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OCT-guided PCI — EECC MCQ

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HardCoronary Artery DiseaseOCT-guided PCIEECC

A 55-year-old woman undergoes PCI for NSTEMI. After stent deployment in the proximal LAD, optical coherence tomography (OCT) is performed. Which finding on OCT would most warrant further intervention?

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Correct answer: D — Stent malapposition with a gap of 400 micrometres between the stent struts and vessel wall over a 3 mm segment

OCT provides ultra-high-resolution (10-15 micrometre) intravascular imaging. Significant stent malapposition (gap >200 micrometres over a length >1 mm) is associated with increased risk of stent thrombosis and should be corrected with post-dilation using a non-compliant balloon. Minor tissue prolapse and small edge dissections (<3 mm, not flow-limiting) are generally benign findings that do not require intervention. TCFA in non-stented segments is an atherosclerotic vulnerability marker but does not mandate treatment. OCT is particularly useful in ACS for detecting edge dissections, incomplete stent apposition, and thrombus.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes; ILUMIEN IV Trial