We r discussing some issues of OCT guided PPCI. Please share your thought regard this STEMI case.
A 39yo/M with Anterior STEMI , 4 hrs onset. LAD was occluded #OCT #PrimaryPCI @RoccoVergallo @BURZOTTA_F @ziadalinyc @MaeharaAkiko @twj1974 @YongcheolKim2 @BBpini @AbbottCardio
A 39yo/M with Anterior STEMI , 4 hrs onset. LAD was occluded #OCT #PrimaryPCI @RoccoVergallo @BURZOTTA_F @ziadalinyc @MaeharaAkiko @twj1974 @YongcheolKim2 @BBpini @AbbottCardio
Following thrombosuction, revealed severe stenosis in mid LAD. Would you directly advancing OCT or perform predilation ?
Japanese introduced C-Push and D-Push method. But we have no experience using that strategy, so the lesion was predilated using 2.0 mm balloon at nominal atm before advancing OCT catheter. Here it is the OCT result.
Based on OCT finding, what would you do ?
@PCRonline @DFCapodanno @matheenkhuddus @EuroInterventio @TCTMD @evandrofilhobr @YMurasato @mmamas1973
Tx all for the vote, the insight and suggest. Let me wrap up our discuss regard lesion assessment and PC strategy. I”ll upload what we did based on MLD -MAX workflow approach 
1. M-Morphology :
All agreed that the cause of STEMI was plaque erosion . No plaque rupture seen . There was residual white thrombus over an intact fibrous cap. We concurred unanimously it was not hard lesion. Some of us noticed there was minimal or spotty calcium.
All agreed that the cause of STEMI was plaque erosion . No plaque rupture seen . There was residual white thrombus over an intact fibrous cap. We concurred unanimously it was not hard lesion. Some of us noticed there was minimal or spotty calcium.
2.L- Length
There were good visualization of EEL prox and distal . It was short lesion. One of us suggested to reassess the severity of lesion distal to the culprit at the D2 bifurcation.
There were good visualization of EEL prox and distal . It was short lesion. One of us suggested to reassess the severity of lesion distal to the culprit at the D2 bifurcation.
3. D-Diameter
There was suggest to use EEL distal ref 4.0. It seems right opt , but due to acute phase we prefer less aggressive approach. We chose distal lumen diameter as the reference which showed 3.2 mm. Upsized to 3.5 mm
There was suggest to use EEL distal ref 4.0. It seems right opt , but due to acute phase we prefer less aggressive approach. We chose distal lumen diameter as the reference which showed 3.2 mm. Upsized to 3.5 mm
PCI strategy. Most of us agreed to stent (96%) . There were difference opinion regard the prep. Poll revealed 70% recomm direct stent, 26 % proposed predil. We opted to do direct stenting using 3.5/18 mm DES to 14 atm
Lets use MAX workflow of Post-PCI OCT to check whether we should optimize the stent. As you appreciated , post-OCT showed no stent edge Medial dissection.
Malapp at prox and inadequate Xpansion (62%). Do you want to optimize it ?
Unfort the MAX-workflow does not give a hint to appreciate the protruding tissue especially during PPCI. There was concern of distal emboli/no/slow flow if we chase ideal expansion
In dilemma situat we proceeded to Xpand the stent using less agressive approach. Postdilated using 3.5 NCB to 18 atm. Final OCT showed Malapp at prox , better eXpansion. Do you want to do some more Xpans. We decided to stop interv LAD, proceed implanting 1 stent to CX
Final Angio (1)
Final angio (2). Please share your thought regard OCT guided PPCI
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