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. 2020 Jun 12:2020:4817239.
doi: 10.1155/2020/4817239. eCollection 2020.

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

Vincent Roule  1   2 , Idir Rebouh  1 , Adrien Lemaitre  1 , Mathieu Bignon  1 , Pierre Ardouin  1 , Rémi Sabatier  1 , Fabien Labombarda  1   2 , Katrien Blanchart  1 , Farzin Beygui  1   2   3
Affiliations

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

Vincent Roule et al. J Interv Cardiol. .

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.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Percentage of quadrants with artifacts in the different explored segments, p < 0.0001. LAD, left anterior descending; LCX, left circumflex; LM, left main.
Figure 2
Figure 2
Optical frequency domain imaging examples of artifacts: quadrants out of the field of view (white arrow) (a), incomplete blood displacement by iodine contrast producing volute (white arrow) with high attenuation of optical signal (b), sew-up artifact (c) (white arrow), and artifact related to eccentric wire position causing elliptical image and signal attenuation (d) (white arrows).
Figure 3
Figure 3
Optical frequency domain imaging examples of plaque analysis: normal LM (a), fibrous plaque (b) (white arrow), and fibrocalcific plaque (c) (white arrows) with intimal hyperplasia and disappearance of the media.
See this image and copyright information in PMC

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