The atherosclerotic plaques that form in the wall of a coronary artery can be different from each other. And to choose the optimal treatment on a case-by-case basis, having a technique available that allows you to reveal even the most hidden secrets of the plaque as well as any tortuosity of a vessel appears to be of fundamental importance.
On this front, there is something new: an innovative catheter of Oct (la sigla sta per Optimal Coherence Tomography, o Coherent Radiation Optical Tomography, in practice a sort of examination that allows us to see the structure under examination as a Tca layer by layer) of Abbott Medical Italia. It is an additional diagnostic opportunity, for specific patients, to define the treatment path and then proceed with endovascular treatments, such as the balloon with any stent to keep the treated artery dilated.
The technology, developed by Abbott Medical Italia, was used by the team of Carlo Trani, director of the Complex Operating Unit of Cardiological Intervention and Invasive Diagnostics of the Agostino Gemelli IRCCS University Polyclinic Foundation and adjunct professor of the Department of Cardiovascular and Pneumological Sciences of the Catholic University of the Sacred Heart, Rome campus.
The OCT was introduced into clinical practice about 15 years ago and allows you to study the structure and pathologies of coronary arteries from the inside, obtaining details of the artery wall that in the past could only be observed with microscopes in autopsies. “Our center – explains Trani – has for years embraced the use of the Oct: seeing the coronary arteries in detail from the inside allows us to personalize the treatment of patients with ischemic heart disease. In particular, the Oct allows us to define the anatomical characteristics of atherosclerotic plaques (severity, composition) and to optimize treatment in the case of angioplasty with stent implantation. The Oct is a relatively young method, which over the years has undergone a series of technological evolutions. The new catheter in particular allows to obtain better quality intra-coronary images and has been structured in such a way as to facilitate its application in the most difficult coronary anatomies “.
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How to do the exam
Obviously, the technology should be reserved for cases where it is really needed, since it has an additional cost compared to other methods of studying arteries. The Oct represents one of the most modern technologies to “look” inside the coronary arteries, using a light with near infrared frequencies to obtain high resolution intravascular images. The tiny catheter of Oct that is inserted into the vessel to be studied rotates rapidly inside it, illuminating its walls with its special light; this allows to acquire in a few seconds and with microscopic precision, an image of the internal side of the coronary artery and to know the composition of the atherosclerotic plaque; the ‘illuminated’ structures reflect or absorb the light of the Oct differently in different ways, according to their composition (the plaque can be calcific, fibrotic or lipidic).
The information obtained with the OTC allows cardiologists to have a very precise idea of the position and structure of the plates atherosclerotic, allowing them to plan the revascularization treatment with greater precision and detail. They also allow you to accurately choose the coronary segments to be treated with stents and to select antithrombotic therapy or thrombus aspiration techniques. Plates with a lipid component (‘soft’) usually allow easier positioning of the stent; those strongly calcified are more difficult to dilate and instead require a more complex preparation (coronary lithotripsy, rotational atherectomy). Finally, in acute coronary syndromes, the Oct represents the best way to identify the so-called ‘culprit’ lesion of the heart attack and the possible presence of thrombus accumulations.
Not just coronary, because atherosclerosis is a threat to the heart
Moreover, the Oct has long been used in other conditions as well study of the retina. When the eye is investigated, the examination does not cause any pain and uses a laser beam to “photograph” the retina itself, so it is a kind of CT scan that allows you to “cut into slices”, obviously in a figurative sense, the retina from ‘forward backwards. The test normally lasts a few minutes and allows to explain the origin of the alteration. It is indicated for the diagnosis and monitoring over time of alterations in the “macula”, that is the central part of the retina.
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