Skip to main content
SpringerLink
Log in

Intravascular ultrasound assessment of the effects of rotational atherectomy in calcified coronary artery lesions

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kawaguchi R, Tsurugaya H, Hoshizaki H et al (2008) Impact of lesion calcification on clinical and angiographic outcome after sirolimus-eluting stent implantation in real-world patients. Cardiovasc Revasc Med 9:2–8

    Article  PubMed  Google Scholar 

  2. Nishida K, Kimura T, Kawai K et al (2013) Comparison of outcomes using the sirolimus-eluting stent in calcified versus non-calcified native coronary lesions in patients on- versus not on-chronic hemodialysis (from the j-Cypher registry). Am J Cardiol 112:647–655

    Article  PubMed  CAS  Google Scholar 

  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 100:1158–1164

    Article  PubMed  Google Scholar 

  4. Généreux P, Redfors B, Witzenbichler B et al (2017) Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents. Int J Cardiol 231:61–67

    Article  PubMed  Google 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 6:10–19

    Article  PubMed  Google Scholar 

  6. Hoffmann R, Mintz GS, Popma JJ et al (1998) Treatment of calcified coronary lesions with Palmaz-Schatz stents. An intravascular ultrasound study. Eur Heart J 19:1224–1231

    Article  PubMed  CAS  Google Scholar 

  7. Kobayashi Y, Okura H, Kume T et al (2014) Impact of target lesion coronary calcification on stent expansion. Circ J 78:2209–2214

    Article  PubMed  Google Scholar 

  8. Madhavan MV, Tarigopula M, Mintz GS et al (2014) Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol 63:1703–1714

    Article  PubMed  CAS  Google Scholar 

  9. Barbato E, Carrié D, Dardas P et al (2015) European expert consensus on rotational atherectomy. EuroIntervention 11:30–36

    Article  PubMed  Google Scholar 

  10. Kawamoto H, Latib A, Ruparelia N et al (2016) In-hospital and midterm clinical outcomes of rotational atherectomy followed by stent implantation: the ROTATE multicentre registry. EuroIntervention 12:1448–1456

    Article  PubMed  Google Scholar 

  11. Eftychiou C, Barmby DS, Wilson SJ et al (2016) Cardiovascular outcomes following rotational atherectomy: A UK Multicentre Experience. Catheter Cardiovasc Interv 88:546–553

    Article  PubMed  Google Scholar 

  12. Mintz GS, Potkin BN, Keren G et al (1992) Intravascular ultrasound evaluation of the effect of rotational atherectomy in obstructive atherosclerotic coronary artery disease. Circulation 86:1383–1393

    Article  PubMed  CAS  Google Scholar 

  13. Kovach JA, Mintz GS, Pichard AD et al (1993) Sequential intravascular ultrasound characterization of the mechanisms of rotational atherectomy and adjunct balloon angioplasty. J Am Coll Cardiol 22:1024–1032

    Article  PubMed  CAS  Google 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, 757–775

    Google 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 37:1478–1492

    Article  PubMed  CAS  Google Scholar 

  16. Mosseri M, Satler LF, Pichard AD et al (2005) Impact of vessel calcification on outcomes after coronary stenting. Cardiovasc Revasc Med 6:147–153

    Article  PubMed  Google Scholar 

  17. Liu X, Doi H, Maehara A et al (2009) A volumetric intravascular ultrasound comparison of early drug-eluting stent thrombosis versus restenosis. JACC Cardiovasc Interv 2:428–434

    Article  PubMed  Google 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 63:1845–1854

    Article  PubMed  Google Scholar 

  19. Tomey MI, Kini AS, Sharma SK (2014) Current status of rotational atherectomy. JACC Cardiovasc Interv 7:345–353

    Article  PubMed  Google Scholar 

  20. Mintz GS (2015) Intravascular imaging of coronary calcification and its clinical implications. JACC Cardiovasc Imaging 8:461–471

    Article  PubMed  Google Scholar 

  21. Mintz GS (2004) Intracoronary ultrasound. CRC Press, London

    Google Scholar 

  22. Feldman MK, Katyal S, Blackwood MS (2009) US artifacts. Radiographics 29:1179–1189

    Article  PubMed  Google Scholar 

  23. Yamamoto MH, Maehara A, Karimi Galougahi K et al (2017) Mechanisms of orbital versus rotational atherectomy plaque modification in severely calcified lesions assessed by optical coherence tomography. JACC Cardiovasc Interv 10:2584–2586

    Article  PubMed  Google Scholar 

  24. Kubo T, Shimamura K, Ino Y et al (2015) Superficial calcium fracture after PCI as assessed by OCT. JACC Cardiovasc Imaging 8:1228–1229

    Article  PubMed  Google Scholar 

  25. Maejima N, Hibi K, Saka K et al (2016) Relationship between thickness of calcium on optical coherence tomography and crack formation after balloon dilatation in calcified plaque requiring rotational atherectomy. Circ J 80:1413–1419

    Article  PubMed  Google Scholar 

  26. Vavuranakis M, Toutouzas K, Stefanadis C et al (2001) Stent deployment in calcified lesions: can we overcome calcific restraint with high-pressure balloon inflations? Catheter Cardiovasc Interv 52:164–172

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA

    Sung Sik Kim, Myong Hwa Yamamoto, Akiko Maehara, Kohei Koyama & Gary S. Mintz

  2. NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA

    Sung Sik Kim, Myong Hwa Yamamoto, Akiko Maehara & Kohei Koyama

  3. Golden Jubilee National Hospital, Glasgow, UK

    Novalia Sidik, Colin Berry, Keith G. Oldroyd & Margaret McEntegart

Authors
  1. Sung Sik Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Myong Hwa Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akiko Maehara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Novalia Sidik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kohei Koyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Colin Berry
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Keith G. Oldroyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gary S. Mintz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Margaret McEntegart
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akiko Maehara.

Ethics declarations

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.

Ethical approval

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, S.S., Yamamoto, M.H., Maehara, A. et al. Intravascular ultrasound assessment of the effects of rotational atherectomy in calcified coronary artery lesions. Int J Cardiovasc Imaging 34, 1365–1371 (2018). https://doi.org/10.1007/s10554-018-1352-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-018-1352-y

Keywords

Search

Navigation