الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Coronary angiography is routinely used to guide the invasive treatment of coronary artery disease. However, even the most experienced interventionalist, confronted with lesion and patient complexity, may face doubts in decisions based only on the angiographic lumen profile. A number of limitations of coronary angiography (eg, limited planar resolution to inform on complex 3-dimensional anatomy, limited reliability in assessing true area and length dimensions, and low sensitivity in detecting calcium) may affect decisions made during percutaneous coronary interventions (PCI). Accordingly, decision making on lesion preparation and assessment of the immediate stent results are the cornerstones of patient outcome. Optical coherence tomography is a high-resolution light-based intravascular imaging modality that immediately provides after acquisition automatic detection metrics of the coronary lumen and stents across the entire explored vessel. Because of the high frame rate in acquisition and the high-speed pullback, OCT automatically displays a pristine longitudinal lumen contour that is easier to measure and interpret. OCT can differentiate tissue characteristics based on the polarization properties of light, permitting precise analysis of plaque morphology, composition, and distribution. Calcification strongly correlates with advanced atherosclerosis, increased age and comorbidities. The presence of calcified and rigid lesions makes PCI challenging, often requiring adjuvant techniques to achieve satisfactory stent results. The aim of this study was to evaluate the role of optical coherence tomography, and how it affects the operator decision in management and optimizing percutaneous coronary intervention for complex coronary lesions, including left main and non-left main bifurcation lesions, calcific lesions and in stent restenosis. The study was a prospective observational single center study, conducted in Cardiovascular department, Policlinico Largo Agostino Gemelli, Catholic university of Sacred Heart, Rome, Italy. It was carried out on 60 patients underwent elective PCI for complex coronary lesions, starting from December 2019 to December 2020. Patients included in this study were categorized into two groups according to the change in the operator opinion after performing OCT, either before or after stenting. • group I (n=19) patients with no change in operator decision based on OCT. • group II (n=41) patients with change in operator decision based on OCT. Among the 60 patients included in the study, the decision of the operator was changes in 41 patients (68%). The change based on the pre-PCI assessment was found in 21 patients (51% of all changes). The changes were either change in the number of stents, the technique of the bifurcation intervention, or the need of atherectomy devices in calcific lesion for good lesion preparation. The change in the decision based on pots-PCI OCT only was found in 10 patients (41% of all changes). The main change of the procedure based on post-PCI OCT was mainly further post dilatation due to mal-apposition or significant tissue protrusion, or implantation of another stent for distal edge dissection.