Looking into the Future: Optical Coherence Tomography for the Assessment of Cardiac Allograft Vasculopathy

Introduction Current guidelines recommend coronary angiography with intravascular ultrasound (IVUS) as a screening and surveillance tool for the assessment of cardiac allograft vasculopathy (CAV). The role of optical coherence tomography (OCT) has not been thoroughly evaluated for patients with CAV. Case Description A 59 M with history of ICM with subsequent OHT in 2016 with evidence of an eccentric LAD plaque and CAV with IMT of 0.66 mm on IVUS being treated with Rosuvastatin and Sirolimus presented for second annual follow up angiogram. On coronary angiography all of his vessels appeared angiographically “pristine” without evidence of vasculopathy (Figure 1). OCT showed show evidence of extensive subintimal hyperplasia (0.45 mm at thickest area) with negative vessel remodeling, unappreciable on the coronary angiography (Figure 2). Conclusion IVUS has traditionally been used for the assessment of CAV. OCT has a much higher resolution (10microns) compared to IVUS (80microns) and provides exceptional tissue characterization similar to a light microscope. OCT should hence be considered for the routine evaluation and surveillance of CAV.