Optical coherence tomography: assessment of coronary artery disease and guide to percutaneous coronary intervention

Abstract

Background and aims Angiographic guidance for percutaneous coronary intervention (PCI) has significant limitations in interpretation. The superior spatial resolution of optical coherence tomography (OCT) can provide meaningful clinical benefits, although limited data is available on Asian populations. This study aimed to determine whether OCT can provide additional advantages and useful clinical information beyond that obtained by angiography alone in decision making for PCI. Methods This was an observational study based on a single tertiary cardiac center in Pakistan, which includes 67 patients who underwent coronary angiogram and stenting. Their pre and post stenting OCT findings were recorded. Any additional intervention was also recorded. The data were analysed using IBM SPSS software version 26.0. Results The mean age was 55.00 ± 9.00 years. Majority of the patients were males (65.7%). On angiography, there was an equal number of stable and ruptured plaques (38.8%). Post stenting results showed 29.9% under deployed stents and 34.3% were either undersized or mal-apposed. Out of 67 patients, 50 (74.6%) needed re-intervention after PCI. Among different procedures, post-dilatation was most common. Conclusion The main OCT benefit is in borderline lesions on CA, in whom OCT identifies significant coronary stenosis and leads to PCI indication in patients. In the post-PCI context, OCT leads to an indication of PCI optimisation in half of the coronary lesions.

SARS-COV-2 colonizes coronary thrombus and impairs heart microcirculation bed in asymptomatic SARS-CoV-2 positive subjects with acute myocardial infarction

“…Taken together, these data raise the doubt that asymptomatic status in SARS-COV-2 positive patients might affect STEMI outcomes as it may have major implications in patient management. As background for these associations, pre-COVID data regarding the influenza virus suggest that patients with acute respiratory infections were at significantly elevated risk for developing atherosclerotic plaque rupture leading to myocardial infarction, the profound inflammatory response, and hemodynamic changes [ 18 ]. These previously reported features are associated with higher coronary thrombus burden and poorer outcomes in COVID-19 cohorts with STEMI [ 19 – 21 ].…”

“…Relative to venous thromboembolism, arterial thrombus formation is more likely to be due to platelet activation and endothelial dysfunction. SARS-CoV-2 causes a systemic inflammatory response, leading to endothelial and hemostatic activation, including the activation of platelets and the coagulation cascade [ 18 ]. In keeping with this, the data presented here show significantly higher rates of CPR, D-dimer, and Troponin I levels in the ASAP patients suggesting that this condition may also confer an increased risk of poorer blush grade outcome in ASAP patients.…”

Reducing waiting lists for laparoscopic cholecystectomy: An intensive approach to aid COVID-19 recovery

“…The COVID-19 period has also had a substantial impact upon surgical training across all grades, with complete loss of training in elective operating during the first lockdown reported in almost 50% of cases, and over 40% of junior trainees being redeployed to alternative specialties [ 9 , 10 ]. An intensive period of repetitive training, even with segmental operative learning, for example umbilical port placement, may provide an excellent opportunity for trainees to regain their basic skills and confidence quickly after a prolonged period of reduced training opportunities.…”

Resurgence of Covid-19 pandemic: Challenging situation of economics vs. healthcare

“…Two articles on imaging in cardiovascular medicine are worth mentioning in this issue. First related a novel technology of optical coherence tomography 11 and second on more routine coronary angiography 12 in heart disease. Optical Coherence Tomography is fast growing imaging technique in other areas as well.…”