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Optical coherence tomography guided carotid artery stent procedure: technique and potential applications
Author(s) -
Dohad Suhail,
Zhu Alexander,
Krishnan Sandeep,
Wang Frances,
Wang Serena,
Cox Justin,
Henry Timothy D.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27344
Subject(s) - medicine , fluoroscopy , intravascular ultrasound , optical coherence tomography , radiology , stent , coronary artery disease , ultrasound , carotid arteries , surgery , cardiology
Objectives To (1) present a guide on how to perform optical coherence tomography (OCT) in carotid artery stenting (CAS), to (2) highlight several instructive cases illustrating OCT‐guidance as an interventional strategy, and to (3) present the largest case‐series of OCT‐guided CAS performed in North America, demonstrating its feasibility as an imaging modality in this setting. Background OCT is an intravascular imaging method that captures images with an axial resolution 10 times higher than intravascular ultrasound. OCT has proven to be a useful modality in coronary angiography and may have similar applications in evaluating carotid atherosclerotic disease. Methods We compared our experience in CAS utilizing OCT (40 patients) versus that of CAS without OCT guidance (52 patients). Results No strokes or deaths occurred in either group postprocedurally or at 12 months. Fluoroscopy time was reduced in the OCT arm (14 ± 1 vs. 16 ± 1 min). Postprocedural creatinine levels were identical (1 ± 0 mg/dl, P = 0.96). Procedure time (96 ± 8 vs. 80 ± 3 min, P = 0.06) and contrast use (94 ± 4 vs. 83 ± 4 ml, P = 0.05) was slightly elevated in the OCT arm. Conclusions We established a standardized protocol to consistently obtain OCT images that helped guide interventional decision‐making during CAS. OCT imaging in the carotids requires a higher contrast load and prolongs procedure time. However, it can be performed without significant increases in fluoroscopy time or negatively affecting renal function. There were no negative safety signals in this pilot study.