Abstract
Background Severely calcified coronary artery stenting remains a challenge due to stent thrombosis, target vessel failure, and higher mortality. Moreover, optimal vessel preparation for calcified plaque with a crack formation pattern has not been established yet. We aimed to identify the effect of crack formation in calcified plaque in the coronary artery on the lumen area after stenting. Materials and Methods We evaluated 50 consecutive patients undergoing drug-eluting stent implantation for severely calcified lesions by using optical frequency domain imaging (OFDI) (54 lesions); we analyzed OFDI image slices every 3 mm and evaluated the segments of 242 images in those who had the arc of calcium more than 180°. Crack formation in calcified plaque was classified into three types: type 0, no cracks; type 1, no dissection between calcified plaque and vessel wall; and type 2, any dissection between calcified plaque and vessel wall. Results Type 2 had a significantly higher area expansion ratio between preballooning and poststenting (type 0, 196% (interquartile range (IQR), 163–244); type 1, 210% (IQR, 174–244); type 2, 237% (IQR, 203–294)). Conclusions The dissection between calcified plaque and vessel wall was a significant factor affecting lumen area expansion after stenting.
Highlights
Percutaneous coronary intervention (PCI) outcomes have improved with the development of drug-eluting stent (DES) [1–4]
In the treatment of calcified plaque, ultrasound waves are reflected by the surface of calcium; intravascular ultrasound (IVUS) cannot provide quantitative evaluation of calcified plaque. us, this study aimed to evaluate the effect of crack formation pattern in calcified plaque after balloon angioplasty on final lumen area using optical frequency domain imaging (OFDI)
Calcified nodule was defined based on previous reports as “when fibrous cap disruption was detected over a calcified plaque characterized by protruding calcification, superficial calcium, and the presence of substantive calcium proximal and/or distal to the lesion” [14]. us, the study population consisted of 50 patients (54 lesions). e stent choice, use of debulking devices, type of balloons, poststenting dilatation, OFDI pullback speed, and dual antiplatelet therapy duration were decided upon the discretion of individual centers
Summary
Calcified coronary artery stenting remains a challenge due to stent thrombosis, target vessel failure, and higher mortality. Optimal vessel preparation for calcified plaque with a crack formation pattern has not been established yet. We aimed to identify the effect of crack formation in calcified plaque in the coronary artery on the lumen area after stenting. Crack formation in calcified plaque was classified into three types: type 0, no cracks; type 1, no dissection between calcified plaque and vessel wall; and type 2, any dissection between calcified plaque and vessel wall. Type 2 had a significantly higher area expansion ratio between preballooning and poststenting (type 0, 196% (interquartile range (IQR), 163–244); type 1, 210% (IQR, 174–244); type 2, 237% (IQR, 203–294)). E dissection between calcified plaque and vessel wall was a significant factor affecting lumen area expansion after stenting Conclusions. e dissection between calcified plaque and vessel wall was a significant factor affecting lumen area expansion after stenting
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