High-definition intravascular ultrasound versus optical frequency domain imaging for the detection of calcium modification and fracture in heavily calcified coronary lesion.

Masaru Ishida,Ryohei Sakamoto,Yorihiko Koeda,Yudai Shimoda,Yuya Taguchi,Tomonori Itoh,Yoshihiro Morino,Yu Ishikawa,Takumi Kimura,Yuya Oshikiri

doi:10.1007/s10554-021-02521-8

Abstract

While optical frequency domain imaging (OFDI) can delineate calcium modification and fracture, the capability of high-definition intravascular ultrasound (HD-IVUS) for detecting these remains unclear. This study evaluated diagnostic accuracy of HD-IVUS for assessing calcium modification and fracture as compared to OFDI. HD-IVUS and OFDI were used during orbital or rotational atherectomy procedures conducted for 21 heavily calcified coronary lesions in 19 patients. With OFDI assessment used as the gold standard, diagnostic accuracies of HD-IVUS for calcium modification and fracture were compared every 1mm to the matched pre-stenting images (n = 1129). Calcium modification, as assessed by OFDI, was defined as polished and concave-shaped calcium. For HD-IVUS, calcium modification was defined as the presence of reverberation with concave-shaped calcium. In both assessments, the definition of calcium fracture was defined as a slit or complete break in the calcium plate. Calcified plaque was found in 86.4% of analyzed OFDI images. Calcium modification and fracture were detected in 20.6% and 11.0% of detected calcified plaques. Sensitivity, specificity, positive and negative predictive values of HD-IVUS detection for calcium modification and fracture were 54.4%, 97.8%, 86.7%, 89.1% and 86.0%, 94.5%, 58.2%, 96.8%, respectively. Discordance cases between both assessments demonstrated that heterogeneous calcium visualized by OFDI, separated calcium, and guide wire artifact can be misdiagnosed. Diagnostic accuracies of HD-IVUS for assessing calcium modification and fracture were acceptable as compared to OFDI. Such findings can be of utility during imaging guided interventional procedures with atherectomy.

Highlights

Even when using current-generation drug-eluting stents, a calcified coronary lesion remains a risk factor for poor clinical outcome of percutaneous coronary intervention (PCI) [1, 2], which is primarily caused by stent underexpansion due to thick and circumferential coronary calcium [3, 4]
Diagnostic accuracies of high-definition intravascular ultrasound (HD-IVUS) for assessing calcium modification and fracture were modest as compared to Optical frequency domain imaging (OFDI)
These results suggest that OFDI guidance is more feasible during treatment of heavily calcified coronary lesions versus HD-IVUS guidance

Summary

Introduction

Even when using current-generation drug-eluting stents, a calcified coronary lesion remains a risk factor for poor clinical outcome of percutaneous coronary intervention (PCI) [1, 2], which is primarily caused by stent underexpansion due to thick and circumferential coronary calcium [3, 4]. Before implanting a stent in a heavily calcified lesion, the PCI operator needs to confirm whether or not the target lesion is expandable. Optical frequency domain imaging (OFDI) and optical coherence tomography (OCT), which can delineate calcium modification by atherectomy devices and calcium fracture caused by angioplasty, are considered to be an appropriate imaging modality for evaluating the expandability before stent implantation in heavily calcified coronary lesions [5]. 60 MHz high-definition intravascular ultrasound (HD-IVUS), which has a relatively highresolution image as compared to conventional IVUS, has been widely used to assess the presence of a favorable lesion preparation after atherectomy or ballooning, in addition to helping to confirm stent optimization [6,7,8]. To evaluate the diagnostic accuracy of HD-IVUS for heavily calcified lesions, we compared HDIVUS and OFDI with regard to the detection of calcium modification and fracture

Methods

Results

Conclusion