'Complex coronary artery disease', optical coherence tomography improves prognosis
Sep 05, 2024
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A research team led by Kim Byeong-geuk, Hong Seong-jin, Lee Seung-joon, and honorary professor Jang Yang-soo at Yonsei University announced on the 5th that when treating complex coronary stenosis, which refers to a condition that requires high-level procedures due to its very complex shape, intervention based on optical coherence tomography lowers the incidence of various complications by nearly 40 percent and increases the success rate of stents being inserted normally into blood vessels.
The results of this study were published in the latest issue of the world-renowned international medical journal Lancet (IF98.4).
When blood vessels narrow due to blood clots (blood cakes) in the coronary arteries that supply blood to the heart, coronary stenosis occurs, which causes blood flow disorders. It can lead to various diseases such as angina. At this time, coronary artery stenosis can occur in a wide variety of shapes, including chronic obstructive lesions, branch lesions, left main lesions, and calcified lesions. This is called a combined coronary stenosis.
In the past, percutaneous coronary intervention (PCI) in which a stent is inserted by administering a contrast agent into a blood vessel to treat coronary stenosis has been commonly performed. However, if PCI is performed for complex coronary stenosis, not only the difficulty of stent insertion increases, but also the seating rate decreases, and the incidence of complications increases due to damage such as inner membrane dissection to blood vessels.
The research team paid attention to optical coherence tomography (OCT) as a way to improve treatment outcomes. Using OCT, which photographs blood vessels in 3D, we can clearly identify the anatomical structure and obtain the information needed to establish a treatment plan for complex forms of stenosis.
The research team compared and analyzed the treatment outcomes of 1604 patients with complex coronary stenosis treated at more than 20 institutions across the country, including Severance Cardiovascular Hospital, from January 2019 to September 2022.
As a result, 7.4% of patients in group A (801) who underwent conventional PCI procedures based on contrast administration developed side effects such as cardiovascular death, myocardial infarction, stent thrombosis, and vascular reperfusion by ischemia. On the other hand, in group B (803) who received OCT-based intervention, complications were about 38% lower at 4.6%.
The research team analyzed that these results resulted from improved 'stent optimization', such as the stent being seated in blood vessels without gaps and reducing damage to the inner wall of blood vessels by securing stent insertion space. This is because it is possible to establish a 'customized treatment plan' according to individual patients by reflecting the shape and characteristics of blood vessels even in coronary artery stenosis, which is complexly formed through OCT-guided intervention that provides 3D images of blood vessels.
In fact, the medical staff who performed OCT-guided intervention were able to more accurately check the appropriate size and insertion location of the stent according to the coronary stenosis, which may vary from patient to patient. Even after insertion, it was easy to proceed with auxiliary procedures such as balloon dilatation to increase the stent seating rate.
Professor Kim Byung-keuk said, `OCT-guided intervention provides blood vessel shape in 3D images, which greatly helps establish customized treatment plans according to individual conditions.' `We expect that the treatment guidelines will change through this study, which is the first to reveal the prognostic improvement effect of OCT-based intervention in the treatment of complex coronary artery disease.'
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