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

Optical Coherence Tomography to Guide Percutaneous Coronary Intervention of the Left Main Coronary Artery: the LEMON study

DOI: 10.4244/EIJ-D-20-01121

1. Department of Cardiology, Institut Mutualiste Montsouris, Paris, France, France
2. Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
3. Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
4. Cardiology Department, Clinique St Hilaire, Rouen, France
5. Department of Cardiology, EA3920, University Hospital Jean Minjoz, Besançon, France
6. Cardiology Department, CHU Nimes, University of Montpellier, Nimes, France
7. Cardiology Department, Clinique St Augustin, Bordeaux, France
8. Institut Cardio-Vasculaire Paris Sud , Hopital Privé Jacques Cartier , Massy , France

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AIMS: IVUS is currently recommended by international guidelines to guide left main stem (LMS) PCI. Although OCT resolution outmatches IVUS, this tool is not yet recommended in LMS angioplasty due to the absence of data. This pilot study aimed to analyze the feasibility, safety and impact of OCT-guided LMS PCI.

 METHODS & RESULTS: This prospective, multicenter trial investigated whether patients might benefit from OCT-guided PCI for mid/distal LMS according to a pre-specified protocol. The primary endpoint was procedural success defined as follows: residual angiographic stenosis <50% + TIMI 3 flow in all branches + adequate OCT stent expansion (LEMON criteria). 

Seventy patients were included in the final analysis (median age: 72 (64-81) y, 73% male).  The OCT pre-specified protocol was applied in all patients. The primary endpoint was achieved in 86 % of subjects. Adequate stent expansion was observed in 86%, significant edge dissection in 30% and residual significant struts malapposition in 24% of the cases. OCT guidance modified operators’ strategy in 26% of the patients.  The one-year survival free from major clinical adverse events was 98.6 (97.2-100) %.

CONCLUSION: This study is the first to report the feasibility and performance of OCT-guided LMS PCI according to a pre-specified protocol. 

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