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

Kim, S. S., Yamamoto, M. H., Maehara, A., Sidik, N., Koyama, K., Berry, C. , Oldroyd, K. G., Mintz, G. S. and McEntegart, M. (2018) Intravascular ultrasound assessment of the effects of rotational atherectomy in calcified coronary artery lesions. International Journal of Cardiovascular Imaging, 34(9), pp. 1365-1371. (doi: 10.1007/s10554-018-1352-y) (PMID:29663177)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McEntegart, Dr Margaret and Oldroyd, Dr Keith and Berry, Professor Colin and Sidik, Ms Novalia
Authors: Kim, S. S., Yamamoto, M. H., Maehara, A., Sidik, N., Koyama, K., Berry, C., Oldroyd, K. G., Mintz, G. S., and McEntegart, M.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:International Journal of Cardiovascular Imaging
Publisher:Springer
ISSN:1569-5794
ISSN (Online):1573-0743
Published Online:16 April 2018

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