Background: Stent enhancement techniques allows improved visualization of coronary stents. However, the effect of the additional use of these techniques during percutaneous coronary intervention (PCI) has not yet been evaluated in a randomized study.

Purpose: The aim of this ongoing study was to compare the results of angiography-guided and stent enhancement-guided PCI in a randomized patient cohort using optical coherence tomography (OCT). 

Methods: Angiography-guided or stent enhancement-guided PCI were performed randomly in 11 patients with clinically relevant coronary stenoses and indication for interventional treatment. OCT was used at the end of the procedure to compare stent areas, overlap length, and vessel wall configuration. Patient clinical data and procedural characteristics were collected additionally.

Results: The mean patient age was 62±14 years. All patients were symptomatic with stable angina. Angiography-guided PCI was performed in 5 patients, and stent enhancement-guided PCI was performed in 6 patients. 

The mean amount of contrast media, radiation dose, and procedure time did not differ between angiography- and stent enhancement-guided PCI (194±83 ml vs. 188±91 ml, p=0.98; 4741±930 cGy*cm² vs. 4231±992 cGy*cm², p=0.43; 61±13 min vs. 66±17 min, p=0.73). There were no significant differences regarding mean stent diameter and stent area as determined by OCT (angio: 2.17±0.52 mm vs. stent enhancement: 2.29±0.51 mm, p=0.76; angio: 6.23±1.36 mm² vs. stent enhancement: 6.3±2.68 mm², P=0.97). In 4 of 6 cases with stent enhancement-guided PCI, additional post-dilatation was performed due to stent-underexpansion visualized by the stent enhancement technique. Stent overlap length was significantly shorter with stent enhancement performed as compared to angiography guidance (angio: 3 patients with stent overlap; mean stent overlap length: 2.11±0.44mm vs. stent enhancement: 3 patients with stent overlap; mean stent overlap length: 0.80±0.45mm; p=0.003)

Conclusion: The implementation of stent enhancement techniques in routine clinical practice may provide the opportunity to easily improve the procedural outcome of PCI and seems not to be associated with a higher contrast load, radiation dose, or a longer procedure time as compared with classical angiography-guided PCI.