LEMON Study Demonstrates Feasibility of OCT-Guided PCI of the Left Main Coronary Artery

December 8, 2020—Online in EuroIntervention, Nicolas Amabile, MD, et al recently published findings from the LEMON study of optical coherence tomography (OCT) to guide percutaneous coronary intervention (PCI) of the left main coronary artery. This pilot study aimed to analyze the feasibility, safety, and impact of OCT-guided left main stem (LMS) PCI.

In the study abstract, the investigators explained that intravascular ultrasound (IVUS) is currently recommended by international guidelines to guide LMS PCI. OCT resolution outmatches IVUS but is not yet recommended in LMS angioplasty due to lack of data.

As summarized in EuroIntervention, the prospective, multicenter trial investigated whether patients might benefit from OCT-guided PCI for mid/distal LMS according to a prespecified protocol. The primary endpoint was procedural success, defined as residual angiographic stenosis < 50% plus Thrombolysis in Myocardial Infarction (TIMI) 3 flow in all branches plus adequate OCT stent expansion (LEMON criteria). The final analysis included 70 patients (median age, 72 (64-81) years; 73% male, and the OCT prespecified protocol was applied in all patients.

The investigators reported the following findings in EuroIntervention:

• Achievement of the primary endpoint in 86%
• Adequate stent expansion in 86%
• Significant edge dissection in 30%
• Residual significant strut malapposition in 24%
• OCT guidance modified operator strategy in 26% of patients
• 1-year survival free from major clinical adverse events of 98.6% (97.2%-100%)

Overall, the study demonstrated the feasibility and performance of OCT-guided LMS PCI according to a prespecified protocol, concluded the investigators in EuroIntervention.