The MLD MAX OCT algorithm: An imaging‐based workflow for percutaneous coronary intervention

Abstract

Although extensive clinical data support the utility of intravascular imaging to guide and optimize outcomes following percutaneous coronary interventions (PCI), clinical adoption remains limited. One of the primary reasons for limited utilization may be a lack of standardization on how to best integrate the data provided by intravascular imaging practically. Optical coherence tomography (OCT) offers a high‐resolution intravascular imaging modality with integrated software automation that allows for incorporation of OCT into the routine workflow of PCIs. We suggest use of an algorithm called MLD MAX to incorporate OCT for imaging‐guided interventions: the baseline OCT imaging run is intended to facilitate procedural planning and strategizing, consisting of assessment for predominant lesion morphology (M), measurement for stent length (L) and determination of stent diameter (D); the post‐PCI OCT imaging run is designated for assessment of need for further optimization of stent result, and consists of analysis for medial dissections (M), adequate stent apposition (A) and stent expansion (X). Incorporation of the MLD MAX algorithm into daily practice guides an efficient and easily‐memorable workflow for optimized PCI procedures.

Does artificial intelligence enhance physician interpretation of optical coherence tomography: insights from eye tracking

“…However, to take a full advantage of this dataset, physicians must process and interpret this additional information under the time pressures of clinical care, a scenario that may test the limits of their working memory (8). By standardizing the OCT workflow (21), and using AI-enhanced software to focus clinician attention on this standardized workflow, the use of cognitive load barriers could be reduced. In the LightLab experience, a standardized OCT workflow meaningfully impacted physician PCI decisions and reduced equipment use but increased procedure time by 9 min on average (27).…”

“…All inexperienced operators received formal training in the Ultreon TM 2.0 software. This training consisted of a standardized instruction tutorial provided by Abbott Vascular, structured in two separate videos on pre-and post-PCI image review following the MLD MAX algorithm (21).…”

Optimal Pre-dilatation Treatment before Implantation of a Magmaris Bioresorbable Scaffold in Coronary Artery Stenosis. The OPTIMIS trial

“…Scaffold malapposition was defined to be present when the distance between the abluminal surface of the strut and the luminal surface of the vessel wall exceeded the struts thickness of 150 µm. Major malapposition was defined as struts > 0.3 mm from the lumen wall for >3 mm in length 18 , and the remaining were classified as minor. At baseline, malapposition area, distance, and volume were analyzed.…”