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Intracoronary Imaging

There are various intracoronary imaging methods available and the imaging will help operators to visualize coronary arterial wall.

Intravascular ultrasound (IVUS)

Two types of IVUS systems are available.

  1. Phased Array: use multiple transducer elements permanently mounted along the circumference of the catheter tip
  2. Mechanical: utilizes single transducer mounted at the tip, which quickly rotates to visualize the entire vessel in cross-section

Indications of IVUS

  • To determine lumen area, lesion complexity (e.g., plaque burden, calcification), and lesion length, especially in bifurcations lesions
  • To access the severity of angiographically intermediate left main disease
  • To analyze stent apposition, lesion coverage, and edge dissection post stent deployment
  • To investigate coronary vasculopathy in transplanted hearts

Optical Coherence Tomography (OCT)

OCT technology utilizes backscattering (reflection) of light (in the 1300 nm range) wavelength to obtain cross-sectional images of coronary artery and has a 10-fold higher image resolution than IVUS). This allows imaging of the coronary artery in great detail and potentially providing unique insights into coronary artery pathophysiology.

Two Methods are Used:

Time domain OCT — is used in first generation OCT. Due to its relatively slow data acquisition and the need for an occlusion balloon to remove the blood from vessels, its use is limited.

Fourier domain OCT — Since 2008, a new generation of OCT systems (also called Fourier domain OCT systems) have been available for widespread clinical use. The data acquisition speed in Fourier-domain OCT is much faster than time-domain OCT system.

Indications of OCT

  • Assessment of plaque morphology (e.g., plaque erosion in ACS)
  • Analyze stent apposition, lesion coverage, and edge dissection
  • Evaluate for adequate stent expansion, especially in cases of in-stent restenosis and stent thrombosis

Near-infrared Spectroscopy (NIRS)

  • NIRS and IVUS could determine lipid core-containing plaques (LCPs) by using near-infrared region of the electromagnetic spectrum (from 780 nm to 2500 nm)
  • In contrast to OCT, NIRS can image through blood, as it does not need light to be directly reflected back to the detector
  • Although utility of NIRS is mainly used in clinical trial, its use in daily clinical practice remains limited
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