Original title: Frecuency domain optical coherente tomography to assess non-ostial left main artery. Reference: Francesco Burzotta, et al. EuroIntervention 2015;10e1-e8

Optical coherence tomography (OCT) has proved valuable in making decisions and monitoring stents implanted in coronary arteries, but its role in the assessment of left main (LM) lesions remains unclear.

The study included 54 patients presenting moderate to severe LM de novo lesions and bifurcation with anterior descending and circumflex ostia compromise and compared OCT to quantitative coronary angiography (QCA). 

After OCT, 26 patients (48%) received PCI, 25 (47%) medical treatment and 3 (5%) myocardial revascularization surgery. There was a good correlation between LM segment length, artefact frames, minimal lumen area and reference lumen area. The mean number of LM artefact frames was 8±10 (19%) and was more frequent at proximal and ostial level than at distal level (43.3% vs. 2.1% p<0.0001).

There was high correlation between OCT and QCA except for LM length, which was more efficient with QCA (8.4 vs. 11.6 p=0.001).

Conclusion

Study results show that OCT is feasible with good quality imaging for non ostial LM lesions. Assessment is more efficient for distal than proximal lesions.

Editorial Comment

OCT has proved to be safe and to provide quality imaging superior to IVUS, but in LM lesions this is different, since it has important technical limitations to assess ostial and proximal lesions.

To determine segment length, perhaps we should use not just one method but many, such as FFR, IVUS and even QCA. Another limitation to OCT is the need to use contrast to obtain images, especially in patients presenting compromised kidney function and renal failure.

Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation 
Buenos Aires -Argentina

Carlos Fava