Optical Coherence Tomography Provides Detailed Window Inside Arteries and Cardiac Procedures

The ability to see inside the arteries of vascular disease patients in high resolution before and during stenting procedures can offer an abundance of important data. A new study of optical coherence tomography (OCT) validated the safety and feasibility of this imaging technique in the carotid arteries. However, because of cost issues, OCT still has a long way to go before becoming widely utilized.

The June 2012 issue of the Journal of Endovascular Therapy published a study by researchers from the department of surgery, vascular, and endovascular surgery unit, University of Siena (Italy) of OCT use in carotid stent patients and two commentaries on the topic. A number of physicians lend their support to OCT as a way of gaining more knowledge of cardiac disease and improving the stenting procedure.

OCT is an invasive intravascular imaging system that generates high-resolution images using light. Its resolution is 10 times higher than that of any other clinically available diagnostic imaging method, and it can provide images of tissues at almost histologic resolution. Limitations of OCT include interference by blood flow and the level of tissue penetration it can achieve.

In the current study, 25 patients undergoing carotid artery stenting also underwent OCT before stent deployment, immediately after stent placement, and following postdilation of the stent. The OCT technique had a success rate of 97.3%, and no complications occurred for the patients during the procedures or in the hospital.

Physicians were able to visualize, through the use of OCT, among other details, rupture of the fibrous cap, plaque prolapse, and stent malapposition in patients. As the authors of the commentaries noted, future applications could reveal additional details that increase our understanding of carotid stenting and influence clinical policies regarding its use. Carotid artery stenting has not reached its predicted potential, in part owing to lack of reimbursement in the United States and mixed results from European trials. OCT may provide evaluation of critical aspects of carotid artery stenting. Moreover, more evidence from OCT clinical research could help health authorities realize the value of the carotid artery stenting procedure.

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University of Siena