Name of the Procedure:

Intravascular Optical Coherence Tomography (OCT) - Coronary Native Vessel or Graft

Summary

Intravascular Optical Coherence Tomography (OCT) is a high-resolution imaging technique used inside coronary arteries to visualize the vessel walls in detail. This procedure helps in diagnosing and guiding interventions for heart-related conditions by capturing detailed images of the coronary arteries.

Purpose

OCT is primarily used to assess coronary artery disease, evaluate the severity of blockages, and guide treatment decisions during interventions like stenting. The goal is to get a precise view of the artery's interior to ensure the best possible treatment outcomes.

Indications

• Chest pain or angina
• Suspected or known coronary artery disease
• Previous heart attack
• Assessment of stent placement or restenosis
• Abnormal results from other cardiac imaging tests

Preparation

• Fasting for a few hours before the procedure.
• Adjustment or pausing of certain medications, as advised by the physician.
• Baseline blood tests and possibly an electrocardiogram (ECG).

Procedure Description

1. The patient is given mild sedatives to help them relax.
2. A catheter is inserted into a blood vessel, usually through the groin or wrist.
3. The catheter is carefully guided to the coronary arteries.
4. A specialized OCT probe is introduced through the catheter.
5. Using light waves, the OCT probe captures high-resolution images of the artery walls.
6. The images are used to guide any necessary interventions, such as stenting.
7. The catheter and OCT probe are removed, and the insertion site is bandaged.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the complexity of the case.

Setting

Performed in a hospital cardiac catheterization lab (cath lab) or specialized surgical center.

Personnel

• Interventional cardiologist
• Cardiac nurses
• Radiologic technologist
• Anesthesiologist (if deeper sedation is required)

Risks and Complications

• Minimal risk of infection at the catheter insertion site
• Rare cases of vessel damage or perforation
• Allergic reactions to the dye used during imaging
• Potential for blood clot formation
• Risk of bleeding at the insertion site

Benefits

• Precise visualization of coronary artery structure
• Improved accuracy in diagnosing blockages and other abnormalities
• Enhanced guidance for placing stents or performing other interventions
• Immediate feedback during the procedure ensuring better treatment outcomes

Recovery

• Patients are monitored for a few hours in a recovery area.
• Most patients can go home the same day or after an overnight stay.
• Instructions may include avoiding strenuous activity for a few days.
• Follow-up appointments will be scheduled to monitor recovery and discuss results.

Alternatives

• Coronary angiography
• Intravascular ultrasound (IVUS)
• Non-invasive imaging tests like CT angiography or stress tests

Pros and Cons of Alternatives:

• Coronary angiography: Good for visualizing blockages but less detailed than OCT.
• IVUS: Provides good images but with lower resolution than OCT.
• Non-invasive tests: Less risk but may be less accurate and detailed.

Patient Experience

During the procedure, the patient might feel slight pressure at the catheter insertion site. Post-procedure, they may experience some bruising or soreness. Pain management includes over-the-counter pain relievers if necessary. Rest and hydration are encouraged to aid recovery.