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Response by Chamié et al to Letter Regarding Article, “Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions: The iSIGHT Randomized Trial”
2021; Lippincott Williams & Wilkins; Volume: 14; Issue: 7 Linguagem: Inglês
10.1161/circinterventions.121.011004
ISSN1941-7632
AutoresDaniel Chamié, Ricardo Petraco, Fausto Feres,
Tópico(s)Peripheral Artery Disease Management
ResumoHomeCirculation: Cardiovascular InterventionsVol. 14, No. 7Response by Chamié et al to Letter Regarding Article, "Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions: The iSIGHT Randomized Trial" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBResponse by Chamié et al to Letter Regarding Article, "Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions: The iSIGHT Randomized Trial" Daniel Chamié, MD, PhD Ricardo Petraco, MD, PhD Fausto FeresMD, PhD Daniel ChamiéDaniel Chamié https://orcid.org/0000-0003-3258-2458 Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil (D.C., F.F.). , Ricardo PetracoRicardo Petraco National Heart and Lung Institute, Imperial College London, United Kingdom (R.P.). and Fausto FeresFausto Feres Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil (D.C., F.F.). Originally published29 Jun 2021https://doi.org/10.1161/CIRCINTERVENTIONS.121.011004Circulation: Cardiovascular Interventions. 2021;14In Response:We read with interest the letter by Alfonso et al1 about our iSIGHT trial (Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions)2 and value their expert commentaries. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) both exert their benefits by minimizing the error on stent sizing judgment by operators, a principle which is indisputable and supported by guidelines. Debate remains on how to use each modality to identify landing zones and safely size stents and balloons.Alfonso et al raise an interesting point: iSIGHT found that stent sizing to the external elastic membrane (EEM) diameter in the OCT arm was more frequent than in the IVUS arm. At first, this appears counterintuitive, as the ability to see deeper layers of coronary arteries with IVUS is greater than with OCT. The answer lies precisely in the superior ability of IVUS to quantify plaque burden: IVUS studies have shown that landing stent borders onto an area with a plaque burden ≥50% increases the risk of edge complications.3 Therefore, in the IVUS arm in iSIGHT, whenever a landing zone had >50% plaque burden, we sized stents to the maximum lumen diameter to minimize injury at stent edges. This happened in 35.5% and 29.4% of the distal and proximal references, respectively. This approach is backed up by expert consensus and reflects widely accepted clinical practice.3 In the OCT arm, because plaque burden is not routinely quantified, stent sizing was more aggressive towards the EEM whenever it was visible for >180°—an approach applied to 92.2% and 80.4% of the distal and proximal references.iSIGHT should simply be viewed as an additional stent sizing protocol by OCT. There are other approaches, of course. A lumen-based stent sizing by OCT leads to smaller stents than an EEM sizing strategy by IVUS.4 Stent sizing to the EEM by OCT, rounding it down to the nearest 0.25 mm diameter results in noninferior minimal stent areas compared with IVUS (no specific protocol).5 In iSIGHT, we tested a more aggressive EEM sizing by OCT that resulted in noninferior stent expansions to a traditionally sizing algorithm by IVUS, with the potential for numerical superiority. Operators now have a menu of options that can suit patient's anatomic characteristics and interventionalists preferences. IVUS and OCT can be safely used interchangeably, providing the limitations of each modality are taken into consideration. The final message from iSIGHT is the following: use imaging and use it well.Disclosures None.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.References1. Alfonso F, Rivero F, Prati F. Letter by Alfonso et al regarding article, "Optical coherence tomography versus intravascular ultrasound and angiography to guide percutaneous coronary interventions: the iSIGHT randomized trial".Circ Cardiovasc Interv. 2021; 14:e010912. doi: 10.1161/CIRCINTERVENTIONS.121.010912LinkGoogle Scholar2. Chamié D, Costa JR, Damiani LP, Siqueira D, Braga S, Costa R, Seligman H, Brito F, Barreto G, Staico R, et al.. Optical coherence tomography versus intravascular ultrasound and angiography to guide percutaneous coronary interventions: the iSIGHT randomized trial.Circ Cardiovasc Interv. 2021; 14:e009452. doi: 10.1161/CIRCINTERVENTIONS.120.009452LinkGoogle Scholar3. Räber L, Mintz GS, Koskinas KC, Johnson TW, Holm NR, Onuma Y, Radu MD, Joner M, Yu B, Jia H, et al.; ESC Scientific Document Group. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions.Eur Heart J. 2018; 39:3281–3300. doi: 10.1093/eurheartj/ehy285CrossrefMedlineGoogle Scholar4. Kubo T, Shinke T, Okamura T, Hibi K, Nakazawa G, Morino Y, Shite J, Fusazaki T, Otake H, Kozuma K, et al.; OPINION Investigators. Optical frequency domain imaging vs. intravascular ultrasound in percutaneous coronary intervention (OPINION trial): one-year angiographic and clinical results.Eur Heart J. 2017; 38:3139–3147. doi: 10.1093/eurheartj/ehx351CrossrefMedlineGoogle Scholar5. Ali ZA, Maehara A, Généreux P, Shlofmitz RA, Fabbiocchi F, Nazif TM, Guagliumi G, Meraj PM, Alfonso F, Samady H, et al.; ILUMIEN III: OPTIMIZE PCI Investigators. Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial.Lancet. 2016; 388:2618–2628. doi: 10.1016/S0140-6736(16)31922-5CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails July 2021Vol 14, Issue 7Article InformationMetrics Download: 154 © 2021 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.121.011004PMID: 34182787 Originally publishedJune 29, 2021 PDF download SubjectsOptical Coherence Tomography (OCT)AngiographyUltrasoundImagingPercutaneous Coronary Intervention
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