Figure 1.

OCT-Guided PCI With DES Implantation for the Severe Calcified Lesions

Case 1. (A) Angiogram showing severe stenosis in the mid-portion of the LAD in a 67-year-old woman presenting with non–ST-segment elevation myocardial infarction. (B and C) Pre-PCI OCT assessment of a longitudinal circumferential calcified plaque with OCT-based calcium score of 3 points (maximal calcium angle >180° [2 points], calcium length >5.0 mm [1 point], and maximal calcium thickness [0 point]). (D) Post-ballooning OCT showing a calcium fracture after balloon angioplasty using a scoring balloon (arrowhead). (E) Post-stent cross-sectional OCT showing the presence of cracks (arrows). (F) 3-dimensional stent image and apposition index demonstrating a well-expanded stent without malapposition. (G) Final angiography showing good distal flow without residual stenosis after stent implantation, Case 2. (H) Angiogram showing diffuse severe stenosis with heavy calcification in the proximal to mid-portion of the LAD in a 54-year-old man presenting with stable angina. (I) Pre-PCI OCT assessment of diffuse circumferential plaques with thick calcifications leading to OCT-based calcium score of 4 points (maximal calcium angle >180° [2 points], calcium length >5.0 mm [1 point], and maximal calcium thickness [1 point]). (J) Post-rota and ballooning OCT showing good modification of the calcified plaque by rotational atherectomy and noncompliant balloon inflation. (K) Post-stent OCT showing multiple calcium fractures (arrowheads). (L) The final angiogram showing good distal flow without residual stenosis. DES = drug-eluting stent(s); LAD = left anterior descending artery; OCT = optical coherence tomography; PCI = percutaneous coronary intervention; POBA = plain old balloon angioplasty.