Zero-Contrast Optical Coherence Tomography- and Physiology-Guided Percutaneous Coronary Intervention for Severely Calcified Lesion.

Abstract

Please find supplementary file(s); http://dx.doi.org/10.1253/circj.CJ-19-0302 A n 80-year-old man with severe kidney dysfunction (estimated glomerular filtration rate, 26 mL/min/ 1.73 m2) not requiring hemodialysis presented with effort angina. Diagnostic angiography with minimum contrast showed a diffuse lesion in the proximal right coronary artery (RCA; Figure A). On a later day, optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) with dextran injection was performed. Because multiple cracks were seen in the severely calcified lesion after pre-dilation (Figure B,C; Supplementary Movie 1), an everolimus-eluting stent (3.25–33 mm) was implanted (Figure D). The final OCT showed sufficient luminal expansion (minimum stent area, 6.01 mm2; Figure E,F; Supplementary Movie 2), and the fractional flow-reserve (FFR) indicated no residual ischemia (Figure G–J). No contrast medium was injected during the procedure. The alternative dextran injection facilitated OCT of sufficient quality, and further FFR assessment confirmed that PCI was hemodynamically sufficient. Zero-contrast OCT-guided PCI in combination with FFR assessment is Received April 5, 2019; revised manuscript received May 7, 2019; accepted May 12, 2019; J-STAGE Advance Publication released online May 28, 2019 Time for primary review: 29 days Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan Mailing address: Yoshiyasu Minami, MD, PhD, Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan. E-mail: [email protected] ISSN-1346-9843 All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: [email protected] Zero-Contrast Optical Coherence Tomographyand Physiology-Guided Percutaneous Coronary Intervention for Severely Calcified Lesion