“…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
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
“…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
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
“…The results of the CLIMA study indicated the feasibility and efficacy of OCT for detecting high-risk plaques leading to adverse events. Further trials such as the ILUMIEN IV: Optimal PCI trial (NCT03507777) and October trial (NCT03171311) ( 27 ) are expected to further demonstrate the clinical safety and efficacy of OCT in guiding PCI.…”
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been developed and improved as both diagnostic and guidance tools for interventional procedures over the past three decades. IVUS has a resolution of 100 µm with a high tissue penetration and capability of assessing the entire structure of a coronary artery including the external elastic membrane, whereas OCT has a higher resolution of 10-20 µm to assess endoluminal structures with a limited tissue penetration compared to IVUS. Recently, two companies, CONAVI and TERUMO, integrated IVUS and OCT into a single catheter system. With their inherent strength and limitations, the combined IVUS and OCT probes are complementary and work synergistically to enable a comprehensive depiction of coronary artery. In this review, we summarize the performance of the two intracoronary imaging modalities-IVUS and OCT-and discuss the expected potential of the novel hybrid IVUS-OCT catheter system in the clinical field.
“…However, both OCT and IVUS can provide insight in composition of lesions and may result in a different stenting strategy Bifurcation lesions assessment and guidance (4) OCT might support bifurcation guidance by assessment of plaque composition and distribution, stent sizing, and deployment sites and positioning of the re-crossing wire. An RCT by Holm et al (OCTOBER, 2018) comparing clinical outcomes after OCT guidance compared with CAG guidance in bifurcation lesions is currently running [ 63 ] Post-PCI stent assessment and optimization (5) OCT provides detailed insight in how the stent is positioned inside the coronary artery (apposition, expansion, and edge dissections). Optimization may result in improved clinical outcomes Assessment of stent failure (5) OCT provides detailed insight in mechanisms associated with stent failure (thrombosis, in-stent restenosis, malapposition, under-expansion, edge dissections, tissue protrusions) Patients with impaired kidney function Only IVUS should be considered, as contrast injections are needed with OCT CAG coronary angiography, FFR fractional flow reserve, iFR instantaneous wave-free ratio, IVUS intravascular ultrasound, OCT optical coherence tomography, RCT randomized controlled trial Fig.…”
Section: Discussionmentioning
confidence: 99%
“…The first results are expected mid-2021, while the estimated completion date is mid-2022. The OCTOBER trial is a European RCT that aims to demonstrate the superiority of OCT-guided stenting in bifurcations lesions [ 63 ]. They aim to include 1200 patients.…”
Introduction
Coronary angiography (CAG) is the standard modality for assessment of coronary stenoses and intraprocedural guidance of percutaneous coronary interventions (PCI). However, the limitations of CAG are well recognized. Intracoronary imaging (ICI) can potentially overcome these limitations. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the main ICI techniques utilized in clinical practice.
Aim
This narrative literature review addresses the current clinical applications of OCT in relation to IVUS and CAG in patients with coronary artery disease (CAD). Items reviewed are: technical implications of OCT and IVUS, lesion characterization and decision-making, stent optimization criteria, post-stenting results, safety in terms of procedural complications, clinical outcomes, and indications.
Main Findings
OCT is able to reveal more detail than IVUS due to its higher resolution. However, this higher resolution comes at the cost of a lower penetration depth. Pre-stenting OCT results in procedural change in more than 50% of the cases in terms of stent length and diameter. Post-stenting OCT resulting in stent optimization is reported in at least 27% of the cases. Malapposition and under-expansion are treated with post-dilatations, while edge dissections are treated with additional stent placement. Stent expansion, stent apposition, distal stent edge dissections, and reference lumen areas seem to be the most important stent optimization criteria for both decision-making and for reducing the risk of adverse events during follow-up. Both OCT and IVUS are superior in terms of post-stenting results compared with CAG alone. However, there is no consensus about whether OCT guidance results in better stent expansion than IVUS guidance. OCT, IVUS, and CAG are safe procedures with few reported procedural complications. In general, OCT guidance seems to contribute to favorable clinical outcomes compared with CAG guidance only. However, OCT guidance results in similar clinical outcomes as with IVUS guidance. OCT could be considered for lumen assessment and stent-related morphology in more complex cases in which CAG interpretation remains uncertain. Since OCT and IVUS have distinct characteristics, these techniques are complementary and should be considered carefully for each patient case based on the benefits and limitations of both techniques.
Electronic supplementary material
The online version of this article (10.1007/s40119-020-00185-4) contains supplementary material, which is available to authorized users.
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