Improving Stent Decisions with OCT and IVUS Heart Scans in Angioplasty

The Case for Precision Angioplasty

• 💡 Dr. David Yong advocates for precision angioplasty, suggesting that intravascular imaging like OCT should be a routine practice in angioplasty cases.
• 🧠 He emphasizes the crucial role of coronary physiology in day-to-day practice, despite the vast amount of clinical data available.

Evidence from Key Clinical Trials

• 📊 The DEFER trial showed that deferring treatment for lesions not significant by FFR improves patient outcome.
• 🎯 The FAME and FAME 2 trials demonstrated that multi-vessel PCI guided by physiology is more beneficial than angiography alone, significantly reducing composite endpoints like death and MI.
• 📈 The Renovate Complex PCI trial highlighted a significant reduction in adverse events and target vessel failure with imaging-guided PCI compared to angiography-guided PCI, especially for complex lesions.

Benefits of Intravascular Imaging (OCT/IVUS)

• 🔍 Imaging provides clear views inside arteries, enabling precise stent placement and reducing the chance of future heart problems.
• 🔬 It allows for detailed assessment of lesion morphology, including calcified, fibrous, or lipidic plaque, and accurate measurement of lesion length and diameter.
• ✅ Imaging ensures optimal stent sizing and expansion, proper apposition, and helps avoid issues like stent edge dissection.

Guidelines and Best Practices

• 📌 The 2024 ESC guidelines recommend intracoronary imaging (IVUS or OCT) for performing PCI on anatomically complex lesions, such as left main stem, true bifurcation, and long lesions, as a Class 1A indication.
• 🛠️ The MLDD Max algorithm is presented as an effective tool for pre- and post-PCI assessment, focusing on morphology, length, diameter, and dissection/apposition.
• 👏 Dr. Yong suggests that imaging guidance should extend beyond complex cases to routine PCI, as it offers superior outcomes.