Utility of Frequency Domain Optical Coherence Tomographic Evaluation of Angiographically Optimized Stented Lesions

Given its high resolution, optical coherence tomography (OCT) may be a useful clinical tool to optimize stent deployment.

We reviewed 100 patients with post-PCI OCT who had angiographically optimized coronary stent implantation to determine the frequency of further intervention based on OCT pathology. OCT pathology was classified as "significant" if an OCT finding prompted further intervention.

OCT pathology was found in 90% of patients and considered significant in 52%. Stent strut malapposition by OCT was the most common reason for prompting further treatment, with approximately one-half due to relative stent undersizing. Based on OCT findings, 42% underwent balloon dilation, 9% underwent another stent implantation, and 3% underwent treatment with a glycoprotein IIb/IIIa inhibitor. Minor plaque protrusion was present in 11%, which prompted no further intervention.

Post-PCI OCT in angiographically optimized vessels was helpful in improving stent deployment in more than one-half of the cases. Our findings suggest that post-PCI OCT may be a clinically useful tool in angiographically optimized stenting. Prospective studies will provide further clarity on the place of OCT in this setting.