Randomized comparison of stent strut coverage following angiography- or optical coherence tomography-guided percutaneous coronary intervention

Introduction and objectives: The clinical benefits of optical coherence tomography-guided percutaneous coronary intervention are unclear. Therefore, in this study we sought to evaluate the impact of optical coherence tomography guidance on stent strut coverage following drug-eluting stent implantation.

Methods: A total of 101 patients in 105 lesions were randomly assigned to receive percutaneous coronary intervention under either optical coherence tomography guidance (n = 51 lesions of 50 patients) or angiography guidance (n = 54 lesions of 51 patients), and underwent a follow-up optical coherence tomography examination 6 months after zotarolimus-eluting stent implantation. The primary and secondary end points were the percentage of uncovered and malapposed struts, respectively, on 6-month follow-up optical coherence tomography.

Results: The percentage of uncovered struts was significantly lower in the optical coherence tomography-guided arm (1.60% [1.84]%, [median, 1.06%] vs 4.51% [5.43]% [median, 2.38%]; P = .0004) at 6-month follow-up. The incidence of stents with ≥ 5.9% uncovered struts was also significantly lower in the optical coherence tomography-guided arm (2 patients [3.9%] vs 14 patients [25.9%]; P = .002). In addition, the percentage of malapposed struts was significantly lower in the optical coherence tomography-guided arm (0.19% [0.51]% [median, 0.0%] vs 0.98% [2.53]% [median, 0.0%]; P = .027).

Conclusions: Optical coherence tomography-guided percutaneous coronary intervention significantly reduced the incidence of uncovered stent struts at 6 months compared to angiography-guided percutaneous coronary intervention. These findings suggest that optical coherence tomography-guided percutaneous coronary intervention has a beneficial effect on drug-eluting stent strut coverage.