Seeing the unseen: OCT and the future of coronary interventions in India

Dr Rajneesh Kapoor, Chairman, Interventional Cardiology, Medanta Hospital, reflects on the evolving role of imaging in coronary interventions, arguing that while angiography remains foundational, it often falls short of revealing the full complexity of coronary artery disease

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As interventional cardiologists, we have long relied on coronary angiography as the cornerstone of diagnosing and treating coronary artery disease. It has served us well, offering a roadmap of the coronary arteries, helping us identify blockages, and guiding interventions. Yet, over time, it has become increasingly clear that angiography, for all its strengths, shows us only a silhouette. It outlines the lumen of the vessel but leaves much of the vessel wall where the true story often lies hidden from view.

In daily practice, this limitation is not just theoretical. We encounter patients whose symptoms seem disproportionate to angiographic findings, or cases where the cause of an acute coronary event is not immediately obvious. These moments remind us that coronary artery disease is more than just narrowing; it is a complex, dynamic process occurring within the vessel wall. This is where Optical Coherence Tomography (OCT) has begun to reshape our understanding.

OCT offers a level of detail that feels almost intuitive once experienced. By producing high-resolution, cross-sectional images of coronary arteries, it allows us to visualise structures that were previously beyond our reach in the catheterisation laboratory. The layers of the vessel wall, the characteristics of plaques, and the interaction between stents and the artery become clearer, enabling a more nuanced approach to intervention.