OCT-guided Percutaneous Coronary Intervention in Bifurcation Lesions

Abstract

Coronary artery bifurcation lesions remain challenging despite significant advancements in stent technology and development of specific bifurcation stenting approaches. Optical coherence tomography (OCT) is the intracoronary imaging technique with the highest resolution and can generate automatically contoured lumen areas across the variable geometry of bifurcation lesions. Knowledge of plaque severity and composition facilitates planning of the best strategy for percutaneous coronary intervention (PCI) and stenting. In particular, the provisional stent strategy preferred in this context can be modified when there is high risk of side-branch compromise at the ostium after main vessel stenting. OCT is unique because it allows the identification of the site of guide wire crossing, an important determinant of the final result. OCT can also be used to assess the procedural success of new dedicated bifurcation stent technologies and for the evaluation at follow-up of potential predictors of stent thrombosis, including stent malapposition, stent under-expansion and stent-edge dissection. Finally, the development of 3D OCT allows a better evaluation of coronary anatomy – particularly of side branch ostium that is difficult to visualise by 2D OCT – further improving the value of this technique in guiding PCI in these patients.

Stenting techniques for coronary bifurcation lesions: Evidence from a network meta‐analysis of randomized clinical trials

“…Both the preservation of the bifurcation geometry and the identification of wire crossing to the side branch are keys to maintain a proper laminar flow, decrease the risk of TLR, and decrease the risk of TVR 24‐26 . Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) have proven benefit in optimization of the neocarina, as well as the assessment of stent malposition, stent under‐expansion, and stent‐edge dissection 27‐29 . Particularly, IVUS evaluation used concomitantly with DK crush technique provides better vessel geometry when compared with other techniques in bench studies.…”

Ostial left circumflex lesion with calcified nodule successfully treated with excimer laser coronary atherectomy and drug-coated balloon

“…Although there is no evidence that the DCB only strategy is superior to the stenting strategy in all lesions, Kleber et al said that this is a useful strategy for bifurcation lesions that show only class A or B dissection and recoil not beyond 30% [8]. Moreover, OFDI is useful in assessing coronary dissection occurrence in bifurcation lesions because of what OFDI reveals about lumen circumferences [9]. Consequently, we applied the DCB-only strategy, and this strategy provided not only acute lumen gain but also late lumen gain.…”

Association of Side-Branch Treatment and Patient Factors in Left Anterior Descending Artery True Bifurcation Lesions: Analysis from the GRAND-DES Pooled Registry

“…Outcomes of bifurcation PCI may rely on various patient, lesion characteristics, device selection, and operator-related factors. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can visualize and calculate the complex anatomy of a bifurcation lesion, making it possible to predict SB compromise beforehand [ 22 , 23 ]. Techniques such as proximal optimization (POT) and final kissing ballooning, jailed wire, and balloon methods have also allowed for better results in bifurcation PCI.…”