Case 02

This case demonstrates how OCT imaging, together with OCT-FFR, ICA, and Lumens Splicing, enabled comprehensive assessment of a long coronary lesion, guided tailored lesion preparation, and confirmed anatomical and physiological improvement following PCI.

The patient presented with progressive CCS class III angina. Coronary CTA revealed a high calcium burden (Agatston score >400), with a diffuse diseased segment extending approximately 65–70 mm.

Two pre-intervention OCT pullbacks were combined using Lumens Splicing to enable comprehensive visualization of the entire lesion.

OCT revealed predominantly diffuse fibrous plaque with focal, non-circumferential calcification.

ICA further characterized the most severe calcified segment:

Despite the high CTA calcium score, OCT findings supported a targeted lesion-preparation strategy rather than aggressive calcium modification.

High-pressure non-compliant balloon dilatation combined with a cutting balloon was performed to modify the predominantly fibrous lesion.

Repeat OCT demonstrated effective plaque modification with multiple controlled plaque incisions.

• Key OCT finding: multiple controlled plaque incisions
• Clinical implication: improved lesion compliance without major thrombotic complications

These findings supported proceeding with stent implantation.

Two stents, measuring 45 mm and 35 mm, were implanted to cover the long diseased segment.

Two consecutive post-PCI OCT pullbacks were acquired and combined using Lumens Splicing, generating a continuous dataset of approximately 95 mm for comprehensive assessment of the entire stented segment.

Final OCT confirmed satisfactory stent expansion and complete strut apposition, with calcium fracture observed at previously calcified sites.

The final assessment demonstrated marked physiological improvement and satisfactory anatomical results following OCT-guided PCI.