Randomized Clinical Trails regarding OCT vs. Angiography Guided PCI
CBSMD
May, 2018"Clinical
use of intracoronary imaging. Part 1: guidance and optimization of
coronary interventions. An expert consensus document of the European
Association of Percutaneous Cardiovascular Interventions: Endorsed by
the Chinese Society of Cardiology"summarized RCT evidence regarding OCT vs.angiography guided PCI. "Currently, there are relatively limited data for OCT-guided interventions."
Why the Comparision between IVUS and Angiography guided PCI
Quote from "Intravascular imaging in coronary artery disease": Coronary angiography is the traditional imaging modality for visual evaluation of coronary anatomy and guidance of percutaneous coronary interventions (PCIs). However, the derived two-dimensional lumenogram cannot depict the arterial vessel wall, and thus evaluate vessel dimensions and plaque characteristics, nor directly assess the result of stent implantation. Intracoronary imaging by means of IVUS and OCT provides valuable incremental information that can be used clinically to optimize stent implantation and minimize stent-related problems."
Studies and Trails comparing OCT vs. Angiography guided PCI & Clinical Benefit in MACE
2012, registry study - "Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l'Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study" reported a reduced rate of cardiac death and MACE in patients who underwent OCT-guided PCI.
Aug, 2015, randomized clinical trail in ACS patients - "Optical Coherence Tomography Guided Percutaneous Coronary Intervention
With Nobori Stent Implantation in Patients With Non-ST-Segment-Elevation
Myocardial Infarction (OCTACS) Trial: Difference in Strut Coverage and
Dynamic Malapposition Patterns at 6 Months" proved that OCT-guided
optimization of Nobori biolimus-eluting stent implantation improves
strut coverage at 6-month follow-up in comparison with angiographic
guidance alone.
Apr,2016, observational study in STEMI patients - "Optical Coherence Tomography-Guided Percutaneous Coronary Intervention
in ST-Segment-Elevation Myocardial Infarction: A Prospective
Propensity-Matched Cohort of the Thrombectomy Versus Percutaneous
Coronary Intervention Alone Trial" showed a larger final in-stent minimum lumen diameter (MLD) and a reduction in the number of stents used with OCT-guided primary PCI.
Apr, 2016, observational study - "Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study" reported on the impact of OCT on physician decision-making and the association with post-PCI FFR values and early clinical events.
Sep, 2016, randomized clinical trail in Non-STEMI ACS patients - "Optical Coherence Tomography to Optimize Results of Percutaneous
Coronary Intervention in Patients with Non-ST-Elevation Acute Coronary
Syndrome: Results of the Multicenter, Randomized DOCTORS Study (Does
Optical Coherence Tomography Optimize Results of Stenting)" made the conclusion that OCT-guided PCI is associated with higher postprocedure fractional flow reserve than PCI guided by angiography alone, the benefit was mainly driven by improved stent expansion.
Feb, 2018, randomized clinical trail in ACS patients - "Early Strut Coverage in Patients Receiving Drug-Eluting Stents and its Implications for Dual Antiplatelet Therapy: A Randomized Trial" showed OCT-guided DES implantation improved early strut coverage compared with angiography-guided DES implantation, with no difference in strut coverage between EES and BES groups.
To be expected is a ongoing randomized clinical trail ILUMIEN-IV, now is being investigated the impact of OCT-guided vs. angiograhy-guided PCI. The ILUMIEN IV trial will enroll up to 3,650 patients with high-risk,
complex disease at 125 centers in North America, Europe and Asia. The
trial will determine if OCT-guided stent procedures result in larger
vessel diameters — thus, allowing increased blood flow — and whether
this will improve clinical outcomes for patients compared to stent
procedures guided by angiography. Patients with complex disease may have
multiple, or totally blocked arteries, or other diseases such as
diabetes; and these patients account for an increasing number of cases.
Another ongoing RCT the OCTOBER Trial which is try to prove whether OCT-guided intervention treating coronary bifurcation lesions with stenosis in a large side branch may improve procedural control of correctable factors and may lead to optimized implantation results.
Combining OCT & Angiography
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