Illusion or Reality? How 3-Dimensional Optical Cohorence Tomography (3-D OCT) overcomes the limitations of Angiography: OCT guided percutaneous coronary intervention of a left main stem disease involving the LAD/LCx bifurcation [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. Ahead of Print: TKDA-34101 | DOI: 10.5543/tkda.2018.34101

Illusion or Reality? How 3-Dimensional Optical Cohorence Tomography (3-D OCT) overcomes the limitations of Angiography: OCT guided percutaneous coronary intervention of a left main stem disease involving the LAD/LCx bifurcation

Aylin Hatice Yamac
Bezmialem Foundation University, Department of Cardiology

Angiography is still the workhorse imaging approach for the vast majority of PCR (Percutaneous coronary revascularization) cases. However the limitations of angiographic guidance for coronary procedures are well established. This case report demonstrates how 3-Dimensional Optical Cohorence Tomography (3-D OCT) changes the treatment strategy, which seemed to be straight forward, if only angiography would have been considered. A 67 years old male patient presented with Non-ST elevation myocardial infarction. The coronary angiogram revealed a tight lesion of the proximal left anterior descending artery (LAD). Angiographically, the vessel ostium seemed not to be involved. To clarify the disease border and determine the right stenting strategy, a 3-Dimensional optical cohorence tomography (3-D OCT; Optis SJM/Lightlab Imag) was performed. Measurements revealed a heavy disease of the LAD, ranging from the ostium to the left main coronary artery (LMCA). It was decided to proceed with a provisional stenting strategy of the LMCA and LAD. After postdilatation, the angiography showed a good result of the LAD, but revealed a significant pinching of the ostium of the LCx. Thus the kissing balloon technique was applied at the LAD/LCx bifurcation The final OCT examination documented a well-expanded stent without areas of malapposition and an open LCx ostium without significant narrowing.
Intracoronary images obtained by optical coherence tomography add significant information to what is provided by angiography alone, thereby improving the understanding of interpreting angiographic images, giving us the opportunity to plan the PCR procedure.

Keywords: ambiguous coronary lesion, optical coherence tomography, ostial LAD lesion.

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Corresponding Author: Aylin Hatice Yamac, Türkiye
© Copyright 2018 Archives of the Turkish Society of Cardiology
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