Prediction of optimal debulking segments before rotational atherectomy based on pre-procedural intravascular ultrasound
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ORIGINAL PAPER
Prediction of optimal debulking segments before rotational atherectomy based on pre‑procedural intravascular ultrasound findings Kenta Hashimoto1 · Kenichi Fujii1 · Hiroki Shibutani1 · Koichiro Matsumura2 · Satoshi Tsujimoto1 · Munemitsu Otagaki2 · Shun Morishita1 · Ichiro Shiojima1 Received: 4 September 2020 / Accepted: 19 October 2020 © Springer Nature B.V. 2020
Abstract This study evaluated whether intravascular ultrasound (IVUS) examination before rotational atherectomy (RA) can predict the optimal route of passage of the RA burr along the vessel. 30 patients with calcified lesions who underwent IVUS before and immediately after RA were enrolled. IVUS analyses were performed at the minimum lumen area (MLA) site and at 0.5 mm intervals. Each IVUS cross-section was divided into 4 quadrants around the center of the lumen, and pre- and postRA IVUS cross-section images were merged. Of 1140 cross-sections, 498 (44%) contained debulked regions. When the guidewire and IVUS were located within the same quadrant, the debulked region were distributed within the same quadrant in 96% of cross-sections. The debulked region and the guidewire were distributed within the same quadrant in 81% and the debulked region and the IVUS in 72% of cross-sections, in case the guidewire and IVUS were located in different quadrants. When the guidewire and the IVUS was apart > 1.0 mm, the debulked regions were distributed within the same quadrant as the guidewire in 100% and the IVUS in 0% of cross-sections. The position of the guidewire rather than that of the IVUS catheter on pre-RA IVUS images could predict the course of the RA burr’s passage, especially when the guidewire and IVUS catheter were located apart from each other. Keywords Coronary artery disease · Percutaneous coronary intervention · Calcification · Intravascular ultrasound · Rotational atherectomy
Introduction Percutaneous coronary intervention (PCI) in patients with severe coronary artery calcification is more technically challenging as it involves advancing balloons and stents to the site of the lesion and achieving optimal stent expansion, which may be difficult [1]. In severely calcified lesions, rotational atherectomy (RA) is often necessary for lesion Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10554-020-02080-4) contains supplementary material, which is available to authorized users. * Kenichi Fujii [email protected] 1
Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata‑city, Osaka 5731010, Japan
Department of Cardiology, Kansai Medical University Medical Center, Moriguchi, Japan
2
modification to permit optimal stent deployment and expansion [2]. While RA is a very useful technique for severely calcified lesions, catastrophic complications such as coronary perforations are more frequently observed in PCI with RA than that without RA [3]. Therefore, it is important to predict the potential occurrence of complications before undertaking RA. I
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