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Background/purpose: We sought to evaluate the morphological characteristics of nonobstructive coronary lesions in patients with ischemic symptoms and/or signs., Materials/methods: We used optical coherence tomography (OCT) to assess the presumed culprit lesion in 142 patients with suspected coronary artery disease in whom coronary angiography showed no lesion with a diameter stenosis ≥50%. Patients with a clinical diagnosis of acute coronary syndrome (ACS, n = 31, including 2 ST-elevation myocardial infarction, 9 non-ST-elevation myocardial infarction, and 20 unstable angina pectoris) were compared to those with stable coronary artery disease (CAD) (n = 111) including 79 patients with stable angina and 32 patients with silent ischemia (positive non-invasive stress test only)., Results: The overall prevalence of thrombus, plaque rupture, intimal laceration, or calcified nodule in the combined groups was 23.2% (33/142) including 15 thrombus, 12 plaque rupture, 9 calcified nodule, and 8 intimal laceration (not mutually exclusive) without differences between ACS and stable CAD patients. Also the prevalence of thin-cap fibroatheroma was not significantly different between ACS and stable patients (12.9% vs 6.3%, p = 0.22). Minimum lumen area (3.1 mm 2 [2.3, 4.1] versus 3.2 mm 2 [2.4, 4.7], p = 0.7) and area stenosis (49.9% [37.1, 56.4] versus 48.1% [37.8, 55.8], p = 0.9) were similar between ACS and stable CAD patients., Conclusion: In patients presenting with ischemic symptoms and/or signs, but angiographically nonobstructive culprit lesions, approximately 25% had abnormal findings by OCT-whether patients presented with acute/unstable or stable CAD., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: We sought to evaluate whether automated coregistration of optical coherence tomography (OCT) with angiography reduces geographic miss (GM) during coronary stenting., Background: Previous intravascular ultrasound or OCT studies have showed that residual disease at the stent edge or stent edge dissection was associated with stent thrombosis or edge restenosis. This has been termed GM., Methods: Two hundred de novo coronary lesions were randomized in a 1:1 ratio to OCT-guided percutaneous coronary intervention (PCI) with versus without automated coregistration of OCT with angiography. GM, the primary endpoint, was defined as angiographic ≥type B dissection or diameter stenosis >50% or OCT minimum lumen area <4.0 mm 2 with significant residual disease or dissection (dissection flap >60°) within 5 mm from the stent edge., Results: The prevalence of GM was not different comparing OCT-guided PCI with versus without automated coregistration (27.6% vs 34.0%, P = 0.33). However, there was a trend toward a reduced prevalence of significant distal stent edge dissection in lesions with automated coregistration (11.1% vs 20.8%, P = 0.07). The discrepancy in the distance between planned versus actual implanted stent location with automated coregistration was significantly shorter than without coregistration (1.9 ± 1.6 mm vs 2.6 ± 2.7 mm, P = 0.03), especially the prevalence of ≥5 mm discrepancy that was less frequent with automated coregistration., Conclusions: Automated coregistration of OCT with angiography did not reduce the primary endpoint of GM after stent implantation., (© 2018 Wiley Periodicals, Inc.)