Allograft vasculopathy vs. coronary artery disease: comparison by optical coherence tomography

Optical coherence tomography (OCT) is a novel high-resolution intravascular imaging technique allowing characterization of coronary artery plaques and evaluation of stent strut coverage. As a new application, OCT can be also used in allograft vasculopathy as demonstrated by the following images. Comparison of OCT and coronary angiography in a cardiac transplant recipient vs. a patient with coronary artery disease: OCT image of the left anterior descending coronary artery in a 72-year-old patient 14 years after heart transplantation and current immunosuppressive treatment with tacrolimus, azathioprine, and prednisone shows a well-defined signal-rich layer indicating concentric intimal hyperproliferation, which is pathognomonic for allograft vasculopathy (Panel A; see Supplementary Data). Optical coherence tomography image in a 70-year-old patient with coronary artery disease demonstrates a lipid-rich plaque with a large, homogeneous, poorly delineated and signal-poor region with alternating signal-rich spots reflecting single calcifications (Panel B). A signal-rich band mirrors a thin fibrous cap extending from 6 to 9 o'clock. Moreover, non-covered stent struts are well visualized (Panel B; see Supplementary Data). Sole coronary angiography does not allow assessing intraluminal tissue morphology such as allograft vasculopathy (Panel C ) and plaque characterization (Panel D) which both may have important prognostic implication on patient outcome. Supplementary Data.