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Updated: May 24, 2026
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Intravascular frequency-domain optical coherence tomography assessment of atherosclerosis and stent-vessel
M R Jones1, G F Attizzani, C A Given
1Baptist Heart and Vascular Institute, Central Baptist Hospital, Lexington, KY, USA. mjones@lexingtoncardio.com
Insights
High-resolution imaging of carotid arteries using FDOCT revealed critical plaque features, challenging traditional risk assessment for stroke and paving the way for improved patient management.
Area of Science:
- Cardiovascular Imaging
- Neurology
- Medical Technology
Background:
- Carotid artery stroke is often embolic, linked to vulnerable atherosclerotic plaque.
- Current risk assessment for asymptomatic patients relies heavily on stenosis, a method facing scrutiny.
- Optical coherence tomography (OCT) offers high-resolution imaging of plaque morphology.
Purpose of the Study:
- To report the first use of Forward-looking OCT (FDOCT) without balloon occlusion in human carotid arteries.
- To assess carotid artery disease and stent-vessel interaction in vivo.
- To evaluate FDOCT's potential in clarifying ambiguous data and guiding treatment strategies.
Main Methods:
- Four patients with asymptomatic carotid artery disease and unclear noninvasive/angiographic data underwent carotid FDOCT.
- FDOCT was used to assess plaque morphology and guide treatment decisions.
- Procedures were performed without vessel occlusion or safety concerns.
Main Results:
- FDOCT identified high-risk plaque features (TCFAs, rupture, thrombus, inflammation) in patients lacking conventional high-risk factors.
- Low-risk features were observed in a patient with a high-risk noninvasive study.
- Significant tissue prolapse through stent struts was noted.
Conclusions:
- FDOCT is technically feasible for imaging cervical carotid arteries.
- This technology can clarify ambiguous diagnostic data in individual patients.
- FDOCT may lead to a paradigm shift in assessing asymptomatic carotid artery disease.
Background And Purpose:
Carotid artery-related stroke is largely an embolic disease that has been correlated with inflammation, plaque rupture, and thrombus formation in "vulnerable" atherosclerotic plaque. Nevertheless, current guidelines for carotid revascularization in asymptomatic patients rely on the calculation of stenosis for risk assessment, a parameter that has been viewed with increasing skepticism. Intravascular OCT is an imaging technique that offers high axial resolution (10 μm), allowing an unprecedented micron-level assessment of human carotid plaque morphology. This observational article reports the first successful use of the newest iteration of this technology, FDOCT without balloon occlusion to assess human carotid artery disease and carotid stent-vessel interaction in vivo.
Materials And Methods:
Four patients with asymptomatic carotid artery disease and ambiguous noninvasive and/or angiographic data underwent carotid FDOCT to assess risk and to formulate a treatment strategy.
Results:
Findings include the unexpected demonstration of TCFAs, plaque rupture, thrombus, inflammation, and marked tissue prolapse through stent struts in patients without high-risk factors by conventional criteria, as well as low-risk features in a patient with a high-risk noninvasive study. The procedures were performed without safety issues or special accommodations for vessel occlusion.
Conclusions:
The present study demonstrates the technical feasibility of FDOCT in cervical carotid arteries. As such, this technology holds the promise of not only clarifying ambiguous data in individual patients but of providing data that might call for a future paradigm shift in the assessment of asymptomatic carotid artery disease.
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