Plaque modification of severely calcified coronary lesions by scoring balloon angioplasty using Lacrosse non-slip element: insights from an optical coherence tomography evaluation
- 108 Downloads
Percutaneous coronary intervention (PCI) for heavily calcified lesions is challenging because these lesions are resistant to balloon dilatation and stenting. Lacrosse non-slip element (NSE) may have the potential to dilate heavily calcified lesions. We aimed to investigate predictors of successful lesion modification using Lacrosse NSE angioplasty via optical coherence tomography (OCT)-guided PCI. We investigated 32 patients with severe target lesion calcification treated with OCT-guided PCI. Successful lesion modification was defined as the complete fracture of calcification after Lacrosse NSE angioplasty. Before PCI, 172 segments with calcification were identified. After pre-dilatation using Lacrosse NSE, successful lesion modification was achieved in 117 segments (68.0%). Calcification was significantly thinner in successfully disrupted segments than in non-disrupted segments (p < 0.001). Calcification angle tended to be larger in disrupted than in non-disrupted segments (p = 0.08). Convex types were less frequently observed in disrupted than in non-disrupted segments (p < 0.001). At minimal lumen area sites, 26 segments (81.3%) were successfully modified. Similar to the overall results, the disrupted group had significantly thinner calcification than the non-disrupted group (p < 0.001). The angle of the calcified plaque was similar between the 2 groups (p = 0.39). Convex-type calcifications were less frequently observed in the disrupted group than in the non-disrupted group (p = 0.05). Receiver-operating characteristic curve analysis showed that calcification thickness < 565 μm was the best predictor of completely disrupted calcification. The thickness and shape of calcifications were predictors of successful lesion modification after Lacrosse NSE angioplasty.
KeywordsPercutaneous coronary intervention Scoring balloon angioplasty Coronary calcified lesion Optical coherence tomography
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
- 4.de Ribamar Costa J, Jr Mintz GS, Carlier SG, Mehran R, Teirstein P, Sano K, et al. Nonrandomized comparison of coronary stenting under intravascular ultrasound guidance of direct stenting without predilation versus conventional predilation with a semi-compliant balloon versus predilation with a new scoring balloon. Am J Cardiol. 2007;100:812–7.CrossRefGoogle Scholar
- 5.Ashida K, Hayase T, Shinmura T. Efficacy of Lacrosse NSE using the “Leopard-Crawl” technique on severely calcified lesions. J Invasive Cardiol. 2013;25:555–64.Google Scholar
- 14.Kume T, Waseda K, Ako J, Sakata K, Yamasaki M, Shimohama T, et al. Intravascular ultrasound assessment of postprocedural incomplete stent apposition. J Invasive Cardiol. 2012;24:13–6.Google Scholar
- 17.Doi H, Maehara A, Mintz GS, Yu A, Wang H, Mandinov L, et al. Impact of post-intervention minimal stent area on 9-month follow-up patency of paclitaxel-eluting stents: an integrated intravascular ultrasound analysis from the TAXUS IV, V, VI and TAXUS ATLAS workhorse, long lesion, and direct stent trials. JACC Cardiovasc Interv. 2009;2:269–75.CrossRefGoogle Scholar
- 23.Kang WC, Ahn TH, Han SH, Shin EK. Successful management of a resistant, focal calcified lesion following direct coronary stenting with a cutting balloon. J Invasive Cardiol. 2004;16:725–6.Google Scholar
- 27.Huisman J, van der Heijden LC, Kok MM, Danse PW, Jessurun GA, Stoel MG, et al. Impact of severe lesion calcification on clinical outcome of patients with stable angina, treated with newer generation permanent polymer-coated drug-eluting stents: a patient-level pooled analysis from TWENTE and DUTCH PEERS (TWENTE II). Am Heart J. 2016;175:121–9.CrossRefGoogle Scholar