Key result
OCT and FFR guidance for PCI achieves ~89% complete revascularization in diffuse and multivessel lesions.
Why the study?
The role of intravascular imaging methods in selecting the surgical strategy for myocardial revascularization required assessment.
Observational (n=62)
The combined use of FFR and OCT in patients with diffuse and multivessel coronary disease reduces unnecessary interventions and helps achieve a high rate of complete revascularization.
May support imaging-guided PCI in complex lesions; hypothesis-generating and requires RCT confirmation before practice change.
Objective Assessment of the role of intravascular imaging methods in choosing the surgical strategy of myocardial revascularization. Material and Methods The study included 62 patients with diffuse and multivessel coronary artery disease, who underwent percutaneous coronary infervention (PCI) using intravascular imaging methods. Measurement of fractional flow reserve (FFR) in diffusely altered arteries was performed under conditions of maximum hyperemia, sequentially between stenoses, using the sensor, starting from the distal segment. Initially, the most distal hemodynamically significant stenosis was stented. Then, a repeated measurement of FFR was performed, and the issue of the need for stenting of other stenoses was solved. The results of stenting, as well as determination of the area of stent implantation were carried out by the method of optical coherence tomography (OCT). Results After FFR measurement the number of arteries with hemodynamically significant stenoses decreased by 24.7% (from 93 to 70). It was also noted that in patients with two-vessel lesions, the average number of such stenoses decreased from 2.95 ± 0.65 to 1.82 ± 0.88, and in patients with three-vessel lesions – from 2.96 ± 0.6 to 2.24 ± 0.76 respectively (p = 0.0024). Complete (functionally adequate according to FFR measurements) myocardial revascularization was achieved in 88.7% of patients. The second-generation drug eluting stents were implanted in 82 (47.1%) patients, and the third generation stents – in 92 (52.9%) patients. At the same time, the success rate of recanalization of occlusions was 100%. Overall, optimal stent implantation was achieved in all patients. Major cardiovascular complications were observed in 1 (1.6%) patient, which required additional interventions. Conclusion Complex use of intravascular imaging methods (OCT and FFR measurements) allows a differentiated approach to the assessment of each stenosis of the affected artery in patients with diffuse and multivessel coronary lesions, to achieve a high frequency of complete myocardial revascularization, as well as to reduce the number of unnecessary interventions and intraoperative complications.
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Maximkin et al. (2021) conducted an observational in diffuse and multivessel coronary artery disease (n=62). Intravascular imaging methods (OCT and FFR) was evaluated on Complete (functionally adequate according to FFR measurements) myocardial revascularization. Intravascular imaging (OCT and FFR) to guide PCI in patients with diffuse and multivessel coronary lesions achieved complete myocardial revascularization in 88.7% of patients.
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