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Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography
Author(s) -
Yamamoto Myong Hwa,
Maehara Akiko,
Kim Sung Sik,
Koyama Kohei,
Kim SongYi,
Ishida Masaru,
Fujino Akiko,
Haag Elizabeth S.,
Alexandru Dragos,
Jeremias Allen,
Sosa Fernando A.,
Karimi Galougahi Keyvan,
Kirtane Ajay J.,
Moses Jeffrey W.,
Ali Ziad A.,
Mintz Gary S.,
Shlofmitz Richard A.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27902
Subject(s) - calcium , medicine , stent , lumen (anatomy) , optical coherence tomography , intravascular ultrasound , radiology
Abstract Objectives We sought to assess plaque modification and stent expansion following orbital atherectomy (OA) for calcified lesions using optical coherence tomography (OCT). Background The efficacy of OA for treating calcified lesions is not well studied, especially using intravascular imaging in vivo. Methods OCT was performed preprocedure, post‐OA, and post‐stent ( n = 58). Calcium modification after OA was defined as a round, concave, polished calcium surface. Calcium fracture was complete discontinuity of calcium. Results Comparing pre‐ vs post‐OA OCT ( n = 29), calcium area was significantly decreased post‐OA (from 3.4 mm 2 [2.4–4.7] to 2.9 mm 2 [1.9–3.9], P < 0.001). Poststent percent calcium fracture (calcium fracture length/calcium length) correlated with post‐OA percent calcium modification (calcium modification length/calcium length) ( r = 0.31, P = 0.01). Among 75 calcium fractures in 35 lesions, maximum calcium thickness at the fracture site was greater with vs without calcium modification (0.58 mm [0.50–0.66] vs 0.45 mm [0.38–0.52], P = 0.003). Final optimal stent expansion, defined as minimum stent area ≥6.1 mm 2 or stent expansion ≥90% (medians of this cohort) at the maximum calcium angle site, was observed in 41 lesions. Larger post‐OA lumen area (odds ratio 2.64; 95% CI 1.21–5.76; P = 0.02) and the presence of calcium fracture (odds ratio 6.77; 95% CI 1.25–36.6; P = 0.03) were independent predictors for optimal stent expansion. Conclusions Calcium modification by OA facilitates poststent calcium fracture even in thick calcium. Greater calcium modification correlated with greater calcium fracture, in turn resulting in better stent expansion.