OCT in Cardiology   (also see www.OCTCardiology.com)

Optical coherence tomography (OCT) is a micron scale, catheter based imaging technology analogous to ultrasound that uses infrared light rather than sound.1-4  In the 1990’s OCT developed rapidly as a technology with the potential for guiding intracoronary procedures and identifying those plaques that lead to acute coronary syndromes (ACS).  Initially it was a ‘tabletop” technology for imaging optically transparent samples at extremely slow data acquisition rates.1, 5, 6, 13  By the end of the millennium, it’s potential for imaging thin capped fibroatheroma (TCFA) and stents was established, direct comparisons were made with high frequency ultrasound (IVUS), and ultimately imaging was performed in vivo, at video rate through small catheters.7-9, 14  In addition, adjuvant techniques such polarization sensitive OCT (PS-OCT), image processing, and elastography were developed that only further advanced its ability to characterize tissue above structural imaging.10-12  Therefore, in view of the tremendous potential of this technology as it entered the decade, why has it not yet received general acceptance by the cardiology community?  More specifically, other than its advantages as a research tool, will this technology ultimately be of benefit in managing patients?  Clinical studies in the early part of this decade were predominately observational and the technology was not readily available to the majority of clinical scientists with extensive backgrounds in clinical trails, nor basic researches with experience in hypothesis driven research14-23.  In addition, much research focused on specific technical issues, many of which may not have ultimately advanced the field without a defined clinical application.  But as OCT systems have recently become available to large numbers of skilled clinical and basic scientists, it has been invaluable in studying, for example, mechanisms for late acute occlusion in drug eluding stent (DES) placement (ex; neointima growth at 1 year) although its role in managing these patients has yet to be established.  Similarly, while its ability to identify TCFA is superior to any clinical technology, a fact known for over a decade, minimal studies were performed which sub classified these plaques by markers into the small percentage that lead to ACS.  This is in spite of a wide range of potential adjuvant techniques available toward this endpoint (example PS-OCT).  As it was over 15 years ago, OCTs greatest potential lies in the identification of plaque leading to ACS and managing stent placement.   A recent review examines the path OCT has taken in intracoronary imaging, state of our current knowledge of the pathophysiology of relevant clinical scenarios (ex; TCFA rupture and stent placement), and potential paths for future clinical research that can lead to its general acceptance by the cardiology community in patient management 24.


1.Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, Hee MR, Flotte T, Gregory K, Puliafito CA, Fujimoto JG: Optical Coherence Tomography. Science. 1991; 254:1178-1181.

2.Brezinski ME: Optical Coherence Tomography: Principle and Practice. Burlington: Academic Press; 2006.

3.Brezinski ME, Tearney GJ, Bouma BE, Izatt JA, Hee MR, Swanson EA, Southern JF, Fujimoto JG: Optical coherence tomography for optical biopsy - Properties and demonstration of vascular pathology. Circulation. 1996; 93:1206-1213.

4.Brezinski ME, Tearney GJ, Bouma BE, Boppart SA, Hee MR, Swanson EA, Southern JF, Fujimoto JG: Imaging of coronary artery microstructure (in vitro) with optical coherence tomography. American Journal Of Cardiology. 1996; 77:92-93.

5.Swanson EA, Huang D, Hee MR, Fujimoto JG, Lin CP, Puliafito CA: High-Speed Optical Coherence Domain Reflectometry. Optics Letters. 1992; 17:151-153.

6.Eickhoff W, Ulrich R: Optical Frequency-Domain Reflectometry In Single-Mode Fiber. Applied Physics Letters. 1981; 39:693-695.

7.Brezinski ME, Tearney GJ, Weissman NJ, Boppart SA, Bouma BE, Hee MR, Weyman AE, Swanson EA, Southern JF, Fujimoto JG: Assessing atherosclerotic plaque morphology: Comparison of optical coherence tomography and high frequency intravascular ultrasound. Heart. 1997; 77:397-403.

8.Patwari P, Weissman NJ, Boppart SA, Jesser C, Stamper D, Fujimoto JG, Brezinski ME: Assessment of coronary plaque with optical coherence tomography and high-frequency ultrasound. American Journal Of Cardiology. 2000; 85:641-644.

9.Fujimoto JG, Boppart SA, Tearney GJ, Bouma BE, Pitris C, Brezinski ME: High resolution in vivo intra-arterial imaging with optical coherence tomography. Heart. 1999; 82:128-133.

10.S. D. Giattina, B. K. Courtney, P. R. Herz, M. Harman, S. Shortkroff, D. L. Stamper, B. Liu, J. G. Fujimoto, and M. E. Brezinski, "Assessment of coronary plaque collagen with polarization sensitive optical coherence tomography (PS- OCT)," International Journal Of Cardiology 107, 400-409 (2006).

11.Rogowska J, Brezinski ME: Evaluation of the adaptive speckle suppression filter for coronary optical coherence tomography imaging. IEEE Transactions On Medical Imaging. 2000; 19:1261-1266.

12.Schmitt JM: OCT elastography: imaging microscopic deformation and strain of tissue. Optics Express. 1998; 3:199-211.

13.Liu B, Harman M, Brezinski ME: Variables affecting polarization-sensitive optical coherence tomography imaging examined through the modeling of birefringent phantoms. Journal Of The Optical Society Of America A-Optics Image Science And Vision. 2005; 22:262-271.

14.Brezinski ME: Optical coherence tomography for identifying unstable coronary plaque. International Journal Of Cardiology. 2006; 107:154-165.

15.Farooq MU, Khasnis A, Majid A, Kassab MY: The role of optical coherence tomography in vascular medicine. Vascular Medicine. 2009; 14:63-71.

16.Jang IK, Bouma BE, Kang DH, Park SJ, Park SW, Seung KB, Choi KB, Shishkov M, Schlendorf K, Pomerantsev E, et al: Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: Comparison with intravascular ultrasound. Journal Of The American College Of Cardiology. 2002; 39:604-609.

17.Suzuki Y, Ikeno F, Koizumi T, Tio F, Yeung A, Yock PG, J. FP, F. FW: In vivo comparison between optical coherence tomography and intravascular ultrasound for detecting small degrees of in-stent neointima after stent implantation. JACC Cardiovasc Intervent. 2008; 1:168-173.

18.Yao ZH, Matsubara T, Inada T, Suzuki Y, Suzuki T: Neointimal coverage of sirolimus-eluting stents 6 months and 12 months after implantation: evaluation by optical coherence tomography. Chinese Medical Journal. 2008; 121:503-507.

19.Tanigawa J, Barlis P, Dimopoulos K, Dalby M, Moore P, Di Mario C: The influence of strut thickness and cell design on immediate apposition of drug-eluting stents assessed by optical coherence tomography. International Journal Of Cardiology. 2009; 134:180-188.

20.Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, Gold HK, Virmani R: Pathological correlates of late drug-eluting stent thrombosis - Strut coverage as a marker of endothelialization. Circulation. 2007; 115:2435-2441.

21.Kume T, Akasaka T, Kawamoto T, Okura H, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K: Measurement of the thickness of the fibrous cap by optical coherence tomography. American Heart Journal. 2006; 152.

22.Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K: Assessment of coronary arterial plaques by optical coherence tomography. American Journal Of Cardiology. 2006; 97:1172-1175.

  1. 23.Manfrini O, Mont E, Leone O, Arbustini E, Eusebi V, Virmani R, Bugiardini R: Sources of error and interpretation of plaque morphology by optical coherence tomography. American Journal Of Cardiology. 2006; 98:156-159.

  2. 24.Brezinski, M.E., Current Capabilities and Challenges for Optical Coherence Tomography as a High-Impact Cardiovascular Imaging Modality. Circulation. 2011; 123: 2913-2915.