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. 2023 Sep 21;9(2):124-132.
doi: 10.4244/AIJ-D-22-00064. eCollection 2023 Sep.

Impact of real-time optical coherence tomography and angiographic coregistration on the percutaneous coronary intervention strategy

Rony Mathew Kadavil  1 , Jabir Abdullakutty  1 , Tejas Patel  2 , Sivakumar Rathnavel  3 , Balbir Singh  4 , Nagendra Singh Chouhan, Fazila Tun Nesa Malik  5 , Shirish Hiremath  6 , Sengottuvelu Gunasekaran  7 , Samuel Mathew Kalarickal  8 , Viveka Kumar  9 , Vijayakumar Subban  10
Affiliations

Impact of real-time optical coherence tomography and angiographic coregistration on the percutaneous coronary intervention strategy

Rony Mathew Kadavil et al. AsiaIntervention. .

Abstract

Background: The use of optical coherence tomography (OCT) with angiographic coregistration (ACR) during percutaneous coronary intervention (PCI) for procedural decision-making is evolving; however, large-scale data in real-world practice are lacking.

Aims: Our study aims to evaluate the real-time impact of OCT-ACR on clinician decision-making during PCI.

Methods: Patients with angiographic diameter stenosis >70% in at least one native coronary artery were enrolled in the study. The pre- and post-PCI procedural strategies were prospectively assessed after angiography, OCT, and ACR.

Results: A total of 500 patients were enrolled in the study between November 2018 and March 2020. Among these, data related to 472 patients with 483 lesions were considered for analysis. Preprocedural OCT resulted in a change in PCI strategy in 80% of lesions: lesion preparation (25%), stent length (53%), stent diameter (36%), and device landing zone (61%). ACR additionally impacted the treatment strategy in 34% of lesions. Postprocedural OCT demonstrated underexpansion (15%), malapposition (14%), and tissue/thrombus prolapse (7%), thereby requiring further interventions in 30% of lesions. No further change in strategy was observed with subsequent postprocedural ACR. Angiographic and procedural success was achieved in 100% of patients, and the overall incidence of major adverse cardiovascular events at 1 year was 0.85%.

Conclusions: The outcomes reflect the real-time impact of OCT-ACR on the overall procedural strategy in patients undergoing PCI. ACR had a significant impact on the treatment strategy and was associated with better clinical outcomes at 1 year after index PCI. OCT-ACR has become a practical tool for improving outcomes in patients with complex lesions.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Study flow, enrolment and follow-up.
A) Study flowchart. B) Study enrolment and follow-up. ACR: angiographic coregistration; OCT: optical coherence tomography; PCI: percutaneous coronary intervention
Figure 2
Figure 2. Strategy changes with OCT and ACR.
A) Change in strategy with OCT (n=483 lesions). B) Change in strategy with ACR (n=472 lesions). ACR: angiographic coregistration; OCT: optical coherence tomography
Figure 3
Figure 3. Post-PCI strategy change (OCT; n=483 lesions).
ACR: angiographic coregistration; OCT: optical coherence tomography; PCI: percutaneous coronary intervention
Figure 4
Figure 4. Comparison of the iOPTICO endpoints with the XV India and XV USA studies.
MI: myocardial infarction; TLR: target lesion revascularisation
Central illustration
Central illustration. OCT-ACR guided decision-making during PCI.
A) An illustrative case of change in PCI strategy after OCT-ACR. A1, A2, and A3 show stent length, diameter and landing zone based on angiogram, OCT and OCT-ACR, respectively. B) PCI strategy change with OCT-ACR. ACR: angiographic coregistration; OCT: optical coherence tomography; PCI: percutaneous coronary intervention
See this image and copyright information in PMC

References

    1. Räber L, Mintz GS, Koskinas KC, Johnson TW, Holm NR, Onuma Y, Radu MD, Joner M, Yu B, Jia H, Meneveau N, de la, Escaned J, Hill J, Prati F, Colombo A, di Mario, Regar E, Capodanno D, Wijns W, Byrne RA, Guagliumi G ESC Scientific Document Group. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J. 2018;39:3281–300. - PubMed
    1. Buccheri S, Franchina G, Romano S, Puglisi S, Venuti G, D’Arrigo P, Francaviglia B, Scalia M, Condorelli A, Barbanti M, Capranzano P, Tamburino C, Capodanno D. Clinical Outcomes Following Intravascular Imaging-Guided Versus Coronary Angiography-Guided Percutaneous Coronary Intervention With Stent Implantation: A Systematic Review and Bayesian Network Meta-Analysis of 31 Studies and 17,882 Patients. JACC Cardiovasc Interv. 2017;10:2488–98. - PubMed
    1. Kuku KO, Ekanem E, Azizi V, Melaku G, Bui A, Meirovich YF, Dheendsa A, Beyene S, Hideo-Kajita A, Lipinski MJ, Waksman R, Garcia-Garcia HM. Optical coherence tomography-guided percutaneous coronary intervention compared with other imaging guidance: a meta-analysis. Int J Cardiovasc Imaging. 2018;34:503–13. - PubMed
    1. Prati F, Guagliumi G, Mintz GS, Costa M, Regar E, Akasaka T, Barlis P, Tearney GJ, Jang IK, Arbustini E, Bezerra HG, Ozaki Y, Bruining N, Dudek D, Radu M, Erglis A, Motreff P, Alfonso F, Toutouzas K, Gonzalo N, Tamburino C, Adriaenssens T, Pinto F, Serruys PW, Di Mario Expert’s OCT Review Document. Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures. Eur Heart J. 2012;33:2513–20. - PMC - PubMed
    1. Mintz GS, Guagliumi G. Intravascular imaging in coronary artery disease. Lancet. 2017;390:793–809. - PubMed

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