(Health Korea News / Yu Ji-in) A study found that treating coronary artery stenosis, which is very complex in shape and requires a high-difficulty procedure, with optical coherence tomography-guided intervention reduces the incidence of various complications by nearly 40% and increases the success rate of stent insertion into the blood vessel.
A research team led by Professors Kim Byeong-geuk, Hong Seong-jin, and Lee Seung-jun of the Department of Cardiology at Severance Cardiovascular Hospital and Professor Emeritus Jang Yang-su of Yonsei University announced on the 5th that they obtained these results by comparing and analyzing the treatment results of 1,604 patients with complex coronary artery stenosis who received treatment at around 20 institutions nationwide, including Severance Cardiovascular Hospital, from January 2019 to September 2022.
When a blood clot (thrombus) forms in the coronary artery that supplies blood to the heart and narrows the blood vessel, coronary artery stenosis occurs due to blood flow disturbance. Coronary artery stenosis appears in various forms such as chronic occlusive lesions, branch lesions, left main lesions, and calcified lesions. For this reason, it is called complex coronary artery stenosis. If severe, it can lead to diseases such as angina pectoris.
Treatment for coronary artery stenosis is usually percutaneous coronary intervention (PCI), which involves injecting contrast media into the blood vessel and inserting a stent. However, when PCI is performed on complex coronary artery stenosis, not only does the difficulty of stent insertion increase, but the rate of stent placement also decreases, and the incidence of complications increases due to damage to the blood vessel, such as intimal dissection.
The research team focused on optical coherence tomography (OCT) as a method that can improve treatment results more than conventional PCI. They explained that by using OCT, which photographs blood vessels in 3D, it is possible to obtain the information necessary to establish a treatment plan for complex stenosis by clearly identifying the anatomical structure.
According to the research results conducted by the research team, group A (801 people) who received conventional PCI based on contrast agent administration had a 7.4% incidence of adverse effects such as death due to cardiovascular disease, myocardial infarction, stent thrombosis, and ischemic revascularization. However, group B (803 people) who received OCT-based intervention had a 4.6% incidence of these adverse effects, which was approximately 38% lower than group A.
The research team explained that these results were because the OCT-based intervention provided an optimal stent environment, such as by ensuring a perfect placement of the stent in the blood vessel, securing a space for stent insertion, and reducing damage to the blood vessel inner wall. The OCT-guided intervention, which can confirm a 3D image of the blood vessel, was able to establish a customized treatment plan that reflects the shape and characteristics of the blood vessels of patients with complexly formed coronary artery stenosis.
The research team explained, “In fact, medical staff who performed OCT-guided intervention were able to more accurately confirm the appropriate stent size and insertion location depending on the coronary artery stenosis condition, which can vary from patient to patient.” They also said, “It was also easier to perform auxiliary procedures, such as balloon angioplasty, to increase the stent placement rate after insertion.”
The results of this study were published in the latest issue of the international medical journal Lancet (IF98.4).
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