Leistner David M, Riedel Matthias, Steinbeck Lisa, Stähli Barbara E, Fröhlich Georg M, Lauten Alexander, Skurk Carsten, Mochmann Hans-Christian, Lübking Laura, Rauch-Kröhnert Ursula, Schnabel Renate B, Westermann Dirk, Blankenberg Stefan, Landmesser Ulf
Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin, Germany.
German Center for Cardiovascular Research (DZHK), Site Berlin, Berlin, Germany.
Catheter Cardiovasc Interv. 2018 Jul;92(1):30-37. doi: 10.1002/ccd.27313. Epub 2017 Sep 20.
Intracoronary optical coherence tomography (OCT) imaging allows for high-resolution characterization of coronary lesions. Difficulties in matching cross-sectional OCT-images with angiographic lesion localization may limit optimal clinical utilization. We sought to prospectively assess the impact of a novel system of real-time OCT coregistration with angiography (ACR) on physician decision-making during percutaneous coronary interventions (PCI).
Strategy for PCI (stent - length, - diameter, - strategy, landing zone) and PCI-optimization (stent-malappostion, -underexpansion, edge-dissections, geographical mismatch) was prospectively assessed in 50 patients with 58 coronary lesions after (I) angiography, (II) OCT imaging, and (III) ACR. Preprocedural OCT imaging altered stent-length (58.9%), diameter (33.9%), and PCI-strategy (12.5%) in 40 (71.4%) lesions. The use of ACR resulted in additional changes in PCI strategy in 40.7% of mostly complex lesions in comparison to OCT imaging alone and involved mainly device landing zone (24.1%) and stent length (22.2%). Postprocedural OCT imaging revealed the need for PCI optimization in 52.2% of the lesions, whereas post-procedural ACR had no further impact.
Real-time OCT ACR had significant impact on PCI strategy, favoring mainly complete lesion coverage especially in complex lesions.
冠状动脉内光学相干断层扫描（OCT）成像可对冠状动脉病变进行高分辨率特征分析。将OCT横断面图像与血管造影病变定位相匹配存在困难，这可能会限制其在临床中的最佳应用。我们旨在前瞻性评估一种新型的OCT与血管造影实时配准系统（ACR）对经皮冠状动脉介入治疗（PCI）期间医生决策的影响。
对50例患者的58处冠状动脉病变在（I）血管造影、（II）OCT成像和（III）ACR后，前瞻性评估PCI策略（支架长度、直径、策略、着陆区）和PCI优化（支架贴壁不良、扩张不足、边缘夹层、地理不匹配）。术前OCT成像改变了40处（71.4%）病变的支架长度（58.9%）、直径（33.9%）和PCI策略（12.5%）。与单独的OCT成像相比，ACR的使用导致40.7%的大多数复杂病变的PCI策略发生额外变化，主要涉及器械着陆区（24.1%）和支架长度（22.2%）。术后OCT成像显示52.2%的病变需要进行PCI优化，而术后ACR没有进一步影响。
实时OCT ACR对PCI策略有显著影响，主要有利于完全覆盖病变，尤其是在复杂病变中。
