Value of Optical Coherence Tomography in Optimizing Chronic Total Occlusion Percutaneous Coronary Intervention

Background:
OCT has a multitude of uses in PCI that are particularly relevant for CTO PCIs. However, OCT is used in only 3% of all CTO PCI procedures and the practical value of OCT use in CTO PCI is not well described.

Methods:
The procedure reports, PCI angiograms, and electronic medical record of patients who underwent CTO PCI at a tertiary care center between August 2015 and August 2017 were reviewed. Follow-up was obtained primarily by review of the electronic medical record.

Results:
A total of 63 patients received CTO PCI procedures. OCT was utilized in 19 cases. Antegrade wire escalation techniques was used in all the cases in which OCT was utilized. The most common use for OCT was for stent optimization. In cases in which OCT was not utilized, antegrade wiring was the most common approach (77.3% of cases) followed by antegrade dissection and re-entry (18.2% of cases) and retrograde (13.6% of cases) approach. CTO PCI procedures utilizing OCT as compared to non-OCT cases had no significant increase in total contrast used (246.4 ± 97.3 mLs in the OCT group vs. 212.2 ± 103.6 mLs in the no-OCT group; p=0.229) or total fluoroscopy time (41.1 ± 18.7 mins in the OCT group vs. 37.4 ± 18.7 mins in the no-OCT group; p=0.487). There was no significant increase in peri-procedural complications in procedures utilizing OCT. Procedural characteristics and outcomes for all CTO PCI procedures are shown in Table 1.

Conclusions:
We conclude that OCT use in CTO PCI can be a valuable tool to optimize CTO PCI result without significant increase in the morbidity of the procedure. Large prospective randomized controlled trials are needed to validate the results of this single-center, retrospective study.