Changing the Flow: Where Innovation Meets Intervention

Optical coherence tomography (OCT) imaging is a non-invasive, high-resolution imaging modality that leverages light waves to capture microscopic, cross-sectional, and 3D tissue images. Instead of soundwaves or radiation, OCT uses infrared light to “bounce off” of tissue and measure the duration of time before the light returns. 

This creates an accurate, microscopic depth profile of tissue structure that uncovers abnormalities, inflammation, or thinning. OCT is typically used in modern eye care and is used to spot, diagnose, and monitor conditions like glaucoma, macular degeneration, and diabetic retinopathy.

Thanks to OCT’s precision, it has moved beyond ophthalmology. It’s also used in neurology and oncology, where it can map the layers of the skin, diagnose some cancers, and assist with evaluation of nerves. In cardiology, OCT can be used to collect high-resolution images inside coronary arteries and evaluate the placement of cardiac stents.

This past April, Abbott secured both U.S. Food and Drug Administration (FDA) and CE mark clearances for the latest iteration of its Ultreon software (Ultreon 3.0), which merges coronary OCT with artificial intelligence (AI)-automated insights. The third-generation Ultreon tool assists doctors while they perform percutaneous coronary intervention (PCI) procedures to open blocked heart arteries.

Dr. Ethan Korngold is divisional VP of medical affairs and chief medical officer at Abbott’s Vascular business. Dr. Korngold is a leader in transcatheter interventions, education, and innovation with more than two decades of experience in medical practice.

Before joining Abbott’s Vascular business, Dr. Korngold had a near 15-year tenure as the medical director and division chief of interventional cardiology and structural heart at Portland, Oregon-based Providence Heart Institute. He also held the role of medical director of cardiovascular research at the same organization. Dr. Korngold spent eight years at Harvard School of Medicine and Massachusetts General Hospital, completing a residency in internal medicine, then fellowships in cardiovascular medicine, interventional cardiology, and vascular medicine and intervention.

Dr. Korngold is board-certified in cardiovascular disease, interventional cardiology, vascular medicine, and vascular ultrasound, speaks regularly at national and international conferences, and has co-authored multiple publications for peer-reviewed journals. Here’s what he had to tell MPO:

Sam Brusco: What originally drew you to interventional cardiology and vascular medicine?

Dr. Ethan Korngold: Interventional cardiology employs a combination of highly effective technology with medical therapy, all supported by robust data to improve people’s lives in an immediate and tangible way. In my exposure to different disciplines in training, I found nothing so gratifying as treating a patient with an acute coronary syndrome or saving the limb of a patient with chronic limb threatening ischemia.

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Brusco: What inspires you most about your work at Abbott’s vascular business?

Dr. Korngold: It’s truly a remarkable time in interventional cardiology. Physicians have more tools and technologies than ever before, and Abbott is at the forefront of that work, providing life-changing technology to people by working closely with interventionalists to help navigate complex cases. At Abbott, our strength is not in any single device, but in our complete offering—a comprehensive portfolio from access to closure, combined with the insights needed to choose how and when to use those tools effectively.

Brusco: How is Abbott integrating AI into vascular imaging and procedural guidance today?

Dr. Korngold: The biggest opportunity for AI is moving from simply providing more data to delivering actionable insights that help guide decision-making in the cath lab in real time for things like lesion preparation or ensuring optimal treatment. However, we know it isn’t enough to just provide insights. We must deliver the right insights, at the right moment, in a way that fits seamlessly into workflow. 

We approach AI in our technology much like GPS in a car: GPS doesn’t drive the car; instead, it guides the driver clearly and intuitively without adding extra effort. That’s exactly how AI should function in healthcare.

An example of how we are doing this is our latest Ultreon 3.0 platform, an AI-powered imaging platform that uses optical coherence tomography (OCT) to give doctors real-time planning guidance while they perform percutaneous coronary intervention (PCI). The technology allows physicians to use OCT images to see the detailed structure of a blockage and incorporates AI to assess the type of plaque causing the blockage, helping the doctor choose the best location and size of the stent to improve blood flow. In this way, we have integrated AI to augment decision-making without disrupting efficiency.

Brusco: What unmet clinical needs are driving the next generation of OCT innovation?

Dr. Korngold: There’s a growing need for the ability to manage sicker and sicker patients with more complex lesions and comorbidities. These patients need the benefit of technologies like OCT, which provide rich, high-resolution information about vessel anatomy and allow physicians to tailor procedures to their specific disease. 

At the same time, there’s growing interest in detecting and treating coronary artery disease at an earlier stage. Traditionally, interventionalists have relied on angiography and hemodynamic assessment to determine which lesions need treatment. Increasingly, there’s a shift toward using plaque morphology to help determine plaques that may be at high risk and merit intervention. With its micron-level, high-resolution imaging, OCT is uniquely poised to help physicians diagnose early forms of coronary disease and guide appropriate treatments.

Simultaneously, we must think about the added stress and strain technology places on healthcare providers. Every healthcare provider today is being asked to do more with less time and resources. It’s incredibly important we provide them with technology that will help streamline their workflow, rather than add extra complexity to their already packed schedules.

Brusco: How is Abbott advancing OCT imaging to support precision-guided interventions both before and after PCI procedures?

Dr. Korngold: We focus our efforts on reducing the invasiveness of care and improving performance and reliability so clinicians have more confidence and patients experience better, more consistent outcomes. We accomplish this by listening closely to patients and clinicians, designing for real world use, and backing our technologies with strong clinical evidence.

As a result of this approach, we have been able to look at the challenges physicians have historically faced with OCT imaging and address them to develop the Ultreon 3.0, which supports better patient outcomes and helps reduce risks. Some of the most notable advancements we have made include:

• A one-second OCT pullback to quickly capture detailed cross-sectional views of the coronary artery, offering higher resolution readings than intravascular ultrasound (IVUS) and with low or zero contrast.
• A clear understanding of the size, shape, and location of a coronary blockage, enabling optimal stent placement to maximize blood flow and guide treatment planning.
• A post-procedure assessment to ensure the stent improved blood flow in the artery.
• A streamlined setup and enhanced AI-automated insights that simplify physicians’ workflow.
• Easily acquired images from inside blood vessels and ability to efficiently plan procedures, specifically tailored for patients with complex coronary disease.

Brusco: What advice would you give young physicians interested in innovation or medtech leadership?

Dr. Korngold: Embrace curiosity. Be willing to ask a lot of questions of your patients and your colleagues. Challenge the status quo and look for better, more efficient ways of doing things. We always want to make sure we’re maintaining medical excellence for our patients, but sometimes that means understanding what isn’t working and finding a new way to tackle an old problem. There are a lot of opportunities for people who aren’t afraid to keep looking for ways to improve the world around them.