Optical coherence tomography-guided coronary stent implantation compared to angiography: a multicentre randomised trial in PCI – design and rationale of ILUMIEN IV: OPTIMAL PCI

Ali, Ziad A.; Landmesser, Ulf; Galougahi, Keyvan Karimi; Maehara, Akiko; Matsumura, Mitsuaki; Shlofmitz, Richard; Guagliumi, Giulio; Price, Matthew J.; Hill, Jonathan; Akasaka, Takashi; Prati, Francesco; Bezerra, Hiram G.; Wijns, William; Mintz, Gary S.; Ben‐Yehuda, Ori; McGreevy, Robert; Zhang, Zhen; Rapoza, Richard; West, Nick E.J.; Stone, Gregg W.

doi:10.4244/eij-d-20-00501

Cited by 92 publications

(97 citation statements)

References 26 publications

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“…The ILUMIEN IV 104 and OCTOBER trials 105 are two large ongoing randomised trials that aim to determine the clinical impact of OCT-guided versus angiography-guided PCI. ILUMIEN IV is a prospective, single-blind, global, multicentre randomised trial comparing OCT-defined EEL-based PCI guidance to angiography-guided PCI in complex patients and coronary lesions.…”

Section: Oct Versus Ivus Versus Angiography In Registries and Randomised Trialsmentioning

confidence: 99%

Intracoronary optical coherence tomography: state of the art and future directions

Ali¹,

Galougahi²,

Mintz³

et al. 2021

EuroIntervention

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Optical coherence tomography (OCT) has been increasingly utilised to guide percutaneous coronary intervention (PCI). Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited. Difficulty in transitioning from intravascular ultrasound (IVUS), complex image interpretation, lack of a standardised algorithm for PCI guidance, and paucity of data from prospective clinical trials have contributed to the modest adoption. Herein, we provide a comprehensive up-do-date overview on the utility of OCT in coronary artery disease, including technical details, device set-up, simplified OCT image interpretation, recognition of the imaging artefacts, and an algorithmic approach for using OCT in PCI guidance. We discuss the utility of OCT in acute coronary syndromes, provide a summary of the clinical trial data, list the work in progress, and discuss the future directions. KEYWORDS• ACS/NSTE-ACS • intravascular ultrasound • optical coherence tomography EuroIntervention 2021;17:e105-e123 e 106 Abbreviations ACS acute coronary syndromes BOOM bifurcation and ostial optical coherence tomography mapping DES drug-eluting stents IVUS intravascular ultrasound MI myocardial infarction MINOCA myocardial infarction with non-obstructive coronary arteries MLA minimal lumen area MLD MAX morphology, length, diameter, medial dissection, apposition, expansion MSA minimal stent area NSTEACS non-ST-segment elevation acute coronary syndromes NURD non-uniform rotational distortion OCT optical coherence tomography OFR optical flow ratio PCI percutaneous coronary intervention STEMI ST-segment elevation myocardial infarction TCFA thin-cap fibroatheroma

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Section: Oct Versus Ivus Versus Angiography In Registries and Randomised Trialsmentioning

confidence: 99%

Intracoronary optical coherence tomography: state of the art and future directions

Ali¹,

Galougahi²,

Mintz³

et al. 2021

EuroIntervention

Self Cite

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“…As we previously mentioned, currently the most important invasive imaging modality is the intravascular OCT. OCT seems to be a powerful tool for discrimination of three types of unstable plaque morphologies underlying coronary thrombosis-such as plaque rupture, erosion, and calcified nodules-but also plaque healing [158]. All the pros and cons of OCT versus IVUS were discussed in a review by Su et al [159]. The main advantage of OCT in comparison to IVUS is 10× higher resolution (15-20 µm vs. 150-200 µm) [160].…”

Section: Role Of Invasive Imaging Methods In Plaque Pathobiology Assessmentmentioning

confidence: 99%

“…In addition, the development of hybrid intravascular imaging methods, which are currently undergoing preclinical evaluation, seem to enable more complete evaluation of the plaque pathophysiology [161]. In fact, there is an ongoing study, the ILUMIEN IV study, that is planned to be completed in 2022, and that will determine if OCT-guided stenting will provide better clinical outcomes than the angiographic guidance alone [159]. Additionally, near-infrared spectroscopy (NIRS) emerged as a viable method in this setting, as multiple studies have demonstrated that the detection of lipids in the walls of the coronary vessels identifies vulnerable patients at increased risk of new CV event [160].…”

Section: Role Of Invasive Imaging Methods In Plaque Pathobiology Assessmentmentioning

confidence: 99%

Circulating Biomarkers Reflecting Destabilization Mechanisms of Coronary Artery Plaques: Are We Looking for the Impossible?

et al. 2021

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Despite significant strides to mitigate the complications of acute coronary syndrome (ACS), this clinical entity still represents a major global health burden. It has so far been well-established that most of the plaques leading to ACS are not a result of gradual narrowing of the vessel lumen, but rather a result of sudden disruption of vulnerable atherosclerotic plaques. As most of the developed imaging modalities for vulnerable plaque detection are invasive, multiple biomarkers were proposed to identify their presence. Owing to the pivotal role of lipids and inflammation in the pathophysiology of atherosclerosis, most of the biomarkers originated from one of those processes, whereas recent advancements in molecular sciences shed light on the use of microRNAs. Yet, at present there are no clinically implemented biomarkers or any other method for that matter that could non-invasively, yet reliably, diagnose the vulnerable plaque. Hence, in this review we summarized the available knowledge regarding the pathophysiology of plaque instability, the current evidence on potential biomarkers associated with plaque destabilization and finally, we discussed if search for biomarkers could one day bring us to non-invasive, cost-effective, yet valid way of diagnosing the vulnerable, rupture-prone coronary artery plaques.

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“…The Ilumien IV study has recently completed recruitment, enrolling more complex patients and lesions, with greater potential for benefit from an OCT-guided approach to PCI compared against angiographic guidance alone. 12 Trials incorporating OCT and IVUS suggest that OCT is non-inferior to IVUS both in terms of acute procedural result and clinical outcomes. 16,17 The favourable clinical outcome data that exists for IVUS is therefore likely applicable to OCT, although RCT data is needed to confirm this view.…”

Section: Evidence -Octmentioning

confidence: 99%

A Vision Of Percutaneous Coronary Revascularisation In 2021: How to take advantage of intra-coronary imaging to perform more effective PCI

Richards

Johnson

2021

JRSM Cardiovascular Disease

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The use of intracoronary imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) can define vessel architecture and has an established role in guidance and optimisation of percutaneous coronary intervention. Additionally intracoronary imaging has an emerging role in diagnosis, afforded by the ability to depict vessel wall characteristics not seen on angiography alone. Use of intracoronary imaging is recommended by international consensus guidelines from the European Society of Cardiology and two recent expert consensus position statements from the European Association of Percutaneous Coronary Interventions (EAPCI). However, uptake in contemporary practice in the United Kingdom appears to lag behind these recommendations. Imaging is particularly advantageous in complex coronary lesions (such as left main stem coronary artery, bifurcation, or heavily calcified lesions) and in complex patients (acute presentations, atypical presentations, and renal dysfunction). Stent detail to the level of individual struts can be appreciated with intracoronary imaging, which facilitates appropriate stent selection and optimisation of the final stent result. We highlight specific subgroups that benefit from an imaging guided approach to percutaneous coronary intervention. We review the evidence and the role of intracoronary imaging and highlight specific subgroups that show particular benefit from imaging guided percutaneous coronary intervention.

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Optical coherence tomography-guided coronary stent implantation compared to angiography: a multicentre randomised trial in PCI – design and rationale of ILUMIEN IV: OPTIMAL PCI

Cited by 92 publications

References 26 publications

Intracoronary optical coherence tomography: state of the art and future directions

Intracoronary optical coherence tomography: state of the art and future directions

Circulating Biomarkers Reflecting Destabilization Mechanisms of Coronary Artery Plaques: Are We Looking for the Impossible?

A Vision Of Percutaneous Coronary Revascularisation In 2021: How to take advantage of intra-coronary imaging to perform more effective PCI

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