This case demonstrates how OCT imaging, together with OCT-FFR and ICA, supported lesion assessment, calcium modification, stent optimization, and final functional evaluation throughout PCI.
Pre-PCI
Pre-intervention OCT identified a long, diffuse, and eccentrically calcified lesion in the mid-LAD.
Minimum lumen area (MLA)
1.85 mm²
Area stenosis
approximately 72.3%
OCT-FFR
0.72
supporting the functional significance of the lesion
ICA further quantified the calcific burden:
- Maximum calcium arc: 241.6°
- Maximum calcium thickness: 0.81 mm
- Calcium length: 23.4 mm
After Predilatation
Repeat OCT after predilatation showed focal fractures within the previously continuous calcific plate , accompanied by mild intimal dissection.
- MLA increased: 1.85 → 2.02 mm²
- Key OCT finding: clear focal calcium fracture
- Clinical implication: effective plaque modification despite limited immediate luminal gain
After Stenting
OCT after implantation of an approximately 47.8 mm stent confirmed complete lesion coverage and substantial overall lumen enlargement.
However, focal underexpansion was detected at the site of the most prominent eccentric calcium:
- Minimum stent area (MSA): 5.43 mm²
- Minimum expansion index (MEI): 60%
- Stent dimensions at MSA: approximately 2.14 × 3.32 mm
- Morphology: distinctly elliptical stent configuration
Correlation with the previous OCT pullbacks indicated that persistent eccentric calcific constraint was limiting expansion along the minimum-diameter axis.
Final OCT
Final OCT demonstrated substantial improvement following targeted post-dilatation.
Relative MSA increase
approximately 24.3%
Minimum stent diameter
2.14 → 2.39 mm
The focal bottleneck was substantially improved, with more adequate and uniform stent expansion. Overall stent apposition was satisfactory, without clinically significant edge dissection or extensive malapposition.
English
Français
Español
Deutsch
Italiano
العربية
IPv6 network supported