Case Overview
This case demonstrates the value of HF-OCT across all steps of PCI, from pre-intervention assessment through post-stent optimization, in a lesion that would likely be uncrossable with conventional intravascular imaging systems without prior modification.
A patient presented with severe coronary artery disease involving the left anterior descending (LAD) artery. Lesion severity, vessel size, and plaque were assessed with HF-OCT to determine appropriate modification and treatment.
STEP 1
Pre-PCI Lesion Assessment
HF-OCT was performed prior to intervention to assess the level of disease and determine treatment strategy.
- Vis-Rx was able to cross critically stenosed LAD with a minimum lumen area (MLA): 0.3 mm², and diameter of 0.6 mm
- Excellent distal visualization achieved, despite the catheter being mostly occlusive
- A lesion modification strategy using non-compliant (NC) and cutting balloons was selected
STEP 2
Assess Modification Strategy
Modifications using NC and Cutting Balloons were performed, and another HF-OCT pullback was done.
HF-OCT Post-Modification Findings:
- Confirmation of lesion modification and fracture
- Luminal area increased from 0.3 mm² to 1.9 mm²
- Confirmed appropriate lesion preparation before stent placement
STEP 3
Post-Stent Imaging
HF-OCT Post-Stent Findings:
- Minimum Expansion Index (MEI): 87%
- Minimum stent area (MSA): 4.4 mm²
- Good angiographic result
- Some minor malapposition observed
Clinical Impact:
HF-OCT enabled successful baseline imaging despite a severely narrowed lesion (MLA 0.3 mm²), providing clear visualization to guide modification and treatment strategy. Post-PCI imaging confirmed stent expansion exceeded the ≥80% MEI threshold supported by clinical evidence for optimal outcomes.¹
1 Prati F, et al. Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study. JACC Cardiovasc Imaging. 2015 Nov;8(11):1297-305. doi: 10.1016/j.jcmg.2015.08.013. PMID: 26563859.
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