Optical Coherence Tomography (OCT)

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Negative and positive remodeling of coronary plaque.[1]
Outcomes of the PROSPECT Trial (Virtual Histology using IVUS).[2]
  • OCT has the resolution needed to determine culprit lesions[3].
  • Clues[3]:
    • Plaque erosion
    • Thrombus

Determining vulnerable plaque

  • Being able to predict which lesions will rupture provides some clinical utility
  • Characteristics which can be used to predict plaque vulnerability include[4]:
    • Remodeling characteristics
      • Positive remodeling: remodeling index > 1.05
      • Minimal luminal area (MLA) < 4.0 mm2.
    • Virtual histology: plaque burden > 70%
    • Fibrous cap thickness: thin-cap fibroatheroma (TCFA)
  • Remodeling characteristics: positive remodeling is associated with a more "unstable" lesion when compared to negative remodeling[1].
  • PROSPECT Trial (patients with ACS who had IVUS performed in multiple vessels)[5]:
    • TCFA was associated with a statistically significant higher adverse event rate compared to the absence of TCFA
    • TCFA + MLA < 4 mm2 was associated with a higher adverse event rate compared to no TCFA and MLA > 4 mm2.
    • TCFA + plaque burden > 70% was associated with a higher adverse event rate compared to no TCFA and plaque burden < 70%.
    • TCFA + plaque burden > 70% + MLA < 4 mm2 was associated with a statistically significant adverse event rate when compared to no TCFA + plaque burden < 70% + MLA > 4.

References

  1. 1.0 1.1 JACC 2014;64:207
  2. NEJM 2011;364:226
  3. 3.0 3.1 JACC 2014;64:207
  4. JACC 2001;38:297-306
  5. NEJM 2011;364:226