Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound
Ik-Kyung Jang, MD, PhD, FACC*,*,
Brett E. Bouma, PhD ,
Dong-Heon Kang, MD* ,
Seung-Jung Park, MD, FACC||,
Seong-Wook Park, MD, FACC||,
Ki-Bae Seung, MD,
Kyu-Bo Choi, MD, FACC,
Milen Shishkov, PhD,
Kelly Schlendorf, BS,
Eugene Pomerantsev, MD, PhD*,
Stuart L. Houser, MD ,
H. Thomas Aretz, MD and
Guillermo J. Tearney, MD, PhD
* Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Wellman Laboratories of Photomedicine, Massachusett General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Department of Cardiology, Kangnam St. Mary’s Hospital and Catholic University of Korea, Seoul, South Korea
|| Department of Cardiology, Asan Medical Center and Ulsan University Medical College, Seoul, South Korea
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Figure 1 Correlation between optical coherence tomography images (A, C, E) and histologic findings (B, D, F) of human coronary artery plaques obtained at autopsy. (A) Optical coherence tomography image of a plaque consists mainly of fibrous tissue documented by histology (B) with subintimal calcifications (c). (C) Optical coherence tomography image of a predominantly fibrous plaque documented by histology (D). (E) Optical coherence tomography image of a plaque with a lipid pool (lp) and an overlying dense fibrous cap (arrowheads) documented by histology (F). Areas of neovascularization (n) can be seen as open spaces within the lipid core. Optical coherence tomography scale bars, 500 µm. Movat’s Pentachrome stain for (B), (D) and (F).
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Figure 2 Fibrous coronary plaque imaged in vivo by optical coherence tomography (OCT) (A) and intravascular ultrasound (IVUS) (B). (A) From 9 o’clock to 2 o’clock, this OCT image demonstrates visualization of the intima (with intimal hyperplasia [i]), media (m) and adventitia (a). The internal and external elastic laminae are visible as signal-rich lines bordering the media (inset). A plaque extending from 2 o’clock to 9 o’clock contains a homogeneous, signal-rich region consistent with a fibrous plaque (f) that is partially obscured by a guidewire shadow artifact (*). (B) In the corresponding IVUS image, the fibrous plaque (f) is also visualized. Tick marks, 1 mm.
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Figure 3 Calcific coronary plaques imaged in vivo by optical coherence tomography (OCT) (A, C) and intravascular ultrasound (IVUS) (B, D). (A) This OCT image shows a well delineated, heterogeneous, signal-poor region corresponding to a macrocalcification (A, arrow), also seen in the corresponding IVUS image (B, arrow). A signal-rich fibrous band (A, two arrowheads) overlying the calcification is easily identified in the OCT image but is obscured by a saturation artifact in the IVUS image. (C) A thin layer of circumferential calcification is seen in this OCT image (arrows) as a well-defined, heterogeneous, signal-poor region within the vessel wall. A side-branch (arrowhead) can be seen adjacent to the guidewire artifact (*). (D) The extent of the calcifications (arrows) and their relation to the surrounding fibrous components of the plaque are not as clearly seen in the corresponding IVUS image. The borders of the guidewire (*) artifact are marked by dotted lines in A, C. Tick marks, 1 mm.
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Figure 4 Echolucent coronary plaque imaged in vivo by optical coherence tomography (OCT) (A) and intravascular ultrasound (IVUS) (B). (A) An atherosclerotic plaque extending from 5 o’clock to 12 o’clock contains regions consistent with fibrous tissue (f) and a homogeneous, signal-poor region (arrow), which is partially obscured by a guidewire shadow artifact (*). The minimum cap (arrowhead) thickness measured 122 ± 7 µm by OCT. (B) The corresponding IVUS image shows the same echolucent region (arrow). Tick marks, 1 mm.
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Figure 5 Echolucent coronary plaque imaged in vivo by optical coherence tomography (OCT) (A) and intravascular ultrasound (IVUS) (B). (A) This plaque demonstrates a homogeneous, signal-poor region (inset, arrow) by OCT that extends near the vessel lumen at the shoulder of the plaque (inset, arrowheads), possibly representing a vulnerable shoulder region. The minimum cap thickness at this region measured 20 ± 3 µm by OCT. (B) The echolucent region (arrow) is also identified in the IVUS image from the same site; but the cap is difficult to visualize, and its thickness cannot be measured. Tick marks, 1 mm.
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