Gupta Ankush, Shrivastava Abhinav, Vijayvergiya Rajesh, Chhikara Sanya, Datta Rajat, Aziz Atiya, Singh Meena Daulat, Nath Ranjit Kumar, Kumar J Ratheesh
Department of Cardiology, Military Hospital Jaipur, Jaipur, India.
Department of Cardiology, Dr Ram Manohar Lohia (RML) Hospital & Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India.
Front Cardiovasc Med. 2022 May 11;9:854554. doi: 10.3389/fcvm.2022.854554. eCollection 2022.
Optical coherence tomography (OCT) is slowly but surely gaining a foothold in the hands of interventional cardiologists. Intraluminal and transmural contents of the coronary arteries are no longer elusive to the cardiologist's probing eye. Although the graduation of an interventionalist in imaging techniques right from naked eye angiographies to ultrasound-based coronary sonographies to the modern light-based OCT has been slow, with the increasing regularity of complex coronary cases in practice, such a transition is inevitable. Although intravascular ultrasound (IVUS) due to its robust clinical data has been the preferred imaging modality in recent years, OCT provides a distinct upgrade over it in many imaging and procedural aspects. Better image resolution, accurate estimation of the calcified lesion, and better evaluation of acute and chronic stent failure are the distinct advantages of OCT over IVUS. Despite the obvious imaging advantages of OCT, its clinical impact remains subdued. However, upcoming newer trials and data have been encouraging for expanding the use of OCT to wider indications in clinical utility. During percutaneous coronary intervention (PCI), OCT provides the detailed information (dissection, tissue prolapse, thrombi, and incomplete stent apposition) required for optimal stent deployment, which is the key to successfully reducing the major adverse cardiovascular event (MACE) and stent-related morbidities. The increasing use of OCT in complex bifurcation stenting involving the left main (LM) is being studied. Also, the traditional pitfalls of OCT, such as additional contrast load for image acquisition and stenting involving the ostial and proximal LM, have also been overcome recently. In this review, we discuss the interpretation of OCT images and its clinical impact on the outcome of procedures along with current barriers to its use and newer paradigms in which OCT is starting to become a promising tool for the interventionalist and what can be expected for the immediate future in the imaging world.
光学相干断层扫描（OCT）正在缓慢但稳步地在介入心脏病专家手中站稳脚跟。冠状动脉的腔内和透壁内容物不再能逃过心脏病专家敏锐的探测目光。尽管介入专家从肉眼血管造影到基于超声的冠状动脉超声再到现代基于光的OCT的成像技术进阶过程缓慢，但随着临床上复杂冠状动脉病例越来越常见，这种转变是不可避免的。尽管血管内超声（IVUS）因其丰富的临床数据在近年来一直是首选的成像方式，但OCT在许多成像和操作方面都对其进行了显著升级。更好的图像分辨率、对钙化病变的准确评估以及对急性和慢性支架失败的更好评估是OCT相对于IVUS的明显优势。尽管OCT具有明显的成像优势，但其临床影响仍然有限。然而，即将开展的更新试验和数据对于将OCT的应用扩展到更广泛的临床用途适应症来说是令人鼓舞的。在经皮冠状动脉介入治疗（PCI）期间，OCT提供了优化支架置入所需的详细信息（夹层、组织脱垂、血栓和支架贴壁不全），这是成功降低主要不良心血管事件（MACE）和支架相关并发症的关键。目前正在研究OCT在涉及左主干（LM）的复杂分叉支架置入中的日益增加的应用。此外，OCT的传统缺陷，如图像采集需要额外的造影剂负荷以及涉及LM开口和近端的支架置入，最近也已被克服。在这篇综述中，我们讨论了OCT图像的解读及其对手术结果的临床影响，以及目前其使用的障碍和新的模式，在这些新模式中，OCT开始成为介入专家的一个有前景的工具，以及在成像领域的近期未来可以期待什么。
