The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

CORONARY INTERVENTIONS

Joint consensus on the use of OCT in coronary bifurcation lesions by the European and Japanese bifurcation clubs

EuroIntervention 2019;14:e1568-e1577 published online November 2018. DOI: 10.4244/EIJ-D-18-00391

1. Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; 2. Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; 3. Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy; 4. Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark; 5. Cardiology Department, Institut Mutualiste Montsouris, Paris, France; 6. Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan; 7. Cardiovascular Research Foundation, New York, NY, USA; 8. Clinique St. Augustin, Bordeaux, France; 9. Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 10. Ramsay Générale de Santé - Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France; 11. Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade, Belgrade, Serbia; 12. International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom

Coronary artery bifurcation lesions comprise approximately 15-20% of all percutaneous coronary interventions (PCI) and constitute a complex lesion subgroup. Intravascular optical coherence tomography (OCT) is a promising adjunctive tool for guiding coronary bifurcation with its unrivalled high resolution. Compared to angiography, intravascular OCT has a clear advantage in that it depicts ostial lesion(s) in bifurcation without the misleading two-dimensional appearance of conventional angiography such as overlap and foreshortening. In addition, OCT has the ability to reconstruct a bifurcation in three dimensions and to assess the side branch ostium from 3D reconstruction of the main vessel pullback, which can be applied to ensure the optimal recrossing position of the wire after main vessel stenting. Recently, online co-registration of OCT and angiography became widely available, helping the operator to position a stent in precise landing zones, reducing the risk of geographic miss. Despite these technological advances, the currently available clinical data are based mainly on observational studies with a small number of patients; there is little evidence from randomised trials. The joint working group of the European Bifurcation Club and the Japanese Bifurcation Club reviewed all the available literature regarding OCT use in bifurcation lesions and here provides recommendations on OCT guiding of coronary interventions in bifurcation lesions.

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