Unrestricted utilization of frequency domain optical coherence tomography in coronary interventions
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ORIGINAL PAPER
Unrestricted utilization of frequency domain optical coherence tomography in coronary interventions Gregory T. Stefano • Hiram G. Bezerra • Emile Mehanna • Hirosada Yamamoto Yusuke Fujino • Wei Wang • Guilherme Attizzani • Daniel Chamie´ • Daniel I. Simon • Marco A. Costa
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Received: 25 January 2012 / Accepted: 25 September 2012 / Published online: 12 October 2012 Ó Springer Science+Business Media Dordrecht 2012
Abstract Frequency domain optical coherence tomography (FD-OCT) has shown promise to evaluate coronary devices in clinical trials, however, little is known about its application in clinical practice. This prospective, single center initiative planned for 100 % FD-OCT utilization in all patients undergoing coronary interventions during a 60-day period. Operators pre-specified the planned intervention based on angiography alone. FD-OCT success was defined as acquisition of good quality images enabling adequate quantification of vessel dimensions and lesion/ percutaneous coronary intervention (PCI) assessment. Impact on management occurred when angiography-based planning was altered based on FD-OCT data. There were 297 FD-OCT acquisitions performed in 155 vessels from 150 patients. There were no FD-OCT procedural related cardiac adverse events and success was obtained in 85.7 % of all target vessels (pre-PCI = 76.8 % vs. post-PCI = 90.1 %, p = 0.004). Success on the first pullback occurred in 80.3 % overall (61.9 % in the initial operator experience and 85.5 % after the third procedure). FD-OCT impact on management was 81.8 % pre-PCI and 54.8 % post-PCI. Stent malapposition was detected in 39.2 % (89.4 % underwent further intervention) and edge dissection in
G. T. Stefano H. G. Bezerra E. Mehanna H. Yamamoto Y. Fujino W. Wang G. Attizzani D. Chamie´ D. I. Simon M. A. Costa (&) Harrington-McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 3001, Cleveland, OH 44106-5038, USA e-mail: [email protected]
32.5 % (21.1 % treated with stent). FD-OCT success and management impact were similar in ACS and non-ACS patients (82.1 vs. 81.1 %, p = 1.000, and 62.5 vs. 65.1 %, p = 0.854, respectively). FD-OCT is safe, can successfully be incorporated into routine practice, and alters procedural strategy in a high proportion of patients undergoing PCI. Keywords Optical coherence tomography Coronary intervention
Introduction Frequency domain optical coherence tomography (FDOCT) is an emerging intravascular imaging modality that employs near-infrared light in a blood free environment to produce high resolution intravascular images. The lumen and arterial wall are imaged at an extremely high speed (100 frames per second in the C7-XRTM OCT Intravascular Imaging System; St. Jude Medical, St. Paul, Minnesota) and axial resolution (10–15 lm), a 10-fold improvement compared to intravascular ultrasound (IVUS) [1]. These features make FD-OCT a very promising modality to evaluat
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