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.
Int J Cardiovasc Imaging. 2013 Apr;29(4):741-52. doi: 10.1007/s10554-012-0135-0. Epub 2012 Oct 12.
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 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.
频域光学相干断层扫描（FD-OCT）已显示出在临床试验中评估冠状动脉器械的潜力，然而，其在临床实践中的应用知之甚少。本前瞻性、单中心研究计划在 60 天内对所有接受冠状动脉介入治疗的患者 100%进行 FD-OCT 检查。术者根据单纯血管造影术预先指定计划的介入治疗。FD-OCT 成功定义为获得高质量图像，能够充分定量血管尺寸和病变/经皮冠状动脉介入治疗（PCI）评估。当根据 FD-OCT 数据改变基于血管造影的计划时，就会对管理产生影响。共对 150 名患者的 155 支血管进行了 297 次 FD-OCT 采集。无 FD-OCT 相关程序不良心脏事件，85.7%的目标血管获得成功（PCI 前为 76.8%，PCI 后为 90.1%，p=0.004）。首次回撤时成功率为 80.3%（初始术者经验中为 61.9%，第 3 次后为 85.5%）。FD-OCT 对管理的影响为 PCI 前 81.8%，PCI 后 54.8%。支架贴壁不良发生率为 39.2%（89.4%进一步介入治疗），边缘夹层发生率为 32.5%（21.1%支架治疗）。ACS 和非 ACS 患者 FD-OCT 成功率和管理影响相似（82.1% vs. 81.1%，p=1.000，62.5% vs. 65.1%，p=0.854）。FD-OCT 安全，可成功纳入常规实践，并改变了高比例 PCI 患者的治疗策略。
