[Contribution of intracoronary imaging in acute coronary syndrome]

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Acute coronary syndrome (ACS) is a significant global health concern, despite advancements in treatment.
• Understanding ACS pathophysiology has evolved with endocoronary imaging, including intravascular ultrasound (IVUS).
• While plaque rupture is a known cause, optical coherence tomography (OCT) reveals plaque erosion is more prevalent than previously assumed.

Purpose of the Study:

• To evaluate the diagnostic and therapeutic utility of optical coherence tomography (OCT) in managing acute coronary syndrome (ACS).
• To highlight OCT's role in identifying specific ACS-related pathologies and optimizing interventional strategies.

Main Methods:

• Review of studies utilizing optical coherence tomography (OCT) in the context of acute coronary syndrome (ACS).
• Analysis of OCT's capabilities in visualizing coronary lesions, dissections, hematomas, and stent deployment.
• Assessment of OCT's impact on therapeutic decisions and procedural outcomes in ACS patients.

Main Results:

• OCT aids in diagnosing the culprit lesion in ACS, differentiating between plaque rupture and erosion.
• OCT is valuable for identifying spontaneous coronary dissection, intramural hematoma, and assessing stent thrombosis.
• Therapeutic applications include reducing stent malapposition, guiding delayed stenting, and informing treatment without stenting.

Conclusions:

• Optical coherence tomography (OCT) offers significant diagnostic value in acute coronary syndrome (ACS), complementing existing imaging modalities.
• OCT provides crucial insights for therapeutic interventions, improving procedural safety and efficacy in the cardiac catheterization lab.
• While not routine, OCT is an indispensable tool within the interventional cardiologist's armamentarium for ACS management.