![]() ![]() Six patients with crossed and one patient with uncrossed SFA lesions were excluded from analysis due to OCT imaging lacking clear visualization of layered arterial wall structures. A matched cohort consisting of 44 uncrossed SFA lesions and 44 successfully crossed SFA lesions was created based on similar patient characteristics and comorbidities. Comorbidities used in matching were characteristics from the medical records including: age, gender, race, and comorbidities including: smoking history, diabetes mellitus, lesion calcification, hypertension, coronary artery disease, and prior cardiac and vascular procedures. Selected comorbidities were correlated to allow for outcome metrics to assess the effectiveness of OCT and crossing total SFA occlusions based on morphologic plaque criteria. A propensity score was created based on preoperative comorbidities to allow for a comparable matched group of uncrossed lesions to cross lesions ( 10). Success of the Ocelot revascularization procedure was determined by the operating physician’s operative note. The treatment paradigm for all patients with TASC D lesions is to first have attempted crossing using OCT catheter technology, which is considered less invasive, prior to the consideration of open bypass surgery. All patients evaluated in this analysis were TASC D total occlusions of the SFA. All patients who underwent lower extremity procedures with the Ocelot catheter from June 2014 to June 2018 were included in this study. This was a single-center, retrospective review of prospectively collected data. In this study, we used the Ocelot catheter and OCT imaging to evaluate arterial wall structure and plaque morphology in an effort to predict successful crossing of chronic SFA occlusions. However, the utility of OCT images acquired during revascularization procedures to predict superficial femoral artery (SFA) lesion crossing has not been previously described. There have been studies analyzing the association between preoperative angiography findings, lesion length, and calcium distribution with successful lesion crossing using the Ocelot catheter ( 9). The CONNECT II trial demonstrated a 97% total cross rate with a 72% cross rate using the Ocelot catheter alone ( 2). Studies have demonstrated that the Ocelot catheter can be utilized safely and effectively to cross TASC D lesions ( 7, 8). Physicians can use OCT to image arterial structures and plaque morphology to guide treatment during revascularization procedures ( 7). Consensus documents found high levels of evidence for the measurement of normal arterial wall layers, fibrous plaque, and fibro calcific plaque structures using OCT imaging ( 6). ![]() Studies evaluating OCT imaging catheters and ex vivo histological sections demonstrate that OCT imaging allows for clear delineation of peripheral arterial atherosclerotic diseases components including layered arterial structures (intima, media, and adventitia) and atheromatous components (fibrous, fibro-calcified, and necrotic core plaque sections) ( 4). The Ocelot (Avinger Inc., Redwood City, CA) is an image-guided catheter that combines a rotating spiral tip with OCT to transmit real time imaging of intraluminal vessel structures and plaque morphology during revascularization procedures. This is more precise than IVUS, which gives a resolution of 150 µm ( 5). Current Fourier-domain OCT uses multiple light wavelengths to create an instantaneous image with an axial resolution of 10 µm and a radial resolution of 20 µm ( 4). OCT imaging measures the difference in time of reflected near-infrared light sent through a tissue sample and reference mirror ( 3). Optical coherence tomography (OCT) uses light to create high-resolution images of vascular structures. The advent of newer endovascular image-guided catheters has expanded treatment options of TASC D lesions for patients deemed poor surgical candidates ( 2). Traditionally, treatment of Trans-Atlantic Inter-Society Consensus Document (TASC) D femoropopliteal lesions required open surgical bypass ( 1). ![]()
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