Frequency-domain optical coherence tomography assessment of unprotected left main coronary artery disease-a comparison with intravascular ultrasound.
OBJECTIVE
To investigate safety and feasibility of imaging unprotected left main (ULM) using frequency-domain optical coherence tomography (FD-OCT) compared with intravascular ultrasound (IVUS).


BACKGROUND
IVUS has been used to assess and guide percutaneous coronary intervention (PCI) of ULM disease. FD-OCT offers 10-fold higher axial resolution than IVUS and its high-speed image acquisition obviates the need for proximal balloon occlusion.


METHODS
We prospectively enrolled 35 consecutive patients with ULM disease. FD-OCT and IVUS assessments were attempted pre- and post-PCI and compared in regards to safety, ability to image the region of interest (ROI), number of pullbacks, volume of contrast and ability to detect malapposition, dissection, and thrombus.


RESULTS
Patients were followed for 1 year when FD-OCT imaging was repeated. FD-OCT required more repeated pullbacks to image the ROI compared to IVUS. Mean lumen and stent areas were similar between FD-OCT and IVUS (11.24 ± 2.66 vs. 10.85 ± 2.47 mm(2) , P = 0.13 and 10.44 ± 2.33 vs. 10.49 ± 2.32 mm(2) , P = 0.82, respectively), whereas imaged stent length was shorter with FD-OCT. Malapposition areas and volumes were larger and more edge dissections were detected by FD-OCT. There were no clinical adverse events and no complications associated with FD-OCT at baseline and 1-year follow-up. All dissections were healed, whereas stent malapposition was still detected at follow-up.


CONCLUSIONS
FD-OCT assessment of ULM is feasible and safe. Direct comparisons with IVUS reveal that FD-OCT achieved imaging completeness less often, whereas it was more sensitive in detecting malapposition and edge dissections, and similar to IVUS in the assessment of lumen and stent dimensions.
Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
Yusuke
Y
Fujino
Hiram G
HG
Bezerra
Guilherme F
GF
Attizzani
Wei
W
Wang
Hirosada
H
Yamamoto
Daniel
D
Chamié
Tomoaki
T
Kanaya
Emile
E
Mehanna
Satoko
S
Tahara
Sunao
S
Nakamura
Marco A
MA
Costa
D000368:Aged; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000009:adverse effects; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects; D014945:Wound Healing
D003287:Contrast Media
intravascular ultrasound; left main coronary artery disease; optical coherence tomography; percutaneous coronary intervention