Randomized Clinical Trails regarding OCT vs. Angiography Guided PCI
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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.

Compared to angiography, intravascular OCT has a clear advantage in that it depicts ostial lesion(s) in bifurcation without the misleading two-dimensional appearance of conventional angiography such as overlap and foreshortening. In addition, OCT has the ability to reconstruct a bifurcation in three dimensions and to assess the side branch ostium from 3D reconstruction of the main vessel pullback, which can be applied to ensure the optimal recrossing position of the wire after main vessel stenting. Recently, online co-registration of OCT and angiography became widely available, helping the operator to position a stent in precise landing zones, reducing the risk of geographic miss.