How intra-coronary imaging with OCT provides details that are not detected by angiography. The OCT findings result in significant changes in treatment plans.
Amazing case , malapposed and under-expanded stents are a nightmare for me . I always think about this point since I saw lots of cases ended up with a complications in follow-up because of this point
Thank you Dr Hussien, very illustrative . It shows how limited is the conventional angiography . I have a question , how do you manage plaque Erosion confirmed by OCT but no significant stenosis in patients with ACS ( usually young patients ) ? and do you routinely stent plaque rupture seen by OCT (again if no significant stenosis ) , i faced this scenario in some patients after successful thrombocytes therapy.
Very hard to answer. You will face this situation if you still use thrombus aspiration. I balloon the lesions in ACS, usually with an NC balloon. If the result is near perfect, then I assume that there is no significant plaque bulk and would hesitate to stent and think of DCB, just to suppress the healing after balloon injury. If the result after ballooning is suboptimal, then I assume it is a bulky plaque then I will usually stent regardless of the surface.
