Watch out Proceed with caution.pptx
SA Heart
Saturday 10 September Room 1,61 1,64Session 3011h40 12h05 Ernest Horsley Watch out! Proceed with caution.
Saturday 10 September 2016Room 1,61 1,64Session 3011h40 12h05 Watch out! Proceed with caution. (dissection/complications case) Ernest Horsley (N1 City Hospital, Cape Town)
Imaging For The Future
Compare the clinical value of FFR, iFR and OCT and how it will contribute to the patient outcome Investigate the basic measurements and visuals derived from FFR, iFR and OCT and their application Review the advantages and disadvantages associated with FFR, iFR and OCT
11h40 12h05 Watch out! Proceed with caution. (dissection/complications case) Ernest Horsley (N1 City Hospital, Cape Town)
1.To identify the role of a technologist in performing imaging procedures2. To demonstrate the clinical application of using OCT in a patient that has a dissection in a coronary artery3. To discuss the decision making process in using the OCT results
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Intravascular Optical Coherence TomographyImaging For The FutureErnest HorsleyDiagnostic Radiographer
Introduction
Watch out! Proceed with caution
10 September 2016 Room 1,61 -1,64 Session 30
[ of note the Watch out! Proceed with caution..Was in relation to case study for SCAD (Spontanious Coronary Artery Disection) and or stent dissectionBut we did not have any to present
Maybe to point out that we need to do more OCT in woman between the ages of late 30s to early 50s that present with chest pain as it is often missed and OCT is the right tool to demonstrate SCADAs well as Stent dissection]2
Angiography
ACRMSOOCT123
The workflow of the slide show is as followsFirst Ill have a light look at Optical Coherence TomographyFollowed By Angio Co-Registration WorkflowAnd Lastly the new Metal Stent Optimisation software3
Angiography
Delineating eccentric plaque Assessing lesions of moderate severityInherent Limitations to Diagnostic AngiographyOverall plaque burden and compositionAppreciation of ostial lesionsCulprit lesion assessment in Acute InfarctSide branch analysis in bifurcation lesionsCalcified lesions pseudo-thrombus
The limitations of angiography in itself - are inherently limitless, it seems
42 is the answer to the ultimate question in lifeUnfortunately no one knows what the question is
But increasingly our knowledge and understanding of our own biological viceshave let us in turn to more clarification 4
Timeline
Basic principles initially used within optical radar & telecommunications applications for biological tissue imaging1980s
developed sub-categories& investigating use of OCT in biomedicalapplications1990s
2000scommercial retinal OCT becomes imaging standard in ophthalmology
2010commercial intravascular OCT imaging becomes standard in cardiology
2013commercial endoscopic OCT imaging
Optical Coherence Tomography OCT has been borrowed from other industries.In shortIts use in art restoration, the ability to see the layers and structure without damaging the art work - peaked an interest in the application in the medical arena.
1988 saw the first paper on the application on biological tissue and during the early 1990s it found its feet in Ophthalmology Before the end of the 90s OCT had established itself in Ophthalmology and its research in microstructural changes of in vivo vascular biology of the coronary vessel, started establishing OCT as an diagnostic tool in the detection of vulnerable or high-risk plaque - improving the understanding of the treatment of acute myocardial infarction
From the early 2000 (2002), in conjunction with LightLab & St Jude Medical, resulted in the development of the commercial devices that today forms the standard in intravascular coronary OCT5
Timeline
Although this slide shows the number of OCT publications per annum - it is noteworthy to see the adoption of OCT in the medical specialities
For instance the assessment of the Radial Artery for coronary bypass graft harvesting
OCT is not new,OCT is not a niche,OCT is not just for research6
What is OCT
Optical CoherenceTomographyrefers to the ability of a light wave to produce interference patterns[ ]
So what is in a name?
Optical Coherence refers to the ability of a light wave to produce interference patterns
Woopy! So what?!
Well, most of the light is not reflected back to the sensor but rather scattered it is this scattered light that would normally dull an image - information overload if you like
But by using this interferometry technique of superimposing two or more waves, and detecting the optical coherences, Background scatter is rejected, while mostly directly reflected light is recorded
It is this clear signal that gives OCT its high resolution, and the ability to build up clear 3D imagesIt is also one of the reasons the tissue penetration is only a few millimetre
And that is why it is called Optical Coherence - Tomography7
What is OCT
Uses echo-location principle
Low Near-infra-red light (eye safe) Ultrasound 1,540 m/secLight 299,792,458 m/sec
Superluminescent Emitting Diode (SLED) monochromatic light (800-1300nm, 5mW)
Simply explained OCT is an optical IVUS on visual steroids instead of ultrasound OCT uses Low Near-Infra-Red (Eye Safe) laser light
It still uses the echo-location principal like IVUS
But because the speed light is faster than the speed of sound it is faster to acquire and coupled with the interferometry technique it provides tissue morphology/microstructure and pathology at a much higher resolution equivalent to a low-power microscope, thus OCT is sometimes referred to an optical biopsy
The technique is limited to imaging 1 to 2mm below the surface in biological tissue8
What is OCT
And just to give you an simple representation to understand the context of the resolution of OCT with regard to the tissue microstructure9
Angio Co-Registration
OPTIS Integrated SystemProduct GoalsStrengthen the link between physiological (FFR) and anatomical (IVOCT & angio) assessment and sub sequent therapeutic actionProvide the physician with increased controlEase-of-use and procedural workflowMake FFR and OCT an integral part of the cath labClinical BenefitsImmediate availability during PCIFull FFR/OCT system control from tablesideRapid set-up without making cable connectionsDirect tableside control of acquisition and analysis by physicianEnables real-time angio co-registration with OCTData displayed on overhead (boom) monitor
You can think of Integrated Systems, the same you would about the Internet of Things (IoT) concept but for Cathlabs
Individual component are seamlessly linked to the whole
You dont have to think or worry about how to incorporated it in to what you do and the time it will add to the procedureIt becomes the procedure the physician just chooses the tool they require to assess the next step
It is Plug and Play
[The on-demand OPTIS system integrates seamlessly into your cath lab, eliminating setuptime and giving you tableside control of optical coherence tomography (OCT) and fractionalflow reserve (FFR) acquisition and review from the sterile field. In addition to workflowefficiencies offered by direct proximity, the always-on, always-ready system optimizes PCIworkflow without adding significant time.]10
Angio Co-Registration
How does it work ?The Software uses the catheter pullback marker bands visible in the angio cine to create the co-registration imagesKey BenefitsFacilitates OCT guided PCICollects key clinical vessel information one angioReduces learning curve to assess location of OCTIncreases confidence in position OCT features Improves workflow efficiency into PCIReduction in contrast & radiation with regard to OCT without AC-RAngio co-registration will facilitate the integration of the OCT pullback into the PCI workflow
Basically co-registration links the intravascular image (be it OCT or IVUS) with a specific angiographic point in the artery- represented by the lens of the intravascular device
There are check an balances as you still need to tell the software at which artery you are looking at and it should be looking at
What co-registration does, is it makes it simpler to show a relationship with the morphology an pathology in an intravascular imaging - with that of an easy recognisable angiographic landmark, that we all are already used to
So it guides the PCI Procedure where, why, how long and just as important - why not
It installs relative confidence - by removing the guess work,not only of the image that we see on the angiogram, -where does that dissection start?but that of the intravascular image too - if we did not use co-registration
When it is all we can go have a look at what a good job was done too stent apposition11
Angio Co-Registration
OPTIS Integrated System ArchitectureDragonfly OPTIS Imaging Catheter featuresOPTIS Integrated System SettingsInjector Pump SettingsX-Ray Equipment SettingsAngio Co-Registration (ACR) OutlinesOPTIS Integrated System Workflow
To perform an OCT Angio Co-Registered pullback we require the right equipment, use the right setting and follow the right workflow
Let's start with the Equipment12
Architecture
OPTIS Integrated System
OperatorMonitorSlaveMonitorOPTIS Mobile SystemOPTISSystem CabinetIlumienOPTIS
AngioCo-Registration
Connectivity Box
The OCT Integrated System Architecture consists of basically two offerings
The first is a fixed free standing unit with a PC interface in Control room
The OPTIS System Cabinet is fully Integrated with OCT, FFR and Angio Co-Registration
The Second Mobile unit can now be converted to offer Angio Co-Registration by adding a Connectivity Box13
Architecture
OPTIS Mobile SystemConnectivity Box
The Connectivity Box is mounted to the x-ray table and is connected into the x-ray feed to make Angio Co-Registration available to the Ilumien OPTIS
Cables from the Connectivity Box are then connected to the Ilumien for Co-Registration capability.14
Architecture
Drive-motor & Optical Controller (DOC)
Tableside Controller
Wi-Box
Other components are:
The Drive-motor and The Optical Controller - to which the OCT Imaging Catheter is connected toThe Tableside Controller for the Integrated Systemit has quick-key buttons for ease of useand a fully controllable mouse or joystick, pivot, twist and select by pressing the button on top of the joystick
Not only can you fully control the OCT system with the TSC, you can control other integrated units like the FFR Wi-Box15
Architecture
Dragonfly OPTISImaging CatheterOuter Diameter2.7 Fr (0.90mm) Distal 280mmLow-profile tipDeliveryRapid Exchange MonorailDual lumenWorking Length135cmCoatingHydrophilic coatingMin Guiding Cath6 Fr Guide Catheter 100cmNo SideholesMax Guide Wire 0.014
Distal MarkerOptical Lens &Lens MarkerProximalMarkerGuide wire &Rapid Exchange Lumen
OPTIS Integrated SystemILUMIEN OPTISILUMIEN PCI Optimization Systems*
And the last of the OCT architecture
The OCT Imaging Catheter
A total working Length of 135cm of witch the last 280mm that goes into the artery is low profile - 2,7 Fr
The Imaging Catheters Hydrophilic coat needs to be wiped with Heparinised saline to be activated
It consists of three markers that the software uses to track the pullback and helps with the placement of the catheter inside the artery
The Distal MarkerThe Lens Marker And The Proximal Marker 50mm from the Lens Marker
50 mm is the shortest scan that the device can perform16
System Settings
OPTIS Integrated System SettingsPULLBACKSurveyHigh Resolution*ReasonLesion SurveyStent SurveyLength75 mm54 mmSpeed180 frames/sec36 mm/sec5 f/mm18 mm/sec10 f/mmTime2,1 sec3,0 secFile Size375 MB540 MB
TriggerManual*/AutoAutomaticAcquire AngioYesNo*
Depending on what you are doing
You have a Survey Mode length for general OCT and a High Resolution Mode length for Regions of Interest Like a Stent
The High Resolution 54 mm moves at a lower speed but at the same time acquiring more frames, thus having more detailed information at the end of the pullback
If you are doing an Angio Co-Registration it is important to remember to select/Tick the Acquire Angio box or the system will not know to follow the markers
We were trained on Manual triggered Pullback but there is no reason for Manual Tigger unless there are complications with the Co-registration or Pullback Automatic works.
Whether to leave out co-register while doing a High Res pullback for a stent is debatable to save on radiation we do it for the co-registration information it provides as we still only use contrast for pullbacks.
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System Settings
Injector Pump Settings
Manual PullbackContrast Volume**35m @3m/s = 11.6 sec40m @4m/s = 10 sec
Automatic PullbackContrast Volume*14m @4m/s = 3.5 sec12m @3m/s for RCA
Contrast Strength300 400 mg I/mContrast Pressureminimum PSI600 PSI> 450 PSI> 300 PSIRise TimeNo Rise 0.0 Sec
12m @3m/s for RCA
Flush Media is undiluted Contrast Media - as the whole blood vessel needs to be cleared of blood cells for an un obstructed OCT to be acquired
Red Blood Cells attenuate the light from the catheter and is noted as an artefact on the OCT image
A slight discrepancy in the minimum recommended PSI values for the two injector system generally available in South AfricaAnd no Rise Time is required for a bolus flush for the trigger to activate appropriately
The Right Coronary Artery may be set at lower volume than the Left Coronary system.
There is an alternative to Contrast Media for Renal Impairment, or other reasons called Dextran or Low-Molecular-Weight Dextran-LAnd since the blood in the blood vessel still needs to be displaced by the Dextran for a pullback acquisition the settings for the automated injector remain the same.
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System Settings
Physical Properties of Flushing Media
Solution Viscosity
LMD-L has been used as the flushing medium for coronary angioscopyContrast media9.40LMD-L (Dextran)3.67Blood & Contrast media (1:1) 5.91Blood & LMD-L (1:1) 4.10
A good article to read for the comparison of Contrast and Dextran
Even though there is a bit of a viscosity difference between Contrast Media and Dextran,One mixed with blood the difference in viscosity are much closer
Of Note is that no significant changes in the measurements were detected in the use of Contrast versus Dextran
[The highest mean proportion of image quality was observed with use ofdextran (mean clear imaging field, 87.2%),followed by heparinized saline (74.3%),contrast (70.1%) and carbon dioxide (10%).Compared with carbon dioxide, the researchers found that contrast, dextran and saline were associated with better image quality (P < .001), according to the results.]19
System Settings
X-ray Equipment Settings
Frame rate of 30fps > 15fpsUn-subtracted image (DA not DSA)Co-Registration on A-Plane only (Bi-Plane)
Co-Registration software needs to register the OCT imaging catheter position
Start Acquisition Before Pullback initiatedEnd Acquisition After Pullback has ceased
For the co-registration software to adequately track the markers - a minimum frame rate of 15 frames per second is advisable
Co-registration software is setup on one plane only and that would be the A-Plane if you use a Bi-Plane unit
You can elect to switch B-Plane off to reduce radiation, but if you leave it active it will not link with the co-registration software
So that the Co-Registration software registers the OCT imaging catheter position it needs to see the 3 markers and then workout that the middle one is the lens before the contrast is added to the vesselSo start acquisition prior to contrast flush
Stopping acquisition before completing the 75 mm or 54 mm pullback will disrupt the co-registrations software operation - and you may lose that co-registration, but not necessarily the OCT Pullback20
Angio Co-Registration
OPTIS Integrated System ArchitectureDragonfly OPTIS Imaging Catheter featuresOPTIS Integrated System SettingsInjector Pump SettingsX-Ray Equipment SettingsAngio Co-Registration (ACR) OutlinesOPTIS Integrated System Workflow
So How far are we with this list of ours for Co-Registration
Weve dealt with the equipment and the setting for the system, Pump Injector and the x-ray equipmentNext well do the workflow
And talk about a few exciting changes to the software - for those who already have Co-Registration and those who have not. 21
Good Practice
Artery SelectionLesion LengthSuitable Landing zone beyond stenosisReasonable CalibreNot Excessively TorturousEccentricity Collaterals
When choosing to use Intravascular OCT there are a few criteria that you have to conceder
The lesion is not always just the bit you see on angiography so plan where you are going to start from
The Guidewire, Distal Marker and Lens Marker all have to be distal from the region of interest tooThat is 27mm excluding the guidewire
If the vessel is too torturous - the pullback may be problematicVessel concertinaing
Arteries supplied by collaterals are not going to deliver flush media to displace the blood
So also keep artery selection in mind if you want to do OCT22
Good Practice
Radiographic Projections
Spider View (LM) LAO CAU (LIO)Foreshortened Overlapping the catheter
Good Angio Acquisition is key for successful Co-Registration and it takes team work to achieve it.
You have obviously done an Angiogram at this stageSelect the view of the target vessel with the least foreshorteningand the least overlapping branchesAnd other structures
Adapt the view if necessary
Steep AP Cranial for mid LADRAO Cranial for Proximal LAD etc
The Spider view is of particular difficulty for the Co-registration software As it is foreshortened and may not pick-up on the slight incremental movements of the Lens Marker during AcqusitioningAnd it may cross the guiding catheter distally23
Good Practice
If you can see the imaging catheter radiopaque marker band on the angio, so can the software
Proximal Guide Catheter Radiopaque MarkerGood engagementDistal Guidewire Radiopaque MarkerOCT LensAvoid vessel foreshortening & overlapping branches
Good Angio Co-Registration Practice
Make sure the image of the pre Co-Registration includesthe distal guide wire,the whole track of the imaging catheter in the vesseland the Guiding Catheter in the ostium
Once this has been set-up dont move itNo Panning No Rotating
Also make sure the guiding catheter is truly engaged You want the flush media to clear as much blood as possible and not have half spilling in the aorta24
Good Practice
Good Angio Co-Registration Practice
ViewsAvoid vessel ForeshorteningOverlapping branches *(Spider view)Radiopaque structures (clips, devices)Field of ViewX-ray equipment must be StationeryFrom the Guiding Catheter tip to the radiopaque section of the GuidewireGuide CathGood engagement in vessel ostiumStable No Sideholes
AcquisitionThe cine recording must encompass the entire OCT pullback, Start to EndWorkflowOne person co-ordinates workflowTalk the Procedure
We have chosen Our ViewWe Got Our Image for Co-registration set-upThe Guider is truly engaged
The x-ray settings have been setThe OCT settings have been setThe Injector Pump has been setThe Imaging Catheter has been prepped
The next step takes 3 second and will feel like forever once it becomes second nature
One person co-ordinates the procedure verbally the other responsible team members follow
Engage (the OCT Angio Co-Registration software)Acquisition Start filming InjectStop injection if you doing manual pullbacksStop Acquisition
One Person talks so choose who it is25
Good Practice
Good Angio Co-Registration Practice
Co-Register
Tips for good control point placement
Control points must be placed from distal to proximal on the guidewireEnsure the control points are within the target vesselThe first and last control points must encompass the OCT pullback between themDo not place a control point in the contrast cloud/reflux into the aortaDo not double back Restart
To start the co-registration workflow
Choose the frame of angiography that will display the entire vessel best
Plot at least 2 control points within the target vessel from Distal to ProximalReview the software tracking the Lens Marker
The first control point should be placed near or on the radiopaque portion of the guidewire, within the target vesselYou may place several more control points to ensure that the software tracks along the pullback, At least one more control point needs to be placed within distal tip of the guide catheter
The Lens Marker is a small white rectangle if the software is certain of the pullback tracking red if not, such as overlapping braches 26
Good Practice
Unload DOCDisconnecting Imaging Catheter from DOC
Always press the Eject button before removing the Imaging Catheter, failure to do so can damage the DOC
Unloading Imaging Catheter
Ensure that the imaging catheter is not rotating, if necessary press the Live View button on the DOC Press Eject button on the DOCThe probe retracting is audible and the Pullback motion LEDs blinkWhen LEDs stop blinking disconnect the imaging catheter by turning it anti-clockwise
Once the procedure is over
Please remember to always EJECT the OCT Imaging Catheter from the Optical ControllerNot Ejecting - before disconnecting the two parts, will damages the Drive-Motor
Its like if dogs are mating and do not disconnect before they are done you get the picture
After pressing eject wait till the LED stops blinking to delink by turning anti-clock wise or lefty-loosie27
Software upgrade
Version E.4 [August 2016]Software FeaturesILUMIENOPTIS OPTIS Mobile SystemBMS / DES Stent Detection/MalappositionSide Branch DisplayGuide Wire DisplayEnhanced 3D viewsStent Roadmap AngioCo-registrationOCT/Angio exportAutomatic Display of Lumen Profile Intravascular OCT (IVOCT) DICOM File FormatMiscellaneous bug fixes Stabilization improvements
OPTIS Metallic Stent Optimization &OPTIS Software Upgrade Version E.4When available on ILUMIEN ORW, 3D renders with reduced resolution and is not available in the full screen displayNot available on ILUMIEN ORW Platforms.CONNECTIVITY BOXOPTIS Mobile. System.OPTISIntegratedSystemOfflineReviewWorkstation
BMS / DES Stent Detection/MalappositionSide Branch DisplayGuide Wire DisplayEnhanced 3D viewsStent Roadmap AngioCo-registrationOCT/Angio exportAutomatic Display of Lumen Profile Intravascular OCT (IVOCT) DICOM File FormatMiscellaneous bug fixes Stabilization improvements
The MSO software upgrade is currently being rolled out in to the OCT CathlabsAnd these machines are specifically targetedNote that by adding a Connectivity Box to the Ilumien system you have basically upgraded to the OPTIS Mobile System and have full functionality of the new software
I will now go through a few of these upgrades with you28
OPTIS Stent Optimization SoftwareAutomated Measurements Stent RoadmapApposition Indicator
Whats NewVersion E.4
3D Bifurcation ModeSide-branch detectionCarina viewExpanded 3D Navigation3D flythrough viewObject segmentation
OPTIS Stent Optimization Software broadens the clinical utility for OCT and to guide daily decision making for complex PCI both pre and post stenting through:
5 NEW clinically relevant features offered in the new Stent Optimization Software
The new software is intended to provide information efficiently and around key clinical applications that are of interest for pre and post decision making
3D Bifurcation ModeSide-branch detectionCarina viewExpanded 3D Navigation3D flythrough viewObject segmentation
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Whats New
Automated MeasurementsClose for both Lumen Profile & L-Mode
Table Side Controller also easy to toggleMenu/Settings to change default settings
=3.00mm=3.08mm23,0mmMean Diameter : 3,26mmMLA 6,83mm2=2,94mm, DS=3,3%Lumen Profile appears now by Default
The lumen profile feature is now default so it is always available.Instead of the imaging catheter being the centre of the pullback the software makes the centre of the lumen of the artery the centre This helps during pre-planning stage of the procedure to assess MLA, distal and proximal markers.These are then easily adjustable as the proper landing zone and stent sizing are determined.
If you want to close the lumen profile you can use the new X close boxesChanging the default settings through the menu/settings The quick-key on the Tableside Controller
Measurement appear automatically as you adjust even in the B-Mod the mean diameter is always displayed
Once more you can change these defaults in the settings menu30
Stent Apposition Indicator Display
*Note: While BVS is detectable in OCT, the scaffolds are not identified through the apposition algorithm offered in this current version so this feature should only be used for metallic stents.Whats New
You select the Stent Apposition Indicator setting from the View Menu
Note the Stent Apposition Indicator software does not work with Bio-Absorbable Scaffolding and thus will give inaccurate information if used in this upgrade31
Stent Apposition Indicator DisplayApposition Indicator BarL-mode (rendered stent selected)Stent Roadmap on Co-RegistrationCross-sectional view (dots)
Whats New
The stent apposition indicator is located between the Lumen Profile and the L-mode And highlights where the software has detected the stent as well as where it is malapposed in red
It also displays sent apposition information in the
L-mode ( displayed if you also selected rendered stent)Stent roadmap on co-registrationCross-sectional view (red, yellow and sliver dots) - Always a good view for a more complete assessment
Note on the Apposition Indicator Bar the colours yellow and red the stent apposition sensitivity can also be adjusted in the settings menu32
Whats New
Stent Roadmap with Optional Bookmarks
PDMLA
Displays Lumen Profile markers: Distal, Proximal landing & MLA on the Co-Registration Angiogram imageOptional bookmarksIcon to toggle this view On & Off2.8 mm tolerance( 1.4mm on each end)Note: OCT Frame Indicator changesThinner for less angio-obstructionLength reduced from 3mm to 2mm (1.0mm on each end)
While adjusting on your other windows the Stent Roadmap will track and display it on the Angio Co-Registration
This includes bookmarks
This feature can be switched on and off by the tick-box provided
You may also notice that the white OCT frame marker
The Lens-marker is thinner and shorter and more accurate with its representation of the view frame33
OPTIS Stent Optimization SoftwareAutomated Measurements Stent RoadmapApposition Indicator
Whats New
3D Bifurcation ModeSide-branch detectionCarina viewExpanded 3D Navigation3D flythrough viewObject segmentation
Hope we all are still having fun - and we have just dealt with the new Stent Optimization Software in short
Im quickly going to deal with the new side-branch detectionAnd 3D Navigation menu34
Whats New
3D Bifurcation mode
Opens with the view that matches the closes side branch view of where the OCT frame marker is currently positionedFunction hidden if no side branches are detected that are approximately 1.5mm diameterSide branches are displayed as pink dots on the lumen profile & dotted lines trailing into the L-mode
The 3D bifurcation mode highlights detected side branch
Side branch detection is represented by pink dots on both L-Mode and Lumen Profile
When this mode is selected, the closest side branch to the last frame you were on is automatically selectedthe 3D cut-plane provides a straight on view of the side branchwhile the L-Mode is adjusted to cut through the side branch
Everything happens automatically
Side branches smaller than 1.5 mm are not detected35
Whats New
NoteGuidewire rendering may vary due to shadow, artifact or out of the cut-plane
3D Navigation *New 3D Options Menu
By default you view from proximal to distal,You can also use the turn-around icon in the lower left corner of the 3D viewto reverse the direction.
*any of the modes can be viewed in the flythrough view, Tissue, Lumen, Stent
Turn on up to two guidewiresAnd turn on or off side-branch (es)36
Whats New
3D Flythrough View
A flythrough view from proximal to distalShowing you the areas of stent malapposition in red and yellow37
Case Study
Male57Coronary Angiogram & OCT of LCx, PCIAdmittedChest pain with AnginaInitial ExaminationTrop I elevatednon STEMICardiac HistoryYesCardiac Risk FactorsYes
This is one of our first OCTs
What is wrong on this image
Firstly it was not a good clearing of the blood in the vesselThe Guider could probably have been better engaged There is no distal guide wire on the image as per co-registrationAnd there are overlapping branches
But we still managed to produce an informative A-CR
We are going to concentrating on the following areas in the next videoThe areas of Plaque Rupture You can see Arterial wall disease and lipid and calcification plaque
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Case Study
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Clinical Application
Anatomy of a PCIChoose your Lesion Choose your ReasonChoose your Length Choose your Size Choose your Device Choose your Tools
Angiography is usually used in isolation to guide PCI and ensure an adequate final stent result.FFR, IVUS and OCT can all be used to assess final PCI results and stent performance over time40
Assess Plaque Composition Lipid, Calcium, Fibrous, Cap Thickness, ThrombusPCI Planning Identify Reference SegmentsChoose Stent SizePre-PCI Assessment Post PCI AssessmentFollow-up AssessmentDetermine Expansion Stent Strut Malapposition Minimal Surface Area (MSA)Neo intimal Growth No Coverage, Thin Coverage, Restenosis, Neovascularization Stent Failure In-stent Thrombus, Late Acquired MalappositionComplications Identify Edge DissectionsIdentify Tissue ProtrusionsClinical Application
How to Use OCT to Improve Procedural Outcomes
In a recent TCTmd Webinar discussing OCT for Daily Clinical Use, Dr. Ali from Columbia University in New York City, discusses how he uses Lumen Profile to plan his procedures accordingly.
Permits assessment of luminal morphology, accurate estimation of fibrous cap thickness, identification of thrombus, and detection of plaque erosion and rupture
Provide information to differentiate and classify plaqueEvaluate lumen area immediately, with automated measurementsOptimize stent sizing and implantationEvaluate stent placement, expansion, apposition
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End
Booth 38OPTIS Integrated QUICK GUIDE SJM-OPS-1014-0015a 7019 Dragonfly OPTIS Spec SheetProduct Manuals (Instructions for Use) (http://manuals.sjm.com/)
Thank you
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