How to Use OCT to Optimize PCI?

  • Teruyoshi Kume
  • Shiro UemuraEmail author


Optical coherence tomography (OCT) has become an important catheter-based imaging technology that can be used as a practical guidance for percutaneous coronary intervention (PCI). OCT gives us detailed information about planning of interventional strategies including device selection. After stent deployment, OCT also shows us the condition of stent implantation which is important for preventing future cardiovascular events. In addition, recent advances in OCT-related software, such as lumen profile display, automatic stent strut detection, OCT/angiography co-registration, and three-dimensional (3D) reconstruction, facilitate image interpretation and the ease of its application. This chapter focuses on the practical use of OCT during PCI procedures.


Optical coherence tomography Percutaneous coronary intervention Lesion assessment Stent Three-dimensional reconstruction 


  1. 1.
    Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, et al. Characterization of human atherosclerosis by optical coherence tomography. Circulation. 2002;106:1640–5.CrossRefGoogle Scholar
  2. 2.
    Takarada S, Imanishi T, Liu Y, Ikejima H, Tsujioka H, Kuroi A, et al. Advantage of next-generation frequency-domain optical coherence tomography compared with conventional time-domain system in the assessment of coronary lesion. Catheter Cardiovasc Interv. 2010;75:202–6.CrossRefGoogle Scholar
  3. 3.
    Kubo T, Shinke T, Okamura T, Hibi K, Nakazawa G, Morino Y, et al. Optical frequency domain imaging vs. intravascular ultrasound in percutaneous coronary intervention (opinion trial): one-year angiographic and clinical results. Eur Heart J. 2017;38:3139–47.CrossRefGoogle Scholar
  4. 4.
    Song HG, Kang SJ, Ahn JM, Kim WJ, Lee JY, Park DW, et al. Intravascular ultrasound assessment of optimal stent area to prevent in-stent restenosis after zotarolimus-, everolimus-, and sirolimus-eluting stent implantation. Catheter Cardiovasc Interv. 2014;83:873–8.CrossRefGoogle Scholar
  5. 5.
    Choi SY, Witzenbichler B, Maehara A, Lansky AJ, Guagliumi G, Brodie B, et al. Intravascular ultrasound findings of early stent thrombosis after primary percutaneous intervention in acute myocardial infarction: a harmonizing outcomes with revascularization and stents in acute myocardial infarction (horizons-ami) substudy. Circ Cardiovasc Interv. 2011;4:239–47.CrossRefGoogle Scholar
  6. 6.
    Kurokawa M, Uemura S, Watanabe M, Dote Y, Sugawara Y, Goryo Y, et al. Changes in the reference lumen size of target lesions before and after coronary stent implantation: evaluation with frequency domain optical coherence tomography. Int J Cardiol Heart Vasc. 2015;8:122–12.7.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Chamie D, Bezerra HG, Attizzani GF, Yamamoto H, Kanaya T, Stefano GT, et al. Incidence, predictors, morphological characteristics, and clinical outcomes of stent edge dissections detected by optical coherence tomography. JACC Cardiovasc Interv. 2013;6:800–13.CrossRefGoogle Scholar
  8. 8.
    Ino Y, Kubo T, Matsuo Y, Yamaguchi T, Shiono Y, Shimamura K, et al. Optical coherence tomography predictors for edge restenosis after everolimus-eluting stent implantation. Circ Cardiovasc Interv. 2016;9:e004231.CrossRefGoogle Scholar
  9. 9.
    Ueda T, Uemura S, Watanabe M, Dote Y, Goryo Y, Sugawara Y, et al. Thin-cap fibroatheroma and large calcification at the proximal stent edge correlate with a high proportion of uncovered stent struts in the chronic phase. Coron Artery Dis. 2016;27:376–84.CrossRefGoogle Scholar
  10. 10.
    Watanabe M, Uemura S, Sugawara Y, Ueda T, Soeda T, Takeda Y, et al. Side branch complication after a single-stent crossover technique: prediction with frequency domain optical coherence tomography. Coron Artery Dis. 2014;25:321–9.CrossRefGoogle Scholar
  11. 11.
    Kobayashi Y, Okura H, Kume T, Yamada R, Kobayashi Y, Fukuhara K, et al. Impact of target lesion coronary calcification on stent expansion. Circ J. 2014;78:2209–14.CrossRefGoogle Scholar
  12. 12.
    Lindsay AC, Paulo M, Kadriye K, Tejeiro R, Alegria-Barrero E, Chan PH, et al. Predictors of stent strut malapposition in calcified vessels using frequency-domain optical coherence tomography. J Invasive Cardiol. 2013;25:429–34.PubMedGoogle Scholar
  13. 13.
    Karimi Galougahi K, Shlofmitz RA, Ben-Yehuda O, Genereux P, Maehara A, et al. Guiding light: insights into atherectomy by optical coherence tomography. JACC Cardiovasc Interv. 2016;9:2362–3.CrossRefGoogle Scholar
  14. 14.
    Maejima N, Hibi K, Saka K, Akiyama E, Konishi M, Endo M, et al. Relationship between thickness of calcium on optical coherence tomography and crack formation after balloon dilatation in calcified plaque requiring rotational atherectomy. Circ J. 2016;80:1413–9.CrossRefGoogle Scholar
  15. 15.
    Koyama T, Okura H, Kume T, Fukuhara K, Neishi Y, Hayashida A, et al. Calcified plaque ablated by rotational atherectomy visualised by optical coherence tomography. EuroIntervention. 2015;11:e1.CrossRefGoogle Scholar
  16. 16.
    Kubo T, Shimamura K, Ino Y, Yamaguchi T, Matsuo Y, Shiono Y, Taruya A, et al. Superficial calcium fracture after pci as assessed by OCT. JACC Cardiovasc Imaging. 2015;8:1228–9.CrossRefGoogle Scholar
  17. 17.
    Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Tanimoto T, et al. Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-st-segment elevation acute coronary syndrome: an optical coherence tomography study. Eur Heart J. 2009;30:1348–55.CrossRefGoogle Scholar
  18. 18.
    Ueda T, Uemura S, Watanabe M, Sugawara Y, Soeda T, Okayama S, et al. Colocalization of thin-cap fibroatheroma and spotty calcification is a powerful predictor of procedure-related myocardial injury after elective coronary stent implantation. Coron Artery Dis. 2014;25:384–91.CrossRefGoogle Scholar
  19. 19.
    Porto I, Di Vito L, Burzotta F, Niccoli G, Trani C, Leone AM, et al. Predictors of periprocedural (type IVa) myocardial infarction, as assessed by frequency-domain optical coherence tomography. Circ Cardiovasc Interv. 2012;5:89–96, S81-86.CrossRefGoogle Scholar
  20. 20.
    Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, et al. Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol. 2007;50:933–9.CrossRefGoogle Scholar
  21. 21.
    Jia H, Abtahian F, Aguirre AD, Lee S, Chia S, Lowe H, et al. In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J Am Coll Cardiol. 2013;62:1748–58.CrossRefGoogle Scholar
  22. 22.
    Prati F, Uemura S, Souteyrand G, Virmani R, Motreff P, Di Vito L, et al. OCT-based diagnosis and management of STEMI associated with intact fibrous cap. JACC Cardiovasc Imaging. 2013;6:283–7.CrossRefGoogle Scholar
  23. 23.
    Jia H, Dai J, Hou J, Xing L, Ma L, Liu H, et al. Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the erosion study). Eur Heart J. 2017;38:792–800.CrossRefGoogle Scholar
  24. 24.
    Xing L, Yamamoto E, Sugiyama T, Jia H, Ma L, Hu S, et al. Erosion study (effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion): a 1-year follow-up report. Circ Cardiovasc Interv. 2017;10:e005860.CrossRefGoogle Scholar
  25. 25.
    Gutierrez-Chico JL, Alegria-Barrero E, Teijeiro-Mestre R, Chan PH, Tsujioka H, de Silva R, et al. Optical coherence tomography: from research to practice. Eur Heart J Cardiovasc Imaging. 2012;13:370–84.CrossRefGoogle Scholar
  26. 26.
    Meneveau N, Souteyrand G, Motreff P, Caussin C, Amabile N, Ohlmann P, et al. Optical coherence tomography to optimize results of percutaneous coronary intervention in patients with non-st-elevation acute coronary syndrome: results of the multicenter, randomized doctors study (does optical coherence tomography optimize results of stenting). Circulation. 2016;134:906–17.CrossRefGoogle Scholar
  27. 27.
    Raber L, Mintz GS, Koskinas KC, Johnson TW, Holm NR, Onuma Y, et al. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J. 2018;39:3281–300.CrossRefGoogle Scholar
  28. 28.
    Sonoda S, Morino Y, Ako J, Terashima M, Hassan AH, Bonneau HN, SIRIUS Investigators, et al. Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the sirius trial. J Am Coll Cardiol. 2004;43:1959–63.CrossRefGoogle Scholar
  29. 29.
    Soeda T, Uemura S, Park SJ, Jang Y, Lee S, Cho JM, et al. Incidence and clinical significance of poststent optical coherence tomography findings: one-year follow-up study from a multicenter registry. Circulation. 2015;132:1020–9.CrossRefGoogle Scholar
  30. 30.
    Tanigawa J, Barlis P, Di Mario C. Intravascular optical coherence tomography: optimisation of image acquisition and quantitative assessment of stent strut apposition. EuroIntervention. 2007;3:128–36.PubMedGoogle Scholar
  31. 31.
    Guo N, Maehara A, Mintz GS, He Y, Xu K, Wu X, et al. Incidence, mechanisms, predictors, and clinical impact of acute and late stent malapposition after primary intervention in patients with acute myocardial infarction: an intravascular ultrasound substudy of the harmonizing outcomes with revascularization and stents in acute myocardial infarction (horizons-ami) trial. Circulation. 2010;122:1077–84.CrossRefGoogle Scholar
  32. 32.
    Romagnoli E, Gatto L, La Manna A, Burzotta F, Taglieri N, Saia F, et al. Role of residual acute stent malapposition in percutaneous coronary interventions. Catheter Cardiovasc Interv. 2017;90:566–75.CrossRefGoogle Scholar
  33. 33.
    Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, et al. Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation. 2007;115:2435–41.CrossRefGoogle Scholar
  34. 34.
    Kawamori H, Shite J, Shinke T, Otake H, Matsumoto D, Nakagawa M, et al. Natural consequence of post-intervention stent malapposition, thrombus, tissue prolapse, and dissection assessed by optical coherence tomography at mid-term follow-up. Eur Heart J Cardiovasc Imaging. 2013;14:865–75.CrossRefGoogle Scholar
  35. 35.
    Bezerra HG, Costa MA, Guagliumi G, Rollins AM, Simon DI. Intracoronary optical coherence tomography: a comprehensive review clinical and research applications. JACC Cardiovasc Interv. 2009;2:1035–46.CrossRefGoogle Scholar
  36. 36.
    Kume T, Okura H, Miyamoto Y, Yamada R, Saito K, Tamada T, et al. Natural history of stent edge dissection, tissue protrusion and incomplete stent apposition detectable only on optical coherence tomography after stent implantation - preliminary observation. Circ J. 2012;76:698–703.CrossRefGoogle Scholar
  37. 37.
    Ali ZA, Maehara A, Genereux P, Shlofmitz RA, Fabbiocchi F, Nazif TM, et al. Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial. Lancet. 2016;388:2618–28.CrossRefGoogle Scholar
  38. 38.
    Sugiyama T, Kimura S, Akiyama D, Hishikari K, Kawaguchi N, Kamiishi T, et al. Quantitative assessment of tissue prolapse on optical coherence tomography and its relation to underlying plaque morphologies and clinical outcome in patients with elective stent implantation. Int J Cardiol. 2014;176:182–90.CrossRefGoogle Scholar
  39. 39.
    Bouki KP, Sakkali E, Toutouzas K, Vlad D, Barmperis D, Phychari S, et al. Impact of coronary artery stent edge dissections on long-term clinical outcome in patients with acute coronary syndrome: an optical coherence tomography study. Catheter Cardiovasc Interv. 2015;86:237–46.CrossRefGoogle Scholar
  40. 40.
    Prati F, Romagnoli E, Burzotta F, Limbruno U, Gatto L, La Manna A, et al. Clinical impact of OCT findings during PCI: the CLI-OPCI II study. JACC Cardiovasc Imaging. 2015;8:1297–305.CrossRefGoogle Scholar
  41. 41.
    Tearney GJ, Waxman S, Shishkov M, Vakoc BJ, Suter MJ, Freilich MI, et al. Three-dimensional coronary artery microscopy by intracoronary optical frequency domain imaging. JACC Cardiovasc Imaging. 2008;1:752–61.CrossRefGoogle Scholar
  42. 42.
    Okamura T, Onuma Y, Yamada J, Iqbal J, Tateishi H, Nao T, et al. 3D optical coherence tomography: new insights into the process of optimal rewiring of side branches during bifurcational stenting. EuroIntervention. 2014;10:907–15.CrossRefGoogle Scholar
  43. 43.
    Onuma Y, Okamura T, Muramatsu T, Uemura S, Serruys PW. New implication of three-dimensional optical coherence tomography in optimising bifurcation PCI. EuroIntervention. 2015;11(Suppl V):V71–4.CrossRefGoogle Scholar
  44. 44.
    Okamura T, Nagoshi R, Fujimura T, Murasato Y, Yamawaki M, Ono S, et al. Impact of guidewire recrossing point into stent jailed side branch for optimal kissing balloon dilatation: core lab 3D optical coherence tomography analysis. EuroIntervention. 2018;13:e1785–93.CrossRefGoogle Scholar
  45. 45.
    Kubo T, Akasaka T, Shite J, Suzuki T, Uemura S, Yu B, et al. OCT compared with IVUS in a coronary lesion assessment: the OPUS-CLASS study. JACC Cardiovasc Imaging. 2013;6:1095–104.CrossRefGoogle Scholar
  46. 46.
    Bavishi C, Sardar P, Chatterjee S, Khan AR, Shah A, Ather S, et al. Intravascular ultrasound-guided vs angiography-guided drug-eluting stent implantation in complex coronary lesions: meta-analysis of randomized trials. Am Heart J. 2017;185:26–34.CrossRefGoogle Scholar
  47. 47.
    Shin DH, Hong SJ, Mintz GS, Kim JS, Kim BK, Ko YG, et al. Effects of intravascular ultrasound-guided versus angiography-guided new-generation drug-eluting stent implantation: meta-analysis with individual patient-level data from 2,345 randomized patients. JACC Cardiovasc Interv. 2016;9:2232–9.CrossRefGoogle Scholar
  48. 48.
    Elgendy IY, Mahmoud AN, Elgendy AY, Bavry AA. Outcomes with intravascular ultrasound-guided stent implantation: a meta-analysis of randomized trials in the era of drug-eluting stents. Circ Cardiovasc Interv. 2016;9:e003700.PubMedGoogle Scholar
  49. 49.
    Prati F, Di Vito L, Biondi-Zoccai G, Occhipinti M, La Manna A, Tamburino C, et al. Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the centro per la lotta contro l’infarto-optimisation of percutaneous coronary intervention (cli-opci) study. EuroIntervention. 2012;8:823–9.CrossRefGoogle Scholar
  50. 50.
    Sheth TN, Kajander OA, Lavi S, Bhindi R, Cantor WJ, Cheema AN, et al. Optical coherence tomography-guided percutaneous coronary intervention in st-segment-elevation myocardial infarction: a prospective propensity-matched cohort of the thrombectomy versus percutaneous coronary intervention alone trial. Circ Cardiovasc Interv. 2016;9:e003414.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of CardiologyKawasaki Medical SchoolKurashikiJapan

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