Sightseeing: in search of the best vascular view
Francesco Prati, Enrico Romagnoli, Laura Gatto
Intravascular imaging guidance represents an unrequited romance for most interventional cardiologists. Indeed, the full potential of the “perfect view” of plaque and vessel contours often remains unexpressed in clinical practice. Optical coherence tomography (OCT) images are very attractive for interventional cardiologists and experts in atherosclerosis. The clinical and research insight of an OCT high-resolution image should not be limited to a simple ideal case, characterised by a mild narrowing located in a proximal coronary segment. The proper identification and characterisation of atherosclerotic plaque morphology probably represents the most important attribute of FD-OCT images. Indeed, the possibility to assess lesions before any treatment (i.e., predilatation) constitutes an important advantage for the better understanding of the vulnerability of the evaluated plaque (i.e., fibrous cap thickness and macrophage infiltration) and the underlying pathophysiologic mechanism (e.g., plaque erosion or ulceration). This is also true for the evaluation of a restenotic severe lesion or stent thrombosis (e.g., acute underexpansion or late malapposition assessment). In all of these cases, balloon predilatation inevitably leads to plaque disruption with consequent loss of the above-mentioned information. Furthermore, a true understanding of luminal dimensions at lesion and reference sites is key to selecting balloon-stent diameters and lengths.
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