EuroPCR 2017: ILUMIEN III substudy: what is the reach of the novel OCT-based stent implantation algorithm?

The ILUMIEN III randomized study showed non-inferiority of OCT-guided stent implantation to achieve optimal stent expansion compared with IVUS guidance.

Reported from EuroPCR 2017, Paris

The stent sizing algorithm used in ILUMIEN III amounted to matching the smaller external elastic lamina (EEL) diameter of the proximal or distal reference segment. Optimal expansion was defined as minimum stent area (MSA) of at least 95% of the closest reference lumen area, for both the proximal and the distal stent half. In cases of post-stenting MSA <95%, post-dilatation at ≥20 atm with NC balloon was required, sized according to EEL, if ≥180⁰ visible, or if EEL <180⁰ was visible, then the NC balloon was to be sized according to the reference lumen.

However, out of 140 patients with OCT-guided PCI in the ILUMIEN III study, less than a half (n=65) completely followed the described algorithm for stent implantation. Importantly, optimal stent expansion (≥95%) was more often achieved in patients where OCT-based algorithm was followed (38.5% vs. 14.7%, p=0.001). Overall, acceptable expansion (≥90%) was obtained in the greater number of patients, albeit again significantly more in patients with correct OCT guidance (56.9% vs. 28.0%, p<0.001).

This ILUMIEN III subanalysis showed that further improvement in the acute results may be expected if the recommended OCT-based stent sizing and optimization protocol is meticulously followed. Future clinical data may shed more light on the clinical utility of the described OCT-based strategy and potentially boost its everyday adoption. 

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