Micro-Optical Coherence Tomography May Greatly Improve Diagnosis and Treatment of Coronary Artery Disease

In a Nature Medicine article published online in July 2011, investigators from the Wellman Center for Photomedicine at Massachusetts General Hospital (MGH; Boston, MA, USA; www.mgh.harvard.edu) described how microOCT--which provides 10 times greater resolution than standard OCT--was able to reveal individual arterial and inflammatory cells, including structures that may identify vulnerable plaques, within coronary artery samples.

“MicroOCT has the contrast and resolution required to investigate the cellular and subcellular components underlying coronary atherosclerosis, the disease that precipitates heart attack,” said Gary Tearney, MD, PhD, of the Wellman Center and the MGH pathology department, who led the study. “This high level of performance opens up the future possibility of observing these microscopic features in human patients, which has implications for improving the understanding, diagnosis, and therapeutic monitoring of coronary artery disease.”

A catheter-based technology, OCT uses reflected near-infrared light to create detailed images of the internal surfaces of blood vessels. Even though the technology is already being utilized to identify arterial plaques that are likely to rupture, conventional OCT can clearly image only structures larger than 10 micrometers. Using new types of lenses and advanced imaging components, microOCT is able to image structures as small as one micrometer, revealing in intact tissue the precise data provided by the prepared tissue slides of conventional pathology much faster and in three dimensions.

The researchers described how using microOCT to examine human and animal coronary artery tissue revealed detailed images of endothelial cells that line coronary arteries; inflammatory cells that contribute to the formation of coronary plaques; smooth muscle cells that produce collagen in response to inflammation; and fibrin proteins and platelets that are involved in the formation of clots.

MicroOCT also produced detailed images of stents placed within coronary arteries, clearly distinguishing bare-metal stents from those covered with a drug-releasing polymer, and revealing defects in the polymer coating.

“When we are able to implement microOCT in humans--probably in three to five years--the 10 times greater resolution will allow us to observe cells in the coronary arteries of living patients,” stated Dr. Tearney, a professor of pathology at Harvard Medical School (Boston, MA, USA). “The ability to track and follow cells in three dimensions could help us prove or disprove many theories about coronary artery disease and better understand how clots form on a microscopic level. Improved definitions of high-risk plaques will lead to greater accuracy in identifying those that may go on to rupture and block the coronary artery, and the ability to monitor healing around implanted devices like stents could reduce the number of patients who must be on anticlotting medications, which are expensive and have side effects.”

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