Optical coherence tomography in endovascular neurosurgery: current applications and future directions

Optical Coherence Tomography (OCT), initially introduced in 1991, has demonstrated efficacy in diagnosing pathologies of the retina, optic nerve, and coronary vessels. Recently, there has been growing research interest in the application of OCT in endovascular neurosurgery, with studies exploring its utility across a range of intracranial and extracranial endovascular diseases. The current review aims to synthesize available literature on the use of OCT in endovascular neurosurgery, encompassing both clinical and preclinical models. 57 studies met the inclusion criteria and were included in the qualitative analysis. These studies were stratified into different categories based on diseases studied. OCT has been utilized to evaluate the in vivo microanatomy of intracranial and extracranial vasculature, assess treatment efficacy and device apposition, and monitor patient outcomes. The results consistently demonstrate greater accuracy and stronger correlation with patient outcomes compared to contemporary imaging techniques. However, limitations such as the large size of current OCT-integrated probes and the lack of standardized workflows hinder the broader adoption of this technology.