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Stable Coronary Artery Disease: Assistance in Complex Percutaneous Coronary Intervention

  • Annapoorna Kini
  • Jagat Narula
  • Yuliya Vengrenyuk
  • Samin Sharma
Chapter

Abstract

Optical coherence tomography (OCT) has been increasingly used in clinical practice as a guide during percutaneous coronary intervention (PCI). Prior to stent implantation, OCT can provide accurate measurements of the minimal lumen area, the distal and proximal reference areas, and lesion length. OCT is particularly useful during challenging procedures, such as calcified lesions, bifurcation, and unprotected left main PCI. In calcified lesions, OCT allows measurements of calcification size, thickness and depth and its precise location within the lesion, which might help select an appropriate atheroablation technique. In bifurcation PCI, OCT can help assess main vessel and side branch stenosis before and after stenting, select appropriate treatment strategy, and evaluate the effects of side branch treatment. Three-dimensional OCT reconstruction of bifurcation lesions provides a unique opportunity to assess the true morphology of the main and side vessel. A recent pilot trial demonstrated the safety and feasibility of frequency-domain OCT for unprotected left main PCI. Compared to IVUS, OCT provided a similar assessment of lumen and stent dimensions but was more sensitive in detecting malapposition and edge dissections. Finally, OCT imaging before stenting can provide patient risk stratification for periprocedural myocardial infarction, since OCT-derived thin-cap fibroatheroma and evidence of plaque rupture have been associated with elevation of post-PCI myocardial necrosis markers.

Keywords

Percutaneous coronary intervention Calcified lesions Bifurcation lesions Rotational and orbital atherectomy Cutting balloon angioplasty Provisional stenting Side branch Periprocedural myocardial infarction Unprotected left main Kissing balloon inflation In-stent restenosis Stent apposition and expansion Edge dissection 

Supplementary material

Video 3.1a

OCT pullback beforerotational atherectomy for a heavily calcified proximal LAD lesion. Part I (AVI 27996 kb)

Video 3.1b

OCT pullback before rotational atherectomy for a heavily calcified proximal LAD lesion. Part II (AVI 31182 kb)

Video 3.2

OCT pullback performed after rotational atherectomy for the LAD lesion (Case 1, Fig. 3.1B2) (AVI 28309 kb)

Video 3.3

Final OCT pullback after stenting (Case 1, Fig. 3.2) (AVI 36781 kb)

Video 3.4

Pre-PCI OCT pullback of a heavily calcified proximal RCA lesion (Case 2, Fig. 3.3, frames B1–B3) (AVI 36952 kb)

Video 3.5

OCT pullback after orbital atherectomy performed in RCA lesion (Case 2, Fig. 3.3, frames B4–B6) (AVI 33631 kb)

Video 3.6

Post-stenting OCT pullback (Case 2, Fig. 3.4) (AVI 42119 kb)

Video 3.7

OCT pullback of in-stent restenosis in the LAD (Case 3, Fig. 3.5) (AVI 42383 kb)

Video 3.8

Post-atherectomy OCT pullback (Case 3, Fig. 3.6) (AVI 30421 kb)

Video 3.9

OCT pullback of LAD-D1 bifurcation lesion (Case 4, Fig. 3.7) (AVI 29942 kb)

Video 3.10

OCT pullback after single stenting followed by kissing balloon inflation (Case 4, Fig. 3.8) (AVI 35184 kb)

Video 3.11

OCT pullback of the LAD after rotational atherectomy (Case 5, Fig. 3.9) (AVI 35288 kb)

Video 3.12

OCT pullback after stenting the main vessel (Case 5, Fig. 3.10) (AVI 35629 kb)

Video 3.13

Final post-PCI OCT pullback after kissing balloon inflation (Case 5, Fig. 3.11) (AVI 31051 kb)

Video 3.14

Preintervention OCT pullback of a mid LAD bifurcation lesion (Case 6, Fig. 3.12) (AVI 30966 kb)

Video 3.15

OCT pullback after V stenting (Case 6, Fig. 3.13) (AVI 34046 kb)

Video 3.16

Preintervention OCT pullback of a calcified LAD-D1 bifurcation (Case 7, Fig. 3.14) (AVI 35757 kb)

Video 3.17

OCT pullback after atherectomy and stenting (Case 7, Fig. 3.15)

Video 3.18

OCT pullback of the left main and proximal LAD before intervention (Case 8, Fig. 3.16) (AVI 39363 kb)

Video 3.19

Pre-PCI OCT pullback of a severely calcified distal left main bifurcation lesion (Case 10, Fig. 3.18) (AVI 35814 kb)

Video 3.20

OCT pullback after atherectomy and stenting (Case 10, Fig. 3.19) (AVI 35034 kb)

Video 3.21

Preintervention OCT pullback of a lipid-rich proximal RCA lesion (Case 10, Fig. 3.20) (AVI 27886 kb)

Video 3.22

Postintervention OCT pullback of the RCA lesion (Case 10, Fig. 3.21) (AVI 27611 kb)

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Annapoorna Kini
    • 1
  • Jagat Narula
    • 2
  • Yuliya Vengrenyuk
    • 3
  • Samin Sharma
    • 4
  1. 1.Director, Cardiac Catheterization Laboratory, Director, Structural Heart Intervention Program, Director, Interventional Cardiology Fellowship Program, Zena and Michael A. Wiener Professor of MedicineIcahn School of Medicine at Mount Sinai, Mount Sinai HospitalNew YorkUSA
  2. 2.Director, Intravascular Imaging Core Laboratory, Instructor, Department of MedicineIcahn School of Medicine at Mount Sinai, Mount Sinai HospitalNew YorkUSA
  3. 3.Philip J. and Harriet L. Goodhart Chair in Cardiology, Chief of Cardiology, Mount Sinai St. Luke’s Hospital, Professor of Medicine and Radiology, Associate Dean, Arnhold Institute for Global HealthIcahn School of Medicine at Mount Sinai, Mount Sinai HospitalNew YorkUSA
  4. 4.Director, Clinical and Interventional Cardiology, President, Mount Sinai Heart Network, Dean, International Clinical Affiliations, Anandi Lal Sharma Professor of MedicineIcahn School of Medicine at Mount Sinai, Mount Sinai HospitalNew YorkUSA

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