Author + information
- Myong Hwa Yamamoto1,
- Akiko Maehara2,
- Song-Yi Kim3,
- Masaru Ishida4,
- Akiko Fujino2,
- Elizabeth Haag5,
- Dragos Alexandru6,
- Allen Jeremias6,
- Fernando Sosa7,
- Keyvan Karimi Galougahi8,
- Jeffrey W. Moses9,
- Ziad Ali9,
- Gary Mintz2 and
- Richard Shlofmitz6
- 1Cardiovascular Research Foundation, New York, United States
- 2Cardiovascular Research Foundation, New York, New York, United States
- 3Cardiovascular research foundation, New York, New York, United States
- 4CRF, New York, New York, United States
- 5St Francis Hospital, Roslyn, New York, United States
- 6St. Francis Hospital, Roslyn, New York, United States
- 7Abbott Vascular, New York, New York, United States
- 8Columbia University Medical Center, New York, New York, United States
- 9New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
Coronary artery calcium fracture following vessel preparation for stenting is associated with improved stent expansion. The ability of orbital atherectomy (OA) to facilitate Ca fracture has not been studied.
Optical coherence tomography (OCT) was performed post-OA and post-stent in 58 lesions. Ca modification was defined as a round, concave, polished lumen surface; and its prevalence was analyzed every 1mm and shown as percentage per lesion. Ca fracture was defined as complete discontinuity of calcified plaque after stenting. Optimal stent expansion was defined as cross-sectional area (CSA) ≥6.1mm2 (median) or stent expansion ≥90% (median).
Post-stent Ca fracture length (Ca fracture length/Ca length) correlated with post-OA Ca modification (Ca modification length/Ca length) (r=0.31, p=0.01). Among 75 Ca fractures in 35 lesions, maximum Ca fracture thickness was higher following Ca-modification than without-Ca-modification (0.58 mm [0.50-0.66] vs 0.45 mm [0.38-0.52], p=0.003) (figure). Post-OA optimal expansion was present in 41 patients (70.7%). Multivariable logistic regression analyses identified larger post-OA lumen CSA (Odds ratio, 2.6; 95%CI, 1.19-5.55; p=0.02) and the presence of Ca fracture (Odds ratio, 7.1; 95%CI, 1.30-38.6; p=0.02) as independent predictors for optimal-expansion.
Ca modification by OA facilitates post-stent Ca fracture even in regions of thick Ca as assessed by OCT. Greater Ca modification was correlated with more Ca fracture, in turn resulting in better stent expansion.
CORONARY: Atherectomy (excluding thrombectomy)