Stable Coronary Artery Disease: Assistance in Complex Percutaneous Coronary Intervention

Abstract

Optical coherence tomography (OCT) has been increasingly used in clinical practice as a guide during percutaneous coronary intervention (PCI). Prior to stent implantation, OCT can provide accurate measurements of the minimal lumen area, the distal and proximal reference areas, and lesion length. OCT is particularly useful during challenging procedures, such as calcified lesions, bifurcation, and unprotected left main PCI. In calcified lesions, OCT allows measurements of calcification size, thickness and depth and its precise location within the lesion, which might help select an appropriate atheroablation technique. In bifurcation PCI, OCT can help assess main vessel and side branch stenosis before and after stenting, select appropriate treatment strategy, and evaluate the effects of side branch treatment. Three-dimensional OCT reconstruction of bifurcation lesions provides a unique opportunity to assess the true morphology of the main and side vessel. A recent pilot trial demonstrated the safety and feasibility of frequency-domain OCT for unprotected left main PCI. Compared to IVUS, OCT provided a similar assessment of lumen and stent dimensions but was more sensitive in detecting malapposition and edge dissections. Finally, OCT imaging before stenting can provide patient risk stratification for periprocedural myocardial infarction, since OCT-derived thin-cap fibroatheroma and evidence of plaque rupture have been associated with elevation of post-PCI myocardial necrosis markers.