E-Science Station

It is known that PCI using only angiography for lesions of the left main as well as for bifurcation lesions is associated with non-optimal implantation of stents, which is associated with a high risk of adverse long-term results. The use of OCT for stenting the left main makes it possible to achieve optimal stent implantation and improve clinical outcomes.

We conducted a one-center randomized study, which should show the advantage of stent implantation in left main bifurcation under OCT control compared with standard implantation under angiographic control. The follow-up period was 1 year, and 100 patients randomized 1: 1 were included in the study. The outcome is the final combined point: cardiac death, ischemia, or myocardial infarction due to changes in the revascularization zone. All patients were elective with angina pectoris of high functional class. With damage to the bifurcation of the left main more than 50%. PCI was performed by the technique of one or two stents, performing kissing dilation and POD using OCT and without.

As a result of the analysis of the data of 100 patients with PCI bifurcation LM using OCT and without, primary endpoint indicators in the group without OCT 16% and 10% per OCT In 13% of cases, when using OCT, a single-stent tactic was chosen instead of a two-stent one.Additional stent optimization is 20% more common in the OCT group. A 3-month follow-up in the OCT group demonstrated in 95% of cases full or partial endothelization of the stent stratum, which made it possible to cancel DAPT earlier, which is important in patients with a high risk of major bleeding.

The use of OCT can improve the intraoperative results of PCI for bifurcation of the left main using controlled factors for optimal stent implantation. As a result, the long-term results of treatment are improved, the time for taking DAPT is reduced, and the number of implantable stents is reduced, which is important in patients with atrial fibrillation and a high risk of painful bleeding.