May 16, 2016 — In a new study using optical coherence tomography (OCT), an invasive laser imaging technique that provides high-resolution images, researchers found that maximum lipid arc and the presence of lipid plaque contralateral to the side branch (SB) ostium before stenting may contribute to significant side branch ostium stenosis (SBOS) after stenting. The results of the ORBID study were presented as a late-breaking clinical trial at the 2016 Society for Cardiovascular Angiography and Interventions (SCAI) annual meeting.
Stenting in the main vessel can result in significant SBOS, making it important for interventional cardiologists to be able to identify at-risk patients before they undergo percutaneous coronary intervention (PCI). Significant SBOS is defined as a blockage of 50 percent or more based on angiography. ORBID study researchers aimed to identify predictors of significant SBOS before a stent is introduced in the main vessel, using OCT, which is in the research-phase for this application. OCT is more accurate and provides higher resolution imaging than ultrasound, which is currently the most widely used method in clinical care.
“When inserting a stent into the main vessel of a patient, we have the option of also inserting a wire in the side branch in case SBOS occurs,” said Samin Sharma, M.D., FSCAI, an investigator of the study and director of clinical cardiology and intervention, dean of international clinical affiliations, and president of the Mount Sinai Heart Network, The Mount Sinai Hospital, N.Y. “In our study, OCT proved helpful in identifying predictors of SBOS prior to PCI, which may allow for avoiding inserting a wire in the side branch in select cases.”
The prospective single-center study analyzed 30 patients who did not have initial blockage in the SB ostium. Post-stenting significant SBOS was observed in 30 percent of patients. Affected patients were characterized by a higher prevalence of lipids in the blood (100 vs. 64 percent, p = 0.040) and spotty calcifications (60 vs. 0 percent, p = 0.005).
A multivariate logistic regression analysis identified maximal lipid arc (odds ratio [OR]: 1.014, p = 0.038) and the presence of lipid plaque contralateral to SB ostium (OR: 8.14, p = 0.046) before stenting as independent predictors of significant SBOS.
“This initial study indicates that OCT is a helpful tool in identifying predictors of significant SBOS in patients before they receive a stent,” Sharma said. “In the future, this imaging technology could be broadly introduced as a tool to identify at-risk patients, thereby giving interventional cardiologists more information before doing bifurcation stenting.”
Sharma reported no disclosures. The study was sponsored by Boston Scientific.
For more information: www. SCAI.org/SCAI2016