Tomoaki Haga, Akihito Tanaka, Yosuke Tatami, Masanori Shinoda
Directional coronary atherectomy (DCA) requires precise spatial orientation. Although the tip detection method is established for intravascular ultrasound, its application in optical coherence tomography (OCT)-guided DCA remains unestablished. We present a case of functionally significant stenosis at the left anterior descending (LAD) artery ostium treated with OCT-guided DCA. We adapted the tip detection method using a second guidewire with a tip curve. Aligning the fluoroscopically directed guidewire with the 3 o'clock position on the OCT cross-section achieved precise three-dimensional spatial co-registration, enabling accurate plaque localization. This first report demonstrates that OCT-guided tip detection offers a safe and sophisticated debulking strategy for complex coronary lesions.