OCT Made Easy

Description:

This book, written by premier authors in the field of OCT intravascular imaging, covers the best practices for using OCT to provide high resolution cross-sectional viewing for atherosclerotic plaque assessment, stent strut coverage and apposition, assessment in stent restenosis evaluation, and PCI guide and optimization. Fully illustrated thorughout in a handy, cath-lab side handbook supplemented by online movie clips, OCT Made Easy includes case studies, angiography, CT correlations, and simple techniques for getting the best image.  

 

Table of Contents:

Contributors

Chapter 1 Optical coherence tomography imaging for stent planning

1. 1 Introduction

1. 2 General outline

1. 3 Preintervention OCT imaging

1.

3. 1 Assessment of coronary stenosis severity

1.

3.

1. 1 Basic nomenclature and definitions

1.

3.

1. 2 Considerations of quantitative measurements of vascular structures

1.

3.

1. 3 Estimating the functional significance of coronary stenoses by quantitative OCT measurements

1.

3. 2 Assessment of lesion morphology, composition, and morphometry

1.

3. 3 Vessel measurements for stent sizing

1.

3.

3. 1 Length measurement

1.

3.

3. 2 Diameter measurement

1. 4 Postintervention OCT imaging

1.

4. 1 Verification and optimization of stent expansion

1.

4. 2 Verification and optimization of stent apposition

1.

4. 3 Assessment of other qualitative parameters after stenting

1.

4.

3. 1 Stent edge dissections

1.

4.

3. 2 In-stent dissections, tissue prolapse, and in-stent thrombus

1. 5 Potential clinical impact of OCT use for PCI planning and guidance

References

Chapter 2 OCT imaging for assessment of plaque modification

2. 1 Introduction

2. 2 Plain ordinary balloon and drug-eluting balloon angioplasty

2.

2. 1 Cutting balloon or scoring balloon angioplasty

2.

2. 2 Rotational atherectomy

2.

2. 3 Plaque modification after stenting

References

Chapter 3 OCT for plaque modification

3. 1 Plaque modification before coronary artery stenting using cutting/scoring balloon

3. 2 Cutting and scoring balloons

3. 3 Trial results with cutting or scoring balloon plaque pretreatment

3. 4 Patient’s clinical cases using cutting and scoring plaque pretreatment

3.

4. 1 First clinical case

3.

4. 2 Second clinical case

3.

4. 3 Third clinical case

References

Chapter 4 OCT for stent optimization

4. 1 Introduction

4. 2 Utilization of OCT for vessel preparation

4.

2. 1 Thrombectomy

4.

2. 2 Calcium modification using rotational atherectomy or cutting balloon

4. 3 OCT for defining stent length and diameter

4.

3. 1 Defining lumen profile

4.

3. 2 Screening for unstable plaques

4.

3. 3 Defining the best stent landing zone

4. 4 OCT for side branch protection

4.

4. 1 OCT after stent deployment

4.

4. 2 Stent malapposition

4.

4. 3 Stent underexpansion

4.

4. 4 Edge dissection

4.

4. 5 Incomplete lesion coverage

4.

4. 6 Tissue prolapse

4. 5 Conclusion

References

Chapter 5 OCT for left main assessment

5. 1 Introduction

5. 2 Safety of FD-OCT for ULM Disease

5. 3 FD-OCT Measurements for ULM Disease

5. 4 Feasibility of FD-OCT for ULM Disease

5. 5 Conclusions

References

Chapter 6 Optical coherence tomography for late stent failure

6. 1 Introduction

6. 2 Restenosis

6.

2. 1 Pathobiology of restenosis

6.

2. 2 OCT patterns of restenosis

6.

2. 3 Management

6. 3 Case report: In-stent restenosis

6. 4 Stent thrombosis

6.

4. 1 Prevalence and etiology of stent thrombosis

6.

4. 2 Role of OCT to identify intrastent pathology in late or very late stent thrombosis

6.

4. 3 Can OCT guide therapy in late or very late stent thrombosis?

References

Chapter 7 OCT assessment in spontaneous coronary artery dissection

7. 1 Spontaneous coronary artery dissection

7.

1. 1 Epidemiology

7.

1. 2 Pathogenesis

7.

1. 3 Fibromuscular dysplasia

7.

1. 4 Angiographic features of SCAD: saw angiographic SCAD classification

7.

1. 5 Intracoronary imaging of SCAD

7. 2 Role of OCT in the diagnosis and management of spontaneous coronary artery dissection

7.

2. 1 OCT guidance for PCI

7. 3 Management of SCAD

7. 4 Future directions

7. 5 Conclusions

References

Chapter 8 Optical coherence tomography assessment for cardiac allograft vasculopathy after heart transplantation

8. 1 Introduction

8.

1. 1 Background

8. 2 Screening and diagnosing CAV

8. 3 CAV Pathophysiology

8.

3. 1 Role of rejection

8.

3. 2 Traditional atherosclerosis

8. 4 OCT utilization post–heart transplantation

8.

4. 1 Intimal hyperplasia

8.

4. 2 Atherosclerotic plaques

8.

4. 3 Correlation with cellular rejection

8.

4. 4 Comparison with IVUS

8. 5 Treatment of CAV

8. 6 Conclusion

References

Chapter 9 OCT assessment out of the coronary arteries

9. 1 Introduction

9. 2 History of intravascular imaging

9. 3 Optical coherence tomography

9.

3. 1 Comparison with IVUS

9.

3. 2 Technique

9. 4 Clinical applications of OCT in the peripheral vasculature

9.

4. 1 Diagnostic utilization: lesion characterization

9.

4.

1. 1 Fibrotic and lipid-rich plaques: case 1

9.

4.

1. 2 Calcified plaques: case 2

9.

4.

1. 3 In-stent restenosis: case 3

9.

4.

1. 4 Vein graft: case 4

9.

4.

1. 5 Vasospasm: case 5

9.

4.

1. 6 Thrombus: case 6

9.

4. 2 Assessment of interventional techniques

9.

4.

2. 1 Angioplasty

9.

4.

2. 2 Atherectomy

9.

4.

2. 3 Stent

9. 5 Future directions

References

Chapter 10 Optical coherence tomography for the assessment of bioresorbable vascular scaffolds

10. 1 Introduction

10. 2 Optical coherence tomography assessment before BVS implantation

10. 3 Optical coherence tomography assessment after BVS implantation

10. 4 Optical coherence tomography assessment for BVS follow-up

Disclosures

References

Chapter 11 ILUMIEN OPTIS Mobile and OPTIS Integrated Technology Overview

11. 1 Platform overview

11.

1. 1 FD-OCT operating principles

11.

1. 2 Common system specifications

11.

1. 3 Catheter specifications

11.

1. 4 Comparison to ILUMIEN, C7xr, M3, and M2 specs

11. 2 ILUMIEN OPTIS Mobile System

11.

2. 1 Imaging engine

11.

2. 2 Driver-motor and optical controller

11.

2. 3 Mobile console

11. 3 OPTIS Integrated System

11.

3. 1 Architectural design

11.

3. 2 Control room cabinet

11.

3. 3 DOC holster

11.

3. 4 Remoting cable

11.

3. 5 Tableside controller

11.

3. 6 Installation options (boom vs. table mount)

11. 4 OCT application software

11.

4. 1 B-Mode, L-Mode, and lumen profile displays

11.

4. 2 3D visualization

11.

4. 3 Data management

11. 5 Angio coregistration software

11.

5. 1 Operating principle

11.

5. 2 Guided workflow

11. 6 Conclusion

References

Chapter 12 Terumo OFDI system

12. 1 Introduction

12. 2 Fastview imaging catheter

12.

2. 1 Components and architecture

12.

2. 2 Clinical setup and compatibility

12.

2. 3 Characteristics of FastView

12. 3 Lunawave OFDI imaging console

12.

3. 1 LUNAWAVE imaging technologies

12.

3.

1. 1 Polygon scanner wavelength filter

12.

3.

1. 2 Sensitivity peak shift

12.

3.

1. 3 Laser safety mechanisms

12.

3. 2 Reliability

12.

3.

2. 1 Data protection and backup system

12.

3. 3 Image acquisition setups

12.

3.

3. 1 Pullback condition setting

12.

3.

3. 2 Pullback speed and frame pitch

12.

3.

3. 3 Automatic injector setup: flush rate and volume

12.

3. 4 Stent implantation supporting software

12.

3.

4. 1 Preinterventional diagnosis

12.

3.

4. 2 Area measurement

12.

3.

4. 3 Length measurement

12.

3.

4. 4 Angio coregistration

12.

3. 5 PCI procedure evaluation

12.

3.

5. 1 Distance and thickness measurement

12.

3.

5. 2 Dual-review mode

12.

3. 6 Evaluation of bifurcation lesion: 3D OFDI

12.

3.

6. 1 3D reconstruction

12.

3. 7 File export

12. 4 Case report: Usefulness of OFDI-guided PCI for the separated proximal and mid–left anterior descending artery lesions

12. 5 Case report: Usefulness of 3D OFDI for bifurcation PCI

12.

5. 1 Introduction

12.

5. 2 Case

12.

5. 3 Discussion

Videos

Acknowledgment

Disclosures

References

Chapter 13 OCT imaging acquisition

13. 1 Introduction

13. 2 System of OCT

13. 3 Imaging procedure

13. 4 Flushing parameters: Recommended injection setting

13. 5 Pitfalls and limitations

13.

5. 1 Incorrect calibration

13.

5. 2 Correction with refractive index

13.

5. 3 Filling of catheter sheath with contrast media

13.

5. 4 Inadequate flushing

13.

5. 5 Lesion selection

13. 6 Conclusions

References

Appendix: Intravascular Bioresorbable Vascular Scaffold Optimization Technique

References

Index