In recent years, the development and widespread clinical utilisation of optical coherence tomography (OCT) has redefined the standard of intracoronary imaging. OCT is a unique, high-resolution, light-based imaging modality for application in the coronary circulation. OCT offers visualisation of coronary arteries at a resolution up to 10 times higher than that of intravascular ultrasound.1 As a result, OCT is useful for assessing atherosclerotic plaque, stent apposition, stent thrombosis and stent bifurcations. The high resolution of OCT enables visualisation of various atherosclerotic plaque rupture (see Figure 1), including thin-cap fibroatheroma (TCFA), fibrous cap thickness and thrombus formation (see Figure 2).
The capabilities of OCT provide cardiologists with an effective tool for the assessment of patients with acute coronary syndrome (ACS), and permit new insights into plaque progression and ruptures. ACS is typically a life-threatening presentation of atherosclerosis. The in-depth lesion evaluation of OCT is invaluable and has enabled the pathophysiology of ACS to be fully unveiled.2
Acute Coronary Syndrome
Cardiovascular diseases are currently some of the leading causes of death and significant morbidities in developed countries. ACS encompasses three related but distinct clinical entities: unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI) (see Table 1). Management of ACS should encompass both acute and long-term strategies.
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- Hamm CW, Bassand JP, Agewall S, et al., ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment elevation. The task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC), Eur Heart J, 2011;32(23):2999–3054.
- Kubo T, Ino Y, Tanimoto T, et al., Optical coherence tomography imaging in acute coronary syndromes, Cardiol Res Pract, 2011;2011:312978.
- Tanaka A, Imanishi T, Kitabata H, et al., Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study, Eur Heart J, 2009;30(11):1348–55.
- Kubo T, Imanishi T, Takarada S, et al., Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy, J Am Coll Cardiol, 2007;50(10):933–9.
- Jang IK, Tearney GJ, MacNeill B, et al., In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography, Circulation, 2005;111(12):1551–5.
- Ino Y, Kubo T, Tanaka A, et al., Difference of culprit lesion morphologies between ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome, JACC Cardiovasc Interv, 2011;4(1):76–82.
- Kato K, Yonetsu T, Kim SJ, et al., Nonculprit plaques in patients with acute coronary syndromes have more vulnerable features compared with those with non-acute coronary syndromes: a 3-vessel optical coherence tomography study, Circ Cardiovasc Imaging, 2012;5(4):433–40.
- Nishiguchi T, Kitabata H, Tanaka A, et al., Very late stent thrombosis after drug-eluting stent in segment with neointimal tissue coverage, JACC Cardiovasc Imaging, 2010;3(4):445–6.