Optical coherence tomography versus intravascular ultrasound to evaluate stent implantation in patients with calcific coronary artery disease

Ingibjorg Gudmundsdottir, Philip Adamson, Calum Gray, James C Spratt, Miles W Behan, Peter Henriksen, David E Newby, Nicholas Mills, Neal G Uren, Nicholas L Cruden, Ingibjorg Gudmundsdottir, Philip Adamson, Calum Gray, James C Spratt, Miles W Behan, Peter Henriksen, David E Newby, Nicholas Mills, Neal G Uren, Nicholas L Cruden

Abstract

Aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration number: NCT02065102.

Keywords: INTERVENTIONAL CARDIOLOGY.

Figures

Figure 1
Figure 1
Bland Altman analyses comparing minimum luminal area (MLA; upper panel) and diameter (MLD; lower panel) obtained using FD-OCT and IVUS. FD-OCT, frequency domain optical coherence tomography; IVUS, intravascular ultrasound.
Figure 2
Figure 2
(A) Matched IVUS and (B) FD-OCT cross-sectional images following coronary stent implantation in a patient treated with rotational atherectomy. An arc of calcification is visible in the vessel wall from the 12 o'clock position around to the 6 o'clock position. Malapposed stent struts are clearly visible in this area with FD-OCT (panel B, arrows) but the interface between stent strut and vessel wall is poorly delineated in the corresponding IVUS image (panel A). An area of thrombus adherent to the luminal surface of the stent is also visible (T). FD-OCT, frequency domain optical coherence tomography; IVUS, intravascular ultrasound.

References

    1. Uren NG, Schwarzacher SP, Metz JA et al. . Predictors and outcomes of stent thrombosis: an intravascular ultrasound registry. Eur Heart J 2002;23:124–32. 10.1053/euhj.2001.2707
    1. Hong MK, Mintz GS, Lee CW et al. . Intravascular ultrasound predictors of angiographic restenosis after sirolimus-eluting stent implantation. Eur Heart J 2006;27:1305–10. 10.1093/eurheartj/ehi882
    1. Doi H, Maehara A, Mintz GS et al. . Impact of post-intervention minimal stent area on 9-month follow-up patency of paclitaxel-eluting stents: an integrated intravascular ultrasound analysis from the TAXUS IV, V, and VI and TAXUS ATLAS Workhorse, Long Lesion, and Direct Stent Trials. JACC Cardiovasc Interv 2009;2:1269–75. 10.1016/j.jcin.2009.10.005
    1. Attizzani GF, Capodanno D, Ohno Y et al. . Mechanisms, pathophysiology, and clinical aspects of incomplete stent apposition. J Am Coll Cardiol 2014;63:1355–67. 10.1016/j.jacc.2014.01.019
    1. Klersy C, Ferlini M, Raisaro A et al. . Use of IVUS guided coronary stenting with drug eluting stent: a systematic review and meta-analysis of randomized controlled clinical trials and high quality observational studies. Int J Cardiol 2013;170:54–63. 10.1016/j.ijcard.2013.10.002
    1. Mintz GS, Anderson WD, Bailey SR et al. . American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents developed in collaboration with the European Society of Cardiology endorsed by the Society of Cardiac Angiography and Interventions. Eur J Echocardiogr 2001;2:299–313. 10.1053/euje.2001.0133
    1. Prati F, Regar E, Mintz GS et al. . Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 2010;31:401–15. 10.1093/eurheartj/ehp433
    1. Bezerra HG, Costa MA, Guagliumi G et al. . Intracoronary optical coherence tomography: a comprehensive review clinical and research applications. JACC Cardiovasc Interv 2009;2:1035–46. 10.1016/j.jcin.2009.06.019
    1. Kubo T, Akasaka T, Shite J et al. . OCT compared with IVUS in a coronary lesion assessment: the OPUS-CLASS study. JACC Cardiovasc Imaging 2013;6:1095–104. 10.1016/j.jcmg.2013.04.014
    1. Okamura T, Gonzalo N, Gutierrez-Chico JL et al. . Reproducibility of coronary Fourier domain optical coherence tomography: quantitative analysis of in vivo stented coronary arteries using three different software packages. EuroIntervention 2010;6:371–9. 10.4244/EIJV6I1A62
    1. Mehanna E, Bezerra HG, Prabhu D et al. . Volumetric characterization of human coronary calcification by frequency-domain optical coherence tomography. Circ J 2013;77:2334–40. 10.1253/circj.CJ-12-1458
    1. Kume T, Okura H, Kawamoto T et al. . Assessment of the coronary calcification by optical coherence tomography. EuroIntervention 2011;6:768–72. 10.4244/EIJV6I6A130
    1. Tanigawa J, Barlis P, Di Mario C. Heavily calcified coronary lesions preclude strut apposition despite high pressure balloon dilatation and rotational atherectomy: in-vivo demonstration with optical coherence tomography. Circ J 2008;72:157–60. 10.1253/circj.72.157
    1. Girassolli A, Carrizo S, Jimenez-Valero S et al. . Utility of optical coherence tomography and intravascular ultrasound for the evaluation of coronary lesions. Rev Port Cardiol 2013;32:925–9. 10.1016/j.repc.2013.06.002
    1. Tomey MI, Kini AS, Sharma SK. Current status of rotational atherectomy. JACC Cardiovasc Interv 2014;7:345–53. 10.1016/j.jcin.2013.12.196
    1. Mintz GS, Nissen SE, Anderson WD et al. . American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2001;37:1478–92. 10.1016/S0735-1097(01)01175-5
    1. Bezerra HG, Attizzani GF, Sirbu V et al. . Optical coherence tomography versus intravascular ultrasound to evaluate coronary artery disease and percutaneous coronary intervention. JACC Cardiovasc Interv 2013;6:228–36. 10.1016/j.jcin.2012.09.017
    1. Yamaguchi T, Terashima M, Akasaka T et al. . Safety and feasibility of an intravascular optical coherence tomography image wire system in the clinical setting. Am J Cardiol 2008;101:562–7. 10.1016/j.amjcard.2007.09.116
    1. Capodanno D, Prati F, Pawlowsky T et al. . Comparison of optical coherence tomography and intravascular ultrasound for the assessment of in-stent tissue coverage after stent implantation. EuroIntervention 2009;5:538–43. 10.4244/EIJV5I5A88
    1. Okamura T, Onuma Y, Garcia-Garcia HM et al. . First-in-man evaluation of intravascular optical frequency domain imaging (OFDI) of Terumo: a comparison with intravascular ultrasound and quantitative coronary angiography. EuroIntervention 2011;6:1037–45. 10.4244/EIJV6I9A182
    1. Tahara S, Bezerra HG, Baibars M et al. . In vitro validation of new Fourier-domain optical coherence tomography. EuroIntervention 2011;6:875–82. 10.4244/EIJV6I7A149
    1. Chae JS, Brisken AF, Maurer G et al. . Geometric accuracy of intravascular ultrasound imaging. J Am Soc Echocardiogr 1992;5:577–87. 10.1016/S0894-7317(14)80323-4
    1. Lindsay AC, Paulo M, Kadriye K et al. . Predictors of stent strut malapposition in calcified vessels using frequency-domain optical coherence tomography. J Invasive Cardiol 2013;25:429–34.
    1. Barlis P, Dimopoulos K, Tanigawa J et al. . Quantitative analysis of intracoronary optical coherence tomography measurements of stent strut apposition and tissue coverage. Int J Cardiol 2010;141:151–6. 10.1016/j.ijcard.2008.11.204
    1. Kawamori H, Shite J, Shinke T et al. . Natural consequence of post-intervention stent malapposition, thrombus, tissue prolapse, and dissection assessed by optical coherence tomography at mid-term follow-up. Eur Heart J Cardiovasc Imaging 2013;14:865–75. 10.1093/ehjci/jes299
    1. Im E, Kim BK, Ko YG et al. . Incidences, predictors, and clinical outcomes of acute and late stent malapposition detected by optical coherence tomography after drug-eluting stent implantation. Circ Cardiovasc Interv 2014;7:88–96. 10.1161/CIRCINTERVENTIONS.113.000797
    1. Dirschinger J, Kastrati A, Neumann FJ et al. . Influence of balloon pressure during stent placement in native coronary arteries on early and late angiographic and clinical outcome: a randomized evaluation of high-pressure inflation. Circulation 1999;100:918–23. 10.1161/01.CIR.100.9.918
    1. Frobert O, Sarno G, James SK et al. . Effect of stent inflation pressure and post-dilatation on the outcome of coronary artery intervention. A report of more than 90,000 stent implantations. PLoS ONE 2013;8:e56348 10.1371/journal.pone.0056348
    1. Goldberg SL, Di Mario C, Hall P et al. . Comparison of aggressive versus nonaggressive balloon dilatation for stent deployment on late loss and restenosis in native coronary arteries. Am J Cardiol 1998;81:708–12. 10.1016/S0002-9149(97)01017-5
    1. Casella G, Klauss V, Ottani F et al. . Impact of intravascular ultrasound-guided stenting on long-term clinical outcome: a meta-analysis of available studies comparing intravascular ultrasound-guided and angiographically guided stenting. Catheter Cardiovasc Interv 2003;59:314–21. 10.1002/ccd.10537
    1. Ahn JM, Kang SJ, Yoon SH et al. . Meta-analysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies. Am J Cardiol 2014;113:1338–47. 10.1016/j.amjcard.2013.12.043
    1. Zhang Y, Farooq V, Garcia-Garcia HM et al. . Comparison of intravascular ultrasound versus angiography-guided drug-eluting stent implantation: a meta-analysis of one randomised trial and ten observational studies involving 19,619 patients. EuroIntervention 2012;8:855–65. 10.4244/EIJV8I7A129
    1. Prati F, Di Vito L, Biondi-Zoccai G et al. . Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l'Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study. EuroIntervention 2012;8:823–9. 10.4244/EIJV8I7A125

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe