OCT Guided Calcified Bifurcation PCI

Quick longitudinal lesion assessment showed that the most distal and proximal cuts would not be covered by a 38 mm stent (Figure 2C), therefore a 2 stent approach was selected for the lesion. Second OCT pullback performed after the first 3.5 X 38 mm stent was implanted distally (Figure 3A) demonstrated no distal edge dissection (Figure 3B) and stent malapposition in the middle of the stent with stent area of 8.8 mm² (Figure 3C). Minimal stent area and stent expansion was 5.6 mm² and 74% respectively. Sizing of the second proximal stent using automatic lumen profile feature is shown in the longitudinal OCT view (Figure 3D, dotted line square). Based on the findings, a 3.5 X 16 mm stent was deployed to the proximal LAD followed by a postdilation of the distal stent with a 3.75 X 15 mm noncompliant balloon to resolve stent malapposition (Figure 4A).