Percutaneous coronary intervention (PCI) is mostly guided by angiography which has well-established limitations:
Multi-phase LightLab data gives further insights into the limitations of angiography in the cath lab and highlights the benefits of using intravascular imaging with OCT.
The workflow facilitates utilization of OCT information to guide treatment decisions during PCI: assessment of lesion Morphology, Length, and Diameter (MLD) from pre-PCI OCT pullback and optimization of stent placement for Medial dissection, stent Apposition, and stent Xpansion (MAX) from the post-PCI OCT pullback.
OCT makes it easy to detect underexpansion. Ultreon™ 1.0 Software displays instantaneous calculations of expansion and apposition values, reference lumen diameter and lumen diameter values in color-coded markers: stent underexpansion indicator—orange, stent malapposition indicator—yellow.6
Implementing OCT with MLD MAX workflow pre- and post-PCI improves PCI safety and efficiency compared to PCI guided by angiography alone.2
When operators use OCT with the full MLD MAX workflow (pre-PCI OCT and post-PCI OCT) vs performing post-PCI OCT only, procedural benefits include reduced rate of underexpansion and malapposition, reduced use of contrast and decreased need for further optimization.5
Compared to PCI performed by angiography guidance alone, implementing an OCT-guided MLD MAX workflow decreased radiation exposure with no difference in contrast utilization and enhanced procedural efficiency by guiding proper device selection, leading to less product utilization and fewer unplanned treatments.
OCT imaging with MLD MAX workflow supports complete vessel evaluation, proper lesion preparation and optimization which are critical to achieve optimal stent expansion. Inadequate stent expansion is the most important predictor of subsequent stent failure due to stent thrombosis (ST) or restenosis.2
LightLab is a multiphase prospective observational data-gathering study conducted between January 2019 and June 2021, with 17 participating hospitals and physicians in the US. Data were gathered in real-time, where OCT guidance was employed during PCI using a standardized OCT-guided workflow MLD MAX.
The LightLab Clinical Initiative was designed in multiple phases to facilitate regular adoption of the MLD MAX workflow during PCI to improve operator and procedural efficiency, and to expand the workflow into increasingly complex procedures.
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