International Journal of Cardiology 197 (2015) 326
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Invited Letter to the Editor
Looking beyond lumen: Optical coherence tomography Hamza Duygu a,⁎, Levent Cerit a, Kamil Gulsen a, Barcin Ozcem b a b
Near East University Hospital, Department of Cardiology, Nicosia, Cyprus Near East University Hospital, Department of Cardiovascular Surgery, Nicosia, Cyprus
a r t i c l e
i n f o
Article history: Received 7 June 2015 Accepted 21 June 2015 Available online 26 June 2015 Keywords: Coronary angiography Optical coherence tomography Intravascular ultrasound
Dear Editor, We have read with interest the paper by Iannaccone and colleagues discussing the case of acute inferior myocardial infarction caused by possible coronary embolism [1]. As outlined in my recent paper, STEMI due to non-atherosclerotic, coronary embolism is very rare, but may develop especially in a specific group of patients. The known etiologies for this rare entity are thrombotic material from prosthetic or native valves, non-valvular atrial fibrillation, infective endocarditis, intracardiac tumors, apical mural thrombus, iatrogenic causes and paradoxical coronary embolism [2]. For many years, coronary angiography has been accepted as “the gold standard” for evaluating patients with atherosclerotic heart disease. However, angiography only provides a planar two-dimensional silhouette of the lumen and is unsuitable for the precise assessment of atherosclerosis [3,4]. Conventional coronary angiography only demonstrates plaque that encroaches on the lumen. Due to shortcomings of conventional coronary angiography, intravascular imaging provides additional anatomic information regarding vessel wall changes in atherosclerosis, The use of intracoronary imaging modalities has seen a significant increase over the past years, as both imaging quality and delivery systems have improved. Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are the two most recognized modalities. Both imaging
⁎ Corresponding author. E-mail address: [email protected] (H. Duygu).
http://dx.doi.org/10.1016/j.ijcard.2015.06.090 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
modalities allow the direct visualization of the arterial wall and atherosclerosis [3,4]. Unlike IVUS, OCT creates an image by directing an optical beam of infrared light onto the tissue and measuring the reflected intensity of light [3]. OCT has emerged as an attractive new imaging modality, which offers superior resolution (10 to 15 μm) as well as in vivo coronary plaque morphology. OCT demonstrates more clearly differentiation of lumen to arterial wall interface or the lumen border, when compared with IVUS. In this particular case, OCT excluded the atherosclerotic plaque formation and rupture after thrombus aspiration. Consequently, authors did not attempt to stent implantation and decide the patient to follow-up with medical therapy. In this way, unnecessary stent implantations and stent-related complications could be prevented. In conclusion, the development of advanced image acquisition technologies enables us to combine modern intravascular imaging technologies and conventional coronary angiography and hereby achieve additional benefit. OCT represents a potentially attractive new technology for the high resolution intravascular assessment. Its ultimate long term role remains the subject of future investigations in patients with non-atherosclerotic myocardial infarction. Conflict of interest None. References [1] M. Iannaccone, A. Montefusco, P. Omede', F. D'ascenzo, C. Moretti, All that glitters ain't gold! A case of embolic STEMI demonstrated by OCT, Int. J. Cardiol. 196 (2015) 14–15. [2] H. Duygu, Paradoxical coronary embolism as a cause of non-atherosclerotic acute coronary syndrome, Int. J. Cardiol. 191 (2015) 225–226. [3] J. Mazhar, J.C. Murphy, G. Figtree, P. Hansen, G.I. Nelson, R. Bhindi, Optical coherence tomography (OCT) as an adjunct to percutaneous coronary intervention; a single centre experience, Int. J. Cardiol. 163 (3) (2013) e49–52. [4] A. Maehara, G.S. Mintz, G.W. Stone, OCT versus IVUS: accuracy versus clinical utility, JACC Cardiovasc. Imaging 6 (10) (2013) 1105–1107.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Invited Letter to the Editor
Looking beyond lumen: Optical coherence tomography Hamza Duygu a,⁎, Levent Cerit a, Kamil Gulsen a, Barcin Ozcem b a b
Near East University Hospital, Department of Cardiology, Nicosia, Cyprus Near East University Hospital, Department of Cardiovascular Surgery, Nicosia, Cyprus
a r t i c l e
i n f o
Article history: Received 7 June 2015 Accepted 21 June 2015 Available online 26 June 2015 Keywords: Coronary angiography Optical coherence tomography Intravascular ultrasound
Dear Editor, We have read with interest the paper by Iannaccone and colleagues discussing the case of acute inferior myocardial infarction caused by possible coronary embolism [1]. As outlined in my recent paper, STEMI due to non-atherosclerotic, coronary embolism is very rare, but may develop especially in a specific group of patients. The known etiologies for this rare entity are thrombotic material from prosthetic or native valves, non-valvular atrial fibrillation, infective endocarditis, intracardiac tumors, apical mural thrombus, iatrogenic causes and paradoxical coronary embolism [2]. For many years, coronary angiography has been accepted as “the gold standard” for evaluating patients with atherosclerotic heart disease. However, angiography only provides a planar two-dimensional silhouette of the lumen and is unsuitable for the precise assessment of atherosclerosis [3,4]. Conventional coronary angiography only demonstrates plaque that encroaches on the lumen. Due to shortcomings of conventional coronary angiography, intravascular imaging provides additional anatomic information regarding vessel wall changes in atherosclerosis, The use of intracoronary imaging modalities has seen a significant increase over the past years, as both imaging quality and delivery systems have improved. Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are the two most recognized modalities. Both imaging
⁎ Corresponding author. E-mail address: [email protected] (H. Duygu).
http://dx.doi.org/10.1016/j.ijcard.2015.06.090 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
modalities allow the direct visualization of the arterial wall and atherosclerosis [3,4]. Unlike IVUS, OCT creates an image by directing an optical beam of infrared light onto the tissue and measuring the reflected intensity of light [3]. OCT has emerged as an attractive new imaging modality, which offers superior resolution (10 to 15 μm) as well as in vivo coronary plaque morphology. OCT demonstrates more clearly differentiation of lumen to arterial wall interface or the lumen border, when compared with IVUS. In this particular case, OCT excluded the atherosclerotic plaque formation and rupture after thrombus aspiration. Consequently, authors did not attempt to stent implantation and decide the patient to follow-up with medical therapy. In this way, unnecessary stent implantations and stent-related complications could be prevented. In conclusion, the development of advanced image acquisition technologies enables us to combine modern intravascular imaging technologies and conventional coronary angiography and hereby achieve additional benefit. OCT represents a potentially attractive new technology for the high resolution intravascular assessment. Its ultimate long term role remains the subject of future investigations in patients with non-atherosclerotic myocardial infarction. Conflict of interest None. References [1] M. Iannaccone, A. Montefusco, P. Omede', F. D'ascenzo, C. Moretti, All that glitters ain't gold! A case of embolic STEMI demonstrated by OCT, Int. J. Cardiol. 196 (2015) 14–15. [2] H. Duygu, Paradoxical coronary embolism as a cause of non-atherosclerotic acute coronary syndrome, Int. J. Cardiol. 191 (2015) 225–226. [3] J. Mazhar, J.C. Murphy, G. Figtree, P. Hansen, G.I. Nelson, R. Bhindi, Optical coherence tomography (OCT) as an adjunct to percutaneous coronary intervention; a single centre experience, Int. J. Cardiol. 163 (3) (2013) e49–52. [4] A. Maehara, G.S. Mintz, G.W. Stone, OCT versus IVUS: accuracy versus clinical utility, JACC Cardiovasc. Imaging 6 (10) (2013) 1105–1107.
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