Optical Coherence Tomography Guidance for Percutaneous Intervention

Abstract

Article, see p 906 Adoption of invasive imaging for guidance during percutaneous coronary interventions (PCI) varies largely between clinical sites and between geographies, being greatest in Japan, intermediate to low in the United States and Asia, and very low to nonexistent in Europe. Yet nearly every interventional cardiologist will agree that intracoronary images obtained by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) add significant information content to what is provided by angiography alone, thereby improving the understanding of and our capacity to interpret angiographic images. Although Japanese colleagues have the opportunity to use either IVUS or OCT in the majority of cases as part of their regular procedural strategy, use of invasive imaging in the rest of the world is hampered by inadequate or restricted reimbursement. Payers and some physicians are indeed claiming that adding IVUS or OCT imaging to simple angiographic guidance has not been shown unequivocally to affect patient outcomes. Observational or retrospective data obtained with use of the more recently developed OCT are even less conclusive than those obtained over the years with IVUS guidance.1 The study reported here by Meneveau et al2 is an important milestone in the journey to accumulating sufficient global evidence to support the role of OCT-guidance eventually during complex PCI and to extend the Practice Guidelines recommendations supporting its use. As mentioned in the original article,3 the DOCTORS (Does Optical Coherence Tomography Optimize Results of Stenting?) randomized trial is an investigator-driven initiative, supported by central analyses performed at the leading participating center, and funded by the French government. DOCTORS is the first, randomized, multicenter study specifically evaluating the impact of combined angiographic and OCT imaging on PCI optimization. The study confirms prior observational or retrospective studies4–7 in identifying OCT findings that jeopardize the immediate PCI …