Author + information
- Laura Gatto1,
- Marco Golino2,
- Chiara Russo2,
- Valeria Marco2,
- Alessio La Manna3,
- Francesco Burzotta4,
- Massimo Fineschi5,
- Francesco Amico6,
- Alessandro Di Giorgio7,
- Alberto Boi8,
- Enrico Romagnoli9,
- Mario Albertucci10 and
- Francesco Prati1
- 1San Giovanni Addolorata Hospital; C.L.I. Foundation, Rome, Rome, Italy
- 2C.L.I. Foundation, Rome, Rome, Italy
- 3University of Catania, Catania, Catania, Italy
- 4Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Rome, Rome, Italy
- 5AZIENDA OSPEDALIERA UNIVERSITARIA SENESE SIENA, Siena, Siena, Italy
- 6Ospedale Cannizzaro, Catania, Catania, Italy
- 7Policlinico G. Martino, Messina, Messina, Italy
- 8Ospedale Brotzu, Cagliari, Cagliari, Italy
- 9San Giovanni Addolorata Hospital C.L.I Foundation, Rome, Rome, Italy
- 10San Giovanni Addolorata Hospital, Rome, Rome, Italy
Quantitative Coronary Angiography (QCA) is still the gold standard for evaluating a correct stent deployment. This despite its limitation in recognizing those morphological features indicative of sub-optimal stent positioning such as under-expansion, malapposition or edge dissection, that can be detected by Optical Coherence Tomography (OCT) and are related to a worse outcome. This sub-analysis of the CLI-OPCI II registry addressed the role of OCT assessment after stenting, to verify if suboptimal OCT deployment occurs in presence of an optimal angiographic result.
We retrospectively analyzed 125 lesions in the 105 patients with Major Adverse Cardiac Events of the CLI-OPCI II registry. Every lesion was evaluated with OCT and angiography, including visual and QCA assessment. Optimal angiographic result was defined as residual stenosis<30% at QCA and absence of haziness at visual angiography. The following OCT features of suboptimal stenting were considered: edge dissection (linear rim of tissue with a width>200μm), reference lumen narrowing (lumen area <4.5mm2 in presence of significant residual plaque adjacent to stent endings); in stent narrowing (minimum lumen area (MLA) <4.5mm2).
We included a complex population (58% of Acute Coronary Syndromes, 65% of patients with multivessel disease and 71% of lesions B2/C). Among the 125 lesions, 105 showed an optimal angiographic result. At OCT a suboptimal positioning was common (56%). In the group of optimal angiographic result, OCT revealed a suboptimal deployment in 54% of cases. MLA<4.5mm2, distal and proximal reference narrowing and distal edge dissections were found in 30%, 25%, 15% and 7% of cases respectively. In 9 cases out of 20, a suboptimal angiographic results was not confirmed by OCT as all OCT metrics were indicative of optimal deployment, in 8 patients OCT revealed significant calcifications either in the stented segment or at the references, which hampered QCA assessments or led to visual haziness.
This sub-study of the CLI-OPCI II showed that in patients with MACE the presence of an optimal post-intervention angiographic appearance with suboptimal OCT metrics is a frequent finding. Our data further support the effectiveness of OCT, which can provide valuable information even in presence of optimal post-stenting angiographic results.
IMAGING: Imaging: Intravascular