Effect of Atherectomy on Lesion Preparation in Heavily Calcified Coronary Artery Disease

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  • Emori Hiroki
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Shiono Yasutsugu
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Terada Kosei
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Higashioka Daisuke
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Takahata Masahiro
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Fujita Suwako
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Wada Teruaki
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Ota Shingo
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Satogami Keisuke
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Kashiwagi Manabu
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Kuroi Akio
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Yamano Takashi
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Tanimoto Takashi
    Department of Cardiovascular Medicine, Wakayama Medical University
  • Tanaka Atsushi
    Department of Cardiovascular Medicine, Wakayama Medical University

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<p>Background: Percutaneous coronary intervention (PCI) of heavily calcified lesions remains challenging. This study examined whether calcified lesion preparation is better with an ablation-based than balloon-based technique.</p><p>Methods and Results: Results of lesion preparations with and without atherectomy devices were compared in 121 patients undergoing optical coherence tomography (OCT)-guided PCI of heavily calcified lesions. Lesion preparation was performed with the ablation-based technique in 59 patients (atherectomy group) and with the balloon-based technique in 62 patients (balloon group). Lower grades of angiographic coronary dissections (National Heart, Lung, and Blood Institute [NHLBI] classification) occurred in the atherectomy than balloon group (atherectomy group: none, 33%; NHLBI A, 59%; B, 8%; C, 0%; D, 0%; balloon group: none, 1%; NHLBI A, 24%; B, 58%; C, 15%; D, 2%). On OCT, a large dissection was less common (49% vs. 90%; P<0.001) and calcium fractures were more frequent (75% vs. 18%; P<0.001) in the atherectomy than balloon group. In multivariable analyses, the ablation-based technique was associated with a lower grade of angiographic coronary dissection (adjusted odds ratio [aOR] 0.04; 95% confidence interval [CI] 0.01–0.12; P<0.001), a lower incidence of OCT-detected large dissection (aOR 0.09; 95% CI 0.03–0.30; P<0.001), and a higher incidence of OCT-detected calcium fracture (aOR 18.19; 95% CI 6.45–58.96; P<0.001).</p><p>Conclusions: The ablation-based technique outperformed the balloon-based technique in the lesion preparation of heavily calcified lesions.</p>

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  • Circulation Reports

    Circulation Reports 4 (5), 205-214, 2022-05-10

    一般社団法人 日本循環器学会

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