Watch out Proceed with caution.pptx

SA Heart

Saturday 10 September Room 1,61 1,64Session 3011h40 12h05 Ernest Horsley Watch out! Proceed with caution.

Saturday 10 September 2016Room 1,61 1,64Session 3011h40 12h05 Watch out! Proceed with caution. (dissection/complications case) Ernest Horsley (N1 City Hospital, Cape Town)

Imaging For The Future

Compare the clinical value of FFR, iFR and OCT and how it will contribute to the patient outcome Investigate the basic measurements and visuals derived from FFR, iFR and OCT and their application Review the advantages and disadvantages associated with FFR, iFR and OCT

11h40 12h05 Watch out! Proceed with caution. (dissection/complications case) Ernest Horsley (N1 City Hospital, Cape Town)

1.To identify the role of a technologist in performing imaging procedures2. To demonstrate the clinical application of using OCT in a patient that has a dissection in a coronary artery3. To discuss the decision making process in using the OCT results

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Intravascular Optical Coherence TomographyImaging For The FutureErnest HorsleyDiagnostic Radiographer

Introduction

Watch out! Proceed with caution

10 September 2016 Room 1,61 -1,64 Session 30

[ of note the Watch out! Proceed with caution..Was in relation to case study for SCAD (Spontanious Coronary Artery Disection) and or stent dissectionBut we did not have any to present

Maybe to point out that we need to do more OCT in woman between the ages of late 30s to early 50s that present with chest pain as it is often missed and OCT is the right tool to demonstrate SCADAs well as Stent dissection]2

Angiography

ACRMSOOCT123

The workflow of the slide show is as followsFirst Ill have a light look at Optical Coherence TomographyFollowed By Angio Co-Registration WorkflowAnd Lastly the new Metal Stent Optimisation software3

Angiography

Delineating eccentric plaque Assessing lesions of moderate severityInherent Limitations to Diagnostic AngiographyOverall plaque burden and compositionAppreciation of ostial lesionsCulprit lesion assessment in Acute InfarctSide branch analysis in bifurcation lesionsCalcified lesions pseudo-thrombus

The limitations of angiography in itself - are inherently limitless, it seems

42 is the answer to the ultimate question in lifeUnfortunately no one knows what the question is

But increasingly our knowledge and understanding of our own biological viceshave let us in turn to more clarification 4

Timeline

Basic principles initially used within optical radar & telecommunications applications for biological tissue imaging1980s

developed sub-categories& investigating use of OCT in biomedicalapplications1990s

2000scommercial retinal OCT becomes imaging standard in ophthalmology

2010commercial intravascular OCT imaging becomes standard in cardiology

2013commercial endoscopic OCT imaging

Optical Coherence Tomography OCT has been borrowed from other industries.In shortIts use in art restoration, the ability to see the layers and structure without damaging the art work - peaked an interest in the application in the medical arena.

1988 saw the first paper on the application on biological tissue and during the early 1990s it found its feet in Ophthalmology Before the end of the 90s OCT had established itself in Ophthalmology and its research in microstructural changes of in vivo vascular biology of the coronary vessel, started establishing OCT as an diagnostic tool in the detection of vulnerable or high-risk plaque - improving the understanding of the treatment of acute myocardial infarction

From the early 2000 (2002), in conjunction with LightLab & St Jude Medical, resulted in the development of the commercial devices that today forms the standard in intravascular coronary OCT5

Timeline

Although this slide shows the number of OCT publications per annum - it is noteworthy to see the adoption of OCT in the medical specialities

For instance the assessment of the Radial Artery for coronary bypass graft harvesting

OCT is not new,OCT is not a niche,OCT is not just for research6

What is OCT

Optical CoherenceTomographyrefers to the ability of a light wave to produce interference patterns[ ]

So what is in a name?

Optical Coherence refers to the ability of a light wave to produce interference patterns

Woopy! So what?!

Well, most of the light is not reflected back to the sensor but rather scattered it is this scattered light that would normally dull an image - information overload if you like

But by using this interferometry technique of superimposing two or more waves, and detecting the optical coherences, Background scatter is rejected, while mostly directly reflected light is recorded

It is this clear signal that gives OCT its high resolution, and the ability to build up clear 3D imagesIt is also one of the reasons the tissue penetration is only a few millimetre

And that is why it is called Optical Coherence - Tomography7

What is OCT

Uses echo-location principle

Low Near-infra-red light (eye safe) Ultrasound 1,540 m/secLight 299,792,458 m/sec

Superluminescent Emitting Diode (SLED) monochromatic light (800-1300nm, 5mW)

Simply explained OCT is an optical IVUS on visual steroids instead of ultrasound OCT uses Low Near-Infra-Red (Eye Safe) laser light

It still uses the echo-location principal like IVUS

But because the speed light is faster than the speed of sound it is faster to acquire and coupled with the interferometry technique it provides tissue morphology/microstructure and pathology at a much higher resolution equivalent to a low-power microscope, thus OCT is sometimes referred to an optical biopsy

The technique is limited to imaging 1 to 2mm below the surface in biological tissue8

What is OCT

And just to give you an simple representation to understand the context of the resolution of OCT with regard to the tissue microstructure9

Angio Co-Registration

OPTIS Integrated SystemProduct GoalsStrengthen the link between physiological (FFR) and anatomical (IVOCT & angio) assessment and sub sequent therapeutic actionProvide the physician with increased controlEase-of-use and procedural workflowMake FFR and OCT an integral part of the cath labClinical BenefitsImmediate availability during PCIFull FFR/OCT system control from tablesideRapid set-up without making cable connectionsDirect tableside control of acquisition and analysis by physicianEnables real-time angio co-registration with OCTData displayed on overhead (boom) monitor

You can think of Integrated Systems, the same you would about the Internet of Things (IoT) concept but for Cathlabs

Individual component are seamlessly linked to the whole

You dont have to think or worry about how to incorporated it in to what you do and the time it will add to the procedureIt becomes the procedure the physician just chooses the tool they require to assess the next step

It is Plug and Play

[The on-demand OPTIS system integrates seamlessly into your cath lab, eliminating setuptime and giving you tableside control of optical coherence tomography (OCT) and fractionalflow reserve (FFR) acquisition and review from the sterile field. In addition to workflowefficiencies offered by direct proximity, the always-on, always-ready system optimizes PCIworkflow without adding significant time.]10

Angio Co-Registration

How does it work ?The Software uses the catheter pullback marker bands visible in the angio cine to create the co-registration imagesKey BenefitsFacilitates OCT guided PCICollects key clinical vessel information one angioReduces learning curve to assess location of OCTIncreases confidence in position OCT features Improves workflow efficiency into PCIReduction in contrast & radiation with regard to OCT without AC-RAngio co-registration will facilitate the integration of the OCT pullback into the PCI workflow

Basically co-registration links the intravascular image (be it OCT or IVUS) with a specific angiographic point in the artery- represented by the lens of the intravascular device

There are check an balances as you still need to tell the software at which artery you are looking at and it should be looking at

What co-registration does, is it makes it simpler to show a relationship with the morphology an pathology in an intravascular imaging - with that of an easy recognisable angiographic landmark, that we all are already used to

So it guides the PCI Procedure where, why, how long and just as important - why not

It installs relative confidence - by removing the guess work,not only of the image that we see on the angiogram, -where does that dissection start?but that of the intravascular image too - if we did not use co-registration

When it is all we can go have a look at what a good job was done too stent apposition11

Angio Co-Registration

OPTIS Integrated System ArchitectureDragonfly OPTIS Imaging Catheter featuresOPTIS Integrated System SettingsInjector Pump SettingsX-Ray Equipment SettingsAngio Co-Registration (ACR) OutlinesOPTIS Integrated System Workflow

To perform an OCT Angio Co-Registered pullback we require the right equipment, use the right setting and follow the right workflow

Let's start with the Equipment12

Architecture

OPTIS Integrated System

OperatorMonitorSlaveMonitorOPTIS Mobile SystemOPTISSystem CabinetIlumienOPTIS

AngioCo-Registration

Connectivity Box

The OCT Integrated System Architecture consists of basically two offerings

The first is a fixed free standing unit with a PC interface in Control room

The OPTIS System Cabinet is fully Integrated with OCT, FFR and Angio Co-Registration

The Second Mobile unit can now be converted to offer Angio Co-Registration by adding a Connectivity Box13

Architecture

OPTIS Mobile SystemConnectivity Box

The Connectivity Box is mounted to the x-ray table and is connected into the x-ray feed to make Angio Co-Registration available to the Ilumien OPTIS

Cables from the Connectivity Box are then connected to the Ilumien for Co-Registration capability.14

Architecture

Drive-motor & Optical Controller (DOC)

Tableside Controller

Wi-Box

Other components are:

The Drive-motor and The Optical Controller - to which the OCT Imaging Catheter is connected toThe Tableside Controller for the Integrated Systemit has quick-key buttons for ease of useand a fully controllable mouse or joystick, pivot, twist and select by pressing the button on top of the joystick

Not only can you fully control the OCT system with the TSC, you can control other integrated units like the FFR Wi-Box15

Architecture

Dragonfly OPTISImaging CatheterOuter Diameter2.7 Fr (0.90mm) Distal 280mmLow-profile tipDeliveryRapid Exchange MonorailDual lumenWorking Length135cmCoatingHydrophilic coatingMin Guiding Cath6 Fr Guide Catheter 100cmNo SideholesMax Guide Wire 0.014

Distal MarkerOptical Lens &Lens MarkerProximalMarkerGuide wire &Rapid Exchange Lumen

OPTIS Integrated SystemILUMIEN OPTISILUMIEN PCI Optimization Systems*

And the last of the OCT architecture

The OCT Imaging Catheter

A total working Length of 135cm of witch the last 280mm that goes into the artery is low profile - 2,7 Fr

The Imaging Catheters Hydrophilic coat needs to be wiped with Heparinised saline to be activated

It consists of three markers that the software uses to track the pullback and helps with the placement of the catheter inside the artery

The Distal MarkerThe Lens Marker And The Proximal Marker 50mm from the Lens Marker

50 mm is the shortest scan that the device can perform16

System Settings

OPTIS Integrated System SettingsPULLBACKSurveyHigh Resolution*ReasonLesion SurveyStent SurveyLength75 mm54 mmSpeed180 frames/sec36 mm/sec5 f/mm18 mm/sec10 f/mmTime2,1 sec3,0 secFile Size375 MB540 MB

TriggerManual*/AutoAutomaticAcquire AngioYesNo*

Depending on what you are doing

You have a Survey Mode length for general OCT and a High Resolution Mode length for Regions of Interest Like a Stent

The High Resolution 54 mm moves at a lower speed but at the same time acquiring more frames, thus having more detailed information at the end of the pullback

If you are doing an Angio Co-Registration it is important to remember to select/Tick the Acquire Angio box or the system will not know to follow the markers

We were trained on Manual triggered Pullback but there is no reason for Manual Tigger unless there are complications with the Co-registration or Pullback Automatic works.

Whether to leave out co-register while doing a High Res pullback for a stent is debatable to save on radiation we do it for the co-registration information it provides as we still only use contrast for pullbacks.

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System Settings

Injector Pump Settings

Manual PullbackContrast Volume**35m @3m/s = 11.6 sec40m @4m/s = 10 sec

Automatic PullbackContrast Volume*14m @4m/s = 3.5 sec12m @3m/s for RCA

Contrast Strength300 400 mg I/mContrast Pressureminimum PSI600 PSI> 450 PSI> 300 PSIRise TimeNo Rise 0.0 Sec

12m @3m/s for RCA

Flush Media is undiluted Contrast Media - as the whole blood vessel needs to be cleared of blood cells for an un obstructed OCT to be acquired

Red Blood Cells attenuate the light from the catheter and is noted as an artefact on the OCT image

A slight discrepancy in the minimum recommended PSI values for the two injector system generally available in South AfricaAnd no Rise Time is required for a bolus flush for the trigger to activate appropriately

The Right Coronary Artery may be set at lower volume than the Left Coronary system.

There is an alternative to Contrast Media for Renal Impairment, or other reasons called Dextran or Low-Molecular-Weight Dextran-LAnd since the blood in the blood vessel still needs to be displaced by the Dextran for a pullback acquisition the settings for the automated injector remain the same.

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System Settings

Physical Properties of Flushing Media

Solution Viscosity

LMD-L has been used as the flushing medium for coronary angioscopyContrast media9.40LMD-L (Dextran)3.67Blood & Contrast media (1:1) 5.91Blood & LMD-L (1:1) 4.10

A good article to read for the comparison of Contrast and Dextran

Even though there is a bit of a viscosity difference between Contrast Media and Dextran,One mixed with blood the difference in viscosity are much closer

Of Note is that no significant changes in the measurements were detected in the use of Contrast versus Dextran

[The highest mean proportion of image quality was observed with use ofdextran (mean clear imaging field, 87.2%),followed by heparinized saline (74.3%),contrast (70.1%) and carbon dioxide (10%).Compared with carbon dioxide, the researchers found that contrast, dextran and saline were associated with better image quality (P < .001), according to the results.]19

System Settings

X-ray Equipment Settings

Frame rate of 30fps > 15fpsUn-subtracted image (DA not DSA)Co-Registration on A-Plane only (Bi-Plane)

Co-Registration software needs to register the OCT imaging catheter position

Start Acquisition Before Pullback initiatedEnd Acquisition After Pullback has ceased

For the co-registration software to adequately track the markers - a minimum frame rate of 15 frames per second is advisable

Co-registration software is setup on one plane only and that would be the A-Plane if you use a Bi-Plane unit

You can elect to switch B-Plane off to reduce radiation, but if you leave it active it will not link with the co-registration software

So that the Co-Registration software registers the OCT imaging catheter position it needs to see the 3 markers and then workout that the middle one is the lens before the contrast is added to the vesselSo start acquisition prior to contrast flush

Stopping acquisition before completing the 75 mm or 54 mm pullback will disrupt the co-registrations software operation - and you may lose that co-registration, but not necessarily the OCT Pullback20

Angio Co-Registration

OPTIS Integrated System ArchitectureDragonfly OPTIS Imaging Catheter featuresOPTIS Integrated System SettingsInjector Pump SettingsX-Ray Equipment SettingsAngio Co-Registration (ACR) OutlinesOPTIS Integrated System Workflow

So How far are we with this list of ours for Co-Registration

Weve dealt with the equipment and the setting for the system, Pump Injector and the x-ray equipmentNext well do the workflow

And talk about a few exciting changes to the software - for those who already have Co-Registration and those who have not. 21

Good Practice

Artery SelectionLesion LengthSuitable Landing zone beyond stenosisReasonable CalibreNot Excessively TorturousEccentricity Collaterals

When choosing to use Intravascular OCT there are a few criteria that you have to conceder

The lesion is not always just the bit you see on angiography so plan where you are going to start from

The Guidewire, Distal Marker and Lens Marker all have to be distal from the region of interest tooThat is 27mm excluding the guidewire

If the vessel is too torturous - the pullback may be problematicVessel concertinaing

Arteries supplied by collaterals are not going to deliver flush media to displace the blood

So also keep artery selection in mind if you want to do OCT22

Good Practice

Radiographic Projections

Spider View (LM) LAO CAU (LIO)Foreshortened Overlapping the catheter

Good Angio Acquisition is key for successful Co-Registration and it takes team work to achieve it.

You have obviously done an Angiogram at this stageSelect the view of the target vessel with the least foreshorteningand the least overlapping branchesAnd other structures

Adapt the view if necessary

Steep AP Cranial for mid LADRAO Cranial for Proximal LAD etc

The Spider view is of particular difficulty for the Co-registration software As it is foreshortened and may not pick-up on the slight incremental movements of the Lens Marker during AcqusitioningAnd it may cross the guiding catheter distally23

Good Practice

If you can see the imaging catheter radiopaque marker band on the angio, so can the software

Proximal Guide Catheter Radiopaque MarkerGood engagementDistal Guidewire Radiopaque MarkerOCT LensAvoid vessel foreshortening & overlapping branches

Good Angio Co-Registration Practice

Make sure the image of the pre Co-Registration includesthe distal guide wire,the whole track of the imaging catheter in the vesseland the Guiding Catheter in the ostium

Once this has been set-up dont move itNo Panning No Rotating

Also make sure the guiding catheter is truly engaged You want the flush media to clear as much blood as possible and not have half spilling in the aorta24

Good Practice

Good Angio Co-Registration Practice

ViewsAvoid vessel ForeshorteningOverlapping branches *(Spider view)Radiopaque structures (clips, devices)Field of ViewX-ray equipment must be StationeryFrom the Guiding Catheter tip to the radiopaque section of the GuidewireGuide CathGood engagement in vessel ostiumStable No Sideholes

AcquisitionThe cine recording must encompass the entire OCT pullback, Start to EndWorkflowOne person co-ordinates workflowTalk the Procedure

We have chosen Our ViewWe Got Our Image for Co-registration set-upThe Guider is truly engaged

The x-ray settings have been setThe OCT settings have been setThe Injector Pump has been setThe Imaging Catheter has been prepped

The next step takes 3 second and will feel like forever once it becomes second nature

One person co-ordinates the procedure verbally the other responsible team members follow

Engage (the OCT Angio Co-Registration software)Acquisition Start filming InjectStop injection if you doing manual pullbacksStop Acquisition

One Person talks so choose who it is25

Good Practice

Good Angio Co-Registration Practice

Co-Register

Tips for good control point placement

Control points must be placed from distal to proximal on the guidewireEnsure the control points are within the target vesselThe first and last control points must encompass the OCT pullback between themDo not place a control point in the contrast cloud/reflux into the aortaDo not double back Restart

To start the co-registration workflow

Choose the frame of angiography that will display the entire vessel best

Plot at least 2 control points within the target vessel from Distal to ProximalReview the software tracking the Lens Marker

The first control point should be placed near or on the radiopaque portion of the guidewire, within the target vesselYou may place several more control points to ensure that the software tracks along the pullback, At least one more control point needs to be placed within distal tip of the guide catheter

The Lens Marker is a small white rectangle if the software is certain of the pullback tracking red if not, such as overlapping braches 26

Good Practice

Unload DOCDisconnecting Imaging Catheter from DOC

Always press the Eject button before removing the Imaging Catheter, failure to do so can damage the DOC

Unloading Imaging Catheter

Ensure that the imaging catheter is not rotating, if necessary press the Live View button on the DOC Press Eject button on the DOCThe probe retracting is audible and the Pullback motion LEDs blinkWhen LEDs stop blinking disconnect the imaging catheter by turning it anti-clockwise

Once the procedure is over

Please remember to always EJECT the OCT Imaging Catheter from the Optical ControllerNot Ejecting - before disconnecting the two parts, will damages the Drive-Motor

Its like if dogs are mating and do not disconnect before they are done you get the picture

After pressing eject wait till the LED stops blinking to delink by turning anti-clock wise or lefty-loosie27

Software upgrade

Version E.4 [August 2016]Software FeaturesILUMIENOPTIS OPTIS Mobile SystemBMS / DES Stent Detection/MalappositionSide Branch DisplayGuide Wire DisplayEnhanced 3D viewsStent Roadmap AngioCo-registrationOCT/Angio exportAutomatic Display of Lumen Profile Intravascular OCT (IVOCT) DICOM File FormatMiscellaneous bug fixes Stabilization improvements

OPTIS Metallic Stent Optimization &OPTIS Software Upgrade Version E.4When available on ILUMIEN ORW, 3D renders with reduced resolution and is not available in the full screen displayNot available on ILUMIEN ORW Platforms.CONNECTIVITY BOXOPTIS Mobile. System.OPTISIntegratedSystemOfflineReviewWorkstation

BMS / DES Stent Detection/MalappositionSide Branch DisplayGuide Wire DisplayEnhanced 3D viewsStent Roadmap AngioCo-registrationOCT/Angio exportAutomatic Display of Lumen Profile Intravascular OCT (IVOCT) DICOM File FormatMiscellaneous bug fixes Stabilization improvements

The MSO software upgrade is currently being rolled out in to the OCT CathlabsAnd these machines are specifically targetedNote that by adding a Connectivity Box to the Ilumien system you have basically upgraded to the OPTIS Mobile System and have full functionality of the new software

I will now go through a few of these upgrades with you28

OPTIS Stent Optimization SoftwareAutomated Measurements Stent RoadmapApposition Indicator

Whats NewVersion E.4

3D Bifurcation ModeSide-branch detectionCarina viewExpanded 3D Navigation3D flythrough viewObject segmentation

OPTIS Stent Optimization Software broadens the clinical utility for OCT and to guide daily decision making for complex PCI both pre and post stenting through:

5 NEW clinically relevant features offered in the new Stent Optimization Software

The new software is intended to provide information efficiently and around key clinical applications that are of interest for pre and post decision making

3D Bifurcation ModeSide-branch detectionCarina viewExpanded 3D Navigation3D flythrough viewObject segmentation

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Whats New

Automated MeasurementsClose for both Lumen Profile & L-Mode

Table Side Controller also easy to toggleMenu/Settings to change default settings

=3.00mm=3.08mm23,0mmMean Diameter : 3,26mmMLA 6,83mm2=2,94mm, DS=3,3%Lumen Profile appears now by Default

The lumen profile feature is now default so it is always available.Instead of the imaging catheter being the centre of the pullback the software makes the centre of the lumen of the artery the centre This helps during pre-planning stage of the procedure to assess MLA, distal and proximal markers.These are then easily adjustable as the proper landing zone and stent sizing are determined.

If you want to close the lumen profile you can use the new X close boxesChanging the default settings through the menu/settings The quick-key on the Tableside Controller

Measurement appear automatically as you adjust even in the B-Mod the mean diameter is always displayed

Once more you can change these defaults in the settings menu30

Stent Apposition Indicator Display

*Note: While BVS is detectable in OCT, the scaffolds are not identified through the apposition algorithm offered in this current version so this feature should only be used for metallic stents.Whats New

You select the Stent Apposition Indicator setting from the View Menu

Note the Stent Apposition Indicator software does not work with Bio-Absorbable Scaffolding and thus will give inaccurate information if used in this upgrade31

Stent Apposition Indicator DisplayApposition Indicator BarL-mode (rendered stent selected)Stent Roadmap on Co-RegistrationCross-sectional view (dots)

Whats New

The stent apposition indicator is located between the Lumen Profile and the L-mode And highlights where the software has detected the stent as well as where it is malapposed in red

It also displays sent apposition information in the

L-mode ( displayed if you also selected rendered stent)Stent roadmap on co-registrationCross-sectional view (red, yellow and sliver dots) - Always a good view for a more complete assessment

Note on the Apposition Indicator Bar the colours yellow and red the stent apposition sensitivity can also be adjusted in the settings menu32

Whats New

Stent Roadmap with Optional Bookmarks

PDMLA

Displays Lumen Profile markers: Distal, Proximal landing & MLA on the Co-Registration Angiogram imageOptional bookmarksIcon to toggle this view On & Off2.8 mm tolerance( 1.4mm on each end)Note: OCT Frame Indicator changesThinner for less angio-obstructionLength reduced from 3mm to 2mm (1.0mm on each end)

While adjusting on your other windows the Stent Roadmap will track and display it on the Angio Co-Registration

This includes bookmarks

This feature can be switched on and off by the tick-box provided

You may also notice that the white OCT frame marker

The Lens-marker is thinner and shorter and more accurate with its representation of the view frame33

OPTIS Stent Optimization SoftwareAutomated Measurements Stent RoadmapApposition Indicator

Whats New

3D Bifurcation ModeSide-branch detectionCarina viewExpanded 3D Navigation3D flythrough viewObject segmentation

Hope we all are still having fun - and we have just dealt with the new Stent Optimization Software in short

Im quickly going to deal with the new side-branch detectionAnd 3D Navigation menu34

Whats New

3D Bifurcation mode

Opens with the view that matches the closes side branch view of where the OCT frame marker is currently positionedFunction hidden if no side branches are detected that are approximately 1.5mm diameterSide branches are displayed as pink dots on the lumen profile & dotted lines trailing into the L-mode

The 3D bifurcation mode highlights detected side branch

Side branch detection is represented by pink dots on both L-Mode and Lumen Profile

When this mode is selected, the closest side branch to the last frame you were on is automatically selectedthe 3D cut-plane provides a straight on view of the side branchwhile the L-Mode is adjusted to cut through the side branch

Everything happens automatically

Side branches smaller than 1.5 mm are not detected35

Whats New

NoteGuidewire rendering may vary due to shadow, artifact or out of the cut-plane

3D Navigation *New 3D Options Menu

By default you view from proximal to distal,You can also use the turn-around icon in the lower left corner of the 3D viewto reverse the direction.

*any of the modes can be viewed in the flythrough view, Tissue, Lumen, Stent

Turn on up to two guidewiresAnd turn on or off side-branch (es)36

Whats New

3D Flythrough View

A flythrough view from proximal to distalShowing you the areas of stent malapposition in red and yellow37

Case Study

Male57Coronary Angiogram & OCT of LCx, PCIAdmittedChest pain with AnginaInitial ExaminationTrop I elevatednon STEMICardiac HistoryYesCardiac Risk FactorsYes

This is one of our first OCTs

What is wrong on this image

Firstly it was not a good clearing of the blood in the vesselThe Guider could probably have been better engaged There is no distal guide wire on the image as per co-registrationAnd there are overlapping branches

But we still managed to produce an informative A-CR

We are going to concentrating on the following areas in the next videoThe areas of Plaque Rupture You can see Arterial wall disease and lipid and calcification plaque

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Case Study

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Clinical Application

Anatomy of a PCIChoose your Lesion Choose your ReasonChoose your Length Choose your Size Choose your Device Choose your Tools

Angiography is usually used in isolation to guide PCI and ensure an adequate final stent result.FFR, IVUS and OCT can all be used to assess final PCI results and stent performance over time40

Assess Plaque Composition Lipid, Calcium, Fibrous, Cap Thickness, ThrombusPCI Planning Identify Reference SegmentsChoose Stent SizePre-PCI Assessment Post PCI AssessmentFollow-up AssessmentDetermine Expansion Stent Strut Malapposition Minimal Surface Area (MSA)Neo intimal Growth No Coverage, Thin Coverage, Restenosis, Neovascularization Stent Failure In-stent Thrombus, Late Acquired MalappositionComplications Identify Edge DissectionsIdentify Tissue ProtrusionsClinical Application

How to Use OCT to Improve Procedural Outcomes

In a recent TCTmd Webinar discussing OCT for Daily Clinical Use, Dr. Ali from Columbia University in New York City, discusses how he uses Lumen Profile to plan his procedures accordingly.

Permits assessment of luminal morphology, accurate estimation of fibrous cap thickness, identification of thrombus, and detection of plaque erosion and rupture

Provide information to differentiate and classify plaqueEvaluate lumen area immediately, with automated measurementsOptimize stent sizing and implantationEvaluate stent placement, expansion, apposition

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End

Booth 38OPTIS Integrated QUICK GUIDE SJM-OPS-1014-0015a 7019 Dragonfly OPTIS Spec SheetProduct Manuals (Instructions for Use) (http://manuals.sjm.com/)

Thank you

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