Buonpane Angela, Trimarchi Giancarlo, Di Muro Francesca Maria, Nardi Giulia, Ciardetti Marco, Coceani Michele Alessandro, Pastormerlo Luigi Emilio, Paradossi Umberto, Berti Sergio, Trani Carlo, Liuzzo Giovanna, Porto Italo, Leone Antonio Maria, Crea Filippo, Burzotta Francesco, Vergallo Rocco, De Caterina Alberto Ranieri
Center of Excellence for Cardiovascular Sciences, Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy.
Cardiothoracic Department, Fondazione Toscana G. Monasterio, G. Pasquinucci Heart Hospital, 54100 Massa, Italy.
J Clin Med. 2025 Aug 2;14(15):5451. doi: 10.3390/jcm14155451.
Optical Coherence Tomography (OCT) has evolved from a breakthrough ophthalmologic imaging tool into a cornerstone technology in interventional cardiology. After its initial applications in retinal imaging in the early 1990s, OCT was subsequently envisioned for cardiovascular use. In 1995, its ability to visualize atherosclerotic plaques was demonstrated in an in vitro study, and the following year marked the acquisition of the first in vivo OCT image of a human coronary artery. A major milestone followed in 2000, with the first intracoronary imaging in a living patient using time-domain OCT. However, the real inflection point came in 2006 with the advent of frequency-domain OCT, which dramatically improved acquisition speed and image quality, enabling safe and routine imaging in the catheterization lab. With the advent of high-resolution, second-generation frequency-domain systems, OCT has become clinically practical and widely adopted in catheterization laboratories. OCT progressively entered interventional cardiology, first proving its safety and feasibility, then demonstrating superiority over angiography alone in guiding percutaneous coronary interventions and improving outcomes. Today, it plays a central role not only in clinical practice but also in cardiovascular research, enabling precise assessment of plaque biology and response to therapy. With the advent of artificial intelligence and hybrid imaging systems, OCT is now evolving into a true precision-medicine tool-one that not only guides today's therapies but also opens new frontiers for discovery, with vast potential still waiting to be explored. Tracing its historical evolution from ophthalmology to cardiology, this narrative review highlights the key technological milestones, clinical insights, and future perspectives that position OCT as an indispensable modality in contemporary interventional cardiology. As a guiding thread, the myth of Prometheus is used to symbolize the evolution of OCT-from its illuminating beginnings in ophthalmology to its transformative role in cardiology-as a metaphor for how light, innovation, and knowledge can reveal what was once hidden and redefine clinical practice.
光学相干断层扫描（OCT）已从一项突破性的眼科成像工具发展成为介入心脏病学的一项基础技术。20世纪90年代初其最初应用于视网膜成像后，OCT随后被设想用于心血管领域。1995年，一项体外研究证明了其可视化动脉粥样硬化斑块的能力，次年获得了首张人体冠状动脉的体内OCT图像。2000年迎来了一个重要里程碑，首次在活体患者中使用时域OCT进行冠状动脉内成像。然而，真正的转折点出现在2006年，频域OCT的出现极大地提高了采集速度和图像质量，使得在导管室能够进行安全且常规的成像。随着高分辨率第二代频域系统的出现，OCT在临床上变得切实可行，并在导管室中得到广泛应用。OCT逐渐进入介入心脏病学领域，首先证明了其安全性和可行性，然后在指导经皮冠状动脉介入治疗及改善治疗效果方面显示出优于单纯血管造影的优势。如今，它不仅在临床实践中发挥着核心作用，还在心血管研究中发挥着重要作用，能够精确评估斑块生物学特性及对治疗的反应。随着人工智能和混合成像系统的出现，OCT现在正演变成一种真正的精准医疗工具——一种不仅能指导当今的治疗，还能开辟新的发现前沿，仍有巨大潜力有待探索。通过追溯其从眼科到心脏病学的历史演变，这篇叙述性综述突出了关键的技术里程碑、临床见解以及未来展望，这些使得OCT成为当代介入心脏病学中不可或缺的一种方式。作为一条主线，普罗米修斯的神话被用来象征OCT的演变——从其在眼科的启发性开端到其在心脏病学中的变革性作用——作为光、创新和知识如何能够揭示曾经隐藏的事物并重新定义临床实践的一个隐喻。
