Optical coherence tomography safe in carotid artery stenting procedures


A new study of optical coherence tomography (OCT) confirms the safety and feasibility of this imaging technique in the carotid arteries. However, because of cost issues, OCT still has a long road to travel to become widely utilized, according to a study recently published in the current issue of the Journal of Endovascular Therapy

Optical coherence tomography is an invasive intravascular imaging system that produces high-resolution images using light rather than ultrasound. Its resolution is 10 times higher than that of any other clinically available diagnostic imaging method, and it can provide images of tissues at nearly histological resolution. Limitations of OCT include interference by blood flow and the degree of tissue penetration it can achieve.

Carlos Setacci and colleagues from the Department of Surgery, Vascular and Endovascular Surgery Unit, University of Siena, Italy, analysed 25 patients undergoing carotid artery stenting (15 men; mean age 74±4 years) who also underwent optical coherence tomography before stent deployment, immediately after stent placement, and following postdilation of the stent. The OCT technique had a success rate of 97.3%, and no complications occurred for the patients during the procedures in the hospital. The images obtained were of high quality (mean value 8.1 out of 10), with good inter- and intraobserver agreement (κ‰Û_=‰Û_0.81–0.87 and κ‰Û_=‰Û_0.95, respectively).

Setacci et al wrote that through the use of OCT in this study, physicians were able to see, among other details, rupture of the fibrous cap, plaque prolapse, and stent malapposition in patients.

The authors conclude that “carotid OCT with a nonocclusive technique is safe and effective, allowing the collection before and after carotid artery stenting of good quality images and informative details that are not available with other existing imaging systems.” They also state: “In the near future, application of this intravascular imaging system may reveal some innovative details (such as rupture of the fibrous cap, plaque prolapse, and stent malapposition) at such high definition that it might revolutionise our understanding of the mechanisms of carotid stenting and influence our clinical policies.”