Cardiac Imaging: OCT

Introduction Intracoronary imaging by means of optimal coherence tomography (OCT) provides valuable incremental information that can be used clinically to optimize stent implantation and minimize stent-related problems. Over the past decades, OCT has progressively evolved with respect to technical performance and procedural aspects. Principle OCT is a fiberoptic wire with a rotating lens emitting near infrared (1,300 nm) light and records the light reflected from the tissue. The currently used Fourier domain-OCT allows superior image quality and faster image acquisition. OCT in Acute Coronary Syndrome (ACS) It helps in accurate detection of actual event leading to ACS among plaque rupture, plaque erosion, and calcified nodule. OCT has an advantage over intravascular ultrasound for identification of vulnerable plaque and also detection of thin cap fibroatheroma < 65 µm. Clinical Utility OCT helps in diagnosis of an angiographically ambiguous lesion such as dissection, thrombus, and calcified nodule. It also helps in planning different aspects of percutaneous coronary intervention such as lesion preparation, determining stent size and length and also helps in optimization of results of stent deployment. Certain nonatherosclerotic events such as coronary arteritis can be diagnosed with OCT. Continued advancement in technology, faster image acquisition, and more sophisticated coregistered image analysis will facilitate greater adoption through ease of use and interpretation.