que se leu este artigo
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(A) Bright-blood image showing apical aneurysm (white arrow) and submitral aneurysm (red arrow) in vertical long-axis view; (B) bright-blood image showing apical aneurysm (white arrow) and anterior aneurysm (yellow arrow) in 4-chamber view.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Abhishek P. Raval, Anand Shukla, Rajiv Garg, Yashpal Rana, Komal Shah" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Abhishek P." 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Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tomografia de coerência ótica coronária: uma revisão prática das aplicações clínicas atuais" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1765 "Ancho" => 1625 "Tamanyo" => 320379 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography revealing stent malapposition with a large distance between struts and vessel wall.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0060" class="elsevierStylePara elsevierViewall">Coronary angiography is the standard invasive imaging method for diagnosis of coronary artery disease and for guiding coronary interventional procedures.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">1</span></a> In addition to intravascular ultrasound (IVUS), optical coherence tomography (OCT) has emerged as an imaging modality able to evaluate the vessel structure in detail, for which angiography may not suffice.<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2–4</span></a> The OCT image is formed by the backscattering of emitted near-infrared light, creating cross-sectional images of the coronary vessel.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">2</span></a> Compared to IVUS, the wavelength used in OCT is shorter, enabling higher spatial resolution (10–20 μm axial resolution and 20–30 μm lateral resolution).<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2,5,6</span></a> However, except for calcium, penetration depth of OCT is lower than with IVUS, particularly for thrombotic and lipid components.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">2</span></a> Coronary OCT systems have evolved from first-generation time-domain systems to second-generation frequency-domain OCT.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">4</span></a> The latter produces images at higher frame rates with slightly deeper penetration, using a short, non-occlusive flush and rapid spiral pullback.<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2,4</span></a> We had the opportunity to perform the first OCT studies in Portugal. In addition to research purposes, we recognize the invaluable potential of OCT as a diagnostic technique and as an adjunctive tool for percutaneous coronary intervention (PCI).<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Data relevant to this topic have recently been published and we review the evidence on current clinical applications of OCT from a practical perspective. The potential use of OCT in the successive stages in coronary artery disease management is discussed, including morphologic lesion characterization and quantification of stenosis, guidance for the decision to perform percutaneous coronary intervention and subsequent planning, and evaluation of immediate and long-term results following PCI.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Morphologic lesion characterization</span><p id="par0070" class="elsevierStylePara elsevierViewall">Animal and human post-mortem studies have shown the ability of OCT to accurately characterize coronary atherosclerotic plaques.<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2,5</span></a> Due to its high spatial resolution, OCT has proved superior to other imaging modalities, including IVUS, for detecting different plaque components.<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2,5,6</span></a> A landmark post-mortem study showed a high sensitivity and specificity for detecting fibrous, fibrocalcific and lipid-rich plaques in histological specimens.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">5</span></a> OCT is currently the only method with sufficient resolution to accurately measure the fibrous cap.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">7</span></a> Historically, thin-cap fibroatheromas (TCFAs) are the substrate of approximately two-thirds of acute myocardial infarctions as presented in pathology series.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">8</span></a> Recently, this has been validated in vivo in the OCTAVIA study.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Furthermore, macrophage infiltration, which is a marker of plaque instability, may be identified using OCT.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">10</span></a> In acute coronary syndrome (ACS) OCT is useful for identification of plaque dissection, ulceration, and erosion, calcified nodules and thrombus<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">7</span></a> (<a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1 and 2</a>). In addition, OCT can differentiate between red and white thrombi.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">11</span></a> A complete description of the appearance of atherosclerotic and thrombotic components on OCT is beyond the scope of this review and is reported elsewhere.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">OCT is particularly valuable in providing insights into the pathophysiological mechanisms of ACS and may help with the development of individualized therapeutic strategies.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">13</span></a> TCFA, plaque rupture and red thrombus have been detected in most patients with ST-elevation myocardial infarction and are more frequent in comparison to non-ST elevation ACS.<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">14,15</span></a> However, not all ACS lesions showed plaque rupture and the presence of intact fibrous cap was associated with better prognosis.<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">16,17</span></a> Moreover, plaque rupture, intracoronary thrombi, lipid-rich plaques and TCFAs were more frequent in culprit compared to nonculprit lesions.<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">18</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">There are, however, some pitfalls in plaque characterization, mainly related to the low penetration depth. Penetration is lowest for thrombotic material, which may lead to signal-free shadowing, and non-protruding red thrombi may be misinterpreted as necrotic lipid pools due to a similar OCT signal pattern.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">12</span></a> Furthermore, in the majority of lesions an accurate measurement of lipid pool thickness cannot be performed.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Stable coronary syndrome: predicting physiology and assessing stenosis severity</span><p id="par0090" class="elsevierStylePara elsevierViewall">OCT may be used to assess lesions of intermediate stenosis severity in vessels without a large size.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">4</span></a> The proposed thresholds of minimal luminal area (MLA) and minimal luminal diameter (MLD) for detecting a hemodynamically significant lesion are based on recent validations against fractional flow reserve (FFR), which is considered the gold standard for assessing hemodynamic significance.<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">19–22</span></a> In most studies, FFR ≤0.80 was taken as the threshold and the derived cut-offs of MLA and MLD ranged from 1.59 mm<span class="elsevierStyleSup">2</span> to 2.54 mm<span class="elsevierStyleSup">2</span> and from 1.23 mm to 1.77 mm, respectively.<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">20–22</span></a> Taking FFR <0.75 as the threshold, an MLA <1.91 mm<span class="elsevierStyleSup">2</span> and an MLD <1.35 mm have been identified as the best cut-off values.<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">23</span></a> A recent consensus report suggests a MLA threshold of 1.95 mm<span class="elsevierStyleSup">2</span>, which has moderate sensitivity and negative predictive value for hemodynamic significance.<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">4,24</span></a> In small vessels lower thresholds should probably be used.<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">24</span></a> In most studies, however, the correlation between FFR- and OCT-derived measurements was only moderate.<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">20,21,23</span></a> Despite potentially higher precision in determining MLA, this simple cross-section value cannot predict physiology accurately, as shown in a recent meta-analysis.<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">25</span></a> The ability of OCT to automatically segment the lumen through the entire pullback enables volumetric analysis of the vessel for the first time. Applying the physical principles of fluid dynamics, a better correlation with FFR was obtained by deriving virtual flow reserve.<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">26</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Importantly, MLA values obtained with OCT are consistently lower than with IVUS. It has been speculated that the absence of non-uniform rotation distortion on OCT allows for a more precise contour of the lumen.<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">27</span></a></p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Percutaneous coronary intervention guided by optical coherence tomography</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Adjunctive tool in decision-making for percutaneous coronary intervention</span><p id="par0100" class="elsevierStylePara elsevierViewall">Few data are available on the clinical impact of using OCT for guiding the decision to perform PCI, but the results are encouraging. In a single-center study, 90 patients with ambiguous or intermediate lesions underwent PCI if MLA was <3.5 mm<span class="elsevierStyleSup">2</span> or in the presence of thrombus.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">28</span></a> Post-dilatation or additional stent implantation was performed in cases of stent underexpansion, incomplete stent apposition (ISA), significant intraluminal tissue prolapse, or edge dissection extending beyond 200 μm.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">28</span></a> In addition to high procedural success, good clinical outcomes were reported at 4.6±3.2 months of follow-up, with 2.2% repeat revascularization and no stent thrombosis.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">28</span></a> An ongoing randomized trial (FORZA) is evaluating the feasibility of PCI guided by OCT in angiographically intermediate lesions with stenosis area ≥75% assessed by OCT, or 50–75% with MLA <2.5 mm<span class="elsevierStyleSup">2</span>, or if a major plaque ulceration is detected.<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">29</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Recently, OCT has been used to guide treatment in ACS in a different way. The unique ability of the method to detect thrombus and plaque rupture adds an unprecedented level of confidence in determining the underlying mechanism of plaque instability.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">7</span></a> In a small study of 100 patients treated with thrombus aspiration followed by OCT, no stent was implanted if the occlusion was mostly thrombotic and no significant coronary narrowing was detected by OCT, provided that the patient was symptom-free and TIMI flow was ≥2 (20 patients).<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">30</span></a> Follow-up OCT studies showed a “normal vessel” and there were no adverse events at 12-month follow-up. The safety and feasibility of medical management without stent placement in selected ACS patients with large thrombus burden detected by OCT has also been reported in other studies, in which OCT revealed lesion characteristics that were not disclosed by angiography and facilitated treatment decisions.<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">31,32</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Adjunctive tool for planning percutaneous coronary intervention</span><p id="par0110" class="elsevierStylePara elsevierViewall">Similarly to IVUS, OCT may be used to help plan the intervention and, when used systematically, it has been reported to alter procedural strategy in over 80% of cases.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">33</span></a> OCT can provide highly reproducible measurements of lesion length and reference vessel lumen diameter, which may guide stent selection.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">4</span></a> Information on plaque components such as calcification may suggest the use of ancillary devices such as rotational atherectomy.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">3</span></a> OCT is the only method that can accurately image calcium thickness, and a combination of high thickness and circumferential distribution may identify non-dilatable lesions.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">3</span></a> Moreover, a lower calcium angle depicted by OCT correlates with asymmetric (eccentric) stent expansion and a higher calcium angle correlates with stent underexpansion.<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">34</span></a> OCT may also be useful during complex procedures such as PCI of chronic total occlusions, where it may identify subintimal wire entrapment or double channels.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">4</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Another potential use of OCT regarding PCI planning is risk stratification. Previous OCT studies have linked lesion morphology with periprocedural microvascular damage or myocardial infarction. In non-ST-elevation ACS, the presence of TCFA and the size of the lipid arc at the culprit plaque were predictors of no-reflow.<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">35</span></a> The presence of TCFA was also associated with elevation of post-PCI myocardial necrosis markers, particularly if colocalized with spotty calcification.<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">36</span></a> In addition, in-stent thrombus or dissection detected by OCT after PCI also predicted periprocedural myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">37</span></a> Although these OCT findings could aid risk stratification before or during PCI, larger studies are needed to confirm the role of this clinical application.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Adjunctive tool for post-stenting assessment</span><p id="par0120" class="elsevierStylePara elsevierViewall">One of the main contributions of OCT is in assessing stent expansion, sizing and apposition (defined elsewhere<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3,38</span></a>) more accurately and with lower interobserver variability than angiography or IVUS. Stent underexpansion and undersizing have been linked to stent restenosis and stent thrombosis.<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">39</span></a> The minimum stent area and lumen area of the reference vessel can be measured using OCT, enabling accurate estimation of stent expansion.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">3</span></a> ISA (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>) delays neointimal coverage of the struts and is associated with stent thrombosis, although neointimal hyperplasia usually tends to reduce ISA over time.<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3,40</span></a> OCT can measure the distance between the struts and the vessel wall and quantify the number of struts with incomplete apposition.<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">41,42</span></a> Stent apposition is thus assessed at the strut level.<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">42</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Regarding vascular injury after PCI, intimal dissection at the stent edges, small thrombi and tissue prolapse commonly occur following stent deployment (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>).<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">43</span></a> OCT is much more sensitive than IVUS for detecting these vascular responses.<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">43</span></a> Nevertheless, their prognostic impact is controversial, as discussed below.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">OCT may thus be useful after stent deployment, as it may prompt optimization with further stenting or high-pressure or larger-sized balloon inflation, with low procedural complication rates.<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">44,45</span></a> Angiographic guidance for PCI in 335 patients was compared with angiographic plus OCT guidance in 335 patients in a propensity-score adjusted analysis (the CLI-OPCI study).<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">45</span></a> OCT disclosed adverse features, including stent malapposition, stent underexpansion, lumen narrowing, thrombus, or edge dissection, requiring further stenting or additional balloon dilatation in 34.7% of patients. The OCT-guided approach resulted in lower adjusted risk of cardiac death or nonfatal myocardial infarction at 12 months of follow-up (OR 0.49, 95% confidence interval 0.25–0.96).<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">45</span></a> In another study, even after achieving an optimal angiographic result following stenting, removal of in-stent thrombus detected by OCT using balloon dilatation was shown to be a safe approach.<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">46</span></a> Of note, left main intervention can be performed with OCT guidance, and in a head-to-head comparison against IVUS, OCT identified more findings that prompted additional interventions.<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">47</span></a> The DOCTORS trial is currently evaluating the utility of OCT for optimizing the results of coronary angioplasty in non-ST-segment elevation ACS, beyond angiography alone.<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">48</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Nevertheless, following stent deployment, minor stent malapposition with a short distance between the struts and the vessel wall, small thrombus, mild tissue prolapse, or minor stent edge dissection do not seem to be associated with worse prognosis.<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">49</span></a> Improvement is expected during follow-up when these small non-flow limiting abnormalities are left untreated, without adverse impact on clinical outcome.<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">49</span></a> Conversely, a dissection flap thickness >0.31 mm carries an adverse clinical impact in the long term.<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">50</span></a> Regarding malapposition, some operators recommend no additional post-dilatation unless there is >200 μm distance between the stent and wall vessel at multiple strut locations.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">4</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Follow-up evaluation</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Stent coverage</span><p id="par0140" class="elsevierStylePara elsevierViewall">OCT has been used extensively to assess neointimal hyperplasia and strut coverage with different types of stents, placed using different stenting techniques, with or without adjunctive techniques. Different quantitative measurements may be obtained.<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3,51–55</span></a> Accuracy is greater than with IVUS; not only the completeness of individual strut coverage but also the thickness of coverage can be assessed.<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3,51</span></a> OCT studies have shown that a greater percentage of uncovered struts is associated with increased risk of major adverse events after drug-eluting stent (DES) implantation, a cut-off of ≥5.9% of uncovered struts on follow-up OCT having been reported.<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">56</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Stent restenosis</span><p id="par0145" class="elsevierStylePara elsevierViewall">Quantitative measurements such as percentage lumen obstruction can be obtained by OCT.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">3</span></a> In addition, different tissue patterns of in-stent restenosis (ISR) have been described, including layered, homogeneous and heterogeneous patterns.<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">57</span></a> A heterogeneous pattern is more frequent in focal than in diffuse ISR and has been associated with the presence of fibrinoid or proteoglycans.<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">57</span></a> In bare-metal stents, early ISR is usually homogeneous due to neointimal proliferation, which is rich in smooth muscle cells, while late ISR may have a heterogeneous appearance due to lipid pools, calcification and neovascularization, suggesting that neoatherosclerosis is the underlying mechanism.<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">58</span></a> ISR of DES is typically characterized by a layered or heterogeneous intrastent tissue band and may be part of the spectrum of in-stent neoatherosclerotic changes, such as TCFA-containing neointima, particularly if the stent had been placed for at least 20 months.<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">58</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In a recent study on ISR, morphological assessment using OCT was useful for identifying lesions favorable for paclitaxel-coated balloon dilatation or DES placement.<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">59</span></a> Of the 428 treated ISR lesions, a homogenous structure was associated with higher rates of repeated ISR and target lesion revascularization using plain balloon angioplasty alone compared with paclitaxel-coated balloon dilatation or DES placement (target lesion revascularization rates of 38.7%, 10.6% and 10.7%, respectively, in a follow-up of 211±40 days); conversely, no differences were found between the three treatment approaches in ISR lesions of heterogeneous appearance.<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">59</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Stent thrombosis</span><p id="par0155" class="elsevierStylePara elsevierViewall">The mechanisms for stent thrombosis may be readily elucidated by OCT, as mentioned above. Strut malapposition or underexpansion, incomplete strut coverage, stent fracture, incomplete lesion coverage by the stent, edge dissection, in-stent neoatherosclerosis and ruptured neointima, particularly in areas of lipid-laden neointima, may be detected by OCT.<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">4,60,61</span></a></p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Future directions</span><p id="par0160" class="elsevierStylePara elsevierViewall">As a clinical tool, OCT is currently potentially able to replace IVUS in every situation with the exception of diagnosis of lesions in the ostial left main or right coronary arteries, in which the flow in the aorta prevents adequate blood clearance.<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2–4</span></a> However, most of these patients should be assessed with FFR.<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2–4</span></a> Another exception is chronic total occlusions in which antegrade injections are of potential concern.<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The method continues to evolve, with pullback speeds now reaching 40 mm/s<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">62</span></a> and the potential for a paradigm shift, with opportunities to save contrast compared to conventional angiography. The introduction of angiographic frame co-registration enables precise spatial location for stent implantation.<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">63</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">OCT can replicate IVUS metrics that are essentially cross-sectionally derived, but most importantly allows for full volumetric analysis of the vessel.<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">27</span></a> Virtual fractional flow reserve derived from OCT is a potentially disruptive technology in predicting physiology and assessing results after stenting.<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">27</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Finally, OCT is the most accurate method for follow-up assessment after placement of bioresorbable stents, considering their low opacity at fluoroscopy and the lower accuracy of IVUS.<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">64</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0180" class="elsevierStylePara elsevierViewall">The current clinical applications of OCT encompass the successive stages in coronary artery disease management, from initial lesion evaluation to assessment of the final results of PCI, including accurate lesion characterization and quantification of stenosis, guidance for the decision to perform PCI and subsequent planning, and evaluation of immediate and long-term results following PCI.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres604824" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec618928" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres604823" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec618929" "titulo" => "Palavras-chave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Morphologic lesion characterization" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Stable coronary syndrome: predicting physiology and assessing stenosis severity" ] ] ] 5 => array:3 [ "identificador" => "sec0020" "titulo" => "Percutaneous coronary intervention guided by optical coherence tomography" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Adjunctive tool in decision-making for percutaneous coronary intervention" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Adjunctive tool for planning percutaneous coronary intervention" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Adjunctive tool for post-stenting assessment" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Follow-up evaluation" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Stent coverage" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Stent restenosis" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Stent thrombosis" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Future directions" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-06-22" "fechaAceptado" => "2015-09-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec618928" "palabras" => array:4 [ 0 => "Clinical application" 1 => "Coronary artery disease" 2 => "Percutaneous coronary intervention" 3 => "Optical coherence tomography" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec618929" "palabras" => array:4 [ 0 => "Aplicação clínica" 1 => "Doença coronária" 2 => "Intervenção coronária percutânea" 3 => "Tomografia de coerência ótica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronary optical coherence tomography has emerged as the most powerful in-vivo imaging modality to evaluate vessel structure in detail. It is a useful research tool that provides insights into the pathogenesis of coronary artery disease. This technology has an important clinical role that is still being developed. We review the evidence on the wide spectrum of potential clinical applications for coronary optical coherence tomography, which encompass the successive stages in coronary artery disease management: accurate lesion characterization and quantification of stenosis, guidance for the decision to perform percutaneous coronary intervention and subsequent planning, and evaluation of immediate and long-term results following intervention.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A tomografia de coerência ótica coronária surgiu como a modalidade de imagem <span class="elsevierStyleItalic">in-vivo</span> que permite a avaliação estrutural vascular mais detalhada. Trata-se de uma ferramenta valiosa em investigação, tendo contribuído para melhor entendimento da patogénese da doença coronária. Apresenta igualmente um papel importante na prática clínica, e o leque de sua aplicabilidade tem aumentado. Enquadrando na evidência disponível, discutimos neste artigo as principais aplicações da tomografia de coerência ótica coronária na prática clínica, que englobam as diferentes etapas na abordagem da doença coronária, incluindo a caracterização da lesão e quantificação da estenose, o papel na decisão de realizar angioplastia, o contributo na planificação da mesma e a avaliação dos resultados a curto e a longo prazo após a intervenção.</p></span>" ] ] "nomenclatura" => array:1 [ 0 => array:3 [ "identificador" => "nom0005" "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0025">List of abbreviations</span>" "listaDefinicion" => array:1 [ 0 => array:1 [ "definicion" => array:11 [ 0 => array:2 [ "termino" => "ACS" "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">acute coronary syndrome</p>" ] 1 => array:2 [ "termino" => "DES" "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">drug-eluting stent</p>" ] 2 => array:2 [ "termino" => "FFR" "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">fractional flow reserve</p>" ] 3 => array:2 [ "termino" => "ISA" "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">incomplete stent apposition</p>" ] 4 => array:2 [ "termino" => "ISR" "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">in-stent restenosis</p>" ] 5 => array:2 [ "termino" => "IVUS" "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">intravascular ultrasound</p>" ] 6 => array:2 [ "termino" => "MLA" "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">minimal luminal area</p>" ] 7 => array:2 [ "termino" => "MLD" "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">minimal luminal diameter</p>" ] 8 => array:2 [ "termino" => "OCT" "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">optical coherence tomography</p>" ] 9 => array:2 [ "termino" => "PCI" "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">percutaneous coronary intervention</p>" ] 10 => array:2 [ "termino" => "TCFA" "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">thin-cap fibroatheroma</p>" ] ] ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 772 "Ancho" => 1700 "Tamanyo" => 212426 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Left main artery lesion: appearance on optical coherence tomography, with ulceration (arrow); (B) thrombus (triangles) and a thin-cap fibroatheroma (asterisk); (C) these findings were undetected by invasive coronary angiography.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1228 "Ancho" => 3167 "Tamanyo" => 561153 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A–C) Optical coherence tomography showing a large spontaneous ulceration in the circumflex artery.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1765 "Ancho" => 1625 "Tamanyo" => 320379 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography revealing stent malapposition with a large distance between struts and vessel wall.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1536 "Ancho" => 2667 "Tamanyo" => 514212 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">(A) Edge dissection, and (B) small thrombus following stent placement, detected by optical coherence tomography.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:64 [ 0 => array:3 [ "identificador" => "bib0325" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quantitative coronary angiography in the current era: principles and applications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. 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Ano/Mês | Html | Total | |
---|---|---|---|
2024 Novembro | 8 | 6 | 14 |
2024 Outubro | 39 | 33 | 72 |
2024 Setembro | 47 | 28 | 75 |
2024 Agosto | 50 | 32 | 82 |
2024 Julho | 57 | 28 | 85 |
2024 Junho | 42 | 28 | 70 |
2024 Maio | 48 | 32 | 80 |
2024 Abril | 52 | 29 | 81 |
2024 Maro | 37 | 18 | 55 |
2024 Fevereiro | 37 | 16 | 53 |
2024 Janeiro | 38 | 27 | 65 |
2023 Dezembro | 41 | 19 | 60 |
2023 Novembro | 56 | 30 | 86 |
2023 Outubro | 27 | 19 | 46 |
2023 Setembro | 28 | 21 | 49 |
2023 Agosto | 41 | 22 | 63 |
2023 Julho | 51 | 1 | 52 |
2023 Junho | 39 | 6 | 45 |
2023 Maio | 84 | 23 | 107 |
2023 Abril | 55 | 17 | 72 |
2023 Maro | 64 | 30 | 94 |
2023 Fevereiro | 47 | 21 | 68 |
2023 Janeiro | 35 | 17 | 52 |
2022 Dezembro | 43 | 19 | 62 |
2022 Novembro | 52 | 21 | 73 |
2022 Outubro | 31 | 28 | 59 |
2022 Setembro | 39 | 32 | 71 |
2022 Agosto | 41 | 42 | 83 |
2022 Julho | 58 | 45 | 103 |
2022 Junho | 35 | 15 | 50 |
2022 Maio | 39 | 23 | 62 |
2022 Abril | 43 | 39 | 82 |
2022 Maro | 46 | 31 | 77 |
2022 Fevereiro | 24 | 29 | 53 |
2022 Janeiro | 35 | 21 | 56 |
2021 Dezembro | 23 | 29 | 52 |
2021 Novembro | 42 | 43 | 85 |
2021 Outubro | 45 | 42 | 87 |
2021 Setembro | 33 | 35 | 68 |
2021 Agosto | 46 | 39 | 85 |
2021 Julho | 28 | 26 | 54 |
2021 Junho | 31 | 19 | 50 |
2021 Maio | 20 | 22 | 42 |
2021 Abril | 49 | 20 | 69 |
2021 Maro | 90 | 27 | 117 |
2021 Fevereiro | 59 | 11 | 70 |
2021 Janeiro | 45 | 23 | 68 |
2020 Dezembro | 44 | 14 | 58 |
2020 Novembro | 40 | 20 | 60 |
2020 Outubro | 15 | 17 | 32 |
2020 Setembro | 58 | 17 | 75 |
2020 Agosto | 31 | 8 | 39 |
2020 Julho | 54 | 15 | 69 |
2020 Junho | 43 | 15 | 58 |
2020 Maio | 43 | 5 | 48 |
2020 Abril | 43 | 12 | 55 |
2020 Maro | 57 | 16 | 73 |
2020 Fevereiro | 125 | 37 | 162 |
2020 Janeiro | 40 | 4 | 44 |
2019 Dezembro | 53 | 12 | 65 |
2019 Novembro | 45 | 7 | 52 |
2019 Outubro | 44 | 10 | 54 |
2019 Setembro | 32 | 9 | 41 |
2019 Agosto | 32 | 13 | 45 |
2019 Julho | 50 | 10 | 60 |
2019 Junho | 44 | 8 | 52 |
2019 Maio | 48 | 9 | 57 |
2019 Abril | 34 | 14 | 48 |
2019 Maro | 65 | 10 | 75 |
2019 Fevereiro | 72 | 13 | 85 |
2019 Janeiro | 54 | 6 | 60 |
2018 Dezembro | 85 | 11 | 96 |
2018 Novembro | 253 | 10 | 263 |
2018 Outubro | 669 | 16 | 685 |
2018 Setembro | 56 | 8 | 64 |
2018 Agosto | 40 | 13 | 53 |
2018 Julho | 76 | 6 | 82 |
2018 Junho | 103 | 5 | 108 |
2018 Maio | 181 | 10 | 191 |
2018 Abril | 180 | 9 | 189 |
2018 Maro | 255 | 17 | 272 |
2018 Fevereiro | 213 | 29 | 242 |
2018 Janeiro | 136 | 9 | 145 |
2017 Dezembro | 253 | 13 | 266 |
2017 Novembro | 45 | 18 | 63 |
2017 Outubro | 34 | 5 | 39 |
2017 Setembro | 41 | 9 | 50 |
2017 Agosto | 63 | 13 | 76 |
2017 Julho | 42 | 12 | 54 |
2017 Junho | 66 | 9 | 75 |
2017 Maio | 82 | 16 | 98 |
2017 Abril | 36 | 12 | 48 |
2017 Maro | 73 | 59 | 132 |
2017 Fevereiro | 121 | 6 | 127 |
2017 Janeiro | 48 | 10 | 58 |
2016 Dezembro | 24 | 13 | 37 |
2016 Novembro | 48 | 5 | 53 |
2016 Outubro | 60 | 18 | 78 |
2016 Setembro | 41 | 14 | 55 |
2016 Agosto | 20 | 8 | 28 |
2016 Julho | 13 | 11 | 24 |
2016 Junho | 5 | 0 | 5 |
2016 Maio | 5 | 27 | 32 |
2016 Abril | 35 | 7 | 42 |
2016 Maro | 59 | 47 | 106 |
2016 Fevereiro | 97 | 71 | 168 |