Additional debulking efficacy of low-speed rotational atherectomy after high-speed rotational atherectomy for calcified
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ORIGINAL PAPER
Additional debulking efficacy of low‑speed rotational atherectomy after high‑speed rotational atherectomy for calcified coronary lesion Norihiro Kobayashi1 · Masahiro Yamawaki1 · Keisuke Hirano1 · Motoharu Araki1 · Tsuyoshi Sakai1 · Yasunari Sakamoto1 · Shinsuke Mori1 · Masakazu Tsutsumi1 · Naohiko Sahara1 · Masahiro Nauchi1 · Yohsuke Honda1 · Kenji Makino1 · Shigemitsu Shirai1 · Masafumi Mizusawa1 · Yuta Sugizaki1 · Takahide Nakano1 · Tomoya Fukagawa1 · Toshihiko Kishida1 · Yuki Kozai1 · Yusuke Setonaga1 · Shutaro Goda1 · Yoshiaki Ito1 Received: 18 December 2019 / Accepted: 4 June 2020 © Springer Nature B.V. 2020
Abstract We aimed to evaluate the additional debulking efficacy of low-speed rotational atherectomy (RA) after high-speed RA by using intravascular imaging. A total of 22 severe calcified coronary lesions in 19 patients (age, 74 ± 10 years; 74% male) were retrospectively analyzed. All of these lesions underwent RA under optical coherence tomography (OCT) or optical frequency domain imaging (OFDI) guidance. At first, we performed high-speed RA with 220,000 rpm until the reduction of rotational speed disappeared; then, low-speed RA with 120,000 rpm using the same burr size was performed. OCT or OFDI was performed after both high-speed and low-speed RAs, and the minimum lumen area were compared. The initial and final burr sizes of high-speed RA were 1.5 (1.5–1.75) and 1.75 (1.5–2.0) mm, respectively. The number of sessions, total duration time, and maximum decreased rotational speed during high-speed RA were 11 ± 5 times, 113 ± 47 s, and 4000 (3000–5000) rpm, respectively. During low-speed RA, the number of sessions, total duration time, and maximum reduction of rotational speed were 3 ± 1 times, 32 ± 11 s, and 1000 (0–2000) rpm, respectively. The minimum lumen area was similar between after high-speed and after low-speed RA [2.61 ± 1.03 m m2 (after high-speed RA) vs. 2.65 ± 1.00 m m2 (after lowspeed RA); P = 0.91]. Additional low-speed RA immediately after sufficient debulking by high-speed RA was not associated with increased lumen enlargement. There was no clinical efficacy of low-speed RA after high-speed RA. Keywords Calcified coronary lesion · Optical coherence tomography · Optical frequency domain imaging · Rotational atherectomy · Rotational speed
Introduction Newer generation drug-eluting stent (DES) has improved efficacy and safety issues compared to second-generation DES in randomized clinical trials [1, 2]. However, heavily calcified lesion still remains difficult to treat even using DES due to stent under-expansion and subsequent high incidence of target lesion revascularization (TLR) [3, 4]. Rotational atherectomy (RA) is an effective device to debulk heavy calcification and to achieve sufficient stent expansion and reduces the incidence of TLR [5]. The operator is able to * Norihiro Kobayashi [email protected] 1
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3‑6‑1 Shimosueyoshi, Tsurumi‑ku, Yokohama, Kanagawa 230‑8765, Japan
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