Abstract
Introduction: During complex coronary lesions revascularization, procedural outcome optimization is critical due to the significant hazard of stent underexpansion, incomplete stent apposition and edge dissection. Optical coherence tomography (OCT) is an established imaging modality for the precise identification of such adverse features. The study aimed to assess the effect of OCT on intraprocedural planning modification during complex coronary lesions revascularization.
Methods: Consecutive patients who had OCT-guided Xience stent implantation from January 2014 to December 2020 were included. The study comprised 177 lesions from 138 patients with the following lesion complexities: 24 true bifurcation lesions requiring stenting (13.5%), 31 moderate/heavily calcified lesion (17.5%), 10 coronary total occlusions (CTOs) (5.6%), 63 ostial left anterior descending (LAD)/Left circumflex (LCX) (35.6%), and 45 in-stent restenosis (25.4%).
Results: Despite optimal angiographic results, 45.8% of the examined stents required additional intervention based on OCT assessment. The OCT-based modifications were more prevalent in specific lesion complexity; ostial LAD/LCX lesions (62.7%), overlapped stents (55%), moderate and heavy calcifications (48.4%), CTOs (50%), bifurcation stenting (54%), and left main stenting (54.5%).
Conclusion: Intraprocedural OCT guidance significantly changed interventional procedural planning in complex coronary interventions particularly in cases of ostial LAD/LCX lesions and overlapped stents.