Antoniadis, Antonios P.

Giannoglou, George D.

Jaguszewski, Milosz

Lüscher, Thomas F.

Maier, Willibald

Templin, Christian

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CARDIOVASCULAR FLASHLIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .doi:10.1093/eurheartj/eht226Online publish-ahead-of-print 5 July 2013Geometrically correct three-dimensional optical coherence tomography:first self-expanding bifurcation stent evaluationAntonios P. Antoniadis1, Milosz Jaguszewski2, Willibald Maier2, George D. Giannoglou1, Thomas F. Lu¨scher2and Christian Templin2*1First Cardiology Department, AHEPA University General Hospital, Aristotle University Medical School, Thessaloniki, Greece and 2Cardiovascular Center, Cardiology,University Hospital Zu¨rich, Cardiovascular Center, Cardiology, Raemistr. 100, 8091 Zu¨rich, Switzerland* Corresponding author. Tel: +41 442559585, Fax: +41 442554401, Email: christian.templin@usz.chThis paper was guest edited by Brahmajee Kartik Nallamothu, MD, MPH, bnallamo@umich.edu, University of Michigan.A 78-year-old female was referred to the AndreasGruentzig Catheterization Laboratories sufferingfrom angina pain CCS II. Coronary angiographydemonstrated a bifurcation lesion in the middleleft anterior descending and the first diagonalbranch (Panel A). Based on these findings, percu-taneous coronary intervention (PCI) was per-formed with implantation of a self-expandingbiolimus A9TM-eluting dedicated bifurcationstent with an abluminal biodegradable coating(AXXESS, Biosensors International, Panel B).After the stent implantation (Panel C), optical co-herence tomography (OCT) was carried out toevaluate the final result (Panels D and E). Thethree-dimensional (3D) configuration of theartery was reconstructed post hoc from the angio-graphic lumen outline in two projections. Thecross-sectional lumen borders were traced inthe OCT images. These luminal contours werealigned in the previously reconstructed 3D arterialbackbone and appropriately rotated. Then, theluminal boundaries were connected in non-uniform rational basis spline surfaces forming the3D arterial model (Panel F). The arterial geometrydownstream of the bifurcation was visualized bylinearly connecting the respective luminalborders as traced in the OCT images whereboth branches were visible. Endothelial shearstress (Panel G) and blood velocity (Panel H, seeSupplementary material online, Video S1) werecalculated with the use of computational fluiddynamics.Endothelial shear stress was high in the carina and low in the lateral walls of the bifurcation. In line with this, flow velocity was higher in thecentral flow divider region and lower at the lateral aspects of the bifurcation. We present for the first time a geometrically correct 3Dreconstruction of a bifurcation stent by integrating OCT and biplane coronary angiography. This novel methodology provides a detailedanatomical and functional assessment of a stented bifurcation lesion, enables a precise evaluation of endothelial shear stress and local bloodflow, and may be used as a complementary tool to improve outcomes after PCI.Supplementary material is available at European Heart Journal online.Published on behalf of the European Society of Cardiology. All rights reserved.& The Author 2013. For permissions please email: journals.permissions@oup.comCardiovascular flashlight 2715

Geometrically correct three-dimensional optical coherence tomography: first self-expanding bifurcation stent evaluation

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