Abstract 14241: Feasibility and Safety of Non-Contrast Optical Coherence Tomography Imaging Using Hydroxyethyl Starch in Coronary Arteries

Background/Objectives: Contemporary high-resolution intracoronary optical coherence tomography (OCT) requires injection of flushing media for image acquisition. There is a growing need for an alternative flushing media other than iodine contrast to reduce the risk of acute kidney injury. To address this issue, we investigated the safety and feasibility of hydroxyethyl starch (pentastarch) as a flushing media for OCT image acquisition and compared with the contrast media flushed images. Methods: We prospectively enrolled 43 patients with 70 coronary lesions (46 stented and 24 pre-stented or non-culprit lesions). Paired OCT images were obtained by manual injection of iodine contrast (average 12 mL), followed by pentastarch (average 15 mL). A total of 162 runs (81 pairs) were analyzed and each OCT pullback was assessed on a frame-by-frame basis by automated customized lumen contour and stent strut segmentation algorithm. Results: Image quality as assessed by proportion of clear image segments were comparable between the contrast media and pentastarch flushed images (93.3% vs. 93.7%; p=0.501). Pixel-based flushing capability showed no significant difference between the paired image segments (median(IQR), 0.951(0.947-0.953) vs. 0.951(0.949-0.952), p=0.264; Figure). Quantitative measurements of minimal stent area (R 2 =0.977, p<0.001), minimal lumen area (R 2 =0.983, p<0.001) correlated well between the paired OCT runs. There were no clinically relevant complications associated with OCT imaging with pentastarch such as anaphylaxis, life-threatening arrhythmia, or acute renal deterioration. Conclusions: Intracoronary OCT using pentastarch is safe and technically feasible without affecting the optical signal intensity and overall image quality. Non-contrast imaging with pentastarch significantly reduces the obligatory iodine contrast load, therefore, could be considered as a promising strategy in high-risk patients for renal impairment.