Coronary interventions - Mini focus on optical coherence tomography

Optical coherence tomography to guide percutaneous coronary intervention of the left main coronary artery: the LEMON study

EuroIntervention 2021;17:e124-e131. DOI: 10.4244/EIJ-D-20-01121

Nicolas Amabile
Nicolas Amabile1, MD, PhD; Grégoire Rangé2, MD; Geraud Souteyrand3, MD; Matthieu Godin4, MD; Mohamed Mehdi Boussaada1, MD; Nicolas Meneveau5, MD, PhD; Guillaume Cayla6, MD, PhD; Frederic Casassus7, MD; Thierry Lefèvre8, MD; Radwane Hakim2, MD; Imane Bagdadi1, BSc; Pascal Motreff3, MD, PhD; Christophe Caussin1, MD
1. Department of Cardiology, Institut Mutualiste Montsouris, Paris, 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

Background: Intravascular ultrasound (IVUS)-guided PCI improves the prognosis of left main stem (LMS) PCI and is currently recommended by international guidelines. Although OCT resolution is greater than that of IVUS, this tool is not yet recommended in LMS angioplasty due to the absence of data.

Aims: This pilot study aimed to analyse the feasibility, safety and impact of OCT-guided LMS PCI.

Methods: This prospective, multicentre 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).

Results: Seventy patients were included in the final analysis (median age: 72 [64-81] years, 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 strut malapposition in 24% of the cases. OCT guidance modified the operators’ strategy in 26% of the patients. The rate of one-year survival free from major adverse clinical events was 98.6% (97.2-100).

Conclusions: This pilot 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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drug-eluting stentsleft main arteryoptical coherence tomography
Coronary interventionsLeft main and multivessel disease
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