Frequency domain optical coherence tomography for guidance of coronary stenting

Objective: To evaluate the role of Frequency domain optical coherence tomography (FD-OCT) in guiding stent implantation procedures.

Methods: Dragonfly-imaging catheter was used pre-intervention, after pre-dilatation or at various stages of stent deployment/post-dilatation to assess lesion severity, characteristics and guide stent expansion/apposition.

Results: We performed 398 OCT pull-backs in 108 consecutive patients. The 371 pull-backs analysable, had an average length of 35 mm and encompassed 193 lesions (1.8 lesions per patient). Seventy-six percent of patient had AHA-ACC-class B-C lesions. In the pre-intervention group deferral of treatment was decided for 13/68 pullbacks (19.1%), whereas strategies different from conventional predilatation (e.g. thrombectomy, rotablator, cutting-balloon) were decided in 23 cases (33.8%). After full lesion dilatation 96 pullbacks (25.9%, pre-stenting group) were performed, 46 (47.9%) of which suggested proceeding directly with stenting while 50 (52.1%) suggesting further treatment. Out of the 207 pullbacks in post-stenting group, 29 (14%) suggested new stent implantation because of dissection or residual stenosis; 64 (30.9%) suggested further optimization with high pressure/larger-sized balloon. Average number of pull-backs per patient was 3.4 requiring 75.8 ± 19.3 ml of iopamidol. No major complications were observed. Five cases (4.6%) of contrast-induced nephropathy were reported.

Conclusions: Repeated examinations with FD-OCT can be safely used to guide stent selection and improve stent expansion and apposition.