Impact of Target Lesion Coronary Calcification on Stent Expansion

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp Methods Study PopulationWe retrospectively enrolled 51 consecutive de novo native coronary artery lesions from 44 angina patients who were treated using a single 2nd-generation DES (Xience Prime, Promus Element, or Nobori) under OCT guidance. Exclusion criteria were as follows: coronary artery bypass graft, post-stent dilatation using 2 balloons (kissing balloon inflation and hugging balloon inflation), in-stent restenosis, uninterpretable OCT image, and inability to cross the lesion with the OCT catheter. This study was approved by the Kawasaki Medical School Internal Review Board. Because of the retrospective study design, written informed consent for the interventional procedures, including OCT imaging, was obtained from the patients. Study ProtocolsCardiac Catheterization and OCT After intravenous heparin (100U/kg) and intracoronary nitroglycerin (200 μg) were urrently, 2nd-generation drug-eluting stents (DES) offer good clinical results, 1-4 yet stent underexpansion is still a concern as a cause of DES failure 5-10 or stent thrombosis. 11 Although the extent of coronary calcification is considered to be a contributing factor in stent underexpansion, previous intravascular ultrasound (IVUS) studies have failed to demonstrate a relationship between stent expansion and coronary calcification. 12-14 We previously reported that optical coherence tomography (OCT) offers better quantitative assessment of coronary calcification than IVUS, because OCT can delineate calcified plaque without artifacts. 15 Therefore, we hypothesized that quantitative assessment of coronary calcification using OCT had the potential to predict stent expansion. Accordingly, the purpose of this study was to investigate whether stent expansion could be predicted by the extent of coronary calcification as assessed by OCT. Impact of Target Lesion CoronaryCalcification on Stent Expansion Background: Stent underexpansion remains a concern as a cause of drug-eluting stent (DES) failure. Although coronary calcification is considered to be a contributing factor in stent underexpansion, previous intravascular ultrasound studies have failed to demonstrate this relationship. We investigated whether stent expansion could be predicted by coronary calcification as assessed by optical coherence tomography (OCT).

Relationship Between Thickness of Calcium on Optical Coherence Tomography and Crack Formation After Balloon Dilatation in Calcified Plaque Requiring Rotational Atherectomy

“…19- 22 Recently, Kobayashi et al showed that the extent of target lesion calcification on OCT was associated with stent underexpansion. 23 Thus, complex calcified coronary lesions are associated with poorer outcome due to factors such as in-stent restenosis, even in the DES era. 6,7, 17 RA uses a high-speed, rotating, diamond-coated, elliptical burr to ablate occlusive atherosclerotic material and thereby restore lumen patency.…”

Clinical Utility and Significance of Intravascular Ultrasound and Optical Coherence Tomography in Guiding Percutaneous Coronary Interventions

“…Kobayashi et al demonstrated that the extent of target lesion calcification as assessed by OCT was associated with stent expansion. 29 Several studies have demonstrated the potential utility of IVUS for the treatment of calcified lesions. Roy et al reported that a Rotablator was more frequently used with IVUS guidance than with angiographic guidance, which may have led to the reduction in the incidence of both stent thrombosis and repeat revascularization after DES implantation.…”

iMap-Intravascular Ultrasound Radiofrequency Signal Analysis Reflects Plaque Components of Optical Coherence Tomography-Derived Thin-Cap Fibroatheroma

“…Calcium deposition was defined as a signal-poor or heterogeneous region with a sharply delineated border. 16 Intraobserver and interobserver agreement regarding OCT-TCFA detection was within an acceptable range (κ=0.84 and 0.78, respectively). Figure 1 shows representative OCT and iMap-IVUS images.…”