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PCI guidance with OCT is easier now with the development of the standardized step-by- step workflow (also referred as algorithm), MLD MAX, which is mnemonic for Morphology, Length, Diameter, Medial Dissection, Apposition and Xpansion. Using OCT with MLD MAX workflow can improve stent expansion4 without additional contrast while reducing radiation exposure compared to angiography-guided PCI.5 Stent expansion is linked to better PCI outcomes.6

The OCT catheter is intended for the imaging of coronary arteries. Available catheters include Dragonfly Opstar™ and Dragonfly™ Optis™ catheter.

The cross-sectional area of the vessel is visualized along the entire length of the examined vessel segment. It allows precise determination of the vessel diameter (mean reference diameter) and the length of the altered segment. The white marker is located at the position of the cross-section shown.

Achieving optimal expansion is proven to reduce rates of major adverse cardiac events during PCI9. Proper expansion confirmed by imaging results in safety and efficacy benefits.6

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To create an OCT scan, an OCT catheter is inserted into the vessel and an infrared laser is used to scan the vessel wall in a spiral-like manner. The laser beam penetrates the tissue 2-3mm deep, is reflected from there and returned to the OCT device via the catheter for evaluation.7

Due to the OCT systems’ high acquisition speed, images of pullback can be produced and visualized in a matter of seconds. The system provides precise information about the scanned vessel segment.7

OCTin Cardiology

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The hardware that runs the OCT software. OPTIS™ Systems use optical imaging catheters that emit near-infrared light to produce high-resolution real-time images. The OPTIS ™ Imaging Systems can be integrated with the cath lab angio systems to display OCT and angio co-registration (ACR) on the same screen.

Watch this video to learn how to initiate a pullback. The step-by-step instructions are also available on the OCT screen.

Optical coherence tomography

These images provide additional information on the degree and characteristics of coronary artery disease compared to angiography which doesn’t delineate the composition of the coronary artery.1 With automated, highly accurate measurements, OCT can guide stent selection, placement, and deployment.1

Note: In the absence of EEL to represent healthy tissue find the largest lumen to avoid areas of TCFA or lipid pools so as to not land your stent edge in these high-risk areas3

Cross-sectional visualization is used to obtain detailed findings, such as structures in the lumen and in the various layers of the vessel wall.

There are three types of dissections: intimal, medial and intramural hematoma. A dissection which penetrates the medial layer and > 1 quadrant arc needs to be treated although various recommended angles exist, including > 60 degrees.9 A simplified approach used by operators is to measure a 1 quadrant arc.

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Watch this video to learn how to set up the OCT system. These step-by-step instructions are available on the OCT screen for easy guidance.

Optical Coherence Tomography (OCT) is an intravascular imaging modality that uses near-infrared light to provide high-definition, cross-sectional and three-dimensional images of the vessel microstructure.

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Using OCT with MLD MAX workflow, the standardized step-by-step workflow, helps to guide pre- and post-PCI decisions. Use of the workflow resulted in an 88% change in treatment decisions8 compared to angiography alone without a change in contrast usage and a 10% reduction in radiation5, as shown in the LightLab Clinical Initiative.

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AHA/ACC 2021 Guidelines recommend intravascular imaging for PCI guidance because of limitations of angiography. OCT is recommended for stent implantation and to determine mechanism of stent underexpansion.

Ultreon™ 1.0 Software is the newest software that includes auto detection of certain components of the vessel based on artificial intelligence. The software is intended to be used only with compatible OPTIS™ Next Imaging Systems. The first generation AptiVue™ Software is intended to be used only with compatible OPTIS™ Imaging Systems.

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Watch these videos to learn more about each step of the MLD MAX workflow: Morphology, Length, Diameter, Medial dissection, Apposition, and Xpansion. If you are already using Ultreon™ 1.0 Software, see how to apply MLD MAX and Ultreon™ Software to an OCT-guided PCI.

Ultreon™ 1.0 Software is powered by artificial intelligence (AI) and automation. It has an improved and intuitive user-interface over the previous generation.