Relationship Between Thickness of Calcium on Optical Coherence Tomography and Crack Formation After Balloon Dilatation in Calcified Plaque Requiring Rotational Atherectomy
Nobuhiko Maejima,Kiyoshi Hibi,Kenichiro Saka,Eiichi Akiyama,Masaaki Konishi,Mitsuaki Endo,Noriaki Iwahashi,Kengo Tsukahara,Masami Kosuge,Toshiaki Ebina,Satoshi Umemura,Kazuo Kimura +11 more
TLDR
Estimation of the effects of rotational atherectomy and subsequent balloon angioplasty on calcified coronary lesions using optical coherence tomography found presence of calcium crack was the important determinant of optimal stent expansion.Abstract:
BACKGROUND Target lesion calcification is known to influence percutaneous coronary intervention. We evaluated the effects of rotational atherectomy (RA) and subsequent balloon angioplasty on calcified coronary lesions using optical coherence tomography (OCT). METHODS AND RESULTS Thirty-seven calcified lesions in 36 patients were treated with RA followed by balloon angioplasty and stent implantation. In all patients, serial OCT images obtained after RA, after balloon angioplasty, and after stent implantation were analyzed at 1-mm intervals. The arc and thickness of the calcium component were measured after RA. The formation of calcium cracks was assessed after balloon angioplasty. A total of 625 segments were analyzed. The formation of calcium crack after balloon angioplasty was associated with greater stent cross-sectional area (7.38±1.92 vs. 7.13±1.68 mm(2), P=0.035) as well as greater lumen gain (3.89±1.53 vs. 3.40±1.46 mm(2), P<0.001). Segments with calcium cracks after angioplasty had a larger median calcium arc (360°, IQR, 246-360° vs. 147°, IQR, 118-199°, P<0.001) and a thinner calcium thickness (0.53±0.28 vs. 1.02±0.42 mm, P<0.001) than those without. The optimal thresholds of calcium arc and calcium thickness for the prediction of cracks were 227° and 0.67 mm, respectively. CONCLUSIONS Larger calcium arc and thinner calcium thickness were associated with formation of calcium crack. Presence of calcium crack was the important determinant of optimal stent expansion. (Circ J 2016; 80: 1413-1419).read more
Citations
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Optical Coherence Tomography Characterization of Coronary Lithoplasty for Treatment of Calcified Lesions: First Description
Ziad A. Ali,Todd J. Brinton,Jonathan Hill,Akiko Maehara,Mitsuaki Matsumura,Keyvan Karimi Galougahi,Uday Illindala,Matthias Götberg,Robert Whitbourn,Nicolas M. Van Mieghem,Ian T. Meredith,Carlo Di Mario,Jean Fajadet +12 more
TL;DR: High-resolution imaging by OCT delineated calcium modification with fracture as a major mechanism of action of lithoplasty in vivo and demonstrated efficacy in the achievement of significant acute area gain and favorable stent expansion.
Journal ArticleDOI
High-Speed Rotational Atherectomy Versus Modified Balloons Prior to Drug-Eluting Stent Implantation in Severely Calcified Coronary Lesions
Mohamed Abdel-Wahab,Ralph Toelg,Robert A. Byrne,Volker Geist,Mohamed El-Mawardy,Abdelhakim Allali,Tobias Rheude,Derek R. Robinson,Mohammad Abdelghani,Dmitriy S. Sulimov,Adnan Kastrati,Gert Richardt +11 more
TL;DR: Lesion preparation with upfront RA before drug-eluting stent implantation is feasible in nearly all patients with severely calcified coronary lesions, is more commonly successful as a primary strategy compared with MB, and is not associated with excessive late lumen loss.
Journal ArticleDOI
IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal.
TL;DR: Procedural guidance with intravascular ultrasound (IVUS) imaging improves the clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) by: 1) informing the necessity for lesion preparation; 2) directing appropriate stent sizing to maximize the final stent area and minimize geographic miss; 3) selecting the optimal stent length to cover residual disease adjacent to the lesion, thus minimizing geographic miss as discussed by the authors.
Journal ArticleDOI
In Vivo Calcium Detection by Comparing Optical Coherence Tomography, Intravascular Ultrasound, and Angiography.
Xiao Wang,Mitsuaki Matsumura,Gary S. Mintz,Tetsumin Lee,Wenbin Zhang,Yang Cao,Akiko Fujino,Yongqing Lin,Eisuke Usui,Yoshihisa Kanaji,Tadashi Murai,Taishi Yonetsu,Tsunekazu Kakuta,Akiko Maehara +13 more
TL;DR: Angiographic detection of target lesion coronary calcium (compared to intravascular imaging) has not changed in the past 2 decades, and angiographically invisible calcium (only detectable by IVUS or OCT) did not appear to inhibit stent expansion.
Journal ArticleDOI
Management of Calcific Coronary Artery Lesions: Is it Time to Change Our Interventional Therapeutic Approach?
TL;DR: It seems likely that combining enhanced intravascular imaging, which allows definition of the patterns of calcification with these new technologies, will herald a change in procedural algorithms for treatment of LHCC.
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