Optical coherence tomography guidance during bioresorbable scaffold implantation: intraprocedural decision-making and post-procedural imaging outcomes
J Yin, C P Liu, R Wang, C Y Zhou, C G Li, F Zhang, H Lu, G Zhao, S N Zhang, K Yao, J Y Qian, Li Shen, J B GeAbstract
Background
Optical coherence tomography (OCT) influences decision-making during metallic drug-eluting stent implantation, but its procedural impact during bioresorbable scaffold (BRS) implantation is less well defined. Because polymeric BRS are radiolucent, have thick struts, and have limited overexpansion tolerance, an OCT-based, BRS-specific workflow may be particularly valuable.
Purpose
To quantify OCT-driven intraprocedural strategy changes and acute post-procedural OCT imaging outcomes after OCT-guided BRS implantation.
Methods
In a single-center prospective observational cohort (March 2021–March 2024), angiography–OCT co-registration was used to guide BRS implantation during percutaneous coronary intervention (PCI) in 172 lesions (170 patients) using a prespecified STOP-HEAD algorithm (STOP: sizing, taper assessment, overlap avoidance, preparation; HEAD: high-pressure post-dilatation and OCT assessment of scaffold expansion, apposition, and edge dissections). Treatment plans based on angiography alone were recorded and compared with plans after pre-PCI OCT; post-PCI OCT findings and any additional optimisation were documented. Post-procedural OCT metrics included scaffold expansion index (SEI) and minimum scaffold eccentricity index (SEC).
Results
Most lesions were in the left anterior descending artery (71.2%), and a single scaffold was implanted in 95.9%. OCT changed operator decision-making in 79% of lesions (136/172). Pre-PCI OCT altered the procedural plan in 76% (131/172), including changes in lesion preparation (unplanned cutting/scoring balloon use in 33%), scaffold diameter selection (35%), and scaffold length selection (52%). Post-PCI OCT prompted further optimisation in 15% (26/172) due to scaffold malapposition (8%) and/or scaffold underexpansion (12%) not detected by angiography. Final SEI was 0.83±0.11 and minimum SEC was 0.72±0.08; both indices were lowest in calcified lesions. Final TIMI 3 flow was achieved in all treated vessels.
Conclusion
Even in angiographically selected lesions considered suitable for BRS implantation, systematic OCT guidance within a prespecified STOP-HEAD workflow frequently changes procedural planning and identifies residual deployment issues requiring further optimisation, supporting routine pre- and post-implantation OCT to refine preparation, sizing, and scaffold optimisation.Figure 1 BRS-specific STOP workflowFor image description, please refer to the figure legend and surrounding text.Figure 2 BRS-speific HEAD WorkflowFor image description, please refer to the figure legend and surrounding text.