Intravascular optical coherence tomography (OCT) is an imaging modality uniquely characterized by its high resolution. OCT can visualize in vivo plaque characteristics and detect vulnerable plaque, such as thin-cap fibroatheroma, which has a large lipid pool with overlying thin fibrous cap. OCT can also help the clinicians to identify the underlying pathology of acute coronary syndrome: plaque rupture, plaque erosion, and calcified nodule. The OCT system enables automated measurement of the lumen diameter, lumen area, and lesion length, which is useful to determine appropriate reference sites, stent size and stent length during percutaneous coronary intervention (PCI). Evaluation of underlying plaque characteristics is helpful in predicting possible complications after PCI. OCT-guided PCI may acquire comparable angiographical and clinical outcomes to intravascular ultrasound-guided PCI. OCT can be used to evaluate characteristics of non-culprit plaque and efficacy of lipid-lowering therapy on plaque stabilization. OCT also clearly visualizes mechanical vessel injury after stent implantation. Notably, the presence of irregular tissue protrusion has been shown to be associated with the occurrence of device-oriented clinical events. Recent studies suggest that OCT is feasible for the selection of conservative management without stenting in patients with acute coronary syndrome caused by plaque erosion.
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