Clinical efficacy of optical coherence tomography-guided versus intravascular ultrasound-guided rotational atherectomy for calcified coronary lesion

Aims:We aimed to evaluate whether optical coherence tomography (OCT)-guided rotational atherectomy (RA) improves stent expansion and clinical outcomes compared to intravascular ultrasound (IVUS)-guided RA.

Methods and results:We identified 247 de-novo calcified coronary lesions that underwent RA from our database between September 2013 and December 2017. Of these, lesions with no intravascular imaging data (n=11), poor image quality (n=7), balloon angioplasty alone (n=16), and complications (2 burr entrapment, 2 perforation) were excluded. Finally, 88 and 121 lesions that underwent OCT-guided and IVUS-guided RA, respectively, were enrolled. The primary endpoint of the present study was percent stent expansion. Burr upsizing was more frequently performed (55% vs. 32%, P=0.001) and the final burr size was significantly larger (1.75[1.50-1.75] vs. 1.50[1.50-1.75] mm, P<0.001) in the OCT-guided RA group. Percent stent expansion was significantly larger in the OCT-guided RA group (83±15% vs. 72±16%, P=0.0004). Although TLR at 1 year was lower in the OCT-guided RA group, there was no statistical difference (6.8% vs. 11.6%, P=0.25).

Conclusions:OCT-guided RA for calcified coronary lesions resulted in larger percent stent expansion compared to IVUS-guided RA. OCT-guided RA may be ideal for treating calcified coronary lesions.