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Review
. 2022 Oct;19(10):684-703.
doi: 10.1038/s41569-022-00687-9. Epub 2022 Apr 21.

Optical coherence tomography in coronary atherosclerosis assessment and intervention

Makoto Araki  1 , Seung-Jung Park  2 , Harold L Dauerman  3 , Shiro Uemura  4 , Jung-Sun Kim  5 , Carlo Di Mario  6 , Thomas W Johnson  7 , Giulio Guagliumi  8 , Adnan Kastrati  9 , Michael Joner  10 , Niels Ramsing Holm  11 , Fernando Alfonso  12 , William Wijns  13 , Tom Adriaenssens  14 , Holger Nef  15 , Gilles Rioufol  16 , Nicolas Amabile  17 , Geraud Souteyrand  18 , Nicolas Meneveau  19 , Edouard Gerbaud  20 , Maksymilian P Opolski  21 , Nieves Gonzalo  22 , Guillermo J Tearney  1 , Brett Bouma  1 , Aaron D Aguirre  1 , Gary S Mintz  23 , Gregg W Stone  24 , Christos V Bourantas  25 , Lorenz Räber  26 , Sebastiano Gili  27 , Kyoichi Mizuno  28 , Shigeki Kimura  29 , Toshiro Shinke  30 , Myeong-Ki Hong  5 , Yangsoo Jang  5 , Jin Man Cho  31 , Bryan P Yan  32 , Italo Porto  33 , Giampaolo Niccoli  34 , Rocco A Montone  35 , Vikas Thondapu  1 , Michail I Papafaklis  36 , Lampros K Michalis  36 , Harmony Reynolds  37 , Jacqueline Saw  38 , Peter Libby  39 , Giora Weisz  40 , Mario Iannaccone  41 , Tommaso Gori  42 , Konstantinos Toutouzas  43 , Taishi Yonetsu  44 , Yoshiyasu Minami  45 , Masamichi Takano  46 , O Christopher Raffel  47 , Osamu Kurihara  46 , Tsunenari Soeda  48 , Tomoyo Sugiyama  49 , Hyung Oh Kim  31 , Tetsumin Lee  50 , Takumi Higuma  51 , Akihiro Nakajima  1 , Erika Yamamoto  52 , Krzysztof L Bryniarski  53 , Luca Di Vito  54 , Rocco Vergallo  55 , Francesco Fracassi  55 , Michele Russo  55 , Lena M Seegers  1 , Iris McNulty  1 , Sangjoon Park  56 , Marc Feldman  57 , Javier Escaned  58 , Francesco Prati  59 , Eloisa Arbustini  60 , Fausto J Pinto  61 , Ron Waksman  62 , Hector M Garcia-Garcia  62 , Akiko Maehara  23 , Ziad Ali  23 , Aloke V Finn  63 , Renu Virmani  63 , Annapoorna S Kini  64 , Joost Daemen  65 , Teruyoshi Kume  4 , Kiyoshi Hibi  66 , Atsushi Tanaka  67 , Takashi Akasaka  67 , Takashi Kubo  67 , Satoshi Yasuda  68 , Kevin Croce  39 , Juan F Granada  23 , Amir Lerman  69 , Abhiram Prasad  69 , Evelyn Regar  70 , Yoshihiko Saito  71 , Mullasari Ajit Sankardas  72 , Vijayakumar Subban  72 , Neil J Weissman  73 , Yundai Chen  74 , Bo Yu  75 , Stephen J Nicholls  76 , Peter Barlis  77 , Nick E J West  78 , Armin Arbab-Zadeh  79 , Jong Chul Ye  56 , Jouke Dijkstra  80 , Hang Lee  1 , Jagat Narula  24 , Filippo Crea  55 , Sunao Nakamura  81 , Tsunekazu Kakuta  49 , James Fujimoto  82 , Valentin Fuster  24 , Ik-Kyung Jang  83   84
Affiliations
Review

Optical coherence tomography in coronary atherosclerosis assessment and intervention

Makoto Araki et al. Nat Rev Cardiol. 2022 Oct.

Erratum in

  • Author Correction: Optical coherence tomography in coronary atherosclerosis assessment and intervention.
    Araki M, Park SJ, Dauerman HL, Uemura S, Kim JS, Di Mario C, Johnson TW, Guagliumi G, Kastrati A, Joner M, Holm NR, Alfonso F, Wijns W, Adriaenssens T, Nef H, Rioufol G, Amabile N, Souteyrand G, Meneveau N, Gerbaud E, Opolski MP, Gonzalo N, Tearney GJ, Bouma B, Aguirre AD, Mintz GS, Stone GW, Bourantas CV, Räber L, Gili S, Mizuno K, Kimura S, Shinke T, Hong MK, Jang Y, Cho JM, Yan BP, Porto I, Niccoli G, Montone RA, Thondapu V, Papafaklis MI, Michalis LK, Reynolds H, Saw J, Libby P, Weisz G, Iannaccone M, Gori T, Toutouzas K, Yonetsu T, Minami Y, Takano M, Raffel OC, Kurihara O, Soeda T, Sugiyama T, Kim HO, Lee T, Higuma T, Nakajima A, Yamamoto E, Bryniarski KL, Di Vito L, Vergallo R, Fracassi F, Russo M, Seegers LM, McNulty I, Park S, Feldman M, Escaned J, Prati F, Arbustini E, Pinto FJ, Waksman R, Garcia-Garcia HM, Maehara A, Ali Z, Finn AV, Virmani R, Kini AS, Daemen J, Kume T, Hibi K, Tanaka A, Akasaka T, Kubo T, Yasuda S, Croce K, Granada JF, Lerman A, Prasad A, Regar E, Saito Y, Sankardas MA, Subban V, Weissman NJ, Chen Y, Yu B, Nicholls SJ, Barlis P, West NEJ, Arbab-Zadeh A, Ye JC, Dijkstra J, Lee H, Narula J, Crea F, Nakamura S, Kakuta T, Fujimoto J, Fuster V, Jang IK. Araki M, et al. Nat Rev Cardiol. 2024 May;21(5):348. doi: 10.1038/s41569-023-00982-z. Nat Rev Cardiol. 2024. PMID: 38110566 Free PMC article. No abstract available.

Abstract

Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing with the rapid progression of atherosclerosis. Accurate detection by OCT of sequelae from percutaneous coronary interventions that might be missed by angiography could improve clinical outcomes. In addition, OCT has become an essential diagnostic modality for myocardial infarction with non-obstructive coronary arteries. Insight into neoatherosclerosis from OCT could improve our understanding of the mechanisms of very late stent thrombosis. The appropriate use of OCT depends on accurate interpretation and understanding of the clinical significance of OCT findings. In this Review, we summarize the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis. Contributions have been made by clinicians and investigators worldwide with extensive experience in OCT, with the aim that this document will serve as a standard reference for future research and clinical application.

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Conflict of interest statement

Disclosure

Dr. Adriaenssens received educational grants from Abbott Vascular. Dr. Aguirre received research grants from Philips Healthcare, Inc. and Amgen, Inc. Dr. Akasaka received research grants from Abbott Vascular Japan, Nipro Inc., and Terumo Inc. and is a medical advisor for Terumo Inc. Dr. Ali: institutional grants from Abbott vascular, and cardiovascular system Inc. to Columbia University and Cardiovascular Research foundation; honoraria from Amgen, Astra Zeneca, Boston scientific; equity from Shockwave. Dr. Amabile received proctoring and consulting fees for Abbott Vascular & Boston Scientific; consulting fees for Shockwave Medical; institutional research grants from Abbott Vascular. Dr. Arbustini received grants from the Ministry of Health to the National IRCCS Cardiology Network (RCR-2019-23669116-001 and RCR-2020-23670065) and from FRRB grant CP_14/2018, INTESTRAT-CAD, Lombardia Region, Italy. Dr. Bouma has OCT patents, assigned to Massachusetts General Hospital and licensed to Terumo Corporation. Dr. Crea received personal fees from Amgen, personal fees from Astra Zeneca, personal fees from Servier, personal fees from BMS, other from GlyCardial Diagnostics, outside the submitted work. Dr. Dauerman is a consultant to Baim Clinical Research Institute, Cardiovascular Research Foundation, Medtronic and Boston Scientific; Dr. Dauerman has research grants from Medtronic and Boston Scientific. Dr. Di Mario received research grants (to the institution) from AMGEN, Behring, Boston Scientific, Chiesi, Daiichi-Sankyo, Edwards, Medtronic, Shockwave Volcano-Philips and speakers’ fees from Abbott and Shockwave. Dr. Finn and Dr. Virmani received institutional research support from NIH (HL141425), Leducq Foundation Grant; 480 Biomedical; 4C Medical; 4Tech; Abbott; Accumedical; Amgen; Biosensors; Boston Scientific; Cardiac Implants; Celonova; Claret Medical; Concept Medical; Cook; CSI; DuNing, Inc; Edwards LifeSciences; Emboline; Endotronix; Envision Scientific; Lutonix/Bard; Gateway; Lifetech; Limflo; MedAlliance; Medtronic; Mercator; Merill; Microport Medical; Microvention; Mitraalign; Mitra assist; NAMSA; Nanova; Neovasc; NIPRO; Novogate; Occulotech; OrbusNeich Medical; Phenox; Profusa; Protembis; Qool; Recor; Senseonics; Shockwave; Sinomed; Spectranetics; Surmodics; Symic; Vesper; W.L. Gore; Xeltis. A.V.F. has received honoraria from Abbott Vascular; Biosensors; Boston Scientific; Celonova; Cook Medical; CSI; Lutonix Bard; Sinomed; Terumo Corporation; and is a consultant to Amgen; Abbott Vascular; Boston Scientific; Celonova; Cook Medical; Lutonix Bard; Sinomed. R.V. has received honoraria from Abbott Vascular; Biosensors; Boston Scientific; Celonova; Cook Medical; Cordis; CSI; Lutonix Bard; Medtronic; OrbusNeich Medical; CeloNova; SINO Medical Technology; ReCore; Terumo Corporation; W. L. Gore; Spectranetics; and is a consultant Abbott Vascular; Boston Scientific; Celonova; Cook Medical; Cordis; CSI; Edwards Lifescience; Lutonix Bard; Medtronic; OrbusNeich Medical; ReCore; Sinomededical Technology; Spectranetics; Surmodics; Terumo Corporation; W. L. Gore; Xeltis. Dr. Fujimoto has financial interests in Optovue, receives royalties from intellectual property owned by MIT and licensed to Optovue and receives research support from Topcon and the National Institutes of Health. Dr. Garcia-Garcia recieved institutional grant support: Biotronik, Boston Scientific, Medtronic, Abbott, Neovasc, Shockwave, Philips, and CorFlow. Dr. Gerbaud is a consultant for Terumo and Abbott Vascular. Dr. Gonzalo received speaker and consultant fees from Abbott, speaker fees from Boston Scientific. Dr. Gori received speakeŕs honoraria and research support from Abbot vascular. Dr. Guagliumi received consultant fees from Abbott Vascular and Infraredx; research grant from Abbott Vascular, Infraredx, and Amgen. Dr. Hibi has received remuneration for lectures from Terumo, Abbott Vascular, and Boston Scientific Japan. Dr. Holm received speaker fees from Terumo, research grants and speaker fees from Abbott and Reva Medical, research grants from Boston Scientific, Biosensors, Bbraun, and Medis Medical Imaging. Dr. Jang received educational grants from Abbott Vascular and consulting fees from Svelte and Mitobridge. Dr. Jung-Sun Kim received proctoring fees from Abbott Vascular. Dr. Libby is an unpaid consultant to, or involved in clinical trials for Amgen, AstraZeneca, Baim Institute, Beren Therapeutics, Esperion Therapeutics, Genentech, Kancera, Kowa Pharmaceuticals, Medimmune, Merck, Norvo Nordisk, Novartis, Pfizer, Sanofi-Regeneron. Dr. Libby is a member of scientific advisory board for Amgen, Caristo, Cartesian, Corvidia Therapeutics, CSL Behring, DalCor Pharmaceuticals, Dewpoint, Kowa Pharmaceuticals, Olatec Therapeutics, Medimmune, Novartis, PlaqueTec, and XBiotech, Inc. Dr. Kume received personal fees from Abbott Japan Co., Ltd. Dr. Libby’s laboratory has received research funding in the last 2 years from Novartis. Dr. Libby is on the Board of Directors of XBiotech, Inc. Dr. Libby has a financial interest in Xbiotech, a company developing therapeutic human antibodies. Dr. Libby’s interests were reviewed and are managed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict-of-interest policies. Dr. Libby’s laboratory has received research funding in the last 2 years from Novartis. Dr. Libby is on the Board of Directors of XBiotech, Inc. Dr. Libby has a financial interest in Xbiotech, a company developing therapeutic human antibodies. Dr. Libby’s interests were reviewed and are managed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict-of-interest policies. Dr. Johnson received consultancy and speaker fees from Abbott Vascular & Terumo. Dr. Joner reports personal fees from Biotronik, personal fees from Orbus Neich, grants and personal fees from Boston Scientific, grants and personal fees from Edwards, personal fees from Recor, personal fees from Astra Zeneca, grants from Amgen, personal fees from Abbott, personal fees from Shockwave, grants from Infraredx, grants from Cardiac Dimensions outside the submitted work. Dr. Lerman received consultant fees from Volcano and Philips. Dr. Michalis received departmental grants from Abbott. Dr. Minami received an honorarium and consulting fee from Abbott. Dr. Mintz received honoraria from Boston Scientific, Philips/Volcano, Medtronic, Abiomed. Equity in SpectraWave. Dr. Nef received speaker honoraria and research grant from Abbott Vascular. Dr. Räber received grants to the institution by Abbott, Biotronik, BostonScientific, Heartflow, Sanofi, Regeneron and speaker/consultation fees by Abbott, Amgen, AstraZeneca, Canon, Occlutec, Sanofi, Vifor. Dr. Regar is a member of the medical advisory board for Zed Medical, Inc. and a clinical advisor for Kaminari Medical BV. Dr. Reynolds received donations for research from Abbott vascular, Siemens, and BioTelemetry. Dr. Shinke received research grant from Abbott Medical Japan. Dr. Souteyrand received consulting for Abbott medical, Terumo, Boston scientific, Medtronic, Schockwave. Dr. Stone received speaker honoraria from Terumo, Cook, Infraredx; consultant to Valfix, TherOx, Robocath, HeartFlow, Ablative Solutions, Vectorious, Miracor, Neovasc, Abiomed, Ancora, Elucid Bio, Occlutech, CorFlow, Reva, MAIA Pharmaceuticals, Vascular Dynamics, Shockwave, V-Wave, Cardiomech, Gore; equity/options from Ancora, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, Valfix, MedFocus family of funds. Dr. Tearney receives sponsored research funding from Canon, CN USA Biotech Holdings, VivoLight and AstraZeneca and catheter materials from Terumo Corporation. Dr. Tearney has a financial/fiduciary interest in SpectraWave, a company developing an OCT-NIRS intracoronary imaging system and catheter. His financial/fiduciary interest was reviewed and is managed by the Massachusetts General Hospital and Mass General Brigham HealthCare in accordance with their conflict of interest policies. Dr. Tearney (Terumo, Canon, Spectrawave) has the right to receive royalties from licensing arrangements. Dr. Toutouzas received research grants from Medtronic, and I am proctor for Medtronic and Abbott. Dr. Uemura received educational grants from Abbott Vascular Japan. Dr. Vergallo received speaker fees from Abbott. Dr. Weisz is a member of medical advisory board for Filterlex, Intratech, Microbot, and Trisol and received equity from Filterlex, Intratech, and Microbot and consulting fees from Filterlex, Intratech, Microbot, Magenta, and Cuspa. Dr. William: institutional research grant and honoraria from MicroPort (steering Committee TARGET AC trial; co-founder Argonauts, an innovation facilitator; medical advisor Rede Optimus Research and Corrib Core Laboratory, NUI Galway. Dr. Yan received research grant and speaker honorarium from Abbott Vascular. Dr. Yonetsu received endowment from Abbott Vascular Japan, Boston Scientific Japan, WIN International, Japan Lifeline, and Takeyama KK. Dr. Yu received research grants from the National Key R&D Program of China (2016YFC1301103) and the National Natural Science Foundation of China (81827806). The other writing committee members and coauthors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.. Artifacts
(A) Guide wire (arrow) causes a shadow (asterisk). (B) Gas bubbles in the catheter (arrow) cause a shadow (asterisk). (C) Suboptimal vessel flushing leads to residual blood in the lumen (asterisk), hampering the assessment of the vessel (D) Ghost lines (arrow). (E) Non-uniform rotational distortion (NURD) (asterisk). (F) Fold-over artifact (arrow). (G) Tangential signal dropout. Blue lines indicate the direction of light beams tangential to the tissue that appears to have an artifactual light dropout. (H) Seam artifact (arrow). (I) Blooming. Stent struts (arrows) appear thicker than the actual thickness due to blooming artifact. (J) Saturation. Arrows point to high signal intensity artifact that extends along the axial dimension. (K) Merry-go-round artifact is artifactual stretching in the lateral (rotational) direction of stent struts (arrows), which occurs due to scatters in the lumen such as residual blood, clots and neointima. (L) Sunflower artifact may cause a well-apposed stent to appear malapposed in a vessel (white circles).
Figure 1.
Figure 1.. Artifacts
(A) Guide wire (arrow) causes a shadow (asterisk). (B) Gas bubbles in the catheter (arrow) cause a shadow (asterisk). (C) Suboptimal vessel flushing leads to residual blood in the lumen (asterisk), hampering the assessment of the vessel (D) Ghost lines (arrow). (E) Non-uniform rotational distortion (NURD) (asterisk). (F) Fold-over artifact (arrow). (G) Tangential signal dropout. Blue lines indicate the direction of light beams tangential to the tissue that appears to have an artifactual light dropout. (H) Seam artifact (arrow). (I) Blooming. Stent struts (arrows) appear thicker than the actual thickness due to blooming artifact. (J) Saturation. Arrows point to high signal intensity artifact that extends along the axial dimension. (K) Merry-go-round artifact is artifactual stretching in the lateral (rotational) direction of stent struts (arrows), which occurs due to scatters in the lumen such as residual blood, clots and neointima. (L) Sunflower artifact may cause a well-apposed stent to appear malapposed in a vessel (white circles).
Figure 2.
Figure 2.. Normal vessel and plaques
(A) Normal vessel wall is characterized by 3-layered architecture, comprising a high backscattering, thin intima (i), a low backscattering media (m), a high backscattering adventitia (a), internal elastic membrane as the border between the intima and media (blue arrow), and external elastic membrane as the border between the media and the adventitia (yellow arrow). (B) Intimal thickening occurs during the early phase of atherosclerosis in the coronary artery, which is represented as a signal-rich thick intimal band (double-headed arrow). (C) Fibrous plaque exhibits homogeneous, signal-rich (highly backscattering) regions (asterisk). (D) Calcified plaque exhibits signal-poor regions with sharply delineated borders and limited shadowing (asterisk). (E) Lipid plaque exhibits signal-poor regions (asterisk) with diffuse borders and overlying signal-rich bands (double-headed arrow). (F) Thin-cap fibroatheroma (TCFA) is defined as a lipid plaque in which the minimum thickness of the fibrous cap (arrows) is less than a predetermined threshold and lipid occupies >90° in circumference.
Figure 3.
Figure 3.. Qualitative findings
(A) Macrophages are seen as signal-rich, distinct, or confluent punctate regions that exceed the intensity of background speckle noise and cast a dark shadow (arrows). (B) Microvessels within the intima can appear as signal-poor voids that are sharply delineated and can usually be followed in multiple contiguous frames (white circle). (C) Cholesterol crystals appear as thin, linear regions of high intensity (arrow), usually in proximity to a lipid-rich plaque. (D) Thrombus is seen as an irregular mass protruding into the lumen. Red thrombus is seen as a high backscattering protrusion with signal-free shadowing (asterisk). (E) White thrombus is seen as a signal-rich, low backscattering projection, which does not obscure the vessel (asterisk). (F) Layered plaque. The double-headed arrow indicates a layer of different optical densities.
Figure 4.
Figure 4.. Culprit lesions in ACS patients
(A) Plaque rupture is characterized by the presence of fibrous cap discontinuity with a cavity formation (asterisk) within the plaque. (B) Definite erosion is characterized by the presence of attached thrombus (arrows) overlying an intact and visualized plaque. (C) Probable erosion is characterized by luminal surface irregularity (arrows) at the culprit lesion in the absence of thrombus. (D) Eruptive calcified nodule appears in OCT as single or multiple regions of calcium that protrude into the lumen with fibrous cap disruption, frequently forming sharp, protruding edges, and the presence of substantive calcium proximal and/or distal to the lesion (asterisk). (E) Spontaneous coronary artery dissection (SCAD) is seen as a separation of the intima and media from the adventitia (intramural hematoma) (asterisk), with or without communication with the vessel lumen (intimal tear). ACS = acute coronary syndrome
Figure 5.
Figure 5.. Post-PCI findings
(A) Strut malapposition. Stent struts (white arrows) are distant from the luminal surface of the artery wall (blue arrows). (B) Tissue prolapse is a tissue extrusion from inside the stent area (arrow). (C) Edge dissection (arrow).
Figure 6.
Figure 6.. Vascular response after stenting
(A) Covered struts. Stent struts are considered covered when tissue can be identified on the luminal side of the strut. (B) Uncovered struts. Struts are considered uncovered when tissue cannot be identified above the strut (struts in white circles). (C) Evagination. An outward bulge (arrows) in the luminal vessel contour between apposed struts. (D) Neoatherosclerosis. A signal-poor region with a diffuse border (asterisk) and an overlying signal-rich band (arrows), which correspond with lipid-laden tissue is seen within the stent.
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