Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
EuroIntervention. 2020 Jul 17;16(4):e313-e321. doi: 10.4244/EIJ-D-19-00725.
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.
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).
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.
我们旨在评估与血管内超声（IVUS）引导下旋磨术相比，光学相干断层扫描（OCT）引导下旋磨术是否能改善支架扩张和临床结局。
从我们的数据库中，我们确定了 247 例在 2013 年 9 月至 2017 年 12 月期间接受旋磨术治疗的新出现的钙化冠状动脉病变。其中，排除了无血管内成像数据（n=11）、图像质量差（n=7）、单纯球囊血管成形术（n=16）和并发症（2 例磨头嵌顿、2 例穿孔）的病变。最终，88 例和 121 例分别接受了 OCT 引导和 IVUS 引导下旋磨术的病变被纳入本研究。本研究的主要终点是支架扩张百分比。OCT 引导下旋磨术组更频繁地进行磨头增粗（55%比 32%，p=0.001），最终磨头尺寸明显更大（1.75 [1.50-1.75]比 1.50 [1.50-1.75]mm，p<0.001）。OCT 引导下旋磨术组支架扩张百分比明显更大（83±15%比 72±16%，p=0.0004）。尽管 OCT 引导下旋磨术组在一年时 TLR 较低，但无统计学差异（6.8%比 11.6%，p=0.25）。
与 IVUS 引导下旋磨术相比，OCT 引导下旋磨术治疗钙化冠状动脉病变可导致更大的支架扩张百分比。OCT 引导下旋磨术可能是治疗钙化冠状动脉病变的理想选择。
