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Current OCT Approaches Do Not Reliably Identify TCFAs
Mark E Brezinski1,2,3, Kishore J Harjai4
1Center for Optics and Modern Physics, Brigham and Women's Hospital, Boston, M.A, USA.
Abstract:
It is now clearly established that Thin-Capped Fibroatheromas (TCFAs) lead to most Acute Coronary Syndromes (ACSs). The ability to selectively intervene on TCFAs predisposed to rupture and ACSs would dramatically alter the practice of cardiology. While the ability of OCT to identify thin walled plaques at micron scale resolutions has represented a major advance, it is a misconception that it can reliably identify TCFAs. One major reason is that the 'diffuse border' criteria currently used to determine 'lipid plaque' is almost undoubtedly from high scattering in the intima and not because of core composition (necrotic core). A second reason is that, rather than looking at lipid collections, studies need to be focused on identifying necrotic cores with OCT. Necrotic cores are characteristic of TCFAs and not lipid collections. Numerous other OCT approaches are available which can potentially accurately assess TCFAs, but these have not been aggressively pursed which we believe likely stems in part from the misconceptions over the efficacy of 'diffuse borders'.
Insights
Thin-Capped Fibroatheromas (TCFAs) cause most Acute Coronary Syndromes (ACSs). Current OCT methods misidentify plaques, necessitating new approaches to accurately detect TCFAs and prevent ACS events.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Biomedical Engineering
Background:
- Thin-Capped Fibroatheromas (TCFAs) are the primary cause of Acute Coronary Syndromes (ACSs).
- Accurate identification of TCFAs is crucial for targeted intervention and prevention of ACS.
- Optical Coherence Tomography (OCT) has advanced plaque imaging but faces limitations in reliably identifying TCFAs.
Purpose of the Study:
- To address the misconception that current OCT 'diffuse border' criteria reliably identify lipid plaques.
- To highlight the need for OCT methods focused on detecting necrotic cores, characteristic of TCFAs.
- To advocate for the development and pursuit of alternative OCT approaches for accurate TCFA assessment.
Main Methods:
- Critically evaluating the 'diffuse border' criteria used in OCT for lipid plaque identification.
- Analyzing the limitations of current OCT interpretations regarding plaque composition.
- Reviewing potential alternative OCT strategies for TCFA detection.
Main Results:
- The 'diffuse border' criterion is likely due to intimal scattering, not necrotic core composition.
- Current OCT methods may misinterpret lipid collections as indicative of TCFAs.
- Necrotic cores, not lipid collections, are the defining feature of TCFAs.
Conclusions:
- Existing OCT criteria for identifying TCFAs are flawed and based on a misconception.
- Future OCT research must focus on detecting necrotic cores for accurate TCFA assessment.
- Developing and implementing novel OCT techniques is essential to improve TCFA detection and ACS prevention.
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