Optical Coherence Tomography to Better Assess Chronic Total Occlusion Percutaneous Intervention Results: The PERFECTO Study

Abstract

Background: Angioplasty of coronary chronic total occlusions (CTOs) was a breakthrough, but there is a lack of data concerning stent healing after these complex procedures. Objectives: The main aim of the PERFECTO (Post-stEnting assessment of Reendothelialization with optical Frequency domain imaging aftEr CTO procedure) study is to assess, for the first time, stent strut apposition at the index CTO procedure and at 3-month follow-up using frequency-domain optical coherence tomography (FD-OCT). Methods: From March 2018 to January 2020, 114 consecutive patients who underwent successful CTO recanalization >20 mm in length were prospectively included in 7 centers. FD-OCT was performed for ad hoc guidance during the index procedure and at 3-month follow-up. All patients received the same last-generation drug-eluting stent. Results: Mean age was 63.2 years, and 87% were male. The rate of malapposed struts per patient was 7.84% at the end of the index procedure and 15.03% at 3-month follow-up (P < 0.0001), highlighting the phenomenon of acquired malapposition. Malapposed struts occurred more often with dissection and re-entry techniques and subintimal stenting compared to intimal techniques (12.8% vs 5.3%, P = 0.02). At 3-month follow-up, distal vessel minimal lumen area increased from 69% (index 2.19 mm2 vs 3.71 mm2 at 3 months, P < 0.0001). No complication occurred with FD-OCT. Conclusions: CTO-percutaneous coronary intervention could affect stent healing with a high incidence of immediate and late-acquired malapposition. These results support the interest of using FD-OCT during follow-up to better assess CTO recanalization results. (Post-stenting Assessment of Reendothelialization With OFDI After CTO Procedure [PERFECTO]; NCT03209843)