Real-Life Benefit of OCT Imaging for Optimizing PCI Indications, Strategy, and Results

Abstract

Background: The aim of this study was to evaluate the benefit of standard practice Optical Coherence Tomography (OCT) imaging, as a complement to coronary angiography (CA), for optimizing the indications, strategy, and results of percutaneous coronary interventions (PCI). Methods: We retrospectively analyzed 182 patients with OCT imaging in a single tertiary center. Results: OCT use had a low prevalence (3.1% of 4256 CAs and 1.7% of 3027 PCIs). OCT was used post-CA in 71.5% and post-PCI in 28.5% of cases, mainly in acute coronary syndromes—95.6%. OCT was performed for borderline lesions in 43.4% of cases; lesion severity was reassessed as severe and led to PCI in 64.5% of them. OCT was performed for nonsignificant lesions in 17% of cases; lesion severity was reassessed as severe and led to PCI in 38.7% of them. OCT provided optimal selection for PCI strategy in 11% of cases. OCT identified suboptimal PCI results in 54% left main PCIs and in 48% bifurcation PCIs with optimal CA; PCI optimization was performed. In the only seven patients with suboptimal PCI, OCT revealed an optimal result in four cases, thus avoiding unneccessary optimization. In 27.3% of patients with post-CA OCT and PCI result “systematic” OCT control, a PCI optimization was indicated. Conclusion: OCT supplied a major benefit in 86.2% of cases, especially by identifying significant coroanry stenosis in CA borderline and nonsignificant lesions; OCT led to PCI indication in two-thirds and, respectively, one-third of these cases. In the post-PCI context, OCT led to an indication of PCI optimization in half of the complex left main and bifurcation lesions, as well as in a quarter of “systematic” post-PCI OCT controls.

Renal Failure Impact on the Outcomes of ST-Segment Elevation Myocardial Infarction Patients Due to a Left Main Coronary Culprit Lesion Treated Using a Primary Percutaneous Coronary Intervention

“…Plaques are more prone to rupture due to increased inflammation in CKD [3,9]. Optical coherence tomography (OCT) is one of the best imaging techniques for visualizing vulnerable plaques [24]. OCT studies revealed that a lower eGFR was associated with a larger lipid core in non-culprit plaques [9,25].…”

Optical Coherence Tomography for In Vivo Identification, Characterization and Optimal Treatment of Spontaneous Recanalization of Coronary Thrombus

“…During image acquisition, coronary blood flow was replaced by continuous flushing of contrast medium directly from the guiding catheter. All images were recorded digitally, stored, and analyzed using proprietary software (St. Jude Medical, St. Paul, MN, USA) in concordance with standard consensus of OCT use (5).…”

“…Besides the crucial role of OCT in providing lesion severity assessment, identification of SRCT as target lesion provided a support for immediate PCI, as mentioned above, as well as it helped us in the process of selecting PCI materials and assessment of post PCI result. It is well known the fact that sub-optimal PCI result (malposition, edgedissection, under-expansion) is responsible for future MACCE, thus, the use of OCT for PCI guidance enriches the chances for a good immediate and late outcome (5).…”

Optical Coherence Tomography—OCT for Characterization of Non-Atherosclerotic Coronary Lesions in Acute Coronary Syndromes

“…Every effort is made for improving CAD diagnosis, identifying patients with an indication for revascularization and optimal revascularization treatment through either interventional cardiology or cardiac surgery, resulting in a progressive decrease in CAD mortality [ 2 ]. Coronary angiography (CA) is the gold standard invasive procedure currently used for CAD diagnosis, decision-taking and assessing efficacy of percutaneous coronary interventions (PCIs) [ 2 , 3 ]. The main limitations of CA imaging are the two-dimensional (2D) view of the three-dimensional (3D) coronary artery lumen and wall structure, as well as, in some cases, the poor accuracy of estimating atherosclerotic plaque volume, morphology and degree of stenosis severity [ 2 , 3 ].…”

“…Coronary angiography (CA) is the gold standard invasive procedure currently used for CAD diagnosis, decision-taking and assessing efficacy of percutaneous coronary interventions (PCIs) [ 2 , 3 ]. The main limitations of CA imaging are the two-dimensional (2D) view of the three-dimensional (3D) coronary artery lumen and wall structure, as well as, in some cases, the poor accuracy of estimating atherosclerotic plaque volume, morphology and degree of stenosis severity [ 2 , 3 ].…”