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Multicenter Study
. 2021 Jun 11;17(2):e124-e131.
doi: 10.4244/EIJ-D-20-01121.

Optical coherence tomography to guide percutaneous coronary intervention of the left main coronary artery: the LEMON study

Nicolas Amabile  1 , Grégoire Rangé, Geraud Souteyrand, Matthieu Godin, Mohamed Mehdi Boussaada, Nicolas Meneveau, Guillaume Cayla, Frederic Casassus, Thierry Lefèvre, Radwane Hakim, Imane Bagdadi, Pascal Motreff, Christophe Caussin
Affiliations
Multicenter Study

Optical coherence tomography to guide percutaneous coronary intervention of the left main coronary artery: the LEMON study

Nicolas Amabile et al. EuroIntervention. .

Abstract

Background: Intravascular ultrasound (IVUS)-guided PCI improves the prognosis of left main stem (LMS) PCI and is currently recommended by international guidelines. Although OCT resolution is greater than that of IVUS, this tool is not yet recommended in LMS angioplasty due to the absence of data.

Aims: This pilot study aimed to analyse the feasibility, safety and impact of OCT-guided LMS PCI.

Methods: This prospective, multicentre trial investigated whether patients might benefit from OCT-guided PCI for mid/distal LMS according to a pre-specified protocol. The primary endpoint was procedural success defined as follows: residual angiographic stenosis <50% + TIMI 3 flow in all branches + adequate OCT stent expansion (LEMON criteria).

Results: Seventy patients were included in the final analysis (median age: 72 [64-81] years, 73% male). The OCT pre-specified protocol was applied in all patients. The primary endpoint was achieved in 86% of subjects. Adequate stent expansion was observed in 86%, significant edge dissection in 30% and residual significant strut malapposition in 24% of the cases. OCT guidance modified the operators' strategy in 26% of the patients. The rate of one-year survival free from major adverse clinical events was 98.6% (97.2-100).

Conclusions: This pilot study is the first to report the feasibility and performance of OCT-guided LMS PCI according to a pre-specified protocol.

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Conflict of interest statement

N. Amabile reports consulting/lecturing fees (modest) from Abbott Vascular and Boston Scientific, and a research grant from Abbott Vascular. G. Souteyrand reports consulting/lecturing fees (modest) from Terumo, Abbott Vascular and Boston Scientific. N. Meneveau reports consulting fees (modest) from Abbott Vascular. P. Motreff reports consulting fees (modest) from Abbott Vascular and Terumo. G. Cayla reports lectures fees (modest) from Abbott. T. Lefèvre reports honoraria/consultation, personal fees (modest) from Terumo and Boston Scientific. C. Caussin reports consulting/lecturing fees (modest) from Abbott and Boston Scientific. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Global overview of the LEMON protocol.
Figure 2
Figure 2
OCT guidance in LMS PCI in the LEMON trial. A) Roles of the pre-specified OCT runs on the decision-making process during LMS PCI. B1) - B3) Comparison of the calculation of the LEMON, DOCTORS and ILUMIEN III criteria for stent expansion evaluation in bifurcated lesions.
Figure 3
Figure 3
One-year incidence of MACE (cardiovascular death/target vessel revascularisation/stent thrombosis) in the LEMON cohort.
See this image and copyright information in PMC

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