functional assessment of stents Prof. T. Adriaenssens, MD, PhD - - PowerPoint PPT Presentation

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functional assessment of stents Prof. T. Adriaenssens, MD, PhD - - PowerPoint PPT Presentation

Feb 22, 2023 837 likes •1.11k views

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

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Relation between OCT imaging & functional assessment of stents

  • Prof. T. Adriaenssens, MD, PhD

University Hospitals Leuven, Belgium

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OCT & FFR post stent implantation: Should they relate?

  • OCT: detailed cross sectional

morphological assessment of the stented segment + prox & distal edge

  • Cross sections in segment of

interest (50-70 mm); absolutely no information on the rest of the vessel

  • Does not take into account the

magnitude or the viability of the territory supplied

  • FFR: reflection of the susceptibility

to impaired flow at maximal hyperemia (functional assessment)

  • Values to be interpreted for the

whole coronary artery (with some local information to be derived based on pressure drops, to be interpreted with caution)

  • Takes into account the magnitude
  • r the viability of the territory

supplied

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OCT & FFR post stent implantation: Should they relate?

  • OCT: detailed cross sectional

morphological assessment of the stented segment + prox & distal edge

  • Cross sections in segment of

interest (50-70 mm); absolutely no information on the rest of the vessel

  • Does not take into account the

magnitude or the viability of the territory supplied

  • FFR: reflection of the susceptibility

to impaired flow at maximal hyperemia (functional assessment)

  • Values to be interpreted for the

whole coronary artery (with some local information to be derived based on pressure drops, to be interpreted with caution)

  • Takes into account the magnitude
  • r the viability of the territory

supplied

not necessarily…

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Events post ACS: culprit lesion vs. non culprit lesion

Stone et al. PROSPECT NEJM 2011; 364: 226-35.

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  • Relation OCT (IVUS) ~ FFR in native CAD
  • Value of FFR post PCI
  • Relation OCT ~ FFR post stent implantation
  • Future directions (computational flow dynamics)

Relation between OCT imaging & functional assessment of stents

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OCT & IVUS: moderate efficiency in identification of severe CAD

Gonzalo et al. J Am Coll Cardiol 2012; 59: 1080-9.

Optimal cutoff MLA 1.95 mm2 Sensitivity 82%, specificity 63% Optimal cutoff IVUS MLA 2.36 mm2 Sensitivity 82%, specificity 63%

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Koo et al. JACC Intv 2011; 4: 803-11.

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Nam et al. Am J Card 2011; 107: 1763-67.

Prognostic value of FFR post PCI

1 year clinical outcome after PCI with DES

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Piroth et al. Circ Cardiovasc Interv 2017

POST-PCI FFR measurement in FAME 1 and FAME 2

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Piroth et al. Circ Cardiovasc Interv 2017

POST-PCI FFR measurement in FAME 1 and FAME 2

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POST-PCI FFR measurement FAME 1 and FAME 2

Piroth et al. Circ Cardiovasc Interv 2017

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POST-PCI FFR measurement FAME 1 and FAME 2

Piroth et al. Circ Cardiovasc Interv 2017

FFR: predictive value too low to act as surrogate EP or to guide PCI optimization

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Meneveau et al. Circulation 2016; 134: 906-17.

DOCTORS: OCT guided PCI: effect on final FFR

0.94±0.04 0.92±0.05

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ILUMIEN I: Paired final FFR and OCT measurements following optimization

Wijns et al. ILUMIEN I. Eur Heart J 2015; 36: 3346-55.

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Reith S. et al. J Inv Card 2015; 27: 222-8.

Relation between OCT and FFR after PCI: few studies

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Reith S. et al. J Inv Card 2015; 27: 222-8.

Relation between OCT and FFR after PCI

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Li JACC CV Intv 2017; 10: 986-995.

Mechanisms concurring to a lower post-PCI FFR value

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PRESTIGE: Dominant OCT Imaging Factors for ST

Adriaenssens et al. Circulation 2017; 136: 1007-21.

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20 40 60 80 100

100 57,1 21,4 7,1 14,2 14,2

Acute ST Subacute ST Late ST VLST

PRESTIGE: Possibly Contributing Imaging Factors

Adriaenssens et al. Circulation 2017; 136: 1007-21.

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Taniwaki et al. Circulation 2016; 133: 650-660

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Proximal MSA Proximal half 121% Expansion Proximal Reference Ali et a. ILUMIEN III PCI Optimization algorithm Lancet 2016; 388: 2618-28

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Lee Biomed Img 2017

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Poon et al. EHJ 2017

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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

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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

Conclusions (2)