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 BACKGROUND 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. OBJECTIVE 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. CONCLUSION 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.

3D-OCT New implications of optimal SB re-crossing

European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO 3D-OCT New implications of optimal SB re-crossing Author: Yoshinobu Onuma, MD, PhD, Horax Centre, Erasmus MC, Rotterdam, The Netherlands BACKGROUND With advent of the new-generation OCT/OFDI system (C7/8 LightLab, OFDI Terumo) with a high frame rate (100-180fps) and fast pull-back speed (20-40mm/s), 3- dimensional reconstruction of OCT became feasible due to elimination of motion artefacts. 3-dimensional OCT reconstruction gives us better understanding of complex coronary anatomy such as bifurcation, compared to the conventional 2-D OCT. CONCLUSION In 2009-2010, with advance of OCT/OFDI technology, 3D-reconstruction became feasible. In 2011-2013, the potential of the technology was demonstrated in off- line 3D-OCT with manual strut detection. In bifurcation, 3D-OCT may guide positioning of the wire through the appropriate (distal) cell. The early study suggests that such a guidance strategy reduced the incidence of malapposition in bifurcation. In 2014, the on-line 3D OCT/OFDI with automatic strut detection is available. The equipped “real-time” 3D OFDI will help utilization of 3D in clinical situation.

Serial analyses of jailed BVS side branch struts in cohort B1/B2 5 year FU

European Bifurcation Club 2014 - EBC 2014 - Bordeaux, France BVS (2): Time for clinical data The Serial follow-up of jailed side branches after implantation of bioresorbable scaffold. Insights from the ABSORB Cohort B trial using three-dimensional optical coherence tomography Author: Yoshinobu Onuma MD, PhD, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands