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Severe calcification of coronary artery disease is associated with inadequate stent expansion and stent eccentricity. Rotational atherectomy (RA) is effective modality for lesion modification of severe calcified lesion, however, optimal endpoint of RA remains unknown.
Between September 2013 and June 2016, a total of 50 consecutive severe calcified lesions underwent RA with optical frequency-domain imaging (OFDI) guidance. We performed OFDI just after RA and stenting. We measured morphology of calcification and prevalence of dissection after RA, and how these factors influence on stent expansion. Morphology of calcium was measured at the target lesion site with greatest extent of calcium. Stent expansion was measured as minimum stent area divided by the average of the proximal and distal reference lumen area.
Minimum calcification thickness showed significant negative correlation with stent expansion (r = -0.532, P <0.001). On the other hand, calcification arc (r = -0.31, P =0.83), length (r = -0.083, P =0.567), and maximum calcification thickness (r = -0.136, P =0.345) did not show a significant correlation with stent expansion. Dissection after RA occurred in 22 lesions (44%), and stent expansion was significantly better in the lesions with dissection compared to the lesions without dissection (0.96±0.08 vs. 0.82±0.19, P=0.002).
The most important morphology of calcification just after RA may be minimum calcification thickness. In addition, occurrence of dissection after RA may lead to good stent expansion.
IMAGING: Imaging: Intravascular