Intravascular ultrasound assessment of the effects of rotational atherectomy in calcified coronary artery lesions
- 20 Downloads
We sought to clarify intravascular ultrasound (IVUS) features of rotational atherectomy (RA) of calcified lesions. IVUS was performed post-RA and post-stent in 38 lesions and analyzed every 1 mm. Pre-intervention IVUS was performed when the IVUS catheter crossed the lesion (n = 11). Calcium Index was average calcium angle multiplied by calcium length. We compared lowest (n = 13), middle (n = 13), and highest (n = 12) Calcium Index tertiles. Reverberations (multiple reflections from calcium) with a concave-shaped lumen in the post-RA IVUS were considered to represent RA-related calcium modification. Newly visible perivascular tissue through a previously solid arc of calcium in the post-stent IVUS was also evaluated. Comparing the pre and post-RA IVUS, maximum reverberation angle, and length increased significantly after RA (angle, from 45° [31, 67] to 96° [50, 148], p = 0.003; length, from 4.0 mm [2.0, 6.0] to 8.0 mm [4.0, 14.0], p = 0.005). In the post-RA IVUS, reverberations had a larger angle in the middle and highest Calcium Index tertiles (lowest, 91° [64, 133]; middle, 135° [107, 201]; highest, 150° [93, 208], p = 0.03). Post-stent newly visible perivascular tissue was more frequent in the middle and highest Calcium Index tertiles (lowest, 30.8%; middle, 69.2%; highest, 75.0%, p = 0.049). Minimum stent area was similar after calcium modification by RA irrespective of the severity of the Calcium Index (lowest, 6.7 mm2 [5.7, 8.9]; middle, 5.6 mm2 [4.9, 6.8]; highest, 6.7 mm2 [5.9, 8.2], p = 0.2). Greater calcium modification by RA occurs in severely calcified lesions with smaller lumen diameters to mitigate against stent underexpansion.
KeywordsIntravascular ultrasound Rotational atherectomy Calcified lesions
Compliance with ethical standards
Conflict of interest
Akiko Maehara has received consulting fees from ACIST, Boston Scientific, and St Jude Medical, and research grants from Boston Scientific; Gary S. Mintz has received consulting fees from ACIST, Boston Scientific, St Jude, and Volcano. The rest of the authors have no conflicts to report.
The study protocol was approved by the institutional ethics committee of Golden Jubilee National Hospital, and written informed consent was obtained from all patients in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
- 3.Bourantas CV, Zhang YJ, Garg S et al (2014) Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart 100:1158–1164CrossRefPubMedGoogle Scholar
- 5.Abdel-Wahab M, Richardt G, Joachim Büttner H et al (2013) High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: the randomized ROTAXUS (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease) trial. JACC Cardiovasc Interv 6:10–19CrossRefPubMedGoogle Scholar
- 14.Popma J, Almonacid A, Burke D (2011) Qualitative and quantitative coronary angiography. In: Topol EJ, Teirstein PS (eds) Textbook of interventional cardiology, 6th edn. Saunders, Philadelphia, pp, 757–775Google Scholar
- 15.Mintz GS, Nissen SE, Anderson WD (2001) American college of cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (IVUS). A report of the American College of Cardiology Task Force on clinical expert consensus documents. J Am Coll Cardiol 37:1478–1492CrossRefPubMedGoogle Scholar
- 18.Généreux P, Madhavan MV, Mintz GS et al (2014) Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. J Am Coll Cardiol 63:1845–1854CrossRefPubMedGoogle Scholar
- 21.Mintz GS (2004) Intracoronary ultrasound. CRC Press, LondonGoogle Scholar