Comparison of optical coherence tomography-guided and intravascular ultrasound-guided rotational atherectomy for calcified coronary lesions

Weili Teng,Jian Liu,Chang Hou,Qi Li,Yuliang Ma,Mingyu Lu,Weimin Wang,Hong Zhao,Chengfu Cao

doi:10.1186/s12872-021-02103-5

Weili Teng, Jian Liu + Show 7 more

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https://doi.org/10.1186/s12872-021-02103-5

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Abstract

BackgroundTo compare the effect and outcomes of optical coherence tomography (OCT)-guided rotational atherectomy (RA) with intravascular ultrasound (IVUS)-guided RA in the treatment of calcified coronary lesions.MethodsData of calcified coronary lesions treated with RA that underwent OCT-guided or IVUS-guided from January 2016 to December 2019 at a single-center registry were retrospectively analyzed. The effect and outcomes between underwent OCT-guided RA and IVUS-guided RA were compared.Results A total of 33 lesions in 32 patients received OCT-guided RA and 51 lesions in 47 patients received IVUS-guided RA. There was no significant difference between OCT-guided RA group and IVUS-guided RA group in clinical baselines characteristics. Comparing the procedural and lesions characteristics of the two groups, the contrast volume was larger [(348.8 ± 110.6) ml vs. (275.2 ± 76.8) ml, P = 0.002] and the scoring balloon was more frequently performed (33.3% vs. 3.9%, P = 0.001) after RA and before stenting in the OCT-guided RA group. Comparing the intravascular imaging findings of the two groups, stent expansion was significantly larger in the OCT-guided RA group ([82 ± 8]% vs. [75 ± 9]%, P = 0.001). Both groups achieved procedural success immediately. There were no significantly differences in the incidence of complications. Although there was no statistical difference in the occurrence of MACE at 1 year between OCT-guided RA group and IVUS-guided RA group (3.1% vs. 6.4%, P = 0.517), no cardiovascular death, TVR and stent thrombosis occurred in OCT-guided RA group.ConclusionsOCT-guided RA compared to IVUS-guided RA for treating calcified coronary lesions resulted in better stent expansion and may have improved prognosis.

Highlights

To compare the effect and outcomes of optical coherence tomography (OCT)-guided rotational atherectomy (RA) with intravascular ultrasound (IVUS)-guided RA in the treatment of calcified coronary lesions
Baseline clinical characteristics Initially, 88 patients with coronary heart disease and moderate or severe calcified lesions treated with RA under OCT guidance or IVUS guidance in the study
There were no significant differences between OCT-guided-RA group and IVUS-guided RA group for baseline characteristics including age, gender, risk factors, comorbidities and past history of percutaneous coronary intervention (PCI) and coronary artery bypass graft, and coronary heart disease diagnosis (P > 0.05, all)

Summary

Introduction

To compare the effect and outcomes of optical coherence tomography (OCT)-guided rotational atherectomy (RA) with intravascular ultrasound (IVUS)-guided RA in the treatment of calcified coronary lesions. The treatment of coronary artery calcified lesions remains a serious challenge for percutaneous coronary intervention (PCI). Ultrasound itself cannot penetrate calcium, due to acoustic shadowing, which limits the value of IVUS in the assessment of heavily calcified lesions. Optical coherence tomography (OCT) provides greater resolution imaging than IVUS and can in many cases assess calcium thickness and volume [7, 8]. The comparative of OCT-guided RA and IVUS-guided RA for calcified coronary lesions remains poorly studied.

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