Presence and severity of coronary artery calcification is growing; up to 25% of patients, or 1 in 4, have moderate to severe calcium.2 If left undiagnosed and untreated, coronary artery calcification adversely impacts PCI outcomes.3
From left to right: Superficial almost 360 degree calcium; Calcific nodule from 12-3 o’clock and from 8-10 o’clock; Superficial 360 degree concentric calcium that’s fractured at 3, 6 and 9 o’clock.
OCT workflow, MLD MAX guides a user through treatment decisions for pre- and post- PCI. The first step of the workflow is to assess Morphology (M) to understand what type of plaque you are dealing with and how to best prepare the vessel before stenting. In calcified lesions, this assessment helps to determine the type of calcific plaque and its severity.
In LightLab Clinical Initiative,5 physicians changed lesion prep strategy in nearly 1/3 of lesions after they assessed lesion morphology and severity with OCT. When a change in vessel prep strategy occurred, calcification was the predominant morphology as seen with OCT.
In the LightLab case, pre-PCI angio assessment and planned treatment approach (left image) was changed after performing pre-PCI OCT (right image).
The impactful changes include:
The use of intravascular imaging allows for more specific characterization and quantification of calcification compared to angiographic calcium classification as mild, moderate, or severe.
OCT helps to classify calcium into deep, superficial and nodular, as well as eccentric or concentric calcium. Morphology, and calcium, assessment is performed in the first step of the MLD MAX workflow. M- Morphology, is an important factor in determining the optimal treatment approach because different types of calcium require a different treatment technique.1
Measuring calcium depth with an OCT-based calcium scoring algorithm can help identify calcific lesions that would benefit from plaque modification before stent implantation.6 This algorithm looks at calcium thickness, calcium angle and calcium length which are among the most important parameters used to predict the need and success of calcium modification devices.
≤ 90° 0 point
90° < Angle ≤ 180° 1 point
> 180° 2 points
≤ 0.5 mm 0 point
> 0.5 mm 1 point
≤ 5.0 mm 0 point
> 5.0 mm 1 point
1 0.5 mm thickness
2 50% vessel arc
3 5.0 mm long
OCT is the best imaging modality to detect, localize and quantify coronary calcium.8
Coronary angiography, coronary computed tomography (CT), intravascular ultrasound (IVUS), radiofrequency (RF), intravascular ultrasound-virtual histology (IVUS-VH), and optical coherence tomography (OCT) can all detect and attempt to localize and quantify calcium, albeit with very different diagnostic accuracies, as concluded by Gary Mintz after 20 years of intravascular imaging studies of the relationship between calcium and coronary atherosclerosis.8
|Coronary Angiography||CT||IVUS||RF-IVUS (IVUS-VH)||OCT|
|Detection of coronary artery calcium||+||+++||+++||+++||++++|
|Localization of coronary artery calcium||+||+++||+++||+++||++++|
|Quantification of coronary artery calcium||+||+++||++||+++||++++|
Successful PCI and reduction in future revascularizations are closely tied to final stent expansion.1 Coronary artery calcification is often underappreciated by angiography because angiography underestimates morphological lesion severity which impacts treatment strategy.5
Using OCT imaging with MLD MAX workflow to guide PCI helps to determine the right treatment approach and achieve optimal stent expansion. In LightLab, operators achieved 80% minimal stent expansion on average when following MLD MAX workflow.
You are about to enter an Abbott country- or region-specific website.
Please be aware that the website you have requested is intended for the residents of a particular country or countries, as noted on that site. As a result, the site may contain information on pharmaceuticals, medical devices and other products or uses of those products that are not approved in other countries or regions
Do you wish to continue and enter this website?