Role of OCT in Assessing Vasa Vasorum in Chronic Coronary Syndrome: Insights from Long-Term Follow-Up

<b>Background/Objectives</b>: The aim of this study was to analyze the presence of vasa vasorum in optical coherence tomography (OCT) among patients undergoing coronary angiogram for chronic coronary syndrome with intermediate-grade coronary stenoses in relation to long-term follow-up. <b>Methods</b>: This prospective, observational, single-center study enrolled patients with chronic coronary syndrome and intermediate-grade coronary stenosis. OCT was used to assess the presence of vasa vasorum, type of plaque, mean lumen area, fibrous cap thickness (FCT), and minimal lumen diameter. Patients were divided into two groups based on the presence of vasa vasorum. <b>Results</b>: Overall, 97 patients were enrolled, of whom 82.5% were male. Lesions with vasa vasorum were found in 76 patients. Comorbidities such as diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease did not differ significantly between groups. Among patients with vasa vasorum, there were higher serum creatinine levels (1.03 ± 0.24 vs. 0.87 ± 0.22, <i>p</i> = 0.009). OCT showed that minimal lumen diameter differed between groups (2.26 ± 0.38 mm vs. 2.57 ± 0.57 mm <i>p</i> = 0.026) for the vasa vasorum group and no vasa vasorum, respectively, however minimal lumen area was similar in both groups (3.88 ± 1.76 mm² vs. 4.01 ± 2.00 mm², <i>p</i> = 0.731, for vasa vasorum and no vasa vasorum, respectively). Furthermore, the presence of vasa vasorum seemed to have no significant correlation with cardiovascular events in the 2-year, 5-year, and 10-year follow-up. <b>Conclusions</b>: The presence of lesions with vasa vasorum was not shown to be linked to any unfavorable patients' outcomes. Among men, coronary atherosclerotic plaques were more likely to contain OCT-visualized vasa vasorum.