Frequency domain optical coherence tomography to assess non-ostial left main coronary artery

Selected in EuroIntervention by S. Brugaletta



Burzotta F Dato I Trani C Pirozzolo G De Maria G Porto I Niccoli G Leone A Schiavoni G Crea F - See more at:


EuroIntervention. 2015 Jan 22;10(9):e1-8


January 2015


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My Comment

What is known 

Frequency domain optical coherence tomography (FD-OCT) is a high-resolution intracoronary imaging technique, which may improve the assessment of complex coronary lesions. Of note, OCT is associated with the need for full blood displacement by contrast injection and it does not have enough penetration so that large vessels especially with a proximal location (such as left main [LM]) are often considered unsuitable for this technique. The aim of the present study was to assess the feasibility and efficacy of FD-OCT imaging for non-ostial LM.

Major findings 

  • A total of 54 patients with non-ostial LM disease entered the study.
  • The mean number of LM artefact frames was 8±10, corresponding to 19% of the total number of LM frames analysed.
  • The percentages of artefact frames differed significantly according to the segment analysed: 43.3% proximal LM, 11.4% mid LM and 2.1% distal LM, 1.9% ostial left anterior descending artery and 0% ostial left circumflex artery (p<0.0001).
  • All LM OCT measurements were significantly correlated with QCA measurements.

My comments  

OCT is usually not used in clinical practice to evaluate left main due to two inherent limitations of the technique: poor penetration of light with inability to visualise vessel of big diameters and the need of contrast injection to eliminate blood, which is difficult to obtain in ostial lesion. Both these limitation may be present in left main evaluation. It is of note that left main evaluation is somehow difficult with other imaging techniques as well, such as IVUS, due to the fact that LM ostium does not have a circular but an elliptical shape and that it is difficult to obtain a co-axial relationship between left main and the imaging catheter. The present study shows that in non-ostial left main disease OCT imaging is feasible with a good correlation with QCA measurements and very low rate of artifacts in the distal segment.

Which imaging techniques do you usually use in your clinical practice to evaluate left main disease?

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