Impact of Frequency-Domain Optical Coherence Tomography Guidance for Optimal Coronary Stent Implantation in Comparison With Intravascular Ultrasound Guidance

Abstract

Background-Frequency-domain optical coherence tomography (FD-OCT) is a novel, high resolution intravascular imaging modality. Intravascular ultrasound (IVUS) is a widely used conventional imaging modality for achieving optimal stent deployment. The aim of this study was to evaluate the impact of FD-OCT guidance for coronary stent implantation compared with IVUS guidance. Methods and Results-A total of 70 patients with de novo coronary artery lesions and either unstable or stable angina pectoris were enrolled in this randomized study (optical coherence tomography [OCT] group: nϭ35, IVUS group: nϭ35). In the OCT group, stent implantation was performed under FD-OCT guidance alone and final stent expansion was evaluated by IVUS. In the IVUS group, conventional IVUS guidance was used and final stent apposition was evaluated by FD-OCT. There were no significant differences regarding the procedural, fluoroscopy time, and contrast volume. Although device and clinical success rates also were similar, the visibility of vessel border was significantly lower in the OCT group (PϽ0.05). Minimum and mean stent area and focal and diffuse stent expansion were smaller (6.1Ϯ2.2 mm versus 7.1Ϯ2.1 mm, 7.5Ϯ2.5 versus 8.7Ϯ2.4 mm, 64.7Ϯ13.7% versus 80.3Ϯ13.4%, 84.2Ϯ15.8% versus 98.8Ϯ16.5%, PϽ0.05, respectively), and the frequency of significant residual reference segment stenosis at the proximal edge was higher in the OCT group (PϽ0.05). Incomplete apposed struts in both groups were similar (Pϭ0.34). Conclusions-FD-OCT

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

“…However, there were no significant differences in stent apposition. 50 Therefore, this study found that IVUS A B had a significant advantage over OCT in terms of the reduction of residual stent-edge plaque burden and visibility of vessel border, which is in contrast to the results of the OPUS-CLASS study. 49 Table 3 is a summary of current clinical evidence for IVUS and OCT use.…”

Clinical Utility and Significance of Intravascular Ultrasound and Optical Coherence Tomography in Guiding Percutaneous Coronary Interventions

“…3 In the Centro per la Lotta contro I'Infarto-Optimisatio of Percutaneous Coronary Intervention (CLI-OPCI) study, 9 several definitions were used to achieve optimal stent deployment: (1) MSA >90% mean reference lumen area, (2) stent malapposition with a distance >200 µm, (3) edge dissections with a width >200 µm, and (4) edge lumen narrowing with a lumen area <4 mm 2 . Although OCT can clearly visualize stent malapposition, stent-edge dissection, and mal stent implantation and comprise: (1) complete stent apposition, (2) optimal stent expansion, and (3) symmetric expansion.…”

Expansion of the Clinical Application of Optical Coherence Tomography to Percutaneous Coronary Intervention and Assessment of the Instability of Coronary Atherosclerosis

“…6 Previous IVUS studies showed that stent underexpansion was a predictor of early stent thrombosis or in-stent restenosis with both baremetal and drug-eluting stents. 7 Moreover, larger residual plaque burden adjacent to the reference segment was a predictor of stent-edge restenosis.…”