TCT-582 Quantitative Assessment of Residual Coronary Dissections Six Months After Balloon Angioplasty: a Novel Approach Using Optical Coherence Tomography

Abstract

Introduction: The feasibility of fractional flow reserve (FFR)-guided angioplasty using paclitaxel-coated balloons without stent implantation (DCB-only PCI) has been investigated in the OCTOPUS-2 trial (NCT02120859). According to the study protocol, dissections classified as NHLBI types A and B were not stented, if FFR > 0.8 and residual stenosis Hypothesis: We evaluated the extent of residual dissections using the optical coherence tomography (OCT) recordings obtained at 6-month follow-up (f/u). Methods: A number of 41 pt with 45 lesions were successfully treated by FFR-guided DCB-only PCI and underwent 6-month angiographic and OCT f/u. OCT analysis included manual tracing of dissections and plaques, which were entered into a dedicated software program. The algorithm enabled beyond the spread-out vessel reconstruction (carpet view of inner vessel surface: Fig. 1) also the computation of volume, luminal surface area and length of dissections and plaques. Results: As shown in Table 1, no correlation was found between angiography and OCT at f/u regarding the presence or the extension of dissections. Angiographic dissection type, vessel diameter, lesion length, plaque burden or balloon to artery ratio were not predictive for the presence of dissection at OCT f/u. Conclusions: Clinically silent residual dissections after balloon angioplasty are largely misdiagnosed by angiography. Intracoronary imaging and FFR proved useful to guide the procedure and avoid unnecessary stenting. OCT using this novel algorithm for spread-out vessel reconstruction enables a comprehensive quantitative analysis of coronary artery dissections and plaque burden.