Image Acquisition: A Step By Step Approach

  • SYSTEMIC ANTICOAGULATION : with heparin prior to guidewire insertion into vessel.
  • INTRACORONARY NITROGLYCERIN : to avoid catheter induced vasospasm.
  • OCT is INDICATED in vessels 2.0 – 3.5 mm in diameter.
  • USE CAUTION IF:
    • Severe left ventricular dysfunction
    • Renal impairment
    • Single remaining vessel
    • Contrast Allergy
  • BLOOD CLEARING : needed during image acquisition as infrared light cannot penetrate blood.

*For vessels with near complete stenosis or total occlusion, it is recommended that the blood flow be restored prior to OCT so that the contrast media can adequately clear from the artery.

A STEP BY STEP APPROACH:

  • Patient should receive systemic anticoagulation with heparin or bivalirudin with an ACT >250 sec.
  • Conventional guiding catheters and 0.014’’ intracoronary guidewire can be used to cross the target lesion.
    • The monorail rapid exchange OCT catheter is compatible with a ≥6Fr guiding catheter.
  • Open the OCT catheter from the package and flush the OCT catheter with the attached 3 cc syringe using 100% contrast. Make certain all the air has been purged from the catheter.
  • Connect the catheter to the controller unit and administer 200 µg of intracoronary nitroglycerin.
  • Backload the guidewire through the OCT catheter and advance the distal tip of the catheter past the region of interest.
  • Pullback may be performed manually or automatically (10-40 mm/sec) with simultaneous injection of contrast though the guiding catheter with a pre-set infusion rate of 2-4 mL/sec.
    • If Automatic Pullback: Set the power injector according to the manufacturer’s instructions (typically at least 3cc/sec for a total volume of 12 cc for RCA and 4 cc/sec for a total volume of 14 cc for left coronary with no more than 450 PSI).
  • Check catheter position with a test injection.
  • Activate imaging catheter and injection 100% contrast.
  • Assess acquired images and if clear and adequate then the OCT catheter may be removed.

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