the data of 50 patients who had IVUS-guided PCI and 50 patients who had OCT-guided PCI for ACS between January 2020 and June 2021. Intravascular imaging was done before and after stenting. Both groups were compared in terms of minimal luminal area (MLA), stent dimensions, final minimal stent area (MSA) and stent expansion as well as negative angiographic outcomes. Patients were followed for six months to record major adverse cardiac events (MACE).ResultsThe patients’ mean age was 57 ± 13 years with male predominance (78%). The radiation time and dose were significantly higher among IVUS group. Pre-stenting MLA was significantly higher in IVUS group (2.63 mm vs. 2.22 mm in OCT, P = 0.013). Stent expansion was significantly higher among OCT group (97% vs. 93% in IVUS group, P = 0.001) with no significant difference between both groups regarding MSA [mm2] (8.88 ± 2.87 in IVUS vs. 8.1 ± 2.76 in OCT, P = 0.169). No significant difference between both groups was noted regarding contrast volume, edge dissection, tissue prolapse, and no reflow. The rates of six-month MACE were significantly higher in the IVUS group.ConclusionsOCT-guided PCI in ACS is safe and is associated with similar MSA to that of IVUS-guided PCI. Future randomized trials are needed to confirm these findings.Graphical

Optical coherence tomography versus punch biopsy for diagnosis of basal cell carcinoma: a multicentre, randomised, non-inferiority trial.

Punch biopsy is the gold standard for diagnosis and subtyping of basal cell carcinoma. The aim of this study was to assess whether use of optical coherence tomography (OCT), a non-invasive imaging tool, might avoid the need for biopsy. In a multicentre, randomised, non-inferiority trial, patients (aged ≥18 years) with an indication for biopsy of a suspected basal cell carcinoma outside the H-zone (high-risk zone) of the face were randomly assigned (1:1) to receive either OCT or punch biopsy (regular care) via a web-based randomisation system. Patients were enrolled from three participating centres in the Netherlands: Maastricht University Medical Centre+, Catharina Hospital Eindhoven, and Zuyderland Medical Centre Heerlen. Stratification factors for randomisation were participating centre and the grade of clinical basal cell carcinoma suspicion (high vs low). The primary endpoint was the proportion of patients free from a recurrent or residual lesion (malignant or premalignant) 12 months after treatment. Modified intention-to-treat and per-protocol analyses were conducted, with a predefined non-inferiority margin of -10%. This trial is registered with ClinicalTrials.gov number, NCT03848078, and is complete. Between Feb 25, 2019, and Sept 2, 2020, 598 patients were enrolled and randomly assigned to either the regular care group (n=299) or the OCT group (n=299). Data on the primary endpoint were available in 553 patients (n=268 in the regular care group, n=285 in the OCT group). After median follow-up of 12·7 months (IQR 11·2-14·1) in the OCT group and 12·6 months (10·8-14·3) in the regular care group, 253 (94%) of 268 patients in the OCT group and 266 (93%) of 285 patients in the regular care group were free from recurrent or residual lesions (malignant or pre-malignant) 12 months after treatment. According to our modified intention-to-treat analysis, the absolute difference (OCT vs regular care) was 1·07% (95% CI -2·93 to 5·06; one-sided p=0·30), with the lower limit of the 95% CI not exceeding the predefined non-inferiority margin of -10%. Per-protocol analyses led to proportions free from a residual or recurrent lesion (premalignant or malignant) of 95% (250 of 263) in the OCT group and 94% (262 of 278) in the regular care group, and an absolute difference of 0·81% (95% CI -2·98 to 4·60; one-sided p=0·34). OCT-guided diagnosis and treatment of basal cell carcinoma is non-inferior to regular care punch biopsy. Implementation of OCT for diagnosis of basal cell carcinoma could reduce the number of consultations and invasive procedures. The Netherlands Organization for Health Research and Development and Maurits en Anna de Kock Stichting.

Study of anxiety in patients with glaucoma undergoing standard automated perimetry and optical coherence tomography - A prospective comparative study.

To compare the anxiety levels related to visual field testing and optical coherence tomography (OCT) in patients with glaucoma. This prospective, comparative study was conducted on patients with glaucoma. The participants' anxiety traits were assessed using the State-Trait Anxiety Inventory [STAI]. Before visual field testing on Humphrey visual field analyzer (HVF) and retinal nerve fiber analysis on OCT, the participants completed Form Y1 to measure the current pretest level or 'State' anxiety [pretest anxiety]. Immediately after testing, participants were administered the Form Y1 questionnaire to assess the induced anxiety level during the testing [Intratest anxiety]. A total of 228 patients were enrolled with 152 participants in the HVF group and 76 in the OCT group. The mean age of the participants in the HVF group was 57.2 ± 20.8 years and in the OCT group was 56.8 ± 20 years. There was no significant difference in trait and pretest anxiety between the HVF group and the OCT group (P = 0.971 and P = 0.716). Intratest test anxiety score was slightly higher in the HVF group (HVF: 42.13 ± 10.63, OCT: 40.71 ± 9.76; P = 0.33). The anxiety scores were higher when the experience of previous HVF tests was <2 and least when the number of tests exceeded five. Automated perimetry induces slightly more anxiety than OCT, which may affect test performance. The measured anxiety reduces as patients gain familiarity with the test with experience. This adds credence to the recommendation of more frequent visual field testing in newly diagnosed glaucoma patients.

Optical Coherence Tomography-Guided Percutaneous Coronary Intervention With Low-Molecular-Weight Dextran - Effect on Renal Function.

The excessive volume of contrast needed is a significant limitation of optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI). Low-molecular-weight dextran (LMWD) has been used for OCT image acquisition instead of contrast media. This study compared the effects of OCT-guided PCI using LMWD on renal function and clinical outcomes to those of intravascular ultrasound (IVUS)-guided PCI.Methods and Results:In all, 1,183 consecutive patients who underwent intracoronary imaging-guided PCI were enrolled in this single-center, retrospective, observational study. After propensity score matching, 133 pairs of patients were assigned to undergo either OCT-guided PCI using LMWD or IVUS-guided PCI. There was no significant change from baseline in the primary endpoint, serum creatinine concentrations, after the procedure in either group. There were no significant differences between the OCT and IVUS groups in the volume of contrast medium, the incidence of contrast-induced nephropathy (1.5% vs. 2.3%; P=0.65), and major adverse cardiovascular events (MACE) at 30 days (2.3% vs. 6.0%; P=0.12) and 12 months (2.3% vs. 3.0%; P=0.70) after the procedure. Kaplan-Meier analysis at the 12-month follow-up revealed no significant difference in the incidence of MACE between the 2 groups (P=0.75). OCT-guided PCI using LMWD did not negatively affect renal function and achieved similar short- and long-term clinical outcomes to IVUS-guided PCI.

Intravascular Visualization in Carotid Artery Stenosis Treatment: One-centre Experience

Introduction: The problem of cerebrovascular disease remains relevant and requires study. The main reason for the development of ischemic strokes is atherosclerotic damage to the bifurcation of the common carotid artery (CCA) with the transition to the internal carotid artery (ICA). The use of additional methods of intravascular imaging is a promising direction in endovascular surgery of the carotid arteries. In our opinion, this topic is poorly studied and requires the study of its clinical and scientific significance. We decided to evaluate stenting results in patients with significant stenosis of the ICA using intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Methods: For the period from November to December 2018 in the clinic of vascular surgery 30 procedures using IVUS and 28 procedures with the use of OCT were performed during the stenting of the ICA. All visualization procedures were carried out before and after stent implantation and its postdilatation to determine the reference diameter of the stent, detecting the protrusion of plaque and adoratrice stent. In 100 % of cases in both groups the device of protection against distal embolism was used. Results: Technical success in both groups was 100 %. There was no statistically significant relationship between the plaque structure and the occurrence of protrusion through stent cells. Protrusion of plaque was detected in 5 patients in the IVUS group, 4 of which were implanted stent with an open cell design. We used double-meshed stent in OCT group. In the OCT group residual stenosis was detected in 6 patients with severe calcification of plaques. Postdilatation balloon catheter was performed in 100% of cases in both groups. In both groups there were no complications at the site of vascular access, 30-day mortality was 0 %. In 1 (3.33 %) patient in the group of IVUS there was stent thrombosis intraoperatively with ischemic stroke (NIHSS 13 points, mRs 5 points). In 2 (7.14 %) patients in the group of OCT there was stent thrombosis in 30 days with no significant neurological signs (mRs 0-1 points). Postoperative hospital stay in both groups was 1 day. Conclusion: The use of methods of intravascular visualization (IVUS and OCT) in stenting of the internal carotid artery makes it possible to obtain additional information about the structure of the plaque, the intravascular picture of the implanted stent, residual stenosis and plaque protrusion, as well as to adjust the tactics of treatment of a particular patient. There is some limitations to use OCT due to artery size and repeated vessel lumen flushing. Disclosure: Nothing to disclose

Use of optical coherence tomography for intermediate coronary artery lesions

Aim. To compare the results of interventions for intermediate coronary lesions, which were operated via angiography and optical coherence tomography (OCT).Methods. We performed a study including 130 stable patients with intermediate coronary lesions (40%–70%). The first group (n = 65) underwent angiography control; the second group (n = 65) underwent OCT control. Morphometric coronary indicators were analyzed intraoperatively. During the 12-month follow-up period, major adverse cardiovascular events incidence, angina recurrence frequency, restenosis, and stent thrombosis were assessed.Results. More pronounced coronary changes were noted in the OC group, as evidenced by stenosis indicators (51.5% [45.2–68.4] vs. 78.6 [65.7–80.3], p = 0.012), lesion length (18.4 mm [15.6–20.3] vs. 26.8 [24.6–32.2], p = 0.038), and plaque instability frequency (4.6% [3/65] vs. 12.3% [8/65], p = 0.048). In the OCT group, decision to perform stenting was more common (33.8% [22/65] vs. 83.1%) [54/65], p &lt; 0.001). In stented patients, differences were noted in major adverse cardiovascular events frequency (13.6% vs. 0%, p = 0.021), angina return (36.3% vs. 3.7%, p &lt; 0.001, odds ratio (OR) 14,857 [2,830–77,990]), and stent restenosis (31.8% vs. 1.8%), p &lt; 0.001, OR 24,733 [2,817–217,125]), with an advantage in favor of OCT. In patients receiving drug therapy, differences were noted in angina recurrence frequency (60.5% vs. 18.1%, p = 0.005, OR 6,882 [1,322–35,824]), with an advantage in favor of OCT.Conclusion. The use of OCT for intermediate coronary lesions revealed prominent lesions and optimized intervention outcomes, accompanied by reduced major adverse cardiovascular events frequency, myocardial infarction, angina recurrence, and stent restenosis at 12 months. Received 5 July 2019. Revised 29 October 2019. Accepted 5 November 2019. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Role of optical coherence tomography for distal left main stem angioplasty.

The objective is to analyze the acute and midterm angiographic outcome of percutaneous treatment of left main coronary stem (LM-PCI) guided by optical coherence tomography (OCT). LM-PCI is a complex procedure, and several anatomical factors may impair its outcome. Intravascular imaging is emerging as a useful tool to guide the procedure. We conducted a retrospective analysis of patients undergoing LM-PCI at three European centers between 2014 and 2017 with a control angiography at 6-12 months. Patients were divided into two groups: OCT-guidance (pre- and post-PCI) and control group (standard angiographic guidance with/out intravascular ultrasound [IVUS]). A blinded core lab analyzed all angiographic images. Primary endpoint was late lumen loss (LLL) after 6 months. A total of 112 patients entered the study, 55 in the OCT group and 57 in the control group (10 IVUS). Baseline and procedural characteristics were similar between groups. Overall, reference vessel diameter of the LM was 3.98 ± 0.65 mm. OCT guidance detected four cases of stent underexpansion (7.2%) and six cases of acute malapposition (10.9%). After a median of 207 ± 23 days, LLL of LM tended to be lower in the OCT group (0.12 ± 0.41 vs. 0.26 ± 0.52 mm, p = .10), and was significantly reduced in the distal portion of the main vessel (0.03 ± 0.45 vs. 0.24 ± 0.53 mm, p = .025). Percent diameter stenosis was also lower (14 ± 9 vs. 19 ± 16%, p = .05). Adverse event rates were similar in the two groups. In this study, systematic OCT guidance during LM-PCI allowed a timely detection and correction of acute stent underexpansion and malapposition, and was associated with signs of improved angiographic outcome at midterm, compared to standard practice.