Optical coherence tomography guidance for the management of angiographically intermediate left main bifurcation lesions: Early clinical experience

Francesco Burzotta, Carlo Trani, Filippo Crea, Ilaria Dato, Lazzaro Paraggio, Cristina Aurigemma, Italo Porto, Antonio Maria Leone, Giampaolo Niccoli

Risultato della ricerca: Contributo in rivistaArticolo in rivista

7 Citazioni (Scopus)

Abstract

Background Left main (LM) atherosclerotic lesions affect clinical outcomes. Frequency domain-optical coherence tomography (FD-OCT) allows detailed characterization of non-ostial coronary atherosclerotic lesions. The clinical impact of FD-OCT assessment of LM bifurcation disease on the revascularization decision is unknown. Methods Patients who underwent FD-OCT assessment to guide management of angiographically intermediate distal LM stenosis were retrospectively selected. The FD-OCT LM criteria for percutaneous or surgical revascularization were: – LM area stenosis (AS) ≥ 75%– LM AS > 50% < 75% with minimum lumen area < 4 mm2or plaque ulceration– critical FD-OCT ostial stenosis on the left anterior descending or circumflex arteries.Clinical follow-up was obtained to evaluate the occurrence of target vessel failure (TVF) defined as cardiac death and/or acute myocardial infarction (AMI) not related to other vessel and/or target vessel revascularization. Results Out of 131 patients underwent FD-OCT assessment of LM, 122 patients (93%) entered the study. Based on FD-OCT features, 58 (48%) patients were conservatively managed, while the remaining 64 (52%) were revascularized by stenting (n = 48) or surgery (n = 16). After a mean follow-up of 18 months, TVF-free survival was not different between patients undergoing conservative management vs. revascularization (HR 0.40, CI 95% 0.10–1.61, P = 0.20). Of note, two patients only in the conservative management group had TVF (elective LM stenting, no death or myocardial infarction). Conclusions This preliminary experience suggests that a FD-OCT based management for patients with angiographically-intermediate LM bifurcation stenosis may help identify patients in whom revascularization could be deferred. Such observation calls for further evaluations by appropriately designed trials.
Lingua originaleEnglish
pagine (da-a)108-113
Numero di pagine6
RivistaINTERNATIONAL JOURNAL OF CARDIOLOGY
Volume248
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • Cardiology and Cardiovascular Medicine
  • Distal left main
  • Frequency domain optical coherence tomography
  • Outcome

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