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What is OCT?

Optical Coherence Tomography (OCT) is an imaging modality that uses near-infrared light to provide high-definition images of the artery with high precision allowing to access lesion characteristics and plaque morphology for coronary artery disease. OCT provides automated, accurate measurements to help guide stent selection, placement, and deployment.1

OCT Interface Visual
OCT User Interface. Pre-PCI pullback.
Photo on file at Abbott.

A - Angiogram co-registration denotes location of the cross-sectional OCT image
B - Vessel Cross-Section

- Lumen Profile (Volumetric representation of lumen area)
- Longitudinal View

Why OCT?

Using OCT with MLD MAX workflow to guide PCI reduces ambiguities impacting decisions on morphology assessment, vessel prep and stent sizing, decisions which may affect final stent expansion2, a leading indicator of adverse events.3

 

What is MLD MAX?

MLD MAX is the new standardized step-by-step OCT workflow to guide treatment decisions pre- and post-PCI.

Six letters represent six steps of the PCI goal to MAX-imize stent expansion to deliver optimal results. The first three steps, MLD, performed before PCI, designed to help inform treatment strategy, and the last three steps, MAX, performed post-PCI, to optimize stent placement. MLD MAX was developed as a part of the LightLab Clinical Initiative.

Achieving optimal expansion is proven to reduce rates of major adverse cardiac events during PCI2. Proper expansion confirmed by imaging results in safety and efficacy benefits.4

To learn more about each step, check out these short tweets.

pre-pci oct - strategize
post-pci oct - optimize

1. Fujino, A. et al. A new optical coherence tomography-based calcium scoring system to predict stent under expansion. EuroIntervention, April 2018; 13(18):e2182-e2189. 2. Prati, F. et al. The CLI-OPCI II Study. JACC: Cardiovascular Imaging, 2015: Vol 8, No. 11:1297-305. 3. Kubo, T. et al. Application of Optical Coherence Tomography in Percutaneous Coronary Intervention. Circulation Journal, September 2012: Vol. 76, 2076-2083. 4. Ali, Z. et al. ILUMIEN III: Optimize PCI. Lancet 2016, 388:2618-2628. 5. Souteyrand, G. et al. PESTO French Registry. European Heart Journal, 2016:37:1208-1216. 6. Meneveau, N. et al. DOCTORS Study. Circulation, September 2016, 134:906-917.; Zhang, J. et al. The ULTIMATE Trial. Journal of the American College of Cardiology, Dec 2018: Vol 72, No 24:3126-37.; Russo, R. et al. The AVID Trial. Circ Cardiovasc Intervent, April 2009; 2:113-123.; De Jaegere, P. et al. MUSIC Study. European Heart Journal, February 1998:19,1214-1223.

References

  1. Reyes, M. The next innovation in PCI is not a stent. The value of OCT. CathLab Digest. Oct 6, 2019. Volume 27, Issue 10.
  2. Räber L, et al. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J. 2018;39(35):3281-3300.
  3. Bezerra, H. et al: Analysis of changes in decision-making process during OCT-guided PCI -Insights from the LightLab Initiative. EuroPCR2020 Presentation.
  4. Zhang J, et al. Intravascular ultrasound versus angiography-guided drug-eluting stent implantation: the ULTIMATE trial. J Am Coll Cardiol. 2018;72(24):3126-3137.
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