Optical coherence tomography (OCT) has been revolutionary in the field of medical imaging since its inception in 1991, especially in the field of ophthalmology, but its use in coronary artery disease (CAD) and percutaneous coronary intervention (PCI) is still to be explored to its full potential. OCT has proven benefits in guiding PCI when it comes to assessing baseline lesion characteristics, plaque burden and its composition. OCT images provide high axial resolution (10 micrometer) in assessing intra and transluminal coronary structures, which is useful in identifying vulnerable thin fibrous cap atheroma (TCFA) and to differentiate plaque rupture from plaque erosion causing acute coronary syndrome. Optimal stent placement and periprocedural complications (for example stent malposition, coronary dissections, thrombosis) can be assessed by OCT post intervention. It has also seen increasing use in studies trying to elucidate evolution of atherosclerosis, effects of therapeutic interventions on coronary artery plaques and to follow long-term stent outcomes. In this review, we focus on an overview of OCT imaging, techniques employed in its use, its clinical and research applications, indications and limitations.
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