Abstract
Stent placement guided by angiography alone is often inexact, but of increased importance with bifurcation percutaneous coronary intervention (PCI). We describe a novel technique using optical coherence tomography (OCT)-guided angiographic co-registration termed “Bifurcation and Ostial OCT Mapping” (BOOM). The technique is based on the precise identification and mapping of the side-branch ostium using co-registration to minimize protrusion of stent struts into the main branch while ensuring full coverage of the ostium in the side-branch.
Highlights
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This is a novel bifurcation technique using OCT-guided angiographic co-registration
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It is based on the precise identification and mapping of the side-branch ostium using co-registration
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The BOOM technique may be a useful adjunctive tool to optimize precise stent placement at bifurcation points
Percutaneous coronary intervention (PCI) of bifurcation lesions requires operator skill and is associated with increased early complications and long-term adverse events [ ]. Multiple techniques for bifurcation PCI have been described [ ], but no consensus exists regarding the optimal approach. In particular, T-stenting the side-branch of a bifurcation lesion with angiographic guidance is imprecise, and often results in either geographic miss of the ostium, or the stent excessively protruding in the main-branch. Alternatively, the crush and culotte techniques may be used, but are complex and have significant limitations [ , ]. We herein describe a novel technique using optical coherence tomography (OCT)-guided angiographic co-registration termed “Bifurcation and Ostial OCT Mapping” (BOOM). The technique is based on the precise identification and mapping of the side-branch ostium using co-registration to minimize protrusion of stent struts into the main branch while ensuring full coverage of the ostium in the side-branch.
A 56-year-old male with history of diabetes and hypertension presented with unstable angina. Coronary angiography demonstrated severe stenoses involving the proximal left anterior descending (LAD) coronary artery and the first obtuse marginal (OM1) branch. After PCI of the LAD, a stent was implanted in the OM1 branch. Angiography after stenting of the OM1 demonstrated a significant stenosis at the OM1 bifurcation, with inability to identify an angiographic view of the OM ostium without overlap of the left circumflex artery (LCx) and OM1 side-branch. OCT mapping of the stenosis ( Fig. 1 ) in relation to the bifurcation and co-registration to the angiogram ( Fig. 2 ) allowed precise identification of the ostium and planning of the PCI to the ostial OM branch. Stent diameter and length was determined based on the reference segment external elastic lamina diameter and automated length measurements obtained from OCT. A 3.0 × 12 mm everolimus-eluting stent was implanted at the ostial OM1 using co-registration. Angiography suggested possible stent protrusion into the main LCx. OCT imaging, however, confirmed optimal stent positioning with full ostial coverage without protrusion into the main vessel ( Fig. 3 ). Total procedural contrast volume used was 300 mL with approximately 120 mL used for the PCI to the OM1.
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