RT Journal Article SR Electronic T1 Optical coherence tomography versus intravascular ultrasound to evaluate stent implantation in patients with calcific coronary artery disease JF Open Heart JO Open Heart FD British Cardiovascular Society SP e000225 DO 10.1136/openhrt-2014-000225 VO 2 IS 1 A1 Ingibjorg Gudmundsdottir A1 Philip Adamson A1 Calum Gray A1 James C Spratt A1 Miles W Behan A1 Peter Henriksen A1 David E Newby A1 Nicholas Mills A1 Neal G Uren A1 Nicholas L Cruden YR 2015 UL http://openheart.bmj.com/content/2/1/e000225.abstract AB Aims Stent underexpansion and malapposition are associated with adverse outcomes following percutaneous coronary intervention, but detection and treatment can be challenging in the presence of extensive coronary artery calcification. Frequency domain optical coherence tomography (FD-OCT) is a novel intravascular imaging technique with greater spatial resolution than intravascular ultrasound (IVUS) but its role in the presence of extensive coronary calcification remains unclear. We sought to determine the utility of FD-OCT compared to IVUS imaging to guide percutaneous coronary intervention in patients with severe calcific coronary artery disease.Methods 18 matched IVUS and FD-OCT examinations were evaluated following coronary stent implantation in 12 patients (10 male; mean age 70±7 years) undergoing rotational atherectomy for symptomatic calcific coronary artery disease.Results In-stent luminal areas were smaller (minimum in-stent area 6.77±2.18 vs 7.19±2.62 mm2, p<0.05), while reference lumen dimensions were similar with FD-OCT compared with IVUS. Stent malapposition was detected in all patients by FD-OCT and in 10 patients by IVUS. The extent of stent malapposition detected was greater (20% vs 6%, p<0.001) with FD-OCT compared to IVUS. Postdilation increased the in-stent luminal area (minimum in-stent area: 8.15±1.90 vs 7.30±1.62 mm2, p<0.05) and reduced the extent of stent malapposition (19% vs 34%, p<0.005) when assessed by FD-OCT, but not IVUS.Conclusions Acute stent malapposition occurs frequently in patients with calcific coronary disease undergoing rotational atherectomy and stent implantation. In the presence of extensive coronary artery calcification, FD-OCT affords enhanced stent visualisation and detection of malapposition, facilitating improved postdilation stent apposition and minimal luminal areas.Trial Registration number NCT02065102.