Imaging during percutaneous coronary intervention for optimizing outcomes

Figures

• 

  Fig. 1. Top, angiographically guided stent implantation. Despite acceptable angiographic appearance (A), IVUS demonstrates underdeployment, achieving MSA of only 5.61 mm2 (B) Compared with proximal reference segment of 10.40 mm2 (C). Bottom, both angiographically and IVUS-guided stent implantation. Angiogram after stent deployment in mid right coronary artery with 3.5-mm balloon inflated at 16 atm shows acceptable result (A). Initial IVUS (B) shows underdeployment. IVUS image after further dilatation with 4.0-mm balloon at 16 atm demonstrates substantial improvement in MSA (C).13 IVUS, intravascular ultrasound; MSA, minimal stent area.

• 

  Fig. 2. Suboptimal stent results seen with IVUS. (A) Acute incomplete stent apposition underexpansion, (B) edge dissection, (C) large edge plaque burden, and (D) underexpansion.18

• 

  Fig. 3. OCT guidance during PCI. (A) OCT after stent placement showing well-apposed stent. B, Malapposed stent struts visualized with OCT which led to postdilation with a larger balloon. C, Stent struts visualized at ostium of the first diagonal branch of the left anterior descending coronary artery. For bifurcation angioplasty, OCT guidance can be used to select the distal most cell for passing guidewire. D, Two layers of well-apposed stent struts visualized after bifurcation angioplasty with Crush technique. OCT, optical coherence tomography

• 

  Fig. 4. Top, OCT pullback after stenting showing longitudinal view of the vessel. Stent length can be measured and side-branch ostium visualized. The same view can be used pre-PCI to decide stent length and landing zones. Middle left, stent edge dissection as seen on OCT (long arrow). Middle right, tissue prolapse through stent struts (short arrows). Bottom, OCT findings in acute coronary syndrome. (A) Plaque rupture is defined as a lipid plaque with fibrous cap discontinuity (arrow) and cavity formation inside the plaque. (B) Definite plaque erosion is defined by the presence of attached thrombus (arrow) overlying an intact and visualized plaque. (C) Calcified nodules are defined by fibrous cap disruption (solid arrow) with underlying calcified plaque (dotted arrow) characterized by protruding calcification, superficial calcium, or the presence of significant calcium adjacent to the lesion. The asterisks denote guidewire shadow artifact. OCT, optical coherence tomography.