Very late stent expansion with intracoronary lithotripsy: a case report

Abstract Background Underexpanded stent in heavily calcified coronary lesion is common and persists over years. It is related to long-term failure and negative outcomes. Treatment of this situation after many years with intracoronary lithotripsy (ICL-Shockwave®) could be an option. Case summary We report a case of a man with underexpanded coronary stent implanted 11 years earlier. Optical coherence tomography highlighted the mechanism of stent underexpansion showing the presence of calcium stones under the old struts. Intracoronary lithotripsy crushed calcium under the stent struts causing its geometric change (from elliptical to round shape) and a consequent better transmission of the true radial force of the old stent. Discussion Heavily calcified coronary lesions lead to stent underexpansion which persists over years. Intracoronary lithotripsy could be a very late option to manage this unfavourable common result.

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

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2021.06.069 ◽

2021 ◽

Vol 28 ◽

pp. S30

Author(s):

Luis Augusto P. Dallan ◽

Vladislav Zimin ◽

Juhwan Lee ◽

Yazan Gharaibeh ◽

Gabriel Tensol Rodrigues Pereira ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Ex Vivo ◽

Optical Coherence ◽

Ex Vivo Model ◽

Stent Expansion ◽

Coronary Lesions ◽

Calcified Coronary Lesions

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Optical Coherence Tomography Assessment in Patients Treated With Rotational Atherectomy Versus Modified Balloons

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009819 ◽

2021 ◽

Vol 14 (3) ◽

Author(s):

Rayyan Hemetsberger ◽

Tommaso Gori ◽

Ralph Toelg ◽

Robert Byrne ◽

Abdelhakim Allali ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Rotational Atherectomy ◽

Optical Coherence ◽

Unique Identifier ◽

Stent Expansion ◽

Calcified Plaque ◽

Coronary Lesions ◽

Preparation Strategy ◽

The Impact ◽

Calcified Coronary Lesions

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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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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Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

Interventional Cardiology Review ◽

10.15420/icr.2016.11.01.33 ◽

2016 ◽

Vol 11 (1) ◽

pp. 33

Author(s):

Yohei Sotomi ◽

◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Rotational Atherectomy ◽

Percutaneous Coronary ◽

Orbital Atherectomy ◽

Long Term Follow Up ◽

Coronary Lesions ◽

Calcified Coronary Lesions

Despite advances in technology, percutaneous coronary intervention (PCI) of severely calcified coronary lesions remains challenging. Rotational atherectomy is one of the current therapeutic options to manage calcified lesions, but has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with other PCI techniques due to unfavourable clinical outcome in long-term follow-up. However the results of orbital atherectomy presented in the ORBIT I and ORBIT II trials were encouraging. In addition to these encouraging data, necessity for sufficient lesion preparation before implantation of bioresorbable scaffolds lead to resurgence in the use of atherectomy. This article summarises currently available publications on orbital atherectomy (Cardiovascular Systems Inc.) and compares them with rotational atherectomy.

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Optical frequency-domain imaging findings to predict good stent expansion after rotational atherectomy for severely calcified coronary lesions

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-018-1300-x ◽

2018 ◽

Vol 34 (6) ◽

pp. 867-874 ◽

Cited By ~ 7

Author(s):

Norihiro Kobayashi ◽

Yoshiaki Ito ◽

Masahiro Yamawaki ◽

Motoharu Araki ◽

Tsuyoshi Sakai ◽

...

Keyword(s):

Frequency Domain ◽

Rotational Atherectomy ◽

Optical Frequency ◽

Imaging Findings ◽

Optical Frequency Domain Imaging ◽

Stent Expansion ◽

Coronary Lesions ◽

Calcified Coronary Lesions

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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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