https://orcid.org/0009-0006-4394-867X
Case report
Optical coherence tomography (OCT) imaging has emerged as an invaluable tool for the examination of coronary anatomy with known technical limitations for the evaluation of aorto-ostial lesions. We present a clinical case that underscores the advantageous integration of an OCT catheter in conjunction with a guide extension catheter (GEC) to allow the evaluation of a diseased left main coronary artery (LMCA).
A 67-year-old man presented in our institution for unstable angina, caused by an 80% stenosis at the ostium of the LMCA.
Initial attempts at OCT imaging were hindered by the guiding catheter obstructing the LMCA ostium. The use of a GEC allowed the retraction of the EBU catheter from the left main, while still providing selective contrast delivery mandatory for OCT imaging. We used three different GEC: Guidion, Guideliner and Telescope, each measuring 150 cm in length, 6F in diameter, with a 25 cm distal extension. They all enabled OCT imaging but presented a short blind spot at their distal tip, due to a radiopaque marker, limiting OCT visualization by 1–2 mm (see Supplementary material online, Videos S1 and S2). The Telescope GEC utility in analogous scenarios has been published; however, it is pertinent to note that if alternative GEC proved to be compatible with OCT, they all (Telescope included) revealed circumscribed blind spots, refractory to near-infrared light, resulting in limited constraints for OCT imaging (Panels A–F). Nevertheless, angioplasty of the LMCA was successfully performed. To ensure a proper aorto-ostial evaluation, the GEC needed to be engaged over a length of at least 5 mm within the vessel.
Our report supports the belief that the synergy between GEC and OCT presents significant promise for intravascular coronary assessments, notably for aorto-ostial studies. Additionally, this combination not only facilitates the OCT catheter deliverability but has also the potential to decrease the volume of contrast injection required, thereby enhancing overall imaging quality.
Supplementary material
Supplementary material is available at European Heart Journal – Case Reports online.
Consent: The authors confirm that written consent for the submission and publication of this case, including images and videos, has been obtained from the patient in line with COPE guidance.
Funding: None declared.
Data availability
The data underlying this article are available in the article and in its online supplementary material.
Author notes
Conflict of interest: None declared.
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