Intracoronary imaging can provide detailed information on coronary plaque morphology and other lesion and vessel characteristics and can potentially lead to further optimization of percutaneous coronary intervention (PCI)-strategy. Optical coherence tomography (OCT) is a high-resolution intracoronary imaging tool with a 10-fold higher axial resolution than IVUS. OCT assists with detailed characterization of the coronary artery and lesion morphology before PCI, and thus facilitates optimal stent selection and stent deployment. Post-PCI, OCT assists in the evaluation of PCI results.

There may be difficulties in matching cross-sectional OCT images to the coronary angiogram, which could limit the use of OCT for imaging-guided PCI in clinical practice. Therefore, an innovative technology has been introduced which allows real-time Co-Registration of OCT images with angiography (ACR – Angio Co-Registration). ACR provides stent road and apposition indicators on the angiography. This technology helps in Precise positioning of the devices to treat the coronary lesion with precision.

The “OPTICO-Integration” (Effects of real-time co-registration angiography and OCT on PCI-Strategy; NCT02919943) study assessed the impact of online ACR on PCI strategy before and after PCI in patients with CAD. Preprocedural OCT imaging altered stent-length (58.9%), diameter (33.9%), and PCI-strategy (12.5%) in 71.4% lesions. The use of ACR led to additional changes in PCI strategy in 40.7% of mostly complex lesions in comparison to OCT imaging alone and involved mainly device landing zone (24.1%) and stent length (22.2%). Real-time OCT ACR thus had a significant impact on PCI strategy, favoring primarily complete lesion coverage, particularly in complex lesions.

This is therefore a new-generation OCT system that can help in Precision PCI.