Angio-OCT Co-Registration for Stent Sizing and Optimization

A 71-year-old male, smoker with a history of hypertension, hyperlipidemia and asthma presented to our hospital with angina pectoris. Coronary CTA showed 2 vessel disease and angiography confirmed LAD and RCA lesions. After performing PCI of the LAD with DES, the patient still had the complaints of occasional chest pain and DOE, so he presented for staged PCI of RCA. Coronary angiography showed moderate proximal and severe distal stenosis of the RCA (Figure 1).

To identify the lesion precisely and choose the optimal stent size, we performed an OCT pullback (Figure1, line) and co-registration with angiography (Figure 2). For the distal lesion, we put red marks on the distal healthy vessel as a distal reference (Figure 2 A1, D) and proximal healthy segment as a proximal reference (A2, E). Minimal lumen area and percent area stenosis was automatically calculated and labeled by yellow mark (A3, B) and yellow circle (C). Angio-OCT co-registration allows assessment of the plaque morphology and optimal stent sizing referring to the distal and proximal reference diameter and lesion length (C, D, E). Distal lesion was stented with DES (4.0x12mm) and proximal lesion was evaluated in the same way and OCT confirmed it was a significantly stenotic lesion, treated with another DES (4.0x20mm).

After stenting, we performed the final OCT pullback (Figure 3) to evaluate the stent expansion and apposition to the vessel and the necessity of optimizing stent by using post-balloon and also to rule out edge dissection. In this case, OCT confirmed optimal stent expansion with 80.4% for distal and 87.8% for proximal stent and good apposition of both stent and did not detect stent edge dissection, therefore no additional treatment was performed.