title: Optical coherence tomography versus intravascular ultrasound to evaluate stent implantation in patients with calcific coronary artery disease.
abstract: Stent underexpansion and malapposition are associated with adverse outcomes following percutaneous coronary intervention, but detection and treatment can be challenging in the presence of extensive coronary artery calcification. Frequency domain optical coherence tomography (FD-OCT) is a novel intravascular imaging technique with greater spatial resolution than intravascular ultrasound (IVUS) but its role in the presence of extensive coronary calcification remains unclear. We sought to determine the utility of FD-OCT compared to IVUS imaging to guide percutaneous coronary intervention in patients with severe calcific coronary artery disease.
  
  
  
  18 matched IVUS and FD-OCT examinations were evaluated following coronary stent implantation in 12 patients (10 male; mean age 70±7 years) undergoing rotational atherectomy for symptomatic calcific coronary artery disease.
  
  
  
  In-stent luminal areas were smaller (minimum in-stent area 6.77±2.18 vs 7.19±2.62 mm(2), p<0.05), while reference lumen dimensions were similar with FD-OCT compared with IVUS. Stent malapposition was detected in all patients by FD-OCT and in 10 patients by IVUS. The extent of stent malapposition detected was greater (20% vs 6%, p<0.001) with FD-OCT compared to IVUS. Postdilation increased the in-stent luminal area (minimum in-stent area: 8.15±1.90 vs 7.30±1.62 mm(2), p<0.05) and reduced the extent of stent malapposition (19% vs 34%, p<0.005) when assessed by FD-OCT, but not IVUS.
  
  
  
  Acute stent malapposition occurs frequently in patients with calcific coronary disease undergoing rotational atherectomy and stent implantation. In the presence of extensive coronary artery calcification, FD-OCT affords enhanced stent visualisation and detection of malapposition, facilitating improved postdilation stent apposition and minimal luminal areas.
  
  
  
  NCT02065102.
authors.affiliation: Royal Infirmary of Edinburgh , Edinburgh , UK.
authors.forename: Ingibjorg
authors.initials: I
authors.lastname: Gudmundsdottir
authors.affiliation: Royal Infirmary of Edinburgh , Edinburgh , UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Adamson
authors.affiliation: University of Edinburgh , Edinburgh , UK.
authors.forename: Calum
authors.initials: C
authors.lastname: Gray
authors.affiliation: Forth Valley Royal Hospital , Larbert , UK.
authors.forename: James C
authors.initials: JC
authors.lastname: Spratt
authors.affiliation: Royal Infirmary of Edinburgh , Edinburgh , UK.
authors.forename: Miles W
authors.initials: MW
authors.lastname: Behan
authors.affiliation: Royal Infirmary of Edinburgh , Edinburgh , UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Henriksen
authors.affiliation: University of Edinburgh , Edinburgh , UK.
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.affiliation: University of Edinburgh , Edinburgh , UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mills
authors.affiliation: Royal Infirmary of Edinburgh , Edinburgh , UK.
authors.forename: Neal G
authors.initials: NG
authors.lastname: Uren
authors.affiliation: Royal Infirmary of Edinburgh , Edinburgh , UK.
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Cruden
keywords: INTERVENTIONAL CARDIOLOGY