THE EFFECT OF ROTATIONAL ATHERECTOMY ON COMPLEX CALCIFIED CORONARY LESIONS: SERIAL OPTICAL COHERENCE TOMOGRAPHY STUDY

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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Optical coherence tomography-guided versus intravascular ultrasound-guided rotational atherectomy in patients with calcified coronary lesions

EuroIntervention ◽

10.4244/eij-d-19-00725 ◽

2020 ◽

Vol 16 (4) ◽

pp. e313-e321 ◽

Cited By ~ 1

Author(s):

Norihiro Kobayashi ◽

Yoshiaki Ito ◽

Masahiro Yamawaki ◽

Motoharu Araki ◽

Masaru Obokata ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Intravascular Ultrasound ◽

Rotational Atherectomy ◽

Optical Coherence ◽

Ultrasound Guided ◽

Coronary Lesions ◽

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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