Comparison between intermediate and severe coronary stenoses and clinical outcomes of an OCT-guided PCI strategy

Abstract

aAims We compared optical coherence tomography (OCT) features of intermediate and severe coronary stenoses in patients with stable angina and acute coronary syndrome (ACS), and tested the clinical impact of an OCT-based strategy for treating intermediate stenoses.Methods The study enrolled 135 consecutive patients with either ACS or stable angina and a single de-novo coronary stenosis. Patients were divided into two groups: intermediate stenosis defined as quantitative coronary angiography percentage narrowing less than 70%, or presence of angiographic vessel haziness and severe stenosis with percentage narrowing more than 70%. OCT was performed to assess features of plaque vulnerability and to measure the minimal lumen area. We also appraised the 12-month rate of major adverse event (MACE) of an OCT-guided strategy of percutaneous coronary intervention (PCI) based on the presence of thrombus and/or minimal lumen area less than 3.0 mm 2 .Results Fifty-six patients had intermediate stenoses, whilst 79 had severe stenoses. In the 'intermediate stenosis group', patients with stable angina had a lower asymmetric index (P U 0.02) and a greater calcific arc (P U 0.0001). In the 'severe stenosis group', intermediate lesions of patients with ACS exhibited a greater lipid arc as compared with patients with stable angina (P U 0.03). A higher prevalence of thin cap fibroatheroma was seen in patients with ACS of both groups. The incidence of MACE was not significantly different between patients with an intermediate stenosis who received PCI vs. optimal medical therapy on the basis of OCT findings (P U 0.26).Conclusions Intermediate coronary stenoses showed distinctive OCT-based features according to the initial clinical presentation. The adoption of an OCT-guided PCI strategy, based on the presence of coronary thrombus and significant vessel narrowing, led to encouraging results.

Clinical significance of optical coherence tomography‑guided angioplasty on treatment selection

“…OCT performed after angioplasty is better able to demonstrate the stent-vessel wall association as well as visualize individual stent struts and their distance from the vessel wall ( 10 , 17 , 27 , 35 ). The present study results indicated that dissections were not identified by CAG; however, they were detected by OCT.…”

“…It is a particularly attractive technique because it provides real-time images and microstructural information on the tissues ( 13 , 14 ). Furthermore, it can be used to provide a detailed analysis of the coronary artery wall, including plaque characterization, thin-cap fibroatheroma (TCFA) and vulnerable plaque identification, and assessments of the vascular response to PCI, which may be responsible for acute coronary events ( 11 , 12 , 15 – 17 ). Considerable evidence currently indicates that the early use of OCT reveals various abnormal vessel reactions associated with stent implantation, such as stent malapposition, suboptimal stent deployment, thrombus, tissue prolapse, and edge dissection ( 18 , 19 ).…”

“…Considerable evidence currently indicates that the early use of OCT reveals various abnormal vessel reactions associated with stent implantation, such as stent malapposition, suboptimal stent deployment, thrombus, tissue prolapse, and edge dissection ( 18 , 19 ). Finally, OCT is also helpful for guiding coronary management and interventions, including stent apposition and the early identification of procedure-associated complications ( 17 , 20 ). However, the evaluation of OCT clinical usefulness requires a prospective comparison of the two techniques in a significant number of patients.…”