Optical Coherence Tomography based treatment approach for patients with Acute Coronary Syndrome

ABSTRACT

Introduction:

Areas covered:

In this review, we outline the underlying causes of acute coronary syndrome (ACS) as evaluated by optical coherence tomography (OCT). We report both the definitions of each mechanism and its frequency as reported in the literature to date. Finally, we present an algorithm based on the findings in the review that gives an outlined approach to perform intervention on ACS patients.

Expert opinion:

Although the most common and most accepted intervention in ACS cases is stent implantation, data suggest a stentless approach in cases of plaque erosion, which generally occurs in younger patients presenting with an acute coronary syndrome that have TIMI flow of 2/3 and either a small or large burden of thrombus and underlying stenosis of less than 50%.

KEYWORDS:

• Optical coherence tomography
• acute coronary syndrome
• percutaneous coronary intervention

Article highlights

• The underlying causes of acute coronary syndrome have been described both pathologically, angiographically and using intravascular imaging.

• Three distinct plaque morphologies have been characterized using intravascular imaging namely OCT: plaque rupture being the most common, plaque erosion and calcific nodule.

• We present an algorithm that gives a general approach to ACS intervention, using OCT as a guide.

Declaration of interest

H Garcia-Garcia has declared that they have received institutional research grants from Medtronic, Boston Scientific, Abbott, InfraReDx, Biotronik. Consultancy fees from Conavi. R Waksman has declared the following: Advisory Board: Amgen, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Consultant: Amgen, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Grant Support: AstraZeneca, Biotronik, Boston Scientific, Chiesi; Speakers Bureau: AstraZeneca, Chiesi; Investor: MedAlliance. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.