A randomized trial evaluating on line three dimensional of guided PCI vs angiography guided PCI in bifurcation lesions OPTIMUM STUDY
European Bifurcation Club 2019, EBC 2019 – Barcelona, Spain
CORONARY BIFURCATION IMAGING
A randomized trial evaluating on line three dimensional of guided pci vs angiography guided pci in bifurcation lesions: optium study
Author: Yoshinobu Onuma, MD, PhD, Erasmus Medical Center, The Netherlands
- In bifurcation PCI, re-crossing the distal cell with a wire after main vessel stenting is important to avoid creating a de novo metal carina1. Those protruded/malapposed struts result in lower tissue strut coverage of the side branch ostium and more overhanging metal into the main branch after implantation of the stent.
- Angiography guided PCI is limited in recognizing the recrossing position, while intracoronary imaging during PCI has a potential to visualize the recrossing point and to optimize the acute results.
- The feasibility of off-line 3-dimensional optical frequency domain imaging (OFDI) in bifurcation and its potential benefits were demonstrated in retrospective studies.
- However, the feasibility and efficacy of on-line 3D OFDI guided PCI in bifurcation lesion has not yet been fully investigated.
To determine whether bifurcation PCI guided by on-line 3D- OFDI is superior to bifurcation PCI with angiographic guidance in terms of incomplete stent apposition (ISA) in bifurcation segment.
- In the randomized trial of bifurcation PCI, 3D-OFDI guidance was superior to angio-guidance in acute incomplete strut apposition (creation of metal carina) of bifurcation segment (3D-OFDI 19.5±15.8% vs. angio: 27.5%±14.2%, p=0.008).
- Excellent feasibility of online 3D-OFDI was demonstrated (98%).
- After mandatory POT, the first wiring position was not optimal in 45% of cases, requiring 2nd attempt to redirect the wire into the optimal cell when 3D-OFDI guidance was used.
- On-line 3D OFDI images help operator to undergo rewiring to the optimal cell, resulting in a lower rate of malapposition compared with angiography guided PCI.