Introduction of Utility Of Optical Coherence Tomography Imaging With Angiographic Co-Registration For The Guidance Of Percutaneous Coronary Intervention

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Summary

Intracoronary optical coherence tomography (OCT) is a light-based imaging modality able to visualise with high resolution (~10 μm) the vascular morphology and the acute and chronic effects of intervention with intracoronary devices.^1,2 OCT could therefore find application in the guidance of percutaneous coronary intervention (PCI), allowing a thorough preprocedural lesion assessment, which enables accurate device sizing, selection of the vessel segment requiring treatment, and, thus, efficient planning of the implantation strategy (see Table 1).³ Moreover, it can be used for the assessment of the acute procedural result, allowing the estimation of stent expansion and vessel injury. Consequently, intravascular imaging can in this way assist in the optimisation of the acute implantation result, the significance of which is underscored by observations of an association between suboptimal implantation and stent failure.⁴ Importantly, several studies and meta-analyses have shown that the use of imaging guidance might improve outcome.^5–7

Although OCT can provide a high amount of detail in the assessment of coronary arteries, this information might be challenging to be directly applied in the guidance of interventions in the daily cath lab practice, which are performed using real-time fluoroscopic guidance. This could happen because the spatial correspondence of OCT findings with the vessel angiogram is not always straightforward as a result of vessel overlap, foreshortening or the inability to visualise a complex three-dimensional (3D) structure correctly in a two-dimensional (2D) image. As the operator is using the angiographic image as a guide for performing the intervention, it is essential for him or her to ensure correct spatial orientation of the invasive imaging findings with the angiogram. Such problems might become more exaggerated in cases with diffuse disease, angiographically silent lesions or in the absence of side branches that can function as landmarks. In order to overcome this problem, approaches implementing an online co-registration of OCT with the coronary angiogram, which allows the operator to scroll through a synchronised dataset, would be highly desired. Such information could be useful for procedural planning and longitudinal assessment of atherosclerotic lesions.

We present a new technology allowing the online co-registration of OCT images with the angiogram in the catheterisation laboratory and discuss its potential utility in optimising procedural outcome in everyday practice.