Zhou Yu-He, Zhang Hong-Li, Yang Yang, Wang Mei-Qin, Pan Jun, Xu Tian, Meng Pei-Na, Ye Fei, Wang Yan-Qing
Department of General Practice, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.
Front Med (Lausanne). 2025 Aug 19;12:1640237. doi: 10.3389/fmed.2025.1640237. eCollection 2025.
In the treatment of coronary calcification by rotational atherectomy (ROTA), guidewire bias is often considered to lead to procedure-associated coronary dissections or perforations. However, the actual meaning of guidewire bias is unclear, though it usually refers to the cross-sectional location of the intravascular imaging (IVI) catheter in the coronary artery. This study tentatively explores the quantitative criteria in optical coherence tomography (OCT) imaging of guidewire bias, which may cause ROTA-induced coronary dissection.
A total of 21 patients with severe calcified coronary lesions who underwent ROTA treatment were enrolled in our study. OCT successfully detected these patients pre-ROTA and post-ROTA. All observed coronary segments were analyzed cross-sectionally at every 1-mm interval after manual coregistration of pre-ROTA and post-ROTA OCT images. ROTA-related coronary dissection was the primary endpoint.
A total of 388 OCT cross-sectional images were effectively measured and analyzed to assess the distribution and characteristics of plaque and OCT catheter location pre-ROTA, as well as the presence or absence of coronary dissections post-ROTA after manual coregistration. According to the receiver operating characteristic (ROC) analysis, the distance from the center of OCT catheter to the media at the bias direction (D) (area under the curve (AUC): 1.000, < 0.001, 95% confidence intervals (CI): 0.999-1.000) and the touch angle (AUC: 0.988, < 0.001, 95%CI: 0.968 to 1.000) were strongly correlated with ROTA-related coronary dissection, with the corresponding cutoff values of 0.720 mm and 98.2° respectively.
D and touch angle detected by OCT are two valuable and convenient independent predictors of ROTA-related coronary intimal dissections caused by guidewire bias.
在旋磨术（ROTA）治疗冠状动脉钙化过程中，导丝偏倚常被认为会导致与手术相关的冠状动脉夹层或穿孔。然而，导丝偏倚的实际意义尚不清楚，尽管它通常指血管内成像（IVI）导管在冠状动脉中的横截面位置。本研究初步探索了可能导致ROTA引起冠状动脉夹层的导丝偏倚在光学相干断层扫描（OCT）成像中的定量标准。
本研究纳入了21例接受ROTA治疗的严重钙化冠状动脉病变患者。OCT在ROTA术前和术后成功检测了这些患者。在手动配准ROTA术前和术后的OCT图像后，每隔1毫米对所有观察到的冠状动脉节段进行横断面分析。与ROTA相关的冠状动脉夹层是主要终点。
共有效测量和分析了388张OCT横断面图像，以评估ROTA术前斑块的分布和特征、OCT导管位置，以及手动配准后ROTA术后冠状动脉夹层的有无。根据受试者操作特征（ROC）分析，偏倚方向上OCT导管中心到中膜的距离（D）（曲线下面积（AUC）：1.000，P<0.001，95%置信区间（CI）：0.999 - 1.000）和接触角（AUC：0.988，P<0.001，95%CI：0.968至1.000）与ROTA相关的冠状动脉夹层密切相关，相应的截断值分别为0.720毫米和98.2°。
OCT检测到的D和接触角是由导丝偏倚引起的ROTA相关冠状动脉内膜夹层两个有价值且便捷的独立预测指标
