P63 OPTICAL COHERENCE TOMOGRAPHY–ANGIO CO–REGISTRATION (OCT–ACR) OF LEFT ANTERIOR DESCENDING IN PATIENT WITH ONGOING ANIGNA

Abstract

Abstract We share the case of a 50–year old man, with no cardiovascular risk factor, presented in ER with ongoing angina and positive exercise stress testing. No clinical evidence of heart failure. EKG and echocardiogram was negative. He was referred for invasive coronary angiography, that showed severe stenosis of mid–LAD and moderate ostial LAD stenosis. Subsequent Optical Coherence Tomography–Angio Co–Registration (OCT–ACR) of Left Anterior Descending was performed. An EBU3.5 guiding catheter was engaged in the left coronary artery, and 8000 units of heparin administered. After a pre–dilatation with a semi–compliant balloon of mid LAD, a plaque rupture with thrombus was documented at mid–LAD and a fibro–lipidic plaque with a severe flow limitation (MLA<4mm2) at the ostium, with no involvement of left main (Fig. 1b). Pre–dilatation with SC and NC balloon (2.5–3.5mm) was performed and then stented with a 4.0 × 26 mm DES. Finally, OCT confirmed correct stent expansion, achieving an excellent angiographic result, without carina shifting and compromise of the circ. Patient was discharged, asymptomatic. OCT–ACR guided PCI, taking advantage of its high spatial resolution, permits to plain better the PCI, establish correct stent size, evaluate early complications especially if left main or bifurcation are involved and thanks to co–registration also measurement of long axis of the vessel are facilitated.