Utilization of frequency domain optical coherence tomography and fractional flow reserve to assess intermediate coronary artery stenoses: conciliating anatomic and physiologic information

  • Gregory T. Stefano
  • Hiram G. Bezerra
  • Guilherme Attizzani
  • Daniel Chamié
  • Emile Mehanna
  • Hirosada Yamamoto
  • Marco A. Costa
Original Paper

DOI: 10.1007/s10554-011-9847-9

Cite this article as:
Stefano, G.T., Bezerra, H.G., Attizzani, G. et al. Int J Cardiovasc Imaging (2011) 27: 299. doi:10.1007/s10554-011-9847-9

Abstract

Fractional flow reserve (FFR) and intravascular imaging respectively provide hemodynamic and anatomical assessments of angiographic intermediate stenoses. Frequency domain optical coherence tomography (FD-OCT) is a promising high-resolution imaging modality, but its clinical use in determining severity of coronary disease has yet to be determined. There, we set out to determine the role of FD-OCT to complement FFR in the evaluation of intermediate coronary artery stenoses. FD-OCT was planned in 176 consecutive interventional procedures at our institution to delineate the proper use of FD-OCT in clinical practice. The decision to use other invasive assessments was at the discretion of the operator. This report describes an early series of the 14 patients who underwent FFR of 18 target stenoses in addition to FD-OCT. FD-OCT was successfully performed without complications in all cases. Fractional flow reserve was <0.80 in four patients, with minimal lumen areas and reference vessel diameters ranging from 1.03 to 3.47 mm2 and 2.60 to 2.94 mm by FD-OCT, respectively. FD-OCT was important to rule out plaque rupture, erosion and thrombosis and to help guide decision to defer PCI in six patients with acute coronary syndrome and FFR > 0.80. FD-OCT was also valuable to guide PCI strategy in tandem lesions with an FFR < 0.80. This initial experience with FD-OCT suggests a potential complementary role of physiological and anatomical assessment to guide decision making in complex clinical scenarios. Future investigations are warranted to validate these findings and define the role of FD-OCT in assessing intermediate lesions.

Keywords

Optical coherence tomographyFractional flow reserveIntermediate coronary artery stenosis

Abbreviations

FFR

Fractional flow reserve

IVUS

Intravascular ultrasound

FD-OCT

Frequency domain optical coherence tomography

UH-CMC

University hospitals case medical center

FDA

United States food and drug administration

IRB

Institutional review board

PCI

Percutaneous intervention

PSI

Pounds per square inch

QCA

Quantitative coronary angiography

HTN

Hypertension

DM

Diabetes

DLD

Dyslipidemia

PAD

Peripheral arterial disease

MI

Myocardial infarction

CVA

Cerebrovascular accident

CABG

Coronary bypass surgery

UA

Unstable angina

NSTEMI

Non-ST segment myocardial infarction

STEMI

ST-segment elevation myocardial infarction

LAD

Left anterior descending coronary artery

LCx

Left circumflex coronary artery

RCA

Right coronary artery

LM

Left main coronary

RLA

Reference vessel luminal area (mm2)

mRLA

Mean reference vessel luminal area (mm2)

MLA

Minimal luminal area (mm2)

AS

Area stenosis (%)

RLD

Reference vessel luminal diameter (mm)

mRLD

Mean reference vessel luminal diameter (mm)

MLD

Minimal lumen diameter (mm)

DS

Diameter stenosis (%) lesion length (in mm)

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Gregory T. Stefano
    • 1
  • Hiram G. Bezerra
    • 1
  • Guilherme Attizzani
    • 1
  • Daniel Chamié
    • 1
  • Emile Mehanna
    • 1
  • Hirosada Yamamoto
    • 1
  • Marco A. Costa
    • 1
  1. 1.Harrington-McLaughlin Heart and Vascular Institute, Cardiovascular Imaging Core Laboratory, University Hospitals Case Medical CenterCase Western Reserve University School of MedicineClevelandUSA