OCT Made Easy

Description:

This book, written by premier authors in the field of OCT intravascular imaging, covers the best practices for using OCT to provide high resolution cross-sectional viewing for atherosclerotic plaque assessment, stent strut coverage and apposition, assessment in stent restenosis evaluation, and PCI guide and optimization. Fully illustrated thorughout in a handy, cath-lab side handbook supplemented by online movie clips, OCT Made Easy includes case studies, angiography, CT correlations, and simple techniques for getting the best image.  

Table of Contents:

Contributors

Chapter 1 Optical coherence tomography imaging for stent planning

1.1 Introduction

1.2 General outline

1.3 Preintervention OCT imaging

1.3.1 Assessment of coronary stenosis severity

1.3.1.1 Basic nomenclature and definitions

1.3.1.2 Considerations of quantitative measurements of vascular structures

1.3.1.3 Estimating the functional significance of coronary stenoses by quantitative OCT measurements

1.3.2 Assessment of lesion morphology, composition, and morphometry

1.3.3 Vessel measurements for stent sizing

1.3.3.1 Length measurement

1.3.3.2 Diameter measurement

1.4 Postintervention OCT imaging

1.4.1 Verification and optimization of stent expansion

1.4.2 Verification and optimization of stent apposition

1.4.3 Assessment of other qualitative parameters after stenting

1.4.3.1 Stent edge dissections

1.4.3.2 In-stent dissections, tissue prolapse, and in-stent thrombus

1.5 Potential clinical impact of OCT use for PCI planning and guidance

References

Chapter 2 OCT imaging for assessment of plaque modification

2.1 Introduction

2.2 Plain ordinary balloon and drug-eluting balloon angioplasty

2.2.1 Cutting balloon or scoring balloon angioplasty

2.2.2 Rotational atherectomy

2.2.3 Plaque modification after stenting

References

Chapter 3 OCT for plaque modification

3.1 Plaque modification before coronary artery stenting using cutting/scoring balloon

3.2 Cutting and scoring balloons

3.3 Trial results with cutting or scoring balloon plaque pretreatment

3.4 Patient’s clinical cases using cutting and scoring plaque pretreatment

3.4.1 First clinical case

3.4.2 Second clinical case

3.4.3 Third clinical case

References

Chapter 4 OCT for stent optimization

4.1 Introduction

4.2 Utilization of OCT for vessel preparation

4.2.1 Thrombectomy

4.2.2 Calcium modification using rotational atherectomy or cutting balloon

4.3 OCT for defining stent length and diameter

4.3.1 Defining lumen profile

4.3.2 Screening for unstable plaques

4.3.3 Defining the best stent landing zone

4.4 OCT for side branch protection

4.4.1 OCT after stent deployment

4.4.2 Stent malapposition

4.4.3 Stent underexpansion

4.4.4 Edge dissection

4.4.5 Incomplete lesion coverage

4.4.6 Tissue prolapse

4.5 Conclusion

References

Chapter 5 OCT for left main assessment

5.1 Introduction

5.2 Safety of FD-OCT for ULM Disease

5.3 FD-OCT Measurements for ULM Disease

5.4 Feasibility of FD-OCT for ULM Disease

5.5 Conclusions

References

Chapter 6 Optical coherence tomography for late stent failure

6.1 Introduction

6.2 Restenosis

6.2.1 Pathobiology of restenosis

6.2.2 OCT patterns of restenosis

6.2.3 Management

6.3 Case report: In-stent restenosis

6.4 Stent thrombosis

6.4.1 Prevalence and etiology of stent thrombosis

6.4.2 Role of OCT to identify intrastent pathology in late or very late stent thrombosis

6.4.3 Can OCT guide therapy in late or very late stent thrombosis?

References

Chapter 7 OCT assessment in spontaneous coronary artery dissection

7.1 Spontaneous coronary artery dissection

7.1.1 Epidemiology

7.1.2 Pathogenesis

7.1.3 Fibromuscular dysplasia

7.1.4 Angiographic features of SCAD: saw angiographic SCAD classification

7.1.5 Intracoronary imaging of SCAD

7.2 Role of OCT in the diagnosis and management of spontaneous coronary artery dissection

7.2.1 OCT guidance for PCI

7.3 Management of SCAD

7.4 Future directions

7.5 Conclusions

References

Chapter 8 Optical coherence tomography assessment for cardiac allograft vasculopathy after heart transplantation

8.1 Introduction

8.1.1 Background

8.2 Screening and diagnosing CAV

8.3 CAV Pathophysiology

8.3.1 Role of rejection

8.3.2 Traditional atherosclerosis

8.4 OCT utilization post–heart transplantation

8.4.1 Intimal hyperplasia

8.4.2 Atherosclerotic plaques

8.4.3 Correlation with cellular rejection

8.4.4 Comparison with IVUS

8.5 Treatment of CAV

8.6 Conclusion

References

Chapter 9 OCT assessment out of the coronary arteries

9.1 Introduction

9.2 History of intravascular imaging

9.3 Optical coherence tomography

9.3.1 Comparison with IVUS

9.3.2 Technique

9.4 Clinical applications of OCT in the peripheral vasculature

9.4.1 Diagnostic utilization: lesion characterization

9.4.1.1 Fibrotic and lipid-rich plaques: case 1

9.4.1.2 Calcified plaques: case 2

9.4.1.3 In-stent restenosis: case 3

9.4.1.4 Vein graft: case 4

9.4.1.5 Vasospasm: case 5

9.4.1.6 Thrombus: case 6

9.4.2 Assessment of interventional techniques

9.4.2.1 Angioplasty

9.4.2.2 Atherectomy

9.4.2.3 Stent

9.5 Future directions

References

Chapter 10 Optical coherence tomography for the assessment of bioresorbable vascular scaffolds

10.1 Introduction

10.2 Optical coherence tomography assessment before BVS implantation

10.3 Optical coherence tomography assessment after BVS implantation

10.4 Optical coherence tomography assessment for BVS follow-up

Disclosures

References

Chapter 11 ILUMIEN OPTIS Mobile and OPTIS Integrated Technology Overview

11.1 Platform overview

11.1.1 FD-OCT operating principles

11.1.2 Common system specifications

11.1.3 Catheter specifications

11.1.4 Comparison to ILUMIEN, C7xr, M3, and M2 specs

11.2 ILUMIEN OPTIS Mobile System

11.2.1 Imaging engine

11.2.2 Driver-motor and optical controller

11.2.3 Mobile console

11.3 OPTIS Integrated System

11.3.1 Architectural design

11.3.2 Control room cabinet

11.3.3 DOC holster

11.3.4 Remoting cable

11.3.5 Tableside controller

11.3.6 Installation options (boom vs. table mount)

11.4 OCT application software

11.4.1 B-Mode, L-Mode, and lumen profile displays

11.4.2 3D visualization

11.4.3 Data management

11.5 Angio coregistration software

11.5.1 Operating principle

11.5.2 Guided workflow

11.6 Conclusion

References

Chapter 12 Terumo OFDI system

12.1 Introduction

12.2 Fastview imaging catheter

12.2.1 Components and architecture

12.2.2 Clinical setup and compatibility

12.2.3 Characteristics of FastView

12.3 Lunawave OFDI imaging console

12.3.1 LUNAWAVE imaging technologies

12.3.1.1 Polygon scanner wavelength filter

12.3.1.2 Sensitivity peak shift

12.3.1.3 Laser safety mechanisms

12.3.2 Reliability

12.3.2.1 Data protection and backup system

12.3.3 Image acquisition setups

12.3.3.1 Pullback condition setting

12.3.3.2 Pullback speed and frame pitch

12.3.3.3 Automatic injector setup: flush rate and volume

12.3.4 Stent implantation supporting software

12.3.4.1 Preinterventional diagnosis

12.3.4.2 Area measurement

12.3.4.3 Length measurement

12.3.4.4 Angio coregistration

12.3.5 PCI procedure evaluation

12.3.5.1 Distance and thickness measurement

12.3.5.2 Dual-review mode

12.3.6 Evaluation of bifurcation lesion: 3D OFDI

12.3.6.1 3D reconstruction

12.3.7 File export

12.4 Case report: Usefulness of OFDI-guided PCI for the separated proximal and mid–left anterior descending artery lesions

12.5 Case report: Usefulness of 3D OFDI for bifurcation PCI

12.5.1 Introduction

12.5.2 Case

12.5.3 Discussion

Videos

Acknowledgment

Disclosures

References

Chapter 13 OCT imaging acquisition

13.1 Introduction

13.2 System of OCT

13.3 Imaging procedure

13.4 Flushing parameters: Recommended injection setting

13.5 Pitfalls and limitations

13.5.1 Incorrect calibration

13.5.2 Correction with refractive index

13.5.3 Filling of catheter sheath with contrast media

13.5.4 Inadequate flushing

13.5.5 Lesion selection

13.6 Conclusions

References

Appendix: Intravascular Bioresorbable Vascular Scaffold Optimization Technique

References

Index