Stepwise OCT for treatment optimization in provisional approach of bifurcated coronary lesions
#CardioTwitterCase originally published on Twitter
OCT provides information of the accuracy of every maneuver performed during the treatment of bifurcation lesions. We can clearly see if the POT achieves proximal stent apposition, if the side branch wire crosses through the correct cell, and the impact of final kissing-balloon inflation on stent geometry.
This case was originally published on Twitter by @cardiojsl
Case description
The patient was a 50-year-old male without cardiovascular risk factors, who began with symptoms of angina on exertion in the previous month.
A coronary angiography was performed, which showed a lesion in the left anterior descending artery, at the level of the bifurcation with the diagonal branch (Medina 1,1,1).
The baseline OCT showed a lipid plaque, 15 mm in length, with MLA at the level of the polygon of confluence (1.85 mm2), a proximal lumen reference diameter of 4 mm, and a distal diameter of 3.2 mm.
A 3.5 x 18 mm Xience Skypoint stent was implanted in the LAD, and Proximal Optimization Technique (POT) was performed with a 4 x 8 mm balloon.
After wiring the diagonal branch through the stent, a new OCT was repeated, confirming a correct apposition of the proximal stent, and that the guidewire crossed through the distal cell. This allows optimal post-dilatation of the lateral branch, and scaffolding of the diagonal ostium.
Stent post-dilatation was performed with asymmetric kissing, using NC balloons (3 x 15 mm in the diagonal branch, 3.5 x 15 mm in the anterior descending branch).
The final OCT showed complete opening of the diagonal cell, totally free of struts and with scaffolding of the ostium.
The analysis of the "bench test" shows the impact of post-dilatation on the geometry of the platform, with opening of the cell and absence of deformity in the segment opposite to the diagonal take off.
Final angiographic result is excellent in both LAD artery and diagonal branch.
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Final remark
OCT is an excellent tool for monitoring the treatment of bifurcations. It provides information on basal anatomy, stent apposition, analyzes the wiring of the side branch, and evaluates the impact of post-dilation maneuvers on the platform.
Original tweet and Twitter discussion
LAD- Dg 1-1-1 bifurcation lesion. Provisional approach. Guiding the procedure with OCT is awesome. @pemarlor08@jorgeachv@AntonioGomezM21@iotaegui @@shci_sec@PCRonline@lydiarocappic.twitter.com/5iKj80MCz2
— Javier Suarez d Lezo (@cardiojsl) December 1, 2024
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