Evaluation of Left Main Coronary Artery Using Optical Frequency Domain Imaging and Its Pitfalls

Abstract

Objectives. We aimed to assess the quality of optical frequency domain imaging (OFDI) of the left main (LM) arterial wall and describe and analyse potential artefacts in this setting. Background. OFDI is increasingly used to assess ambiguous lesions and optimize LM percutaneous coronary intervention. However, its ability to provide artefact-free high-quality images of coronary ostia and large segments such as the LM remains uncertain. Methods. We included 42 consecutive patients who underwent OFDI, including LM imaging. Each OFDI frame was subdivided into four quadrants and analysed. The number of quadrants with artifacts was calculated within the proximal, mid, and distal LM and the first 5 mm of the left anterior descending artery (LAD) and/or left circumflex artery (LCX). Results. The quadrants analysis showed an overall artifact rate of 8.9%, mostly out-of-field (45.1%) or residual blood (44.7%) artefacts. Most artifacts were located in the proximal LM (18.6%) with a stepwise reduction of artifact rates towards distal segments (mid LM 5.8%; distal LM 3.6%, ostial LAD 2.6%, and ostial LCX 0%; p<0.001). While 20 (48.8%) patients had angiographically visible plaques, OFDI showed plaques in 32 patients (76.2%; p=0.007). Conclusion. OFDI can accurately evaluate the LM and detect and assess angiographically unvisualized atherosclerotic plaques providing accurate assessment of >90% of the quadrants of the LM and the ostia of its bifurcation branches. However, artifacts mainly located in the proximal LM and decreasing distally in a stepwise fashion should be considered in the interpretation of OFDI in this setting.

The invasive intracoronary imaging assessment of left main coronary artery disease

“…Notwithstanding the afore mentioned limitations, a recent study showed that LMCA was adequately assessed by OCT in more than 90% of the quadrants, most artefacts being located in the proximal segment [21]. The most commonly diseased LMCA segment is the bifurcation, where OCT imaging is accurate.…”

Shared Traumatic Stress and the Impact of COVID-19 on Public Child Welfare Workers

“…These experiences can affect a young person's self-perception that shapes a young person's image of themselves that can last a lifetime (Abramovitz 2005). Workers will witness more such experiences among the children they serve in a large-scale crisis, like a pandemic, as agencies face additional challenges and work demands increase (Roule 2020;Tavormina and Clossey 2015).…”

“…The already limited resources to help children like Collin and their families are much scarcer during the pandemic, as PCW agencies are concerned with their very survival (Amandolare et al 2020;Roule 2020). Children need consistent, healthy relationships with adults who model proper behaviors (Abramovitz 2005;Madden and Aguiniga 2017).…”

“…By supporting the worker, we will effectively support youth like Collin. As the world prepares for a prolonged impact from COVID-19, leadership on international, national, and interagency levels needs to be proactive (Roule 2020). Institutionally supportive practices and policies would directly shift organizational culture across the PCW system and mitigate risk of shared traumatic responses for staff (Corin and Björk 2016;Deglau et al 2018;Spielfogel et al 2016).…”

“…There is a gap in the literature on the effects of large-scale crises on specific human services workforces, including PCW workers. However, given the clear difficulty such crises entail in the sector, leadership needs to be proactive on international, national, local, and interagency levels as the world faces further outbreaks of COVID-19 (Roule 2020). One area that needs further exploration is shared traumatic stress (SdTS), or the dual exposure to trauma PCW workers experience as they encounter secondary trauma from the populations they serve alongside their own reactions from posttraumatic stress (Tosone et al 2015).…”