Optical Coherence Tomography Guidance in Management of Complex Lesions Intervention

Background: Optical Coherence Tomography (OCT) can identify tissue characters depending on the polarisation properties of light, allowing detailed investigation of plaque form, content, and distribution. Calcification strongly correlates with advanced atherosclerosis, increased age, and comorbidities. The presence of calcified and hard lesions makes percutaneous coronary intervention (PCI) difficult and frequently needs adjunctive procedures to get excellent stent outcomes. The purpose of this research was to assess the role of OCT, and how it affects the operator decision in management and optimizing of PCI for complex coronary lesions, including left main and non-left main bifurcation lesions, calcific lesions and in stent restenosis.

Methods: This prospective observational single center research was carried out on 60 patients underwent elective PCI for complex coronary lesions. Cases were classified into two groups based on the change in the operator opinion after performing OCT, either before or after stenting. Group I (n=19) patients with no change in operator decision based on OCT. Group II (n=41) patients with change in operator decision based on OCT. All patients were subjected to Clinical examination, Twelve leads surface electrocardiogram (ECG), Echocardiography, diagnostic coronary angiography.

Results: Among the 60 cases involved in the research, the decision of the operator was changes in 41 patients (68%). The change based on the pre-PCI assessment was found in 21 patients (51% of all changes). The changes were either change in the number of stents, the technique of the bifurcation intervention, or the need of atherectomy devices in calcific lesion for good lesion preparation. The change in the decision based on pots-PCI OCT only was found in 10 patients (41% of all changes). The main change of the procedure based on post-PCI OCT was mainly further post dilatation due to malapposition or significant tissue protrusion, or implantation of another stent for distal edge dissection.

Conclusion: OCT is a very helpful intravascular imaging for optimization of PCI for complex coronary lesion. It significantly changed the decision of the operator for the aim of optimal stent apposition and to reduce complications in complex lesions.