The use of intravascular imaging such as intravascular ultrasound or optical coherence tomography (OCT) both for decision making optimization and percutaneous intervention planning have introduced changes in some scenarios, such as the left main, improving trial end points.
There are ongoing studies set to deliver more evidence on its long term safety and efficacy (especially in complex patients), as the ILUMEN IV. According to US statistics, approximately 10% of PCI procedures are guided by intravascular imaging.
This observational study, prospective and multicenter carried out in the US, was conducted by the LightLab Initiative to characterize the use of OCT for PCI decision making, by looking at pre-PCI morphology, length, diameter, and post PCI medial dissection/ stent edge assessment, stent apposition and expansion (MLD MAX protocol).
From January 2019 to March 2020, researchers looked at 773 OCT guided PCI procedures. 62% of these procedures were transradial, 76% had single vessel lesions, and 70% were non-elective indications. 50% of treated vessels were the anterior descending, 29% right coronary and 15% the circumflex.
The use of OCT according to MLD MAX affected the assessment and decision making for 86% of the lesions observed in this study.
Read also: Trans-Stent Gradient as a Predictor of Adverse Events at Followup.
Pre-PCI OCT use changed operator decision-making in 80% of lesions, and post-PCI OCT changed stent optimization decision-making in 31% of lesions. Changes in decision making were mainly at the expense of lesion morphology, largely because of calcification (they used another vessel preparation device). Compared against conventional angioplasty, calcification degree was underestimated in 85% of cases. However, this had no impact on the number of stents needed.
Post-PCI OCT changed stent optimization decision-making was based on sub-expansion in 25% of cases, malapposition in 10% of cases, and edge dissection in 5%.
Conclusions
The use of a standardized protocol, with MLD MAX from the LightLab initiative had a significant impact on PCI decision making optimization in 86% of cases. When looking at stratification according to operator experience, there was no relevant difference, with similar impact across the sample population.
Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.
Original Title: Decision-Making During Percutaneous Coronary Intervention Guided by Optical Coherence Tomography: Insights From the LightLab Initiative.
Reference: Bergmark B, Dallan LAP, Pereira GTR, et al. Decision-Making During Percutaneous Coronary Intervention Guided by Optical Coherence Tomography: Insights From the LightLab Initiative. Circ Cardiovasc Interv. 2022;15(11):872-881. doi:10.1161/CIRCINTERVENTIONS.122.011851.
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