Clinical applications of optical coherence tomography.

Rupture of vulnerable plaque (VP) is responsible for most coronary events. Optical coherence tomography (OCT) is a high-resolution imaging method that allows excellent characterization of atherosclerotic plaque. While this technique is limited by the need to interrupt blood flow and a shallow depth of penetration, its resolution is an order of magnitude greater than possible with intravascular ultrasound (IVUS), and it has demonstrated better sensitivity and specificity for accurately determining plaque composition. Early in vitro and in vivo experiences have affirmed the excellent quality of these images making it an attractive technology for the analysis of VP. Its high resolution likely renders it the best imaging modality currently available for the evaluation of proper stent deployment and of intracoronary pathology in the setting of percutaneous coronary interventions (PCI). Our institution is currently involved in a multicenter trial to evaluate the effectiveness of OCT when compared to IVUS in this setting. Ongoing technological improvements aim to permit rapid scanning which should alleviate its current major limitation of needing to scan in a blood-free space. OCT is a promising new technology in the evaluation of atherosclerotic plaque and coronary microstructure.