Abstract
Since intravascular imaging such as intravascular ultrasound (IVUS) can provide useful information for rotational atherectomy (RA), intravascular imaging should be attempted before RA. However, some calcified lesions do not allow imaging catheters to cross before RA. Although small burrs (1.25 mm or 1.5 mm) should be selected for such tight lesions, it is unknown whether a 1.25-mm burr or 1.5-mm burr is safer as the initial burr. The aim of this study was to compare the incidence of complications with a 1.25-mm versus a 1.5-mm burr as the initial burr for IVUS-uncrossable lesions. This was a retrospective, single-center study. A total of 109 IVUS-uncrossable lesions were included, and were divided into a 1.25-mm group (n =52) and a 1.5-mm group (n =57). The incidence of slow flow just after RA was not different between the 2 groups (1.25-mm group: 25%, 1.5-mm group: 31.6%, P =0.45). The incidence of peri-procedural MI with slow flow was not different and equally low in the 2 groups (1.25-mm group: 1.9%, 1.5-mm group: 3.5%, P =0.61). The use of the 1.5-mm burr as the initial burr was not significantly associated with slow flow after controlling for chronic renal failure on hemodialysis and reference diameter (vs. 1.25-mm: OR 2.34, 95% CI 0.89–6.19, P =0.09). In conclusion, the incidence of complications following RA was comparable between the 1.25-mm and the 1.5-mm burrs as the initial burr for IVUS-uncrossable lesions. The present study provides insights into the selection of an appropriate burr for IVUS-uncrossable lesions.
Highlights
Rotational atherectomy (RA) is a crucial device for severely calcified coronary lesions, severe complications such as type III perforation is more frequently observed in percutaneous coronary interventions (PCI) with than without rotational atherectomy (RA) [1, 2]
The patient characteristics were comparable except for the prevalence of chronic renal failure on hemodialysis, which was significantly greater in the 1.5-mm group (31.6%) than the 1.25-mm group (15.4%) (P =0.048)
The lesion characteristics were comparable except for the reference diameter, which was significantly greater in the 1.5-mm group (2.36 ± 0.57 mm) than the 1.25-mm group (2.15 ± 0.62 mm) (P =0.03)
Summary
Rotational atherectomy (RA) is a crucial device for severely calcified coronary lesions, severe complications such as type III perforation is more frequently observed in percutaneous coronary interventions (PCI) with than without RA [1, 2]. Some severely calcified lesions do not allow intravascular imaging devices to cross before RA [9]. If lowprofile imaging devices cannot cross the lesion, the initial burr size should be either the smallest burr (1.25 mm) or the second smallest burr (1.5 mm) to avoid serious complications. A smaller device seems to be more useful than a bigger device for severely calcified lesion [10]. The shape of each RA burr is close to an ellipsoid [11]. The smallest burr (1.25 mm) is the sharpest ellipsoid, which may be associated with complications such as burr entrapment
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