Video 1
Abbildung 1: Co-registration of OCT run in the LAD using Ultreon 2.0 software and Dragonfly Optis catheter. The video commences with the proximal segment of the left anterior descending artery (LAD) displaying simultaneous coronary angiogram on left and OCT imaging on right. Notably, the filling of the proximal LAD with contrast appears suboptimal in the angiogram, concomitant with the OCT images which vividly depict blood entering the vessel lumen. As the video progresses distally, the OCT frames exhibit significant artifact clearance from blood and better resolution of the vessel wall segments, concurrent with adequate contrast filling in the angiogram. This is a nice example how artificial intelligence (AI) can prepare imaging data for quick and easy review by the interventional cardiologist: In reality, blood is cleared from the lumen by antegrade dye injection and the OCT-lens is moved from distal to proximal, so in this case it reached the LM when blood already followed the contrast-bolus. AI used the coregistered images and presents the video in antegrade mode for more intuitive interpretation. Keep in mind, though, how the pictures were created, to better understand the creation of artifacts. In this case, less experienced cardiologists may misinterprete blood for thrombus if they only look at still frame OCT pictures. Co-registration of angio and OCT clearly shows the movement of blood. “It is all about the flow!


Keywords: Kardiologie,  OCT-Corner

Film starten

OCT
Abbildung 1: Left: The imaging displays a reduction of the lumen due to an intra luminal protrusion of a high signal formation (yellow star) with high attenuation beneath it (white circle), intima (high signal) is intact and thin (blue triangles), the arrow indicates the coronary wire. Right: The high attenuation of signal beneath a protruding formation with a smooth surface, its proximal localization and intraluminal swirling contouring the wire (green triangle) in the following sequence of images, are all arguments suggesting an artifact related to the blood flowing into the coronary artery when flushing stopped before the pullback was ended.


Keywords: Kardiologie,  OCT

OCT
Abbildung 2: A PrePCI OCT run using Ultreon 2.0 Software by Abbott with co-registration feature: The blue arrow on the angiogram indicates the white marker showing the position of corresponding OCT image if 15 fps are filmed and displays that the contrast has been flushed out by the upcoming blood. (In this series, only 7.5 fps were filmed, so the exact positions of the corresponding OCT pictures had to be extrapolated. Fps: frames per second.


Keywords: Kardiologie,  OCT

OCT
Abbildung 3: Co-Registration of angiography and OCT: A Post PCI OCT run displays stent underexpansion and malapposition with intrastent thrombosis: The yellow star indicates the white thrombus – the dashed white lines demarcate the backscattering beneath (low attenuation)


Keywords: Kardiologie,  OCT

OCT
Abbildung 4: Two guide wires characterized by blocking incident OCT light, casting black shadows on the vessel wall, one is clean (green arrow), the other is surrounded by the a white thrombus (white dotted lines) with low attenuation beneath in a a shape of butterfly. OCT was in the therapeutic range. Different wire surfaces, insufficient wiping, and different indwelling times may explain why one wire stayed completely clean while the other is covered with fresh thrombus.


Keywords: Kardiologie,  OCT