Assessment of Different Post-Dilatation Strategies for Optimal Stent Expansion in Calcified Coronary Lesions in an Ex Vivo Model by Optical Coherence Tomography

Background: Percutaneous intervention of calcified coronary lesions often requires lesion preparation with either balloon dilatation or atherectomy. We sought to evaluate the impact of lesion preparation strategy on stent expansion following preparation of severely calcified coronary lesions with modified (cutting/scoring) balloons (MB) versus rotational atherectomy (RA) and to evaluate the impact of calcium burden as assessed by optical coherence tomography (OCT) on acute stent performance. Methods: In the PREPARE-CALC trial (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions), 200 patients with severely calcified coronary lesions were randomly assigned to receive either lesion preparation with MB or RA. In 122 patients, OCT was performed before lesion preparation and at the end of the procedure. The principal end point of this OCT sub-analysis was stent expansion as assessed by OCT. The key secondary end points included stent asymmetry and eccentricity. Results: The maximal calcific arc (257.5±96.7° versus 248.7±82.1°, P =0.59), thickness (1.34±0.29 versus 1.32±0.27 mm, P =0.76), and length of calcification (21.1±9.7 versus 24.0±10.9 mm, P =0.12) did not differ between the MB versus RA group. Lesion preparation with MB versus RA lead to comparable stent expansion (73.5±13.3% versus 73.1±12.2%, respectively, P =0.85). The use of RA did not have a significant impact on stent asymmetry or eccentricity compared with the use of MB. Length of calcified plaque appeared to be increased in patients with stent underexpansion, while thickness of calcified plaque was increased in patients with stent asymmetry. Target lesion revascularization at 9 months was 3.3% when MB was used and 1.6% when RA was performed ( P =0.62). Conclusions: In this OCT sub-analysis from the PREPARE-CALC trial, calcified plaque length was increased in patients with stent underexpansion, while its thickness was higher in patients with stent asymmetry, with no impact of the lesion preparation strategy. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02502851.

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TCT CONNECT-408 Prediction of Vessel Rupture Assessed by Optical Coherence Tomography as a Function of Increasing Pressure and Balloon Size in Stent Post-Dilatation for Calcified Coronary Lesions in Ex Vivo and In Silico Experimental Model

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2020.09.431 ◽

2020 ◽

Vol 76 (17) ◽

pp. B175

Author(s):

Luis Augusto Dallan ◽

Pengfei Dong ◽

Vladislav Zimin ◽

Juhwan Lee ◽

Yazan Gharaibeh ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Experimental Model ◽

In Silico ◽

Ex Vivo ◽

Optical Coherence ◽

Balloon Size ◽

Coronary Lesions ◽

Vessel Rupture ◽

Calcified Coronary Lesions

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Comparison of optical coherence tomography-guided and intravascular ultrasound-guided rotational atherectomy for calcified coronary lesions

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02103-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Weili Teng ◽

Qi Li ◽

Yuliang Ma ◽

Chengfu Cao ◽

Jian Liu ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Intravascular Ultrasound ◽

Cardiovascular Death ◽

Rotational Atherectomy ◽

Optical Coherence ◽

Scoring Balloon ◽

Stent Expansion ◽

Significant Difference ◽

Coronary Lesions ◽

Calcified Coronary Lesions

Abstract Background To compare the effect and outcomes of optical coherence tomography (OCT)-guided rotational atherectomy (RA) with intravascular ultrasound (IVUS)-guided RA in the treatment of calcified coronary lesions. Methods Data of calcified coronary lesions treated with RA that underwent OCT-guided or IVUS-guided from January 2016 to December 2019 at a single-center registry were retrospectively analyzed. The effect and outcomes between underwent OCT-guided RA and IVUS-guided RA were compared. Results A total of 33 lesions in 32 patients received OCT-guided RA and 51 lesions in 47 patients received IVUS-guided RA. There was no significant difference between OCT-guided RA group and IVUS-guided RA group in clinical baselines characteristics. Comparing the procedural and lesions characteristics of the two groups, the contrast volume was larger [(348.8 ± 110.6) ml vs. (275.2 ± 76.8) ml, P = 0.002] and the scoring balloon was more frequently performed (33.3% vs. 3.9%, P = 0.001) after RA and before stenting in the OCT-guided RA group. Comparing the intravascular imaging findings of the two groups, stent expansion was significantly larger in the OCT-guided RA group ([82 ± 8]% vs. [75 ± 9]%, P = 0.001). Both groups achieved procedural success immediately. There were no significantly differences in the incidence of complications. Although there was no statistical difference in the occurrence of MACE at 1 year between OCT-guided RA group and IVUS-guided RA group (3.1% vs. 6.4%, P = 0.517), no cardiovascular death, TVR and stent thrombosis occurred in OCT-guided RA group. Conclusions OCT-guided RA compared to IVUS-guided RA for treating calcified coronary lesions resulted in better stent expansion and may have improved prognosis.

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QUANTIFICATION BY OPTICAL COHERENCE TOMOGRAPHY IMAGING OF THE ABLATION VOLUME OBTAINED WITH THE ORBITAL ATHERECTOMY SYSTEM IN CALCIFIED CORONARY LESIONS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)30220-0 ◽

2016 ◽

Vol 67 (13) ◽

pp. 219

Author(s):

Yohei Sotomi ◽

Raphael Cavalcante ◽

Richard Shlofmitz ◽

Pannipa Suwannasom ◽

Hiroki Tateishi ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence ◽

Tomography Imaging ◽

Ablation Volume ◽

Orbital Atherectomy ◽

Optical Coherence Tomography Imaging ◽

Coronary Lesions ◽

Calcified Coronary Lesions

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Performing percutaneous coronary interventions with predilatation using non-compliant balloons at high-pressure versus conventional semi-compliant balloons: insights from two randomised studies using optical coherence tomography

Open Heart ◽

10.1136/openhrt-2019-001204 ◽

2020 ◽

Vol 7 (1) ◽

pp. e001204

Author(s):

Florim Cuculi ◽

Matthias Bossard ◽

Wojciech Zasada ◽

Federico Moccetti ◽

Michiel Voskuil ◽

...

Keyword(s):

High Pressure ◽

Optical Coherence Tomography ◽

Stent Implantation ◽

High Pressures ◽

Stable Coronary Artery Disease ◽

Balloon Catheter ◽

Optical Coherence ◽

Stent Expansion ◽

Luminal Area ◽

Coronary Lesions

IntroductionStent underexpansion is a predictor of in-stent-restenosis and stent thrombosis. Semi-compliant balloons (SCBs) are generally used for lesion preparation. It remains unknown whether routine predilatation using non-compliant balloons (NCBs) improves stent expansion in ordinary coronary lesions.MethodsThe PREdilatation by high-pressure NC balloon catheter for better vessel preparation and Optimal lesion preparation with non-compliant balloons for the implantation of bioresorbable vascular scaffolds studies randomised patients presenting with stable coronary artery disease or non-ST-elevation myocardial infarction requiring stent implantation to lesion preparation using NCBs versus SCBs. Stent expansion index (SEI-minimal luminal area/mean luminal area on optical coherence tomography) and periprocedural complications were compared.ResultsWe enrolled 104 patients: 53 patients (54 lesions) vs 51 patients (56 lesions) to the NCB and SCB groups, respectively. Predilatation pressure was higher in the NCB group (24±7 atmospheres (atm) vs 14±3 atm, p<0.0001). Postdilatation using NCBs was performed in 41 (76%) lesions vs 46 (82%) lesions pretreated with NCBs versus SCBs (p=0.57). Similar pressures were used for postdilatation with NCB in both groups (23±8 atm vs 23±9 atm, p=0.65). SEI after stent implantation was 0.88±0.13 in the NCB vs 0.85±0.14 in the SCB group (p=0.18). After postdilatation, SEI increased to 0.94±0.13 in the NCB group vs 0.88±0.13 in the SCB group (p=0.02). No relevant complications occurred.ConclusionsIn simple coronary lesions, predilatation/postdilatation with NCBs at high pressures appears to result in better scaffold and stent expansion. Using SCBs only for predilatation might lead to inadequate stent expansion and postdilatation with NCBs might only partially correct this. Predilatation and postdilatation using NCBs at high pressure is safe.Trial registration numberClinicalTrials.gov no. NCT03518645.

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Abstract 12801: Angled Lesions Have Higher Incidence of Vascular Injury and Incomplete Stent Apposition, as Compared to Non-Angled Lesions, Following Stenting: An Optical Coherence Tomography Study

Circulation ◽

10.1161/circ.130.suppl_2.12801 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Yoshiyasu Minami ◽

Shiro Uemura ◽

Stephen Lee ◽

Soo Joong Kim ◽

Chang-Bum Park ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Stent Implantation ◽

Independent Predictor ◽

Ex Vivo ◽

Vascular Complications ◽

Optical Coherence ◽

Incomplete Stent Apposition ◽

Vessel Injury ◽

Coronary Lesions ◽

Type Of Injury

Backgrounds: Angled lesions are reported to be associated with worse procedural and clinical outcomes. Recent ex vivo studies have demonstrated that an angled arterial wall is exposed to imbalanced mechanical stress, which can cause vessel injuries and incomplete stent apposition (ISA) following stent implantation. Hypothesis: We tested the hypothesis that the angled coronary lesions, compared to non-angled lesions, would have higher incidence of vascular complications and ISA following stent implantation using optical coherence tomography (OCT) in patients. Methods: A total of 245 lesions treated with a single DES [95 zotarolimus-eluting stent (ZES) and 150 everolimus-eluting stent (EES)] were analyzed using OCT. An angled lesion was defined as a lesion on a curve ≥45° (n=59) on an angiogram and non-angled lesion on a curve <45° (n=186). The frequency was expressed as the percentage of stents with at least one type of injury or strut malapposition. Vessel injury included edge dissection, in-stent dissection, thrombus, and tissue protrusion. ISA was defined when the distance between the center of strut and the vessel wall was >100μm in ZES and >90um in EES. Results: The incidence of edge dissection and tissue protrusion was not significantly different between the groups. However, the incidence of in-stent dissection (84.7% vs 63.4%, P<0.01), thrombus (55.9% vs 35.5%, P<0.01) and ISA (76.3% vs 44.6%, P<0.001) was significantly higher in the angled group. The multivariate analysis demonstrated that the lesion on angle ≥60° was the independent predictor for in-stent dissection [Odds ratio (OR) 4.37, P=0.03] and ISA [OR 7.37, P<0.01], and that the angle ≥45° was the independent predictor for thrombus [OR 2.94, P=0.01]. There was no difference in the OCT findings between the ZES and EES groups. Conclusion: Angled coronary lesions had higher incidence of in-stent dissection, thrombus and ISA compared with non-angled lesions following DES implantation as assessed by OCT.

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