Clinical impact of a new optical coherence tomography-derived volumetric method for evaluating stent expansion
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ORIGINAL PAPER
Clinical impact of a new optical coherence tomography‑derived volumetric method for evaluating stent expansion Akito Kawamura1 · Daisuke Nakamura2 · Ryu Shutta1 · Hitoshi Nakamura1 · Yutaka Matsuhiro1 · Naotaka Okamoto1 · Yasuyuki Egami1 · Yasushi Sakata2 · Masami Nishino1 · Jun Tanouchi1 Received: 25 May 2020 / Accepted: 24 October 2020 © Springer Nature B.V. 2020
Abstract The aim of this study was to investigate the impact of a new optical coherence tomography (OCT)-derived volumetric method for stent expansion (new-OCT method) to predict the target lesion revascularization (TLR) and compare the expansion findings between this new method and the conventional method because, in the real world, there are few clinical data on the new-OCT-method for stent expansion. One hundred forty lesions in 135 patients who underwent OCT-guided percutaneous coronary intervention were enrolled. We compared the new-OCT-method and conventional method to predict the TLR at 1 year. A total of 7 lesions (5.0% of treated lesions) in 6 patients experienced TLR during 1 year of follow up. The minimum expansion index (MEI) using the new-OCT method was significantly lower in the TLR group than non-TLR (60.0% vs. 77.0%; p 5.5 mm2 by IVUS and > 4.5 mm2 by OCT. In addition, the consensus document suggested the minimal stent area > 80% of average proximal and distal reference area for the optimal relative stent expansion [6]. However, we still rely on mere single cross sectional narrowing or its index compared to the reference area to determine the stent expansion (conventional method). This conventional method does not take into account vessel tapering and side branches, ultimately neglecting the volumetric nature of the coronary vasculature, likely masking the true under-expansion significance [7]. Optical coherence tomography (OCT) imaging delivers higher resolution and sharper volumetric rendering as compared to intravascular ultrasound (IVUS) [8–10]. Full lumen expansion has been found to be an important aspect of optimizing percutaneous coronary intervention (PCI) in order to reduce the occurrence of post-stent complications.
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A volumetric analysis to assess the lumen expansion that takes into account vessel tapering using OCT with its higher resolution may be more functionally accurate and therefore more predictive of the outcomes. In fact, Nakamura et al. demonstrated that an OCT analysis of the stent expansion with a newly described volumetric method, but not with the conventional method, yielded data that was predictive of both an acute improvement in the fractional flow reserve (FFR)-derived physiology and device-oriented composite endpoint (DoCE) [11]. However, in the real world the difference between the new OCT-derived volumetric method and conventional method has not yet been demonstrated. The aim of the present study was to: (1) evaluate the clinical impact of the new OCT-derived volumetric method on the target lesion revascularization (TLR) at 1 year and (2) compare the expansion fi
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