Atherectomy Essay

779 Words4 Pages
Optical Coherence Tomography Assessment of Calcified Coronary Lesions Modification After Orbital Atherectomy INTRODUCTION Heavy calcification within coronary atherosclerotic plaque is a serious challenge in interventional cardiology and can adversely influences both clinical and procedural success after percutaneous coronary interventions. Coronary artery calcification may be responsible for stent underexpansion, which in turn increases the risk of restenosis, thrombosis, and target-lesion revascularization. Currently available techniques to debulk calcium in target lesions prior to stent implantation are orbital atherectomy, rotational atherectomy, excimer laser and cutting balloon. The coronary orbital atherectomy system (OAS) is newly…show more content…
1A). The region of interest (ROI) was assessed with iOCT (M2CV OCT Imaging System, LightLab Imaging, Westford, MA) imaging pre-PCI, with the aim of obtaining a more accurate lesion evaluation. A highly-calcified segment was depicted (Fig. 1B and C). Due to the presence of a severely CCP, OA (Rotablator, Boston Scientific, Natick, MA) was performed pre-stenting (Fig. 2A) in order to facilitate stent’s delivery and expansion. The burr/artery ratio for the first burr utilized (1.25 mm) was 0.45. Following RA, iOCT revealed two distinct features in different locations of the ROI: lack of plaque modification (Fig. 2B), as well as a channel formation (Fig. 2C(II)). Another attempt of RA with a larger burr (1.75 mm) was conducted (not shown). Following the debulking procedure, a 3.0 mm 13 mm DES was implanted at 14 atm, followed by an intra-stent post-dilation with a non-compliant balloon at 20 atm. In the final iOCT assessment, we can still see regions with the channel behind the stent struts preventing their full apposition to the vessel wall (Fig.…show more content…
iOCT provides detailed plaque microstructural information and has been proven to be a useful tool to quantify calcified plaques, showing great correlation with histology [3]. Furthermore, due to its high axial resolution, iOCT is able to reveal unique details regarding calcified plaque modification with virtually no image artifact. The possibility of performing cross-sectional imaging analysis at strut-level enables a more accurate evaluation of the results of stent implantation. Therefore, it can be a useful tool to achieve a better stent deployment, as well as to provide a greater understanding of potential mechanisms involved in stent failure in
Open Document