Unrestricted utilization of frequency domain optical coherence tomography in coronary interventions

• DOI: 10.1007/s10554-012-0135-0
• Publication Date: 2012-10-11T13:06:30Z
• Authors: Gregory T. Stefano; Hiram G. Bezerra; Emile Mehanna; Hirosada Yamamoto; Yusuke Fujino; Wei Wang; Guilherme Attizzani; Daniel Chamié; Daniel I. Simon; Marco A. Costa
• Keywords: Male; Coronary Artery Disease; Middle Aged; Coronary Angiography; Coronary Vessels; 3. Good health; 03 medical and health sciences; Logistic Models; Percutaneous Coronary Intervention; Treatment Outcome; 0302 clinical medicine; Predictive Value of Tests; Multivariate Analysis; Odds Ratio; Humans; Female; Stents; Prospective Studies; Tomography, Optical Coherence; Aged; Ohio

Frequency domain optical coherence tomography (FD-OCT) has shown promise to evaluate coronary devices in clinical trials, however, little is known about its application in clinical practice. This prospective, single center initiative planned for 100 % FD-OCT utilization in all patients undergoing coronary interventions during a 60-day period. Operators pre-specified the planned intervention based on angiography alone. FD-OCT success was defined as acquisition of good quality images enabling adequate quantification of vessel dimensions and lesion/percutaneous coronary intervention (PCI) assessment. Impact on management occurred when angiography-based planning was altered based on FD-OCT data. There were 297 FD-OCT acquisitions performed in 155 vessels from 150 patients. There were no FD-OCT procedural related cardiac adverse events and success was obtained in 85.7 % of all target vessels (pre-PCI = 76.8 % vs. post-PCI = 90.1 %, p = 0.004). Success on the first pullback occurred in 80.3 % overall (61.9 % in the initial operator experience and 85.5 % after the third procedure). FD-OCT impact on management was 81.8 % pre-PCI and 54.8 % post-PCI. Stent malapposition was detected in 39.2 % (89.4 % underwent further intervention) and edge dissection in 32.5 % (21.1 % treated with stent). FD-OCT success and management impact were similar in ACS and non-ACS patients (82.1 vs. 81.1 %, p = 1.000, and 62.5 vs. 65.1 %, p = 0.854, respectively). FD-OCT is safe, can successfully be incorporated into routine practice, and alters procedural strategy in a high proportion of patients undergoing PCI.