OCT may be best tool to detect vulnerable coronary plaque

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WASHINGTON—Optical coherence tomography (OCT) may be the best tool available to detect vulnerable plaque in coronary arteries, according to findings presented this week at the 20th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium.

A team of researchers at the Ajou University School of Medicine in Suwon, Korea, reported that OCT provides superior contrast and resolution in imaging the components of plaque in coronary arteries versus other methods including intravascular ultrasound (IVUS) and virtual histology (VH-IVUS).

“OCT may answer longstanding questions about the relationship between vulnerable plaque and the risk of heart attack,” said lead investigator So-Yeon Choi, MD, PhD.
To assess the ability of each imaging modality to detect the specific characteristics of vulnerable plaque, investigators performed IVUS, VH-IVUS and OCT in 48 patients, who were categorized as having stable angina pectoris (15) or acute coronary syndromes (33).

The researchers found that “OCT easily detected vulnerable plaque,” with two observers analyzing the images independently.

OCT detected most of the major and minor characteristics of vulnerable plaque, including the thin cap with large lipid core, and it has the ability to detect thrombus and fissured plaque at a higher level than other modalities, according to Choi.

As a result, the investigators concluded that OCT may provide a better understanding of the natural progression of coronary artery disease. For example, stenosis or erosion of endothelial cells with plaque could be detected even in patients with stable angina.

"That finding is something that we had never experienced before; we should study more the clinical implication of these findings," Choi said. "New evolving OCT imaging is moving closer to becoming a powerful diagnostic tool that will provide new insights into the etiology and treatment of coronary artery disease."

The researchers noted that current OCT technology does have some limitations, though, such as the need for a blood-clear zone and a low penetrating depth. However, they noted that procedure is safe and can be performed in a cath lab.