OCT during left main bifurcation PCI

Abstract

80 years old male was admitted with recent history of acute coronary syndrome. Coronary angiogram showed minimal distal left main disease with significant ostial left anterior descending artery (LAD) lesion (Fig. 1A & Video 1). Optical coherence tomogram (OCT) guided percutaneous intervention (PCI) to Left main and LAD was planned using Provisional T stenting strategy. OCT evaluation showed minimal disease in distal left main (E). Ostial LAD showed thin cap fibro-atheroma with multiple calcified plaques (Fig. 1B, C & D). There was no significant calcium requiring de-bulking. Left circumflex artery (LCX) ostium showed minimal disease. After pre-dilatation and stenting of LAD lesion, there was significant plaque shift into the LCX (Fig. 1F & Video 2). Hence it was converted to two stent strategy and bifurcation stenting of LAD/LCX was done using T and protrusion technique (Fig. 1G, H & Video 3). Post stenting, left main bifurcation was assessed by OCT which showed good apposition of the stents in both LAD and LCX (Fig. 1I). Compared to IVUS OCT with lower penetration has limitations in large vessels like the left main, but its higher resolution helped in identifying a clear landing zone in the left main and a TCFA involving ostial LAD which predicted the plaque shift. Fig. 1 A: CAG in AP cranial view showing tight Ostial LAD lesion without any significant Ostial LCX disease. B: Longitudinal OCT image run from LAD to Left main (orientation-from left to right its distal to proximal) C: Cross-sectional OCT image from mid LAD ... Supplementary data related to this article can be found at http://dx.doi.org/10.1016/j.ihj.2014.08.009. The following are the supplementary data related to this article: Video 1: Initial CAG showing critical Ostial LAD disease without any significant left main or LCX disease. Click here to view.(1.1M, mp4) Video 2: After pre-dilation there was significant plaque shift into the LCX ostium. Click here to view.(1.0M, mp4) Video 3: Final angiogram after successful bifurcation PCI to LAD/LCX with two stents using TAP technique. Click here to view.(1.2M, mp4)