3D OCT
THE MOST ADVANCED CARDIAC CATH LAB IN INDIA WITH 3D OCT
AlluraClarity, Cath Lab at Apollo Hospitals, Navi Mumbai is the most advanced cardiac Cath Lab in Maharashtra. It is equipped with 3D OCT and provides high quality imaging for a comprehensive range of clinical procedures, achieving excellent visibility at low X-ray dose levels for patients of all sizes.
3D OCT
3D Intracoronary optical coherence tomography (OCT) is a light-based imaging modality able to visualize with high resolution the vascular morphology and the acute and chronic effects of intervention with intracoronary devices.
3D OCT could therefore find application in the guidance of percutaneous coronary intervention (PCI), allowing a thorough pre-procedural lesion assessment, which enables accurate device sizing, selection of the vessel segment requiring treatment, and thus, efficient planning of the implantation strategy. Moreover, it can be used for the assessment of the acute procedural result, allowing the estimation of stent expansion and vessel injury. Consequently, intravascular imaging can in this way assist in the optimization of the acute implantation result, the significance of which is underscored by observations of an association between suboptimal implantation and stent failure.
Importantly, several studies and meta analyses have shown that the use of imaging guidance might improve outcome.
3D OCT- APPLICATION:
| Setting | Application |
|---|---|
| Lesion Evaluation | Assessment of culprit lesion in acute coronary syndromes: evaluation for plaque rupture and/or thrombus in patients without angiographically evident culprit lesion, Evaluation of lesions with angiographic haziness: differential diagnosis between thrombus, dissection, heavy calcification Determination about presence or absence of plaque (e.g., in coronary spasm) |
| Pre-procedural assessment | Luminal measurements for selection of balloon and stent dimensions, Assessment of plaque morphology in order to guide therapeutic strategy and device selection (rotablation, cutting balloon, etc.), Evaluation of the optimal location in the vessel for implantation of a coronary stent, Use for tracking the exact guidewire position (i.e., in chronic total occlusion or in bifurcation stenting), Use in bifurcation intervention (assessment of carina, ostia of side branches, stent cell geometry) |
| Post-procedural assessment | Assessment of stent expansion (detection of underexpansion, residual stenosis, incomplete stent apposition), Assessment of vascular injury: detection of edge dissections, tissue protrusion, intra-stent thrombus, Assessment of intervention by adjunctive devices: measurement of luminal enlargement after cutting balloon angioplasty, assessment of the reduction of calcification after rotablation, Assessment of adjunctive therapies in acute coronary syndromes: evaluation of residual thrombus burden after thrombectomy or selective administration of IIb/IIIa antagonists |
| Follow-up stent assessment | Mid-term and long-term assessment of stent safety and efficacy: evaluation of stent restenosis (quantitative and qualitative), stent thrombosis, and stent coverage as a surrogate for vessel healing Monitoring of the bioresorption and the healing response after implantation of bioresorbable scaffolds |
3D OCT CATH LAB – ADVANTAGES:
| 3D OCT Cath lab | Conventional Cath lab | Apollo Advantage |
|---|---|---|
| Technology uses infra-red light similar to a HD camera, with image resolution of 10 microns | Images created using ultrasound waves, with resolution of 100-120 microns | High resolution Images are 10 times sharper so that the cardiologist can see the smallest of details |
| Image acquisition is faster, precisely 2.5 seconds | Image capture may take more than 60 sec | Cardiologist can diagnose and work faster |
| Precise placement of stent is possible with sub-millimeter precision | Stent placement is not as accurate | Avoids renarrowing of the artery and reduces risk of clot formation. Precise diagnosis, helps in early recovery time, reduced hospital stay and less risk of infection |
| Precise length and diameter of the stent is achieved | Not possible to measure stent dimensions as precisely | Precise stent size allows for optimum outcomes |
| 12-16 cc of contrast is enough as OCT and Angiogram images are obtained simultaneously (Angio Co-Registration) | Needs more contrast as image has to be taken twice | Less exposure to radiation makes the procedure safer for the patient |
| Gold Standard for implantation of dissolvable stenting (bioresorbable) | Can be used but is not the best option | Better outcome due to use of 3D OCT for bioresorbable stent |
| First in India | – | More precise and gives cardiologist ease of choosing the site of stent implantation |
| Can see the inside of the stent after placement – first time in India (DragonFly) | – | Ensures that the stent is perfectly placed against the artery wall without any gap, leading to low risk of future clot formation |
IMAGE GUIDED STENTING
The Cath Lab is equipped with 3D OCT OPTIS, 1st in India, a technology for optimization of angioplasty and stenting through its metal stent optimization (MSO) and fly through mode technology. This helps in precise choice of length and diameter of the stent to be deployed, and full expansion and apposition of the stent. This leads to minimize the risk of immediate or late clotting of the stent and risk of re narrowing in future.
3D OCT OPTIS is in routine clinical use at Apollo Hospitals, Navi Mumbai. Patients get the accessibility of the highest quality benchmark success and delivery at par with any international institutes.
The OPTIS™ integrated system provides precisely the information you need, exactly where you need it—for more informed decision making, greater efficiency and improved procedural effectiveness,*especially in patients with complex lesions.
Seeing is Believing, OCT 3-D visualization. FFR combined with OCT informs all aspects of PCI planning and decision making, including: Lesion location and functional significance, Plaque morphology characterization, Lesion preparation, Stent sizing and placement decisions, Optimal approaches to bifurcation stenting, Placement and apposition evaluations, Post-dilatation decisions, Functional gain post-PCI
Clinical studies have proven the benefit of OCT Guide Stenting which showed an unacceptably high risk of clinical outcomes. Therefore, recommending a routine use of OCT Guided Image stenting for deploying bioresorbable stents, helps in superior clinical outcomes with lowest risk of re-narrowing and clot formation and better quality of life for the patients.
