Tabriz University of Medical Sciences Journal of Cardiovascular and Thoracic Research 2008-5117 18 3 2026 09 28 Added Value of Optical Coherence Tomography for Complex Coronary Lesion Revascularization: Insights From a Clinical Study 191 197 10.34172/jcvtr.33713 EN Arif A. Al Nooryani https://orcid.org/0000-0002-0329-795X Ahmed Khashaba George Sianos Atif Ur Rahman Nagwa A. Abdelrahman https://orcid.org/0000-0003-1135-8326 Journal Article 10.34172/jcvtr.33713 2025 08 27 2026 05 09 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.