Related Experiment Video
Updated: Aug 14, 2026
Generation and 3-Dimensional Quantitation of Arterial Lesions in Mice Using Optical Projection Tomography
Published on: May 26, 2015
A Case Report: Directional coronary atherectomy supported with optical coherence tomography is useful for the slit
Takeshi Niizeki1, Tadateru Iwayama1, Yu Kumagai1
1Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan.
Insights
Directional coronary atherectomy (DCA) with optical coherence tomography (OCT) offers a stent-less option for high-bleeding-risk patients. This approach successfully treated a complex coronary lesion without needing a stent, relieving angina symptoms.
Area of Science:
- Cardiovascular Interventions
- Medical Imaging in Cardiology
Background:
- Directional coronary atherectomy (DCA) is a plaque removal technique revived in Japan.
- Percutaneous coronary intervention (PCI) aims to treat coronary artery stenosis.
- High bleeding risk necessitates alternative PCI strategies to avoid stent implantation.
Observation:
- A 91-year-old woman presented with angina due to significant left anterior descending artery stenosis.
- Optical coherence tomography (OCT) precisely visualized a slit lesion's flap morphology and epicardial location.
- Intravascular ultrasound (IVUS) was used alongside OCT for detailed lesion evaluation.
Findings:
- DCA, guided by OCT's detailed anatomical information, successfully removed the atherosclerotic flap.
- Stent-less PCI was achieved using DCA followed by drug-coated balloon angioplasty.
- The patient experienced complete symptom resolution and a favorable postoperative course.
Implications:
- OCT-guided DCA provides crucial insights for complex lesion treatment.
- Stent-less PCI using DCA and OCT is a viable option for high-bleeding-risk patients.
- This strategy may expand treatment options for elderly patients with coronary artery disease.
Background:
Directional coronary atherectomy (DCA) was revived in Japan in 2014. DCA is a special procedure to remove the atherosclerotic plaque of coronary artery during percutaneous coronary intervention. We present the case of a 91-year-old woman with symptoms of angina. Coronary angiography revealed significant stenosis with a slit lesion of the proximal left anterior descending artery. Because she had a high risk of bleeding, we did not want to implant a stent to prevent bleeding events. Then, we performed optical coherence tomography (OCT) and intravascular ultrasound to evaluate the morphology of the slit lesion in more detail. OCT showed clearly that the direction of the flap was counterclockwise and the edge of the flap was located in the epicardium. Since we could understand the localization of plaque distribution fully by OCT examination, we successfully removed the flap by DCA based on information from OCT. After that, we performed balloon dilatation with a 3.0-mm drug-coated balloon and finished without implanting the stent successfully. Her symptoms completely disappeared and postoperative course was good. DCA supported with OCT might be one of the options in high bleeding risk patients, suggesting a potential stent-less therapeutic option. <Learning objective: There may be hesitation about implantation of stents in patients with high risk of bleeding, such as the elderly. Stent-less percutaneous coronary intervention using directional coronary atherectomy followed by drug-coated balloon under optical coherence tomography (OCT) guidance may be the one of the option for patients with a high risk of bleeding, because OCT can more clearly show the feature of the lesion and the effect of treatment compared to intravascular ultrasound.>.
More Related Videos
13:07Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
06:15Author Spotlight: Anterior HR-OCT as a Non-Invasive Tool for Characterizing Ocular Surface Squamous Neoplasia
Published on: August 9, 2024
