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Published on: January 15, 2022
Contribution of the Optical Coherence Tomography in Calcified Lesions
Nicolas Combaret1, Nicolas Amabile2, Benjamin Duband1
1Cardiology Department, Clermont-Ferrand University Hospital, CNRS, Université d'Auvergne, 63000 Clermont-Ferrand, France.
Insights
Coronary artery calcification poses challenges for percutaneous coronary intervention (PCI). Intracoronary imaging like Optical Coherence Tomography (OCT) aids in characterizing these lesions for better treatment strategies.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Coronary artery calcification is prevalent in elderly populations and difficult to assess with standard angiography.
- Calcified lesions, though considered stable, increase peri-procedural complications during percutaneous coronary intervention (PCI), leading to poor clinical outcomes.
- Complications include stent under-expansion and malapposition, highlighting the need for improved lesion evaluation.
Purpose of the Study:
- To highlight the limitations of coronary angiography in evaluating calcified lesions.
- To emphasize the role of intracoronary imaging in characterizing calcified coronary artery lesions.
- To discuss how lesion characterization guides the selection of plaque-preparation tools for optimal PCI outcomes.
Main Methods:
- Utilizing intracoronary imaging modalities such as Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) for detailed lesion assessment.
- Employing OCT to identify, localize (superficial vs. deep), and quantify calcified lesions within the coronary artery wall.
- Assessing the impact of plaque-preparation tools (e.g., atherectomy, lithotripsy) on calcified plaque morphology using OCT.
Main Results:
- Intracoronary imaging (IVUS and OCT) offers superior detection, evaluation, and quantification of calcified lesions compared to angiography.
- Characterization of calcified lesions enables selection of appropriate plaque-preparation devices for percutaneous coronary intervention (PCI).
- Optical Coherence Tomography (OCT) can visualize the effects of plaque-preparation tools, such as plaque fracture and burring.
Conclusions:
- Intracoronary imaging, particularly OCT, is crucial for detailed assessment and management of calcified coronary lesions.
- Tailored PCI strategies guided by OCT for calcified lesions require further validation through ongoing clinical studies.
- Optimizing PCI for calcified lesions necessitates advanced imaging and appropriate plaque-modification techniques.
Abstract:
Coronary artery calcification is a complex process found predominantly in the elderly population. Coronary angiography frequently lacks sensitivity to detect, evaluate and quantify these lesions. Yet calcified lesions are considered stable, it remains associated with a higher rate of peri procedural complications during percutaneous coronary intervention (PCI) including an increased risk of stent under expansion and struts mal apposition leading to poor clinical outcome. Intracoronary imaging (Intravascular Ultra Sound (IVUS) and Optical Coherence Tomography (OCT)) allows better calcified lesions identification, localization within the coronary artery wall (superficial or deep calcifications), quantification. This lesions characterization allows a better choice of dedicated plaque-preparation tools (modified balloons, rotational or orbital atherectomy, intravascular lithotripsy) that are crucial to achieve optimal PCI results. OCT could also assess the impact of these tools on the calcified plaque morphology (plaque fracture, burring effects…). An OCT-guided tailored PCI strategy for calcified lesions still requires validation by clinical studies which are currently underway.
