title: Optical coherence tomography guidance for percutaneous coronary intervention with bioresorbable scaffolds.
abstract: BACKGROUND
  The effect of optical coherence tomography (OCT) guidance on the implantation strategy during all phases of percutaneous coronary intervention (PCI) with bioresorbable vascular scaffolds (BVSs) in a real-world scenario has been poorly investigated.
  
  
  METHODS
  Consecutive patients undergoing BVS implantation at our institution were included in this registry. Frequency-domain OCT pullbacks were performed at the operator's discretion during all phases of BVS implantation procedures to optimize preparation of lesions, confirm BVS size, and optimize expansion and apposition of scaffolds.
  
  
  RESULTS
  Between September 2012 and July 2015, 203 BVSs were implanted in 101 consecutive patients at our institution (2.01 BVSs/patient). In 66 patients, the procedure was performed under OCT guidance. In the OCT subgroup, 66 (77.6%) of the 85 treated lesions were complex (B2/C AHA/ACC type). Overall, 147 OCT pullbacks were performed and 72/147 (49.0%) pullbacks indicated the need for changing strategy. After angiography-only-guided optimisation of BVS in 27 (31.8%) lesions, an OCT examination prompted performance of a second post-expansion. This resulted in an increase in the minimal scaffold area (5.5 to 6.3mm(2), p=0.004) and a decrease in the incomplete scaffold apposition area (1.1 to 0.6mm(2), p=0.082), with no new stent fractures. When the population was divided according to the time of BVS implantation, an initial learning adaptation became evident, with the number of OCT-guided changes in strategy significantly decreasing between the initial and final time periods (p=0.017).
  
  
  CONCLUSIONS
  OCT guidance for BVS implantation significantly affects the procedural strategy, with favourable effects on acute results and the learning curve.
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Græcia" University, Catanzaro, Italy; National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Caiazzo
authors.affiliation: National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Longo
authors.affiliation: National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Giavarini
authors.affiliation: Pamukkale University School of Medicine, Cardiology, Denizli, Turkey.
authors.forename: Ismail Dogu
authors.initials: ID
authors.lastname: Kilic
authors.affiliation: National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom; Cardiovascular Department, "Ospedali Riuniti" & University of Trieste, Trieste, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fabris
authors.affiliation: National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors.forename: Roberta
authors.initials: R
authors.lastname: Serdoz
authors.affiliation: National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors.forename: Alessio
authors.initials: A
authors.lastname: Mattesini
authors.affiliation: National Heart Centre Singapore, Singapore.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foin
authors.affiliation: National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors.forename: Gioel Gabrio
authors.initials: GG
authors.lastname: Secco
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Græcia" University, Catanzaro, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Rosa
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Græcia" University, Catanzaro, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Indolfi
authors.affiliation: National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. Electronic address: c.dimario@rbht.nhs.uk.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods; D054457:Tissue Scaffolds; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome
keywords: Bioresorbable vascular scaffold; Optical coherence tomography; Percutaneous coronary intervention