ClinicalIntra- and interobserver reliability and intra-catheter reproducibility using frequency domain optical coherence tomography for the evaluation of morphometric stent parameters and qualitative assessment of stent strut coverage

- Frequency-domain optical coherence tomography (FD-OCT) is increasingly adopted in the catherization laboratories.
- This manuscript adresses the intraobserver, the interobserver, and the intra-catheter reproducibility of FD-OCT.
- Morphometric parameters within stented coronary segments can be reproduced with high accuracy at different time points, between different analysts, and between different pullbacks.
- Qualitative assessment of strut coverage by FD-OCT has excellent intra- and interobserver and good intra-catheter agreement.

PurposeFrequency-domain optical coherence tomography (FD-OCT) is a high-resolution imaging tool (~ 10-15 μm), which enables near-histological in-vivo images of the coronary vessel wall. The use of the technique is increasing, both for research- and clinical purposes. This study sought to investigate the intra- and interobserver reliability, as well as the intra-catheter reproducibility of quantitative FD-OCT-assessment of morphometric stent parameters and qualitative FD-OCT-evaluation of strut coverage in 10 randomly selected 6-month follow-up Nobori® biolimus-eluting stents (N-BESs).MethodsTen N-BESs (213 cross sectional areas (CSAs) and 1897 struts) imaged with OCT 6 months post-implantation were randomly selected and analyzed by 2 experienced analysts, and the same 10 N-BESs were analyzed by one of the analysts 3 months later. Further, 2 consecutive pullbacks randomly performed in another 10 N-BESs (219 CSAs and 1860 struts) were independently assessed by one of the analysts.ResultsThe intraobserver variability with regard to relative difference of mean luminal area and mean stent area at the CSA-level was very low: 0.1% ± 1.4% and 0.5% ± 3.2%. Interobserver variability also proved to be low: − 2.1% ± 3.3% and 2.1% ± 4.6%, and moreover, very restricted intra-catheter variation was observed: 0.02% ± 6.8% and − 0.18% ± 5.2%. The intraobserver-, interobserver- and intra-catheter reliability for the qualitative evaluation of strut coverage was found to be: kappa (κ) = 0.91 (95% confidence interval (CI): 0.88-0.93, p < 0.01), κ = 0.88 (95% CI: 0.85-0.91, p < 0.01), and κ = 0.73 (95% CI: 0.68-0.78, p < 0.01), respectively.ConclusionsFD-OCT is a reproducible and reliable imaging tool for quantitative evaluation of stented coronary segments, and for qualitative assessment of strut coverage.