Original Research
2018 Oct 17. [Epub ahead of print]
JOURNAL:Catheter Cardiovasc Interv.
Article Link

Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography
Yamamoto MH, Maehara A, Kim SS et al.

KEYWORDS
calcified coronary plaque; OCT; orbital atherectomy

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, postOA, and poststent (n = 58). Calcium modification after OA was defined as a round, concave, polished calcium surface. Calcium fracture was complete discontinuity of calcium.

RESULTS - Comparing prevs postOA OCT (n = 29), calcium area was significantly decreased postOA (from 3.4 mm2 [2.4–4.7] to 2.9 mm2 [1.9–3.9], P < 0.001). Poststent percent calcium fracture (calcium fracture length/calcium length) correlated with postOA 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 mm2or stent expansion ≥90% (medians of this cohort) at the maximum calcium angle site, was observed in 41 lesions. Larger postOA 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.

© 2018 Wiley Periodicals, Inc.

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