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Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease Clinical Outcomes and Cost-Effectiveness of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease: Three-Year Follow-Up of the FAME 2 Trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW Impact of myocardial supply area on the transstenotic hemodynamics as determined by fractional flow reserve Physiologic Characteristics and Clinical Outcomes of Patients With Discordance Between FFR and iFR Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry Prognostic Implication of Thermodilution Coronary Flow Reserve in Patients Undergoing Fractional Flow Reserve Measurement Relationship between fractional flow reserve value and the amount of subtended myocardium High-Resolution Cardiac Magnetic Resonance Imaging Techniques for the Identification of Coronary Microvascular Dysfunction
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Clinical Trial1998 Aug;19(8):1224-31.

JOURNAL：Eur Heart J. Article Link

Treatment of calcified coronary lesions with Palmaz-Schatz stents. An intravascular ultrasound study

Hoffmann R, Mintz GS, Popma JJ et al. Keywords: calcified coronary lesions; intracoronary stents, IVUS, rotational atherectomy

ABSTRACT

AIMS - To evaluate the result of coronary stenting in calcified lesions and to find morphological and procedural factors influencing the final result.


METHODS AND RESULTS - Three hundred and twenty three native coronary artery lesions in 303 patients (197 men, mean age 63.9 +/- 11.5 years) treated with Palmaz-Schatz stents were differentiated into four groups depending on their degree of circumferential calcification as defined by intravascular ultrasound [0-90 degrees (n=120), 91-180 degrees (n=58, 181-270$ (n=71) and 271-360 degrees n=74)]. In 117 lesions rotational atherectomy was used prior to stent placement. Intravascular ultrasound and quantitative angiography were performed prior to treatment and after stent placement to measure minimal and maximal lumen diameter and lumen cross-sectional area at the lesion site and the reference segments. Acute lumen gain and eccentricity index were calculated. Although higher balloon pressures were used than in the minimally calcified lesions. the final angiographic minimal lumen diameter decreased with increasing arc of calcification (3.01 +/- 0.47, 3.04 +/- 0.43, 2.85 +/- 0.53, 2.83 +/- 0.40 mm, respectively, P=0.0320) resulting in a decrease in acute diameter gain with increasing arc of calcification (2.06 +/- 0.51, 1.91 +/- 0.46, 1.81 +/- 0.56, 1.78 +/- 0.51 mm, respectively, P=0.0067). Adjunctive rotational atherectomy prior to stent placement resulted in a greater acute diameter and a greater lumen cross-sectional area gain, coupled with less final residual stenosis than pre-treatment with balloon angioplasty.

CONCLUSION - Implantation of stents in calcified lesions results in less optimal stent expansion, especially in lesions with thick, eccentric calcific plaque layers. Use of adjunctive rotational atherectomy before stent placement may improve the procedural result.
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