Efficacy of intravascular ultrasound guided rotational atherectomy for heavily calcified coronary lesions.

Yong Sun; Jun Jiang; Guozhong Zhu; Changling LI; Liang Dong; Xianbao Liu; Liang Lyu; Xinyang HU; Meixiang Xiang; Jian'an Wang

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Efficacy of intravascular ultrasound guided rotational atherectomy for heavily calcified coronary lesions.

Author: Yong SUN ¹ ; Jun JIANG ¹ ; Guozhong ZHU ¹ ; Changling LI ¹ ; Liang DONG ¹ ; Xianbao LIU ¹ ; Liang LYU ¹ ; Xinyang HU ¹ ; Meixiang XIANG ¹ ; Jian'an WANG ²
Author Information

1. Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
2. Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China. Email: wja@zju.edu.cn.
Publication Type:Journal Article
MeSH: Atherectomy, Coronary; Coronary Angiography; Coronary Artery Disease; therapy; Drug-Eluting Stents; Humans; Myocardial Infarction; Retrospective Studies; Stents; Treatment Outcome; Ultrasonography, Interventional; Vascular Calcification; therapy
From: Chinese Journal of Cardiology 2014;42(7):545-550
CountryChina
Language:Chinese
Abstract:
OBJECTIVETo evaluate the efficacy of intravascular ultrasound guided tranradial rotational atherectomy (RA) followed by drug eluting stent (DES) implantation in treating patients with heavily calcified coronary lesions.
METHODSClinical characteristics, coronary angiogram, intravascular ultrasound images, peri-procedure and follow-up data (including death , myocardial infarction and target lesion revascularization) of 44 patients treated with RA and DES implantation under the guidance of IVUS in our department from March 2011 to March 2013 were retrospectively analyzed. IVUS examination was carried out before RA, after RA and stent implantation to guide whether further RA or post dilatation was needed. According to the arc of calcification, the patients were divided into group A (90°-270°, 18 cases) and group B (271°-360°, 26 cases).
RESULTSIn A and B group, the arc of calcification was (195 ± 71)° in group A and (345 ± 23)° in group B (P < 0.01) , length of calcification was (34.4 ± 11.8) mm in group A and (20.0 ± 6.6) mm in group B (P < 0.05). Number of burrs used and size of largest burr used were similar between 2 groups (both P > 0.05). Acute cross sectional area gain after RA was (0.43 ± 0.32) mm in group A and (0.53 ± 0.38) mm² in group B (P > 0.05). After RA, there was significant decrease in the arc of calcification in group B compared with baseline ((324 ± 52)° vs. (345 ± 23)°, P < 0.05). The minimal lumen area and diameter were significantly increased after RA resulting in significant decrease in the plaque burden in both groups (all P < 0.05). The final minimal lumen area after stenting were similar between 2 groups (P > 0.05). Procedure success rate was 100% (44/44) without any major complications such as death, acute myocardial infarction and coronary perforation. During the (16.6 ± 6.3) months follow-up, there was 1 death in group A, 1 target lesion revascularization in group B and there was no acute myocardial infarction in the 2 groups.
CONCLUSIONHeavily calcified coronary lesions can be effectively and safely treated by transradial RA under the guidance of IVUS.