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Intravascular ultrasound, optical coherence tomography, and angioscopy of coronary circulation

Evelyn Regar, MD, PhD, FESC
Neil J Weissman, MD
J Brent Muhlestein, MD
Section Editors
Donald Cutlip, MD
Warren J Manning, MD
Guy S Reeder, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Invasive, radiograph coronary angiography using contrast media at the time of cardiac catheterization is the preferred diagnostic test when information regarding the extent and severity of atherosclerotic narrowing in the coronary circulation is needed. Decisions regarding the need for revascularization are based on information obtained from this procedure, as well as other clinical and noninvasive data. However, coronary angiography is subject to observer bias and interobserver variability, which led to the development of quantitative coronary angiography. (See "Quantitative coronary angiography: Clinical applications" and "Quantitative coronary angiography: Technical issues".)

Coronary angiography is also limited by:

Technical limitations such as the occasional inability to optimally visualize a particular location.

Providing information only about the contour of the vascular lumen. The components of the vascular wall are not visualized.

The intravascular imaging techniques of optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary angioscopy (CA) provide information above and beyond that provided by radiograph coronary angiography (table 1).

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Literature review current through: Nov 2017. | This topic last updated: Jan 04, 2017.
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  1. Yock P, Fitzgerald P, Popp R, et al. Intravascular ultrasound. Sci Am Science Med 1995; 2:68.
  2. Fitzgerald PJ, St Goar FG, Connolly AJ, et al. Intravascular ultrasound imaging of coronary arteries. Is three layers the norm? Circulation 1992; 86:154.
  3. Gussenhoven EJ, Essed CE, Lancée CT, et al. Arterial wall characteristics determined by intravascular ultrasound imaging: an in vitro study. J Am Coll Cardiol 1989; 14:947.
  4. Kawasaki M, Sano K, Okubo M, et al. Volumetric quantitative analysis of tissue characteristics of coronary plaques after statin therapy using three-dimensional integrated backscatter intravascular ultrasound. J Am Coll Cardiol 2005; 45:1946.
  5. Kawasaki M, Takatsu H, Noda T, et al. In vivo quantitative tissue characterization of human coronary arterial plaques by use of integrated backscatter intravascular ultrasound and comparison with angioscopic findings. Circulation 2002; 105:2487.
  6. Nair A, Kuban BD, Tuzcu EM, et al. Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation 2002; 106:2200.
  7. Nishimura RA, Edwards WD, Warnes CA, et al. Intravascular ultrasound imaging: in vitro validation and pathologic correlation. J Am Coll Cardiol 1990; 16:145.
  8. Matsu-ura Y, Kijima Y, Hashimura K, et al. Intravascular ultrasonic evidence by constant cross-sectional area of atherosclerotic plaques during coronary vasomotion in humans. Eur Heart J 1997; 18:949.
  9. Kornowski R, Lansky AJ, Mintz GS, et al. Comparison of men versus women in cross-sectional area luminal narrowing, quantity of plaque, presence of calcium in plaque, and lumen location in coronary arteries by intravascular ultrasound in patients with stable angina pectoris. Am J Cardiol 1997; 79:1601.
  10. Sheifer SE, Canos MR, Weinfurt KP, et al. Sex differences in coronary artery size assessed by intravascular ultrasound. Am Heart J 2000; 139:649.
  11. Herity NA, Lo S, Lee DP, et al. Effect of a change in gender on coronary arterial size: a longitudinal intravascular ultrasound study in transplanted hearts. J Am Coll Cardiol 2003; 41:1539.
  12. Weissman NJ, Arora U, Breall JA, et al. In vivo gender differences in coronary plaque morphology assessed by intravascular ultrasound (abstract). J Am Coll Cardiol 1997; :198A.
  13. Mintz GS, Popma JJ, Pichard AD, et al. Limitations of angiography in the assessment of plaque distribution in coronary artery disease: a systematic study of target lesion eccentricity in 1446 lesions. Circulation 1996; 93:924.
  14. Ziada KM, Tuzcu EM, De Franco AC, et al. Intravascular ultrasound assessment of the prevalence and causes of angiographic "haziness" following high-pressure coronary stenting. Am J Cardiol 1997; 80:116.
  15. Bocksch W, Schartl M, Beckmann S, et al. Safety of intracoronary ultrasound imaging in patients with acute myocardial infarction. Am J Cardiol 1998; 81:641.
  16. Tuzcu EM, Berkalp B, De Franco AC, et al. The dilemma of diagnosing coronary calcification: angiography versus intravascular ultrasound. J Am Coll Cardiol 1996; 27:832.
  17. Mintz GS, Painter JA, Pichard AD, et al. Atherosclerosis in angiographically "normal" coronary artery reference segments: an intravascular ultrasound study with clinical correlations. J Am Coll Cardiol 1995; 25:1479.
  18. St Goar FG, Pinto FJ, Alderman EL, et al. Intravascular ultrasound imaging of angiographically normal coronary arteries: an in vivo comparison with quantitative angiography. J Am Coll Cardiol 1991; 18:952.
  19. Glagov S, Weisenberg E, Zarins CK, et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987; 316:1371.
  20. von Birgelen C, Mintz GS, de Vrey EA, et al. Atherosclerotic coronary lesions with inadequate compensatory enlargement have smaller plaque and vessel volumes: observations with three dimensional intravascular ultrasound in vivo. Heart 1998; 79:137.
  21. von Birgelen C, Mintz GS, de Vrey EA, et al. Successful directional atherectomy of de novo coronary lesions assessed with three-dimensional intravascular ultrasound and angiographic follow-up. Am J Cardiol 1997; 80:1540.
  22. Berglund H, Luo H, Nishioka T, et al. Highly localized arterial remodeling in patients with coronary atherosclerosis: an intravascular ultrasound study. Circulation 1997; 96:1470.
  23. Timmis SB, Burns WJ, Hermiller JB, et al. Influence of coronary atherosclerotic remodeling on the mechanism of balloon angioplasty. Am Heart J 1997; 134:1099.
  24. Mintz GS, Nissen SE, Anderson WD, et al. American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2001; 37:1478.
  25. Prati F, Regar E, Mintz GS, et al. Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 2010; 31:401.
  26. Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography. Science 1991; 254:1178.
  27. Michelson A, Morley E. On the relative motion of the earth and the luminiferous aether. Philos Mag 1887; S5:449.
  28. Yun S, Tearney G, Bouma B, et al. High-speed spectral-domain optical coherence tomography at 1.3 mum wavelength. Opt Express 2003; 11:3598.
  29. Chinn SR, Swanson EA, Fujimoto JG. Optical coherence tomography using a frequency-tunable optical source. Opt Lett 1997; 22:340.
  30. Tearney GJ, Waxman S, Shishkov M, et al. Three-dimensional coronary artery microscopy by intracoronary optical frequency domain imaging. JACC Cardiovasc Imaging 2008; 1:752.
  31. Optical coherence tomography in cardiovascular research, 1st ed, Regar E, van Leeuwn AMGJ, Serruys PW (Eds), Informa Healthcare, London 2007.
  32. Davlouros P, Damelou A, Karantalis V, et al. Evaluation of culprit saphenous vein graft lesions with optical coherence tomography in patients with acute coronary syndromes. JACC Cardiovasc Interv 2011; 4:683.
  33. Okamura T, Gonzalo N, Gutierrez CHICO JL, et al. Does the second generation OCT improve safety and feasibility in clinical practice? A single center experience. J Am Coll Cardiol 2010; 55(A202):E1906.
  34. Imola F, Mallus MT, Ramazzotti V, et al. Safety and feasibility of frequency domain optical coherence tomography to guide decision making in percutaneous coronary intervention. EuroIntervention 2010; 6:575.
  35. Kawasaki M, Bouma BE, Bressner J, et al. Diagnostic accuracy of optical coherence tomography and integrated backscatter intravascular ultrasound images for tissue characterization of human coronary plaques. J Am Coll Cardiol 2006; 48:81.
  36. Kume T, Akasaka T, Kawamoto T, et al. Assessment of coronary intima--media thickness by optical coherence tomography: comparison with intravascular ultrasound. Circ J 2005; 69:903.
  37. Yabushita H, Bouma BE, Houser SL, et al. Characterization of human atherosclerosis by optical coherence tomography. Circulation 2002; 106:1640.
  38. Gonzalo N, Tearney GJ, Serruys PW, et al. Second-generation optical coherence tomography in clinical practice. High-speed data acquisition is highly reproducible in patients undergoing percutaneous coronary intervention. Rev Esp Cardiol 2010; 63:893.
  39. Low AF, Kawase Y, Chan YH, et al. In vivo characterisation of coronary plaques with conventional grey-scale intravascular ultrasound: correlation with optical coherence tomography. EuroIntervention 2009; 4:626.
  40. Kume T, Okura H, Yamada R, et al. Frequency and spatial distribution of thin-cap fibroatheroma assessed by 3-vessel intravascular ultrasound and optical coherence tomography: an ex vivo validation and an initial in vivo feasibility study. Circ J 2009; 73:1086.
  41. Kume T, Akasaka T, Kawamoto T, et al. Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 2006; 97:1713.
  42. Cilingiroglu M, Oh JH, Sugunan B, et al. Detection of vulnerable plaque in a murine model of atherosclerosis with optical coherence tomography. Catheter Cardiovasc Interv 2006; 67:915.
  43. Tanaka A, Imanishi T, Kitabata H, et al. Distribution and frequency of thin-capped fibroatheromas and ruptured plaques in the entire culprit coronary artery in patients with acute coronary syndrome as determined by optical coherence tomography. Am J Cardiol 2008; 102:975.
  44. Chia S, Raffel OC, Takano M, et al. Association of statin therapy with reduced coronary plaque rupture: an optical coherence tomography study. Coron Artery Dis 2008; 19:237.
  45. Tearney GJ, Yabushita H, Houser SL, et al. Quantification of macrophage content in atherosclerotic plaques by optical coherence tomography. Circulation 2003; 107:113.
  46. Vancraeynest D, Pasquet A, Roelants V, et al. Imaging the vulnerable plaque. J Am Coll Cardiol 2011; 57:1961.
  47. Regar E, van Beusekom HM, van der Giessen WJ, Serruys PW. Images in cardiovascular medicine. Optical coherence tomography findings at 5-year follow-up after coronary stent implantation. Circulation 2005; 112:e345.
  48. Bouma BE, Tearney GJ, Yabushita H, et al. Evaluation of intracoronary stenting by intravascular optical coherence tomography. Heart 2003; 89:317.
  49. Gonzalo N, Garcia-Garcia HM, Serruys PW, et al. Reproducibility of quantitative optical coherence tomography for stent analysis. EuroIntervention 2009; 5:224.
  50. Barlis P, Regar E, Serruys PW, et al. An optical coherence tomography study of a biodegradable vs. durable polymer-coated limus-eluting stent: a LEADERS trial sub-study. Eur Heart J 2010; 31:165.
  51. Guagliumi G, Costa MA, Sirbu V, et al. Strut coverage and late malapposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: optical coherence tomography substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial. Circulation 2011; 123:274.
  52. Ormiston JA, Serruys PW, Regar E, et al. A bioabsorbable everolimus-eluting coronary stent system for patients with single de-novo coronary artery lesions (ABSORB): a prospective open-label trial. Lancet 2008; 371:899.
  53. Tearney GJ, Regar E, Akasaka T, et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 2012; 59:1058.
  54. Prati F, Guagliumi G, Mintz GS, et al. Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures. Eur Heart J 2012; 33:2513.
  55. Ali ZA, Maehara A, Généreux P, et al. Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial. Lancet 2016; 388:2618.
  56. Van de Werf F, Bax J, Betriu A, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008; 29:2909.
  57. Regar E, van Soest G, Bruining N, et al. Optical coherence tomography in patients with acute coronary syndrome. EuroIntervention 2010; 6 Suppl G:G154.
  58. Gonzalo N, Serruys PW, Okamura T, et al. Optical coherence tomography patterns of stent restenosis. Am Heart J 2009; 158:284.
  59. Siegel RJ, Ariani M, Fishbein MC, et al. Histopathologic validation of angioscopy and intravascular ultrasound. Circulation 1991; 84:109.
  60. den Heijer P, Foley DP, Hillege HL, et al. The 'Ermenonville' classification of observations at coronary angioscopy--evaluation of intra- and inter-observer agreement. European Working Group on Coronary Angioscopy. Eur Heart J 1994; 15:815.
  61. Uchida Y, Hasegawa K, Kawamura K, Shibuya I. Angioscopic observation of the coronary luminal changes induced by percutaneous transluminal coronary angioplasty. Am Heart J 1989; 117:769.
  62. White CJ, Ramee SR, Mesa JE, Collins TJ. Percutaneous coronary angioscopy in patients with restenosis after coronary angioplasty. J Am Coll Cardiol 1991; 17:46B.
  63. Strumpf RK, Heuser RR, Eagan JT Jr. Angioscopy: a valuable tool in the deployment and evaluation of intracoronary stents. Am Heart J 1993; 126:1204.
  64. Guagliumi G, Valsecchi O, Tespili M, et al. Serial angioscopic assessment of coronary stent lining with antiplatelet or anticoagulant therapy (abstract). J Am Coll Cardiol 1995; :196A.
  65. Yamamoto M, Okamatsu K, Inami S, et al. Relationship between neointimal coverage of sirolimus-eluting stents and lesion characteristics: a study with serial coronary angioscopy. Am Heart J 2009; 158:99.
  66. Teirstein PS, Schatz RA, Wong SC, Rocha-Singh KJ. Coronary stenting with angioscopic guidance. Am J Cardiol 1995; 75:344.
  67. Ueda Y, Nanto S, Komamura K, Kodama K. Neointimal coverage of stents in human coronary arteries observed by angioscopy. J Am Coll Cardiol 1994; 23:341.
  68. Kotani J, Awata M, Nanto S, et al. Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings. J Am Coll Cardiol 2006; 47:2108.
  69. Hara M, Nishino M, Taniike M, et al. High incidence of thrombus formation at 18 months after paclitaxel-eluting stent implantation: angioscopic comparison with sirolimus-eluting stent. Am Heart J 2010; 159:905.
  70. Ventura HO, White CJ, Jain SP, et al. Assessment of intracoronary morphology in cardiac transplant recipients by angioscopy and intravascular ultrasound. Am J Cardiol 1993; 72:805.
  71. Mehra MR, Ventura HO, Jain SP, et al. Heterogeneity of cardiac allograft vasculopathy: clinical insights from coronary angioscopy. J Am Coll Cardiol 1997; 29:1339.
  72. Mizuno K, Miyamoto A, Satomura K, et al. Angioscopic coronary macromorphology in patients with acute coronary disorders. Lancet 1991; 337:809.
  73. de Feyter PJ, Ozaki Y, Baptista J, et al. Ischemia-related lesion characteristics in patients with stable or unstable angina. A study with intracoronary angioscopy and ultrasound. Circulation 1995; 92:1408.
  74. Pearson TA, Dillman J, Solez K, Heptinstall RH. Monoclonal characteristics of organising arterial thrombi: Significance in the origin and growth of human atherosclerotic plaques. Lancet 1979; 1:7.
  75. Mizuno K, Satomura K, Miyamoto A, et al. Angioscopic evaluation of coronary-artery thrombi in acute coronary syndromes. N Engl J Med 1992; 326:287.
  76. Thieme T, Wernecke KD, Meyer R, et al. Angioscopic evaluation of atherosclerotic plaques: validation by histomorphologic analysis and association with stable and unstable coronary syndromes. J Am Coll Cardiol 1996; 28:1.
  77. Asakura M, Ueda Y, Yamaguchi O, et al. Extensive development of vulnerable plaques as a pan-coronary process in patients with myocardial infarction: an angioscopic study. J Am Coll Cardiol 2001; 37:1284.
  78. Fuster V, Badimon L, Cohen M, et al. Insights into the pathogenesis of acute ischemic syndromes. Circulation 1988; 77:1213.
  79. Uchida Y, Nakamura F, Tomaru T, et al. Prediction of acute coronary syndromes by percutaneous coronary angioscopy in patients with stable angina. Am Heart J 1995; 130:195.
  80. Takano M, Mizuno K, Yokoyama S, et al. Changes in coronary plaque color and morphology by lipid-lowering therapy with atorvastatin: serial evaluation by coronary angioscopy. J Am Coll Cardiol 2003; 42:680.
  81. Okada K, Ueda Y, Oyabu J, et al. Plaque color analysis by the conventional yellow-color grading system and quantitative measurement using LCH color space. J Interv Cardiol 2007; 20:324.
  82. Mizuno K, Etsuda H, Nagai T, et al. Differential sensitivity of white and red coronary thrombi to thrombolytic therapy (abstract). J Am Coll Cardiol 1994; :452A.
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