Table 2.
Situations where intracoronary imaging should be considered. (# refers to Fig. 1)
| Situation | Rationale |
|---|---|
| Pre-PCI stent sizing (1) | Both OCT and IVUS can be considered to determine the appropriate stent size. However, OCT provides a higher resolution, which may result in a more accurate size. This is especially important in complex lesions or lesions with uncertain morphology |
| Pre-PCI identification of exact deployment site (1) | Both OCT and IVUS can be considered to determine the deployment site. However, OCT provides a higher resolution, which may result in a better determination of the most appropriate landing zone |
| Pre-PCI lesion characterization (1) | OCT better distinguishes between various types of plaques and lesion characteristics compared to IVUS |
| Ostial left-main lesion assessment and guidance (2) | Only IVUS should be considered, as blood clearance, needed for OCT, may be challenging, if not impossible |
| Uncertainty about severity or composition of lesions (3) | Fractional flow reserve (FFR) and instantaneous wavefree ratio (iFR) seems to be the most appropriate technique for assessing lesion severity. However, both OCT and IVUS can provide insight in composition of lesions and may result in a different stenting strategy |
| Bifurcation lesions assessment and guidance (4) | OCT might support bifurcation guidance by assessment of plaque composition and distribution, stent sizing, and deployment sites and positioning of the re-crossing wire. An RCT by Holm et al. (OCTOBER, 2018) comparing clinical outcomes after OCT guidance compared with CAG guidance in bifurcation lesions is currently running [63] |
| Post-PCI stent assessment and optimization (5) | OCT provides detailed insight in how the stent is positioned inside the coronary artery (apposition, expansion, and edge dissections). Optimization may result in improved clinical outcomes |
| Assessment of stent failure (5) | OCT provides detailed insight in mechanisms associated with stent failure (thrombosis, in-stent restenosis, malapposition, under-expansion, edge dissections, tissue protrusions) |
| Patients with impaired kidney function | Only IVUS should be considered, as contrast injections are needed with OCT |
CAG coronary angiography, FFR fractional flow reserve, iFR instantaneous wave-free ratio, IVUS intravascular ultrasound, OCT optical coherence tomography, RCT randomized controlled trial