Your logos here Relation between OCT imaging & functional assessment of stents Prof. T. Adriaenssens, MD, PhD University Hospitals Leuven, Belgium
OCT & FFR post stent implantation: Should they relate? • OCT : detailed cross sectional • FFR : reflection of the susceptibility morphological assessment of the to impaired flow at maximal stented segment + prox & distal hyperemia (functional assessment) edge • Values to be interpreted for the • Cross sections in segment of whole coronary artery (with some interest (50-70 mm); absolutely no local information to be derived information on the rest of the based on pressure drops, to be vessel interpreted with caution) • Does not take into account the • Takes into account the magnitude magnitude or the viability of the or the viability of the territory territory supplied supplied
OCT & FFR post stent implantation: Should they relate? not necessarily … • OCT: detailed cross sectional • FFR: reflection of the susceptibility morphological assessment of the to impaired flow at maximal stented segment + prox & distal hyperemia (functional assessment) edge • Values to be interpreted for the • Cross sections in segment of whole coronary artery (with some interest (50-70 mm); absolutely no local information to be derived information on the rest of the based on pressure drops, to be vessel interpreted with caution) • Does not take into account the • Takes into account the magnitude magnitude or the viability of the or the viability of the territory territory supplied supplied
Events post ACS: culprit lesion vs. non culprit lesion Stone et al. PROSPECT NEJM 2011; 364: 226-35.
Relation between OCT imaging & functional assessment of stents • Relation OCT (IVUS) ~ FFR in native CAD • Value of FFR post PCI • Relation OCT ~ FFR post stent implantation • Future directions (computational flow dynamics)
OCT & IVUS: moderate efficiency in identification of severe CAD Optimal cutoff IVUS MLA 2.36 mm 2 Optimal cutoff MLA 1.95 mm 2 Sensitivity 82%, specificity 63% Sensitivity 82%, specificity 63% Gonzalo et al. J Am Coll Cardiol 2012; 59: 1080-9.
Koo et al. JACC Intv 2011; 4: 803-11.
Prognostic value of FFR post PCI 1 year clinical outcome after PCI with DES Nam et al. Am J Card 2011; 107: 1763-67.
POST-PCI FFR measurement in FAME 1 and FAME 2 Piroth et al. Circ Cardiovasc Interv 2017
POST-PCI FFR measurement in FAME 1 and FAME 2 Piroth et al. Circ Cardiovasc Interv 2017
POST-PCI FFR measurement FAME 1 and FAME 2 Piroth et al. Circ Cardiovasc Interv 2017
POST-PCI FFR measurement FAME 1 and FAME 2 FFR: predictive value too low to act as surrogate EP or to guide PCI optimization Piroth et al. Circ Cardiovasc Interv 2017
DOCTORS: OCT guided PCI: effect on final FFR 0.92 ± 0.05 0.94 ± 0.04 Meneveau et al. Circulation 2016; 134: 906-17.
ILUMIEN I: Paired final FFR and OCT measurements following optimization Wijns et al. ILUMIEN I. Eur Heart J 2015; 36: 3346-55.
Relation between OCT and FFR after PCI: few studies Reith S. et al. J Inv Card 2015; 27: 222-8.
Relation between OCT and FFR after PCI Reith S. et al. J Inv Card 2015; 27: 222-8.
Mechanisms concurring to a lower post-PCI FFR value Li JACC CV Intv 2017; 10: 986-995.
PRESTIGE: Dominant OCT Imaging Factors for ST Adriaenssens et al. Circulation 2017; 136: 1007-21.
PRESTIGE: Possibly Contributing Imaging Factors 100 100 80 57,1 60 40 21,4 14,2 14,2 20 7,1 0 0 0 0 0 Subacute ST Acute ST Late ST VLST Adriaenssens et al. Circulation 2017; 136: 1007-21.
Taniwaki et al. Circulation 2016; 133: 650-660
Proximal MSA Proximal Reference 121% Expansion Proximal half Ali et a. ILUMIEN III PCI Optimization algorithm Lancet 2016; 388: 2618-28
Lee Biomed Img 2017
Poon et al. EHJ 2017
Conclusions (1) • OCT & FFR assessment post stent implantation correlates moderately, reflecting the assessment of different characteristics of the same coronary artery • OCT & FFR both deliver surrogate measures • Careful clinical judgment to be made on which surrogate parameters to rely
Conclusions (2) OCT guided optimization of PCI: evidence acruing studies of OCT in stent thrombosis Bern Kopenhagen registry, PESTO, PRESTIGE OCT guided PCI • ClI-OPCI II,Ilumien I, OPINION, ILUMIEN III, ILUMIEN IV Established role of FFR in the pre stent implantation assessment Role of FFR post stent implantation remains limited Potential and limitations of CFD OCT-derived functional information
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