Author + information
- Sawako Yada1,
- Takashi Ashikaga2,
- Yuji Matsuda3,
- Taku Fukushima4,
- Kensuke Hirasawa5,
- Hirofumi Otani6,
- Daisuke Ueshima7,
- Yu Hatano8,
- Shunji Yoshikawa9,
- Takanobu Yamamoto10 and
- Mitsuaki Isobe11
- 1Tokyo Medicat and Dental University, Tokyo, Japan
- 2Tokyo Medical and Dental University, Tokyo, Japan
- 3Tokyo Medical and Dental University Hospital Faculty of Medicine, Tokyo, Japan
- 4Tokyo Medical Dental University, Tokyo, Japan
- 5Tokyo, Japan
- 6Tokyo Medicat and Dental University
- 7Tokyo Medical and Dental University, Tokyo, Japan
- 8Tokyo Medical and Dental University
- 9Tokyo Medical and Dental University
- 10Tokyo Medical and Dental University
- 11Tokyo Medical and Dental University
The association between the platform speed and acute lumen gain remains unknown. The purpose of this study is to evaluate the effect of additional lower-speed rotational atherectomy (RA) following conventional high-speed RA on acute lumen gain using sequential optical frequency domain imaging (OFDI) in vitro and in vivo.
We performed in-vitro study using calcification model. In high-speed RA model, RA with 1.5mm burr was performed at 190,000 rpm at first, and the ablation at 110,000 rpm was sequentially added. In lower-speed RA model, the ablation only at 110,000 rpm was performed. Before and after each ablation, OFDI was carried out for the evaluation of Minimum Lumen Diameter (MLD) and Minimum Lumen Area (MLA). All the experiments were performed in quintuplicate. In vivo, we retrospectively enrolled 26 consecutive lesions in 25 consecutive patients who underwent RA with 1.5mm burr from June 2013 to June 2016. Fourteen lesions were ablated at 190,000 rpm, defined as high-speed RA and 12 lesions were ablated at 110,000 rpm followed by the ablation at 190,000 rpm, defined as low-speed RA. We evaluated MLD and MLA immediately after RA using OFDI.
In vitro experiments, the burr could pass the lesion in a smaller number of pecking motion times in high-speed RA model than in lower-speed RA model (72±11 times vs. 134±20 times, p<0.0001). MLD and MLA just after 110,000 rpm ablation were significantly larger than those of 190,000 rpm ablation in high-speed RA model (MLD: 1.50±0.05 mm vs. 1.43±0.05 mm, p=0.015 MLA: 1.90±0.17 mm2 vs. 1.71±0.11 mm2, p=0.037). Furthermore, in vivo data showed that MLD just after low-speed RA was significantly larger than those of high-speed RA group (MLD: 1.21±0.12 mm vs. 1.06±0.14 mm, p=0.006). MLA tended to be larger than those of high-speed RA group (MLA: 1.76±0.53 mm vs. 1.54±0.48 mm, p=0.276).
Additional lower speed RA can pass the calcified lesion easily and achieve larger lumen gain compared with conventional high-speed RA.
CORONARY: Atherectomy (excluding thrombectomy)