Saline as an Alternative to Radio-Contrast for Optical Coherence Tomography-Guided Percutaneous Coronary Intervention: A Prospective Comparison

Gupta, Ankush; Chhikara, Sanya; Vijayvergiya, Rajesh; Seth, Ashok; Mahesh, Nalin Kumar; Singh, Navreet

doi:10.1016/j.carrev.2021.01.010

Cited by 20 publications

(25 citation statements)

References 17 publications

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“…SOCT PCI study was the first study to explore the feasibility, safety and efficacy of heparinized saline as flushing media for coronary OCT with the success rate of 88.1% (Effective runs for PCI that contains 61 good runs and 27.1% clinically usable runs) ( 12 ). Another study did head-to-head comparison of saline and contrast for image quality and measured vessel parameters and found it comparable ( 11 ). But these studies had limitations of small sample size, manual injections for both contrast as well as saline and single center studies.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that low-molecular-weight dextran (LMWD), which exhibits minimal toxicity compared to contrast agents, could be used as a flushing medium to acquire OCT images ( 8 – 10 ). Recently, studies also have evaluated the feasibility of heparinized saline as flushing media for OCT image acquisition during PCI optimization ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and Safety of Very-Low Contrast Combined Ringer's Solution in Optical Coherence Tomography Imaging

Chen

Hou

et al. 2022

Front. Cardiovasc. Med.

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BackgroundOptical coherence tomography (OCT) is an important modality used in coronary intervention. However, OCT requires a high amount of contrast media, limiting its extensive application in clinical practice. This study compared OCT images of coronary lesions obtained using contrast media and very-low contrast combined Ringer's solution (VLCCR) in patients with acute coronary syndrome (ACS).MethodsThirty ACS patients with a total of 36 native lesions and stenoses from 70 to 90% were included in this study. Two kinds of flushing media (a contrast medium and VLCCR) were used in succession in a random order for OCT image pullback of each lesion. VLCCR method is using low volume contrast (4–5 ml) injected into the guiding catheter previously combination with injector infused Ringer's solution instead of pure contrast medium. The safety of procedure was evaluated by recording the patients ‘symptoms, changes of ECG, blood pressure and heart rate. OCT images were analyzed to determine the image clarity. Lumen area and diameter were also measured and the consistency between the two media was compared.ResultsOCT procedure using either contrast or VLCCR did not show any peri-procedural adverse events. There was no difference in changes of blood pressure and heart rate in both procedures, however, VLCCR procedure showed less procedure-related symptoms and ECG changes. We found that the percentage of clear image frame was equivalent between the contrast and VLCCR media (98.0 vs. 96.9%, P = 0.90). We also observed a high degree of similarity between the different lesion phenotypes of ACS for both media. There was a linear correlation of the phenotypes obtained with these two different methods, and a significant correlation was observed between measurements obtained with contrast and VLCCR without correction for the refractive index of VLCCR (correlation coefficients ranged between 0.829 and 0.948).ConclusionsOCT imaging using VLCCR for blood clearance is feasible and safe and provides similar imaging quality compared to OCT imaging obtained using radiographic contrast media for ACS patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of Very-Low Contrast Combined Ringer's Solution in Optical Coherence Tomography Imaging

Chen

Hou

et al. 2022

Front. Cardiovasc. Med.

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“…Another medium that has been studied as an alternative to contrast is heparinized saline which has recently been demonstrated to be feasible and safe with acceptable image quality ( 107 ). One study showed that coronary dimensions measured using saline OCT were comparable to those obtained with contrast and hence saline OCT may be used as a contrast alternative for coronary OCT during PCI optimization ( 108 ) ( Figure 10 ). Further studies in this field are needed to provide firm evidence on the feasibility of saline as a flushing media.…”

Section: Contrast Sparing Octmentioning

confidence: 98%

Optical Coherence Tomography: An Eye Into the Coronary Artery

Gupta¹,

Shrivastava

Vijayvergiya

et al. 2022

Front. Cardiovasc. Med.

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Optical coherence tomography (OCT) is slowly but surely gaining a foothold in the hands of interventional cardiologists. Intraluminal and transmural contents of the coronary arteries are no longer elusive to the cardiologist's probing eye. Although the graduation of an interventionalist in imaging techniques right from naked eye angiographies to ultrasound-based coronary sonographies to the modern light-based OCT has been slow, with the increasing regularity of complex coronary cases in practice, such a transition is inevitable. Although intravascular ultrasound (IVUS) due to its robust clinical data has been the preferred imaging modality in recent years, OCT provides a distinct upgrade over it in many imaging and procedural aspects. Better image resolution, accurate estimation of the calcified lesion, and better evaluation of acute and chronic stent failure are the distinct advantages of OCT over IVUS. Despite the obvious imaging advantages of OCT, its clinical impact remains subdued. However, upcoming newer trials and data have been encouraging for expanding the use of OCT to wider indications in clinical utility. During percutaneous coronary intervention (PCI), OCT provides the detailed information (dissection, tissue prolapse, thrombi, and incomplete stent apposition) required for optimal stent deployment, which is the key to successfully reducing the major adverse cardiovascular event (MACE) and stent-related morbidities. The increasing use of OCT in complex bifurcation stenting involving the left main (LM) is being studied. Also, the traditional pitfalls of OCT, such as additional contrast load for image acquisition and stenting involving the ostial and proximal LM, have also been overcome recently. In this review, we discuss the interpretation of OCT images and its clinical impact on the outcome of procedures along with current barriers to its use and newer paradigms in which OCT is starting to become a promising tool for the interventionalist and what can be expected for the immediate future in the imaging world.

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“…Patients with moderate to severe renal failure should be concerned about the additional use of iodinated contrast. It has been reported that saline or dextran can provide similar OCT image quality as iodinated contrast, and these techniques have the potential to extend OCT to patients with renal dysfunction [59,60].…”

Section: Coronary Angiography Intravascular Ultrasound and Optical Co...mentioning

confidence: 99%

Diagnostic Intravascular Imaging Modalities for Cardiac Allograft Vasculopathy

Tsukamoto¹,

Watanabe²,

Mochizuki³

et al. 2022

Heart Transplantation - New Insights in Therapeutic Strategies

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Cardiac allograft vasculopathy (CAV) is one of the major factors limiting long-term survival after heart transplantation (HTX). Typically, concentric vascular thickening and fibrosis with marked intimal proliferation are found in CAV. Most of HTX patients often remain free from symptoms of typical angina. Therefore, surveillance diagnostic exams are often performed. The gold standard of diagnosing CAV is coronary angiography (CAG). However, CAG can often be a less sensitive modality for the detection of diffuse concentric lesions. Intravascular ultrasound (IVUS) is helpful for direct imaging of vessel walls and provides useful information about coronary intimal thickening; however, it is difficult to evaluate plaque morphology in detail. Optimal coherence tomography (OCT), which delivers high resolution of 10 μm, can provide more details on plaque morphology than conventional imaging modalities. Recently, OCT imaging revealed new insight in CAV such as the development of atherosclerotic lesions and complicated coronary lesions. We review the pathogenesis, clinical features, diagnosis of CAV, with a particular focus on diagnostic intravascular imaging modalities.

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Saline as an Alternative to Radio-Contrast for Optical Coherence Tomography-Guided Percutaneous Coronary Intervention: A Prospective Comparison

Cited by 20 publications

References 17 publications

Feasibility and Safety of Very-Low Contrast Combined Ringer's Solution in Optical Coherence Tomography Imaging

Feasibility and Safety of Very-Low Contrast Combined Ringer's Solution in Optical Coherence Tomography Imaging

Optical Coherence Tomography: An Eye Into the Coronary Artery

Diagnostic Intravascular Imaging Modalities for Cardiac Allograft Vasculopathy

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