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IMAGE FOCUS
. . . .
doi:10.1093/ehjci/jes027
Online publish-ahead-of-print 7 February 2012
Choosing the right cell: guidance with three-dimensional optical coherence
tomography of bifurcational stenting
Eduardo Alegria-Barrero , Nicolas Foin , Pak Hei Chan , Alistair C. Lindsay , and Carlo Di Mario *
Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
*Corresponding author. Tel:+44 20 73518616; fax: +44 20 73518104, Email: c.dimario@rbht.nhs.uk
Upper panel. A 36-year-old male with
progres-sive exertional angina, inducible anterolateral
is-chaemia, and single-vessel disease involving the
bifurcation left anterior descending coronary
artery (LAD)/first diagonal branch (Panel 1A).
Panel
1B
shows
the
three-dimensional
(3D)-optical coherence tomography (OCT)
image of a 2.75
× 28 mm Integrity RESOLUTE
wstent with a wire crossing the struts,
demon-strating that the wire crossed through the
most distal cell of the side-branch ostium. Panel
1C shows the 3D-OCT image after a 2.5 mm
balloon has been dilated at 12 atm across the origin with a 3.0 mm balloon inflated in the LAD (kissing balloon). A perfect circular
opening with no strut malapposition in the ostium is obtained.
Lower panel. A 72-year-old woman with exertional angina and a severe lesion in the bifurcation of LAD/first diagonal branch (Panel
2A). Three-dimensional OCT image (Panel 2B) shows the struts of a similar stent (3.0
× 24 mm Integrity RESOLUTE
w) jailing the
ostium of the side branch. OCT was not used to identify the position of wire crossing. Panel 2C indicates that despite dilatation of
the diagonal ostium with a 2.5 mm balloon with a 3.0 mm balloon in the LAD, a gross malapposition of the main vessel stent
struts persists at the origin of the diagonal. The wire is clearly positioned in the most proximal cell. The final angiographic images
of the two lesions (Panels 1D and 2D) are remarkably similar, giving no clue of the fundamental difference in the result.
High-resolution intravascular imaging with OCT and 3D reconstruction has the unique ability to clearly identify the position of wire
crossing during bifurcational stenting.
Published on behalf of the European Society of Cardiology. All rights reserved.
