The Use of Intracoronary Optical Coherence Tomography in Interventional Cardiology: Safety, Feasibility and Clinical Applications

Interventional cardiology has witnessed tremendous change since 1977 when Andreas Gruentzig successfully performed the first balloon angioplasty. Whereas initial concerns revolved around maintaining vessel patency with issues of recoil and restenosis, the introduction of stents changed the landscape forever. Inherent with their use, stents, and, more specifically, drugeluting stents (DES), have become central to improved patient outcomes but, at some cost. Catastrophic, yet fortunately still rare complications such as stent thrombosis have re-ignited an intense need for greater scrutiny when developing and, subsequently implanting DES into our patients. The demand for detailed information regarding coronary artery disease has seen intravascular imaging become pivotal at delineating atherosclerosis and tissue responses following stent implantation. In fact, the strategy that relied on angiography alone is evolving to include better confirmation of disease severity and stenting technique. With this, optical coherence tomography (OCT) has grown exponentially with a broad diffusion amongst catheterisation laboratories worldwide. Optical coherence tomography is a procedurally demanding technique. Individual experience is often frustrated initially with disappointing images as a result of inadequate blood clearance. With perseverance and adequate proctorship however, one cannot help but be impressed by the clarity and resolution afforded by this imaging modality. It is these images that have attracted considerable attention at cardiology conferences internationally and have helped instil OCT as the most sensitive intravascular imaging technique available today. The aim of this thesis was to evaluate the role of OCT in contemporary coronary intervention. Part 1 embraces the principles of the technique and the physical properties of OCT (chapter 2) and gives an insight into where OCT is placed compared to other intravascular imaging modalities (chapter 3). Despite the adoption of OCT in more and more catheterisation laboratories, little has been documented as to its safety, so, in chapter 4, we review the procedural safety of intracoronary OCT in a large group of patients across six leading European centres