Saline vs Contrast for Optical Coherence Tomography During Percutaneous Coronary Intervention: A Prospective...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Device Technology

Background:

• Optical coherence tomography (OCT) enhances percutaneous coronary intervention (PCI) outcomes but typically requires contrast media.
• Minimizing contrast use is crucial for patients at risk of contrast-induced nephropathy.
• Heparinized saline is explored as a safer alternative flushing agent.

Purpose of the Study:

• To compare heparinized saline versus contrast media as flushing agents for coronary frequency domain OCT during PCI.
• To evaluate the diagnostic accuracy and safety of heparinized saline in OCT imaging.

Main Methods:

• Prospective, multicenter observational study involving 166 patients undergoing PCI.
• Paired contrast and heparinized saline OCT pullbacks were acquired.
• 2072 matched pairs of OCT frames were analyzed for vessel dimensions by blinded investigators.

Main Results:

• No significant differences were observed in proximal reference diameter, minimal lumen area, minimum lumen diameter, or distal reference diameter between saline and contrast groups.
• Bland-Altman analysis indicated good agreement and no proportional bias.
• Moderate to good interobserver reliability (ICC 0.69-0.79) and no adverse events with saline were reported.

Conclusions:

• Heparinized saline provides comparable vessel measurements to contrast media for frequency domain OCT.
• Saline flushing is a safe and feasible alternative for OCT-guided PCI, especially in renally compromised patients.