Blue Cross and Blue Shield of Montana (BCBSMT) considers o
- As an adjunct to percutaneous coronary interventions (PCI) with stenting;
- Risk stratification of intracoronary atherosclerotic plaques; or
- Follow-up of stenting.
Gonzalo et al. conducted a study to assess the reproducibility of the new generation, intracoronary OCT systems for plaque and stent assessment in vivo. They concluded that the second generation FD-OCT technology (frequency-domain OCT) with high speed data acquisition shows good interstudy, interobserver and intraobserver reproducibility for plaque characterization and stent implantation assessment in patients undergoing percutaneous coronary interventions (PCI). However, they pointed out that the study was observational and had a limited sample size, and that some aspects of the study may have influenced the reproducibility.
A study by Jang et al. was performed to evaluate the feasibility and the ability of OCT to visualize the components of coronary plaques in living patients. The goals of this study were: 1) to demonstrate the feasibility and safety of OCT imaging in patients; and 2) to assess OCT images of human coronary pathology acquired in vivo by comparison with IVUS images obtained from corresponding locations. The authors concluded that the study demonstrated the feasibility of intracoronary OCT to visualize coronary plaque microstructure in patients. The OCT images of human coronary atherosclerotic plaques obtained in vivo provide additional, more detailed structural information than intravascular ultrasound (IVUS). The unique capability of OCT to resolve micrometer-scale features of coronary plaques in patients suggests that this new technique holds promise for identifying features of coronary plaques at risk for rupture. The findings of this initial experience should be supported by a prospective clinical trial to test the ability of OCT to identify vulnerable plaques. Once the predictive capability of OCT is established, a trial demonstrating effective treatment could potentially contribute to the prevention of acute myocardial infarction and sudden cardiac death.
Kawamori et al. investigated the usefulness of OCT to evaluate vessel response after stent implantation by comparing with that of IVUS. Their data suggested that OCT might provide more detailed information on the presence of tissue prolapse, thrombus formation and edge dissection than IVUS. Further study is warranted to assess its clinical utility. OCT is a feasible method for the evaluation of PCI procedure without serious complications. There were several limitations to their study. First, this is a non-randomized retrospective study based on a relatively limited sample size, raising the possibility of selection bias. A study involving a larger population would be needed to establish and refine the clinical applications and safety of the OCT imaging system. Second, OCT has limited ability to visualize certain lesions, such as ostial lesions due to the risks associated with producing a blood-free environment by occlusion balloon. Also, severely calcified tortuous vessels could not be imaged with OCT due to the difficulty of passing the occlusion balloon through the lesion. Finally, the current OCT system has a limited penetration depth, which can be a disadvantage in visualizing whole vessel structure. Therefore, if a new imaging device can achieve greater penetration depth without sacrificing its resolution (e.g., combined imaging device of IVUS and OCT), this may provide more comprehensive information, possibly offering more benefit during PCI.
OCT is a promising new technology for intravascular imaging that has advantages over IVUS for imaging coronary arteries. However, further large randomized controlled studies are needed to demonstrate clinical utility for OCT; as a result OCT is considered experimental, investigational and unproven.
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