Gianluca Caiazzo1, Giovanni Longo2, Alessandra Giavarini2, Ismail Dogu Kilic3, Enrico Fabris4, Roberta Serdoz2, Alessio Mattesini2, Nicolas Foin5, Gioel Gabrio Secco2, Salvatore De Rosa6, Ciro Indolfi6, Carlo Di Mario7. 1. 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. 2. National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. 3. Pamukkale University School of Medicine, Cardiology, Denizli, Turkey. 4. 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. 5. National Heart Centre Singapore, Singapore. 6. Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Græcia" University, Catanzaro, Italy. 7. 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.
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.
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: Gioel Gabrio Secco; Monica Verdoia; Gianfranco Pistis; Giuseppe De Luca; Matteo Vercellino; Andrea Audo; Rosario Parisi; Maurizio Reale; Giorgio Ballestrero; Paolo Nicola Marino; Carlo Di Mario Journal: J Thorac Dis Date: 2017-08 Impact factor: 2.895
Authors: Mateusz P Jeżewski; Michał J Kubisa; Ceren Eyileten; Salvatore De Rosa; Günter Christ; Maciej Lesiak; Ciro Indolfi; Aurel Toma; Jolanta M Siller-Matula; Marek Postuła Journal: J Clin Med Date: 2019-12-07 Impact factor: 4.241