PONE-D-21-25048

Feasibility, reproducibility and characteristics of coronary bifurcation type assessment by three-dimensional optical coherence tomography

PLOS ONE

Dear Dr. Okamura,

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Yoshiaki Taniyama, MD, PhD

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors reported the feasibility and reproducibility of online visual 3D-OCT assessment of bifurcation lesion . 3D-OCT bifurcation type is tentatively correlated with the distal bifurcation angle measured by 3D-QCA. This manuscript is well written and organized. However, following issues need to be addressed.

1. It is unclear what will be the clinical implication of the bifurcation type. Debate persists regarding the optimal treatment of side branch bifurcation lesions including assessment of clinical significance. How can the information of bifurcation type before stenting help us to determine the treatment strategy in bifurcation lesion? Basically, it is not a valuable publication unless the authors demonstrate the clinical implication of this study. Please discuss about that.

2. The authors showed a correlation with the distal bifurcation angle measured by 3D-QCA. However, the clinical impact on bifurcation angle before stenting is limited. I believe that it is more important to acquire optimal projection detected by coronary CT or functional assessment using FFR/FFRCT/QFR than the recognition of bifurcation angle or type before procedure.

3. The authors did not describe the difference in lesion characteristic between parallel type and perpendicular. Is there any differences in lesion characteristics such as distal recrossing or appropriate POT or KBI which is the predictor of side branch complication? Please clarify this.

Reviewer #2: The manuscript entitled “Feasibility, reproducibility and characteristics of coronary bifurcation type assessment by three-dimensional optical coherence tomography” investigates the possible role of 3D-OCT to assess bifurcation angles as compared to 3D-QCA.

The manuscript is overall well written and the topic is interesting. Please find below my comments to improve the manuscript quality:

1) According to authors data, 3D OCT seems to be reliable for the detection of parallel and perpendicular bifurcation angles (BA). However, a binary classification of bifurcation angles into two types only might be poorly accurate and 3D OCT might be not accurate in identifying less overt angles (e.g 40-60°). It would be advisable to discuss this point or to include it in the limitations paragraph.

2) Authors justify the use of 3D OCT for the BA as 3d OCT represents also a useful tool for stent optimization. However, in several centres also IVUS is used for this purpose. Please discuss the possible role of IVUS in such context.

3) As reported by the authors, 51° is the cut-off for side branch complications. It would be interesting to add any possible complications in the parallel and perpendicular BAs, as well as in those with angles > and <51°.

4) Although the readership might be familiar with the topic, it would useful to add a figure explaining the three different BAs (distal, proximal and main vessel).

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Reviewer #1: No

Reviewer #2: Yes: Giulio Russo

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Feasibility, reproducibility and characteristics of coronary bifurcation type assessment by three-dimensional optical coherence tomography

PONE-D-21-25048R1

Dear Dr. Okamura,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Yoshiaki Taniyama, MD, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The author responded the problems.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: All issues raised during the revision process have been properly addressed and the manuscript is now suitable for publication

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: Yes: Giulio Russo