Optical Coherence Tomography Versus Intravascular Ultrasound to Evaluate Coronary Artery Disease and Percutaneous Coronary Intervention

ObjectivesWe compared intravascular ultrasound (IVUS) and 2 different generations of optical coherence tomography (OCT)—time-domain OCT (TD-OCT) and frequency-domain OCT (FD-OCT)—for the assessment of coronary disease and percutaneous coronary intervention (PCI) using stents.BackgroundOCT is a promising light-based intravascular imaging modality with higher resolution than IVUS. However, the paucity of data on OCT image quantification has limited its application in clinical practice.MethodsA total of 227 matched OCT and IVUS pull backs were studied. One hundred FD-OCT and IVUS pull backs in nonstented (n = 56) and stented (n = 44) vessels were compared. Additionally, 127 matched TD-OCT and IVUS images were compared in stented vessels.ResultsFD-OCT depicted more severe native coronary disease than IVUS; minimal lumen area (MLA) was 2.33 ± 1.56 mm2 versus 3.32 ± 1.92 mm2, respectively (p < 0.001). Reference vessel dimensions were equivalent between FD-OCT and IVUS in both native and stented coronaries, but TD-OCT detected smaller reference lumen size compared with IVUS. Immediately post-PCI, in-stent MLAs were similar between FD-OCT and IVUS, but at follow-up, both FD-OCT and TD-OCT detected smaller MLAs than did IVUS, likely due to better detection of neointimal hyperplasia (NIH). Post-PCI malapposition and tissue prolapse were more frequently identified by FD-OCT.ConclusionsFD-OCT generates similar reference lumen dimensions but higher degrees of disease severity and NIH, as well as better detection of malapposition and tissue prolapse compared with IVUS. First-generation TD-OCT was associated with smaller reference vessel dimensions compared with IVUS.