I Spy with My Little Eye – Optical Coherence Tomography in the Femoropopliteal Tract

In-stent restenosis in the femoropopliteal tract remains a challenging problem. Current treatment planning, based on digital subtraction angiography (DSA), is limited as DSA only visualizes the vessel lumen in a two-dimensional plane. Treatment planning could be improved by intravascular optical coherence tomography (OCT) as OCT visualizes the vessel lumen, the vessel wall, and the stent in three dimensions with micrometer resolution. In this study, DSA-based and OCT-based treatment planning will be compared to investigate the added value of OCT in the treatment of femoropopliteal disease. In addition, the value of OCT as control of technical success will be compared with DSA. Twenty-five patients diagnosed with femoropopliteal disease and scheduled for endovascular treatment with the Supera stent (Abbott Vascular, Santa Rosa, CA) will be included. Pre- and post-stent placement, DSA scans followed by OCT scans will be performed. Directly after each scan, the findings and the treatment plan will be noted. To date, two patients with, in total, three stenotic lesions have been included. Before stent placement, both DSA and OCT confirmed the presence of the stenotic lesions. Additionally, OCT showed extensive dissection requiring treatment (n = 1) not observed as such with DSA (Fig 1). This changed the reason for the treatment, but not the actual treatment itself. After stent placement, OCT identified proximal stent strut malapposition (n = 1) (Fig 2) not observed with DSA. The post OCT scans did, however, not change the post DSA-based treatment plan. Intermediate results show that OCT can detect new findings (extensive dissection, stent strut malapposition) that are important for the endovascular treatment plan of patients diagnosed with femoropopliteal disease. Inclusion is still ongoing, and more OCT findings that could change the treatment plan are expected.Fig 2Post-stent digital subtraction angiography (DSA) and optical coherence tomography (OCT) scan. Adequate stent placement was observed with DSA. OCT identified proximal stent strut malapposition.View Large Image Figure ViewerDownload Hi-res image Download (PPT)