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Three-Dimensional Coronary Artery Microscopy by Intracoronary Optical Frequency Domain Imaging

Guillermo J. Tearney, MD, PhD^_*,,¶,_*, Sergio Waxman, MD^,||, Milen Shishkov, PhD^_*,, Benjamin J. Vakoc, PhD^_*,, Melissa J. Suter, PhD^_*,, Mark I. Freilich, MBBS, Adrien E. Desjardins, PhD^_*,,¶, Wang-Yul Oh, PhD^_*,, Lisa A. Bartlett, BS^_*,, Mireille Rosenberg, PhD^_*, Brett E. Bouma, PhD^_*,,¶

^_* Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
Department of Dermatology, Harvard Medical School, Boston, Massachusetts
Department of Pathology, Harvard Medical School, Boston, Massachusetts
Department of Cardiology, Lahey Clinic, Burlington, Massachusetts
^¶ Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
^|| Tufts University School of Medicine, Boston, Massachusetts

^_* Reprint requests and correspondence to: Dr. Guillermo J. Tearney, Associate Professor of Pathology, Harvard Medical School, Massachusetts General Hospital and Wellman Center for Photomedicine, 40 Blossom Street, BAR 703, Boston, Massachusetts 02114 (Email: gtearney{at}partners.org).

Objectives: We present the first clinical experience with intracoronary optical frequency domain imaging (OFDI) in human patients.

Background: Intracoronary optical coherence tomography (OCT) is a catheter-based optical imaging modality that is capable of providing microscopic (7-µm axial resolution, 30-µm transverse resolution), cross-sectional images of the coronary wall. Although the use of OCT has shown substantial promise for imaging coronary microstructure, blood attenuates the OCT signal, necessitating prolonged, proximal occlusion to screen long arterial segments. OFDI is a second-generation form of OCT that is capable of acquiring images at much higher frame rates. The increased speed of OFDI enables rapid, 3-dimensional imaging of long coronary segments after a brief, nonocclusive saline purge.

Methods: Volumetric OFDI images were obtained in 3 patients after intracoronary stent deployment. Imaging was performed in the left anterior descending and right coronary arteries with the use of a nonocclusive saline purge rates ranging from 3 to 4 ml/s and for purge durations of 3 to 4 s. After imaging, the OFDI datasets were segmented using previously documented criteria and volume rendered.

Results: Good visualization of the artery wall was obtained in all cases, with clear viewing lengths ranging from 3.0 to 7.0 cm at pullback rates ranging from 5 to 20 mm/s. A diverse range of microscopic features were identified in 2 and 3 dimensions, including thin-capped fibroatheromas, calcium, macrophages, cholesterol crystals, bare stent struts, and stents with neointimal hyperplasia. There were no complications of the OFDI procedure.

Conclusions: Our results demonstrate that OFDI is a viable method for imaging the microstructure of long coronary segments in patients. Given its ability to provide microscopic information in a practical manner, this technology may be useful for studying human coronary pathophysiology in vivo and as a clinical tool for guiding the management of coronary artery disease.

Key Words: intravascular imaging • coronary imaging • optical coherence tomography • stents

Abbreviations and Acronyms   BMS = bare-metal stent   DES = drug-eluting stent   IVUS = intravascular ultrasound   LAD = left anterior descending coronary artery   LCX = left circumflex coronary artery   OCT = optical coherence tomography   OFDI = optical frequency domain imaging   RCA = right coronary artery   TCFA = thin-capped fibroatheroma

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