OCT-Guided Stent Optimization Improves Safety in Complex Coronary Artery Lesions

A study has found that optimizing stents based on optical coherence tomography (OCT) in complex coronary artery lesions can reduce the risk of cardiovascular events.

The research team led by Professors Kim Byunggeuk and Lee Seungjun from the Department of Cardiology at Severance Hospital, Yonsei University, announced on December 9 that OCT-guided stent optimization in patients with complex coronary artery disease can reduce the risk of major cardiovascular events within one year by up to 70%.

This research was published in the international journal "European Heart Journal" (IF 35.7).

Yonsei Medical Center

Percutaneous coronary intervention using stent implantation is the standard treatment for ischemic heart diseases such as acute myocardial infarction or angina. When treating complex coronary artery lesions, such as chronic total occlusion, calcified lesions, left main and bifurcation lesions, intravascular imaging devices like intravascular ultrasound or optical coherence tomography (OCT) are used to precisely visualize the inside of the vessel and improve clinical outcomes.

In particular, OCT is a state-of-the-art imaging technology with more than 10 times the resolution of intravascular ultrasound, allowing for detailed observation of the fine structures of the vessel wall and stent. This enables real-time confirmation of proper stent expansion, apposition to the vessel wall, and detection of vascular injuries such as intimal dissection, thereby contributing to optimal stent deployment. However, the criteria for stent optimization have not been clearly defined, and there is a lack of evidence on which standards lead to better patient outcomes.

The research team conducted the "OCCUPI study" to analyze the impact of achieving stent optimization using OCT on the clinical outcomes of patients with complex coronary artery lesions, as well as to identify specific OCT evaluation criteria for this purpose.

The study analyzed 773 patients with complex coronary artery lesions who underwent OCT-guided stent implantation. Patients were divided into two groups: those who met the "OCCUPI-OCT criteria for stent optimization" defined in the study (optimized group, 71%) and those who did not (non-optimized group, 29%), and their clinical outcomes were compared over one year. The criteria for stent optimization were defined as meeting all three key elements: sufficient stent expansion, complete apposition of the stent to the vessel wall, and absence of major vascular dissection.

The analysis found that the optimized group had a major cardiovascular event rate (including cardiac death, myocardial infarction, and stent thrombosis) of 2.9% within one year, significantly lower than the 9.4% observed in the non-optimized group. The hazard ratio was 0.3, indicating about a 70% reduction in cardiovascular event risk. This result was also superior compared to the group that underwent only angiography (7.5%).

Specifically, patients with insufficient stent expansion, stents separated from the vessel wall by more than 400 micrometers, or remaining major vascular dissection had poorer outcomes. Notably, long lesion length and small vessel diameter were identified as major factors making stent optimization difficult.

Professor Kim Byunggeuk stated, "Through this study, we were able to identify concrete quantitative criteria that clinicians should aim for during stent procedures using intravascular imaging devices. By confirming that the three elements-stent expansion, apposition, and vascular dissection-are each independently and closely related to patient outcomes, we expect that this will help establish standard guidelines for the use of OCT in complex lesion interventions in the future."

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