Clinical application of optical coherence tomography for carotid artery stenosis

S. Yoshimura, K. Yamada, M. Kawasaki, S. Minatoguchi, T. IwamaDepartments of Neurosurgery, Regeneration & Advanced Medical

Science, Graduate School of Medicine, Gifu University

IntroductionIntravascular optical coherence tomography (OCT) is a non-contact, light-based high-resolution imaging device for plaque characterization, which provides additional morphological information beyond intravascular ultrasound (IVUS) images.

OCT Imaging System

OCT (Image Wire, Light-lab Imaging, Goodman, Co, Ltd, Nagoya)

Methodsprobe interface unit withauto pull-back system

9 Fr guiding catheterwith a balloon forCCA occlusion

Guardwire for ECA occlusion

Since OCT is approved only for coronary arteries in Japan, its use for human carotid arteries was approved by our institutional ethics committee (No. 21-108), and the study was registered on the internet (UMIN 000002808).

Case 1 83 M

rt. CAG

The patient presented with temporary lt. hemiparesis.

Just before stenting, plaque shape was changed.So, we performed OCT and IVUS first.

OCT imaging of the carotid artery plaque

Case 1IVUSOCT

black blood MRI HE staining

Summary of the patientsNo. Age Sex Symptom IVUS OCT OCT

Follow1 83 M + ○ ○ 　2 76 M + ○ ○ 　3 71 F + ○ ○ 　4 66 M + ○ ○ 　5 77 M + ○ ○ ○6 79 F + ○ ○ 　7 76 M - ○ ○ 　8 70 M - 　 ○ 　9 77 M - ○ ○ 　

10 75 M - 　 ○ 　11 61 M - ○ ○ 　12 46 M - ○ ○ ○13 65 M - ○ ○ 　14 63 M - ○ ○ 　

Intraluminal findings

Thrombus

Flap formation

Ulceration

OCT IVUS VH-IVUS

Intraluminal　 findings

　 OCT(n=14)

IVUS(n=12)

Thrombus 2 (14%) 1 (8%)

Flap formation 2 (14%) 0

Ulceration 1 (7%) 0

Intraluminal findings of OCT

　 OCT

　 Symptomatic(n=6)

Asymptomatic(n=8)

Total(n=14)

Thrombus 2 (33%) 0 2 (14%)

Flap formation 2 (33%) 0 2 (14%)

Ulceration 1 (17%) 0 1 (7%)

Intraplaque findings

Calcification

Fibrous

Lipid

OCT IVUS VH-IVUS

Intraplaque findings

　 OCT(n=14)

VH-IVUS(n=12)

Fibrous 11 (79%) 12 (100%)

Calc. 9 (64%) 12 (100%)

Lipid 12 (86%) 12 (100%)

Postprocedural findings

Endotheliali-zation

Plaque protｒ usion

Discussion• I this study, OCT examination was performed safely without

any complication. • The typical OCT image has an axial resolution of 10 µm, which

is 10 times higher than those of other clinical imaging.• Thrombus, fibrous cap rupture and postoperative plaque

protrusion could be detected by OCT examination, which were hard to be obtained by other methods.

Conclusions:

• The present study suggested that OCT might be useful to investigate the carotid artery stenosis.

• One of the important limitations of OCT is degree of tissue penetration.

• Then, combination of OCT and VH-IVUS may be a good way to evaluate total plaque morphology.

Thank you for your attention!