The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions

Optical coherence tomography-guided versus intravascular ultrasound-guided rotational atherectomy in patients with calcified coronary lesions

EuroIntervention 2020;16:e313-e321. DOI: 10.4244/EIJ-D-19-00725

1. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan; 2. Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan

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: From our database, we identified 247 de novo calcified coronary lesions that underwent RA 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 (two burr entrapments, two perforations) were excluded. Finally, 88 and 121 lesions that underwent OCT-guided and IVUS-guided RA, respectively, were included in the study. 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 one 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.

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