Spontaneous coronary dissection: Optical coherence tomography insights before and after stenting

Homorodean, Călin; Spînu, Mihail; Ober, Mihai Claudiu; Olinic, Maria; Olinic, Dan Mircea

doi:10.5603/cj.2017.0041

Cited by 5 publications

(10 citation statements)

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“…Multiple centers use OCT in a variety of clinical scenarios for diagnosis and therapeutic optimization in coronary interventions [9,10,11,12,13,14]. A recently issued European Association of Percutaneous Cardiovascular Interventions (EAPCI) expert consensus document on clinical use of intracoronary contained a broad array of OCT indications [10].…”

Section: Discussionmentioning

confidence: 99%

“…OCT is therefore not only a very well recognized in vivo CAD research tool [6,7,8], but also an increasingly used real-life tool. Various indications have been proposed for OCT use in current clinical practice [9,10,11], as experience with OCT use has grown [12,13,14]. Recent guidelines already recommend OCT use for optimizing stent-related PCI procedures [15].…”

Section: Introductionmentioning

confidence: 99%

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

Olinic

Spînu

Homorodean

et al. 2019

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Olinic

Spînu

Homorodean

et al. 2019

JCM

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“…OCT or Intravascular Ultrasound (IVUS) offers the third dimension to the coronary lumen and wall and, due to CA limitations and low sensitivity, is the only method for accurate SCAD diagnosis [ 8 , 9 , 27 , 28 , 29 , 30 ]. Both methods can provide the SCAD diagnosis, but OCT, due to its superior resolution in image acquisitions, is the method of choice [ 8 , 9 ].…”

Section: Spontaneous Coronary Artery Dissection (Scad)mentioning

confidence: 99%

“…The most prevalent coronary lesions are represented by the atherosclerotic plaques, in more than 85% of cases [ 1 ], but there are several other non-atherosclerotic lesions such as spontaneous coronary artery dissection and/or hematoma [ 8 , 9 ] and spontaneous recanalization of coronary thrombus [ 10 , 11 ], which are less common, approximately 5% of cases [ 1 ], but with similar clinical manifestations as well as complications. There are insufficient data regarding the pathological mechanism, true prevalence and optimal treatment of these kind of coronary lesions.…”

Section: Introductionmentioning

confidence: 99%

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

Spînu

Onea

Homorodean

et al. 2022

JCM

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Cardiovascular diseases are the main cause of death worldwide, with coronary artery disease being the predominant underlying etiology. The most prevalent coronary lesions are represented by the atherosclerotic plaques, in more than 85% of cases, but there are several other non-atherosclerotic lesions such as spontaneous coronary artery dissection and/or hematoma and spontaneous recanalization of coronary thrombus, which are less common, approximately 5% of cases, but with similar clinical manifestations as well as complications. There are insufficient data regarding the pathological mechanism, true prevalence and optimal treatment of these kind of coronary lesions. Optical coherence tomography (OCT) is an intracoronary imaging technique, developed in order to overcome the diagnostic limitations of a standard coronary angiography and has an extremely high resolution, similar to that of a usual histological evaluation of a biopsy sample, thus, OCT provides a histological-like information, but in a in vivo environment. The aim of this article is to review the current knowledge regarding non-atherosclerotic coronary lesions, with an emphasis on the importance of OCT for optimal identification, characterization of pathogenic mechanisms and optimal treatment selection.

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“…Thrombus is also better imaged by OCT than IVUS, as even the discrimination between red and white thrombus is possible. Other features of instability, such as vasa vasorum inside lipid plaques or spontaneous dissections can be spotted and characterized by OCT [34,35].…”

Section: Plaque Compositionmentioning

confidence: 99%

The invasive intracoronary imaging assessment of left main coronary artery disease

2022

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Left main coronary artery disease is associated with an unfavorable prognosis. Evidence-based decision making regarding the optimal revascularization strategy in patients with left main disease has become a challenge, in view of the recently published data. An improvement in outcomes following left main percutaneous interventions could be achieved by reducing the rate of repeat target lesion revascularization through stent optimization techniques. In the setting of left main disease, procedural guidance by intravascular ultrasound or optical coherence tomography is essential for good long-term results, in such a way that intravascular imaging has gained more of a therapeutic connotation. Besides stent optimization, intracoronary imaging quantifies lesion severity, guides lesion preparation through morphological data, facilitates stent selection through accurate vessel sizing, identifies the landing zones, diagnoses acute vessel wall complications such as stent-related edge dissection or intramural hematoma, and defines procedural success.This review focuses on the two main intracoronary imaging techniques used for diagnostic evaluation and procedural guidance in left main coronary artery disease: intravascular ultrasound and optical coherence tomography. Based on the most recently published data, the review discusses each technique’s advantages and pitfalls, and summarizes their indications.

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Spontaneous coronary dissection: Optical coherence tomography insights before and after stenting

Cited by 5 publications

References 0 publications

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

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

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

The invasive intracoronary imaging assessment of left main coronary artery disease

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