Application of Optical Coherence Tomography in Determining Stent Deployment Position in Coronary Artery Left Main Bifurcation Lesions

Abstract

Objective: To investigate the clinical value of optical coherence tomography (OCT) in determining stent deployment position and post-procedural optimization during percutaneous coronary intervention (PCI) for coronary artery left main (LM) bifurcation lesions. Methods: A total of 90 patients with LM bifurcation lesions were prospectively enrolled and randomly assigned to an OCT-guided group (45 cases) and an IVUS-guided group (45 cases). Both groups received intravascular imaging guidance in addition to standard angiography. The intraoperative imaging findings, accuracy of stent deployment position, postoperative hemodynamic improvement, and 12-month major adverse cardiovascular events (MACE) were compared. Results: The post-procedural minimal stent area (MSA) in the OCT group was significantly larger than in the IVUS group (8.6 ± 1.2 mm 2 vs 7.8 ± 1.1 mm 2 , p < 0.01). The incidence of malapposition was lower (6.7% vs 17.8%, p = 0.04). The rate of additional optimization due to edge dissection or malapposition during the procedure was higher (31.1% vs 15.6%, p = 0.03). At 12-month follow-up, the MACE rate in the OCT group was 8.9%, lower than the IVUS group’s 20.0% (p = 0.045). Conclusion: OCT can more precisely identify lesion borders and ostial morphology in LM bifurcation lesions, and is superior to IVUS in determining stent deployment position and post-procedural optimization. This suggests its higher clinical application value in complex bifurcation lesions.