Department of Cardiovascular Medicine, Koto Memorial Hospital, 2-1, Hiramatsu-Cho, Higashiomi-Shi, Shiga, 527-0134, Japan.
Heart Vessels. 2024 Apr;39(4):310-318. doi: 10.1007/s00380-023-02340-y. Epub 2023 Dec 8.
The increased amount of contrast media in frequency-domain optical coherence tomography (FD-OCT) imaging during percutaneous coronary intervention (PCI) has raised potential concerns regarding impairment of renal function.
This study aimed to evaluate the effectiveness of heparinized saline flush in FD-OCT-guided PCI and identify clinical factors contributing to optimal image quality.
We retrospectively collected 100 lesions from 90 consecutive patients, and a total of 200 pullbacks were analyzed for the initial and final evaluation in which saline was used as the flushing medium.
The study population had a mean age of 73, with 52% having chronic kidney disease (CKD). The median amount of contrast used was 28 ml, and no complications were observed associated with saline flush OCT. Imaging quality was then categorized as excellent, good, or unacceptable. Among the total runs, 87% demonstrated clinically acceptable image quality, with 66.5% classified as excellent images and 20.5% classified as good images. Independent predictors of excellent images included lumen area stenosis ≥ 70% (adjusted odds ratio [OR] 2.37, 95% confidence interval [CI] 1.02-5.47, P = 0.044), and the use of intensive flushing (adjusted OR 2.06, 95% CI 1.11-3.86, P = 0.023) defined as a deep engagement of guiding catheter (GC) or a selective insertion of guide extension catheter (GE). Intensive flushing was performed in 60% of the total pullbacks, and it was particularly effective in improving image quality in the left coronary artery (LCA).
The use of saline flush during FD-OCT imaging was safe and feasible, which had a benefit in renal protection with adequate imaging quality.
经皮冠状动脉介入治疗（PCI）中频域光相干断层扫描（FD-OCT）成像中造影剂用量的增加引起了对肾功能损害的潜在关注。
本研究旨在评估肝素化盐水冲洗在 FD-OCT 指导 PCI 中的有效性，并确定有助于获得最佳图像质量的临床因素。
我们回顾性地收集了 90 例连续患者的 100 个病变，共分析了 200 个回撤用于初始和最终评估，其中盐水作为冲洗介质。
研究人群的平均年龄为 73 岁，52%患有慢性肾脏病（CKD）。使用的造影剂中位数为 28ml，没有观察到与盐水冲洗 OCT 相关的并发症。然后将成像质量分为优秀、良好和不可接受。在总运行中，87%的运行显示出可接受的临床图像质量，其中 66.5%的图像评为优秀，20.5%的图像评为良好。优秀图像的独立预测因素包括管腔面积狭窄≥70%（调整优势比[OR]2.37，95%置信区间[CI]1.02-5.47，P=0.044）和强化冲洗（调整 OR 2.06，95%CI 1.11-3.86，P=0.023）的使用，定义为引导导管（GC）的深插入或导引导管延长导管（GE）的选择性插入。在总回撤中，有 60%进行了强化冲洗，它在改善左冠状动脉（LCA）的图像质量方面特别有效。
在 FD-OCT 成像中使用盐水冲洗是安全可行的，它具有保护肾功能和获得足够图像质量的优势。
