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Initial Experiences Utilizing Optical Coherence Tomography Imaging in Crossing Femoropopliteal Chronic Total Occlusions
Christopher M. Paprzycki, MD, Sophia G. Afridi, MD, Nessa E. Miller, MD, Lala R. Hussain, MSc, Matthew H. Recht, MD, Patrick E. Muck, MD.
TriHealth - Good Samaritan Hospital, Cincinnati, OH, USA.
OBJECTIVES:
Femoropopliteal chronic total occlusions (CTO) are among the more challenging Trans-Atlantic Inter-Society Consensus (TASC) II class D lesions to treat from an endovascular approach. Optical coherence tomography (OCT) uses near-infrared light to optimize intravascular visualization and allows characterization of plaque and vessel wall anatomy. The Ocelot® catheter (Avinger) is an OCT guided catheter with spiral wedges on the tip rotating in counter directions, and can be used as an adjunct to fluoroscopy. We reviewed our experience with crossing these complex lesions utilizing OCT guidance.
METHODS:
A retrospective review of 28 patients with TASC II class D femoropopliteal lesions was performed where OCT guidance was used. Procedural success was determined by establishing true lumen guidewire access beyond the CTO. We assessed for complications including perforation and embolization.
RESULTS:
Intraluminal crossing was successfully performed in 22 of 28 cases. The average SFA CTO length was 27.7 cm and the average popliteal CTO length was 15.8 cm. There were two cases with combined lesions with lengths of 63.1 cm and 27.0 cm. There were no cases of perforation and embolization.
CONCLUSIONS:
Optical coherence tomography is a safe and effective technique to assist in intraluminal crossing of TASC II class D femoropopliteal CTO’s.
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