OCT Presentation with St. Jude. Medical System

OPTIS SYSTEM(PART I)

OPTICAL COHERENCE TOMOGRAPHY

PRESENTED BY :

MUHAMMAD NAVEED SAEEDCATH LAB TECH.

KING FAISAL SPECIALIST HOSPITAL & RESEACH CENTER. RIYADH, KSA

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OUTLINES :

• Introduction

• What is OCT

• OCT from SJM

• What is Optis system

• Optis system components

• What is DragonFly Duo Catheter

• OCT procedures (How can we do)

• Interpretation Image with OCT

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OCT TECHNOLOGY

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DEFINATION :

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OCT FROM SJM

2004 2007 2009 2011 2012

M2 System M3 System C7XR™ System ILUMIEN™ System ILUMIEN™ OPTIS™

First Commercial OCT System15 fps / 200 linesOcclusion + flush

2nd Generation 20 fps / 240 linesOcclusion + flush

Europe and US only100 fps / 500 linesOcclusion-free

Commercially available 2011100 fps / 54 mm pullbackCombined FFR and OCTWireless FFR

Japan launch 2012180 fps/75 and 54 mm pullbackAdvanced software tools for PCI OptimizationTableside control from DOC

Occlusion balloon + ImageWireTM Occlusion-free Flush FFR and OCT System 2nd Gen FFR and OCT System

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OCT TECHNOLOGY FROM ST. JUDE MEDICAL

• Console• Rapid exchange (Rx) imaging catheter• Contrast flush; balloon occlusion not required• Fast image acquisition: 7.5cm pullback in 2.5 sec

C7 DragonflyTM OCT Catheter

OCT

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OPTIS – SYSTEM COMPONENTS

PressureWireTM AerisTM

ILUMIEN™ Console

Wireless FFR

FFRand OCT

Physician’s Monitor

DOC

Removable Tray

Connector Panel

Service Access Panel

Wheel Locks Main Power Cord Connector

Main Power Switch

Physician’s Side

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ILUMIEN™ – CONSOLE OVERVIEW

Operator’s

Monitor

Keyboard

CD/DVD Drive

Fan Filter

Hibernate/wake-up button

Mouse

Chart Holder

Operator’s Side

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DRAGON-FLY DUO CATHETER ( WHAT IS NEW)

• Fiber optic• Three radioparque

marker • Compatible with

G.C 6 or 7 Fr without holes

• G.W 0.14”

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PULLBACK SETTINGS

System Specifications C7/ILUMIEN C8 Clinical

Impact

Frame rate (frames per second)

100 fps 180 fps Higher frame rate = faster pullback

Pullback speeds

10, 20, 25 mm/sec

18, 36 mm/sec

Faster speed minimizes contrast required for longer

pullback

Pullback length 54 mm 75 mm

~90% of total lesions will occur in the proximal 50 mm of the left arterial

system. In the RCA, 80% of lesions are within 75 mm of the

ostium. Ref: Lesion locations within Arteries; J Am Coll Cardiol, 2005; 45:1186-1192

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APPLICATION OF OCT

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PRIOR TO STARTING A CASERequired Materials

– Dragonfly™ Duo imaging catheter – Sterile DOC cover

– 3 ml purge syringe

– Contrast media indicated for coronary use

– 0.014" guidewire

– Guide catheter (6-7 F, with no sideholes)

HOW CAN WE DO..............................

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TURNING ON THE SYSTEM – POWER SWITCHES

Powerup / Wake-up buttonon upper right of keyboard

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Main Switch next to power cable

Tech.

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ENTERING PATIENT DATA……………………

Tech.

Press Add new patient data.

Put all the information's concerning the patient.

Press New OCT Recording.

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CATHETER PREPARATION

• Purge with contrast until 3-5 drops exit distal tip.

Scrub Tech.

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CATHETER PREPARATION• Remove the hoop carefully from the catheter

Scrub Tech.

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CONNECT CATHETER

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CONNECTING CATHETER TO DOC

Counter clockwise

clockwise

Scrub Tech.

CATHETER PREPARATION

Insert the DOC into the sterile bag.

Scrub Tech Fix the DOC by her hand and the Technician pull the sterile cover.

Place it on the table.

Scrub Tech.

Tech.

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PREPARATIONS

• Watch the five yellow LEDs light up on the DOC

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PREPARATIONS

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PREPARATIONS OF CALIBARATION Press Live View

Ask the physician to put his 2 fingers to calibrate the catheter

Press Auto-Calibrate , The system is calibrated automatically

Tech.

Stop Button

Unload Button

Laser Emission Symbol

Advance

Button

Pullback Button

Pullback Position

LEDs

Load LED

DRIVE MOTOR OPTICAL CONTROLLER (DOC) – OVERVIEW

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INSIDE THE PATIENT

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PULLBACK PREPARATION – PURGE THE CATHETER

• If blood enters the catheter lumen, purge with the attached 3 cc contrast syringe.

Blood in catheter lumen Purged catheter lumen

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PREPARATION OF INJECTION

Recommended Settings:• Injection by hand

• Left coronary, Right coronary arteries: (16----20) ml ;

• We can use 12-20 ml syring In your Cath. (Depend on operator)

• When the operator is ready to inject contrast, click the “Enable Pullback ” button.

• Ask the Physician to inject, 3 sec from the injection and when the image is clear press ”Start Pullback”

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PERFORMING A PROCEDURE

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PULLBACK PREPARATION – PUFF INTO THE VESSEL

• During live scan, puff with the contrast injector to determine guiding catheter position for optimal image clarity.

Suboptimal clearance, blood swirls

Optimal clearance

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REVIEWING AN ACQUIRED IMAGE

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ADJUSTING CALIBRATION

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ADJUSTING CALIBRATION

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BOOKMARKS

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PERFORMING MEASUREMENTS

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ENTERING NOTES

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NEW RECORDING FOR THE SAME PATIENT

Press New Recording

Ask again the physician to put his 2 fingers to do calibration Repeat the same step of the Injection

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ENDING PROCEDURE

• Press “Unload” to disconnect catheter

WHAT WE CAN FOUND WITH OCT ................................

• Detect the Thrombus , not detected with Angio – Image

• Rapture Plaque

• Differentiate between the Red and white Thrombus

• Stent Thrombosis and Malappositon

RAPTURE PLAQUE

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THROMBUS

41White Thrombus Red Thrombus

STENT MALAPOSITION

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THANK YOU FOR YOUR PARTICIPATION AND PATIENCE

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