Optical Coherence Tomography-Guided Directional Coronary Atherectomy Using Tip-Detection Method

Directional coronary atherectomy (DCA) requires precise spatial orientation. Although the tip detection method is established for intravascular ultrasound, its application in optical coherence tomography (OCT)-guided DCA remains unestablished. We present a case of functionally significant stenosis at the left anterior descending (LAD) artery ostium treated with OCT-guided DCA. We adapted the tip detection method using a second guidewire with a tip curve. Aligning the fluoroscopically directed guidewire with the 3 o'clock position on the OCT cross-section achieved precise three-dimensional spatial co-registration, enabling accurate plaque localization. This first report demonstrates that OCT-guided tip detection offers a safe and sophisticated debulking strategy for complex coronary lesions.