The OCTOBER Trial - European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction (OCTOBER)

The purpose is to compare median two-year clinical outcome after OCT guided vs. standard guided revascularization of patients requiring complex bifurcation stent implantation

Coronary bifurcation lesions with stenosis in a large side branch may require complex stent implantation techniques with an elevated risk of suboptimal treatment results. Intra vascular optical coherence tomography (OCT) enables improved procedural control of correctable factors and may lead to optimized implantation results.

It is unknown if routine, systematic use of OCT scans during complex bifurcation stenting improves clinical outcome but present available evidence indicates advantages of OCT guidance that could translate into improved clinical outcome.

Hypothesis: Systematic OCT guided revascularization of patients with bifurcation lesions requiring complex stent implantation provides superior two-year clinical outcome compared to standard revascularization by PCI.

Methods: Investigator initiated and investigator sponsored, randomized (1:1), controlled, prospective, multicenter, superiority trial. Randomization is stratified for 1) Left main or non-Left main artery disease, and 2) up-front planned one-stent technique with kissing balloon inflation, or a two-stent technique.

Systematic OCT guidance is detailed for five complex stent implantation techniques. Standard treatment is angiographic based with optional use of intravascular ultrasound (IVUS).

Eligibility Criteria:
Inclusion Criteria:

* Stable angina pectoris, unstable angina pectoris, clinically stable non-STEMI.
* Age ≥18 yrs.
* Abel to provide written Informed consent and willing to comply with the specified follow-up contacts.

Angiographic inclusion criteria:

* Native coronary bifurcation de novo lesion
* More than 50% diameter stenosis in the main vessel (MV)
* More than 50% diameter stenosis in the side branch (SB) within 5 mm of the ostium.
* Reference size at least 2.75 mm in the main vessel (MV) and ≥2.5 mm in the SB.

Functional inclusion criteria:

Functional significance of the main vessel lesion or documented ischemia of the main vessel territory or other objective documentation of lesion significance. Objective evidence of ischemia is required for all treated lesions except for lesions with more than 80% diameter stenosis that may be considered significant.

Procedural inclusion criteria:

Indication for two-stent technique or one-stent technique with kissing balloon inflation

Exclusion Criteria:

* STEMI within 72 hours
* Cardiogenic shock
* Prior coronary artery bypass grafting (CABG) or planned CABG
* Renal failure with glomerular filtration rate (GFR) \<50 mL/min per 1.73 m2
* Active bleeding or coagulopathy
* Life expectancy \< 2 years
* Ejection fraction \< 30%
* New York Heart Association (NYHA) class \> II
* Relevant allergies (aspirin, clopidogrel, ticagrelor, contrast compounds, everolimus).

Angiographic exclusion criteria:

* Severe tortuosity around target bifurcation
* Chronic total occlusions
* Massive thrombus in Left main coronary artery
* Medina 0.0.1 lesions