Intraluminal Crossing of TASC D SFA Lesions with Direct Intra-arterial OCT Imaging May Be Superior to Traditional Subintimal Techniques

Patency for chronic total occlusions (Inter-Society Consensus for the Management of Peripheral Arterial Disease [TASC] D) of the superficial femoral artery (SFA) after endovascular interventions traditionally demonstrate a low 1-year patency ranging from 40% to 60%. The optical coherence tomography (OCT) catheter (Avinger Inc., Redwood City, CA) uses light-based technology imaging to cross TASC D lesions intraluminally with live direct intra-arterial visualization. Insufficient data exists evaluating intraluminal crossing with OCT imaging vs traditional subintimal techniques. We evaluated outcomes for TASC D lesions crossed intraluminally using OCT imaging. Retrospective analysis of patients with SFA TASC D lesions crossed intra-arterially with the OCT imaging catheter (2014-2021). Descriptive statistics evaluated patient characteristics. Baseline, 30-day, and 1-year outcomes were compared with t tests. Cumulative patency rates were evaluated using Kaplan-Meier analysis. There were 101 patients who underwent elective intervention for SFA TASC D lesions with the OCT catheter. The crossing rate was 78.2% and mean lesion length was 16.2 cm, and runoff at the tibial level was 2.2 patent vessels. Mean age and body mass index were 64 years and 29 kg/m2, respectively. Patients were male (57%); Caucasian (90%); smokers (85%); with hypertension (82%), hyperlipidemia (70%), and diabetes (46%). Preoperative computed tomography scans demonstrated lesions were predominantly eccentric (91%) with mild to moderate calcification (90%). All patients underwent percutaneous transluminal angioplasty, 87% were stented (mean stent length, 186.1 mm), and mean crossing time was 13.4 minutes. Preoperative, 30-day, and 1-year postoperative mean Rutherford-Becker scores were 4, 1, and 1, respectively (P < .0001). Mean preoperative ankle-brachial index was 0.49, compared to 0.84 at 30 days and 0.67 at 1 year (P < .0001). Duplex ultrasound examination demonstrated 6- and 12-month primary patency rates of 89% and 75%; primary assisted patency was 94% and 84% (Figure). Three patients required an amputation and four died within 1 year of intervention. The OCT imaging catheter was successful for crossing long chronic total occlusions of the SFA with direct intra-arterial visualization. Compared to subintimal techniques, patients had high 1-year primary patency, prolonged symptom improvement, and low restenosis with intraluminal crossing. These data suggest that intraluminal crossing of TASC D lesions with live OCT imaging may be superior to traditional subintimal crossing techniques.