Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions

Abstract

This Consensus Document is the first of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The first document appraises the role of intracoronary imaging to guide percutaneous coronary interventions (PCIs) in clinical practice. Current evidence regarding the impact of intracoronary imaging guidance on cardiovascular outcomes is summarized, and patients or lesions most likely to derive clinical benefit from an imaging-guided intervention are identified. The relevance of the use of IVUS or OCT prior to PCI for optimizing stent sizing (stent length and diameter) and planning the procedural strategy is discussed. Regarding post-implantation imaging, the consensus group recommends key parameters that characterize an optimal PCI result and provides cut-offs to guide corrective measures and optimize the stenting result. Moreover, routine performance of intracoronary imaging in patients with stent failure (restenosis or stent thrombosis) is recommended. Finally, strengths and limitations of IVUS and OCT for guiding PCI and assessing stent failures and areas that warrant further research are critically discussed.

Optical Coherence Tomography: Current Applications for the Assessment of Coronary Artery Disease and Guidance of Percutaneous Coronary Interventions

“…IVUS or OCT should be considered for stent optimization, according to recent guidelines and consensus documents [ 5 , 13 , 41 , 42 ]. Most studies included in this review used stent optimization criteria derived from the MUSIC study by De Jaegere et al [ 43 ].…”

“…A recent consensus document by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) appraised current evidence on clinical indications for ICI [ 42 ]. Pre-PCI strategy guidance and stent optimization are the main clinical applications of both OCT and IVUS [ 5 , 13 ].…”

“…In patients with renal dysfunction, IVUS is recommended, as no contrast injections are required. OCT has a much higher resolution compared with IVUS and should therefore be considered for lumen assessment and stent-related morphology, such as thrombosis, restenosis, edge dissections, expansion, and malapposition [ 42 ]. Interpretation of small abnormalities should be considered carefully, as the clinical impact of such abnormalities is unknown [ 18 ].…”

Precision percutaneous coronary intervention: Is optical coherence tomography co‐registration the future?

“…Potential reasons include the steep learning curve for the technology, the lack of automation and most importantly, the absence of a clear algorithm on percutaneous coronary intervention (PCI) optimization.Optical coherence tomography (OCT) with its high resolution and automated measurements, overcomes several limitations inherent to IVUS. Automated measurements limit the subjectivity of data analysis, and algorithms for best practices guide the integration of intravascular imaging into routine clinical practice [3]. Real-time angiographic coregistration (ACR) limits the guesswork of visual estimation inherent in angiography guided PCI, in exchange for more accurate and precise localization for stent implantation.…”

“…Despite the clear impact of intravascular imaging with increasing clinical data, imaging-guided PCI is still only utilized in the minority of cases.The concept of Precision PCI includes identifying the underlying plaque characteristics, determining the need for plaque modification, and choosing the appropriate stent length and diameter for optimal lesion coverage. Selecting a landing zone that is free of plaque can be facilitated by ACR which may result in a reduction of edge dissections and geographic miss [3]. This strategy may also have significant economic benefits that offset the cost of the OCT catheter by avoiding the use of additional devices after sub-optimal angiographic stent implantation.…”