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Lee T, Ashikaga T, Nozato T, Kaneko M, Miyazaki R, Okata S, Nagase M, Horie T, Terui M, Kishigami T, Nagata Y, Misawa T, Taomoto Y, Kachi D, Naito M, Yonetsu T, Sasano T. Predictors of coronary artery injury after orbital atherectomy as assessed by optical coherence tomography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023:10.1007/s10554-023-02837-7. [PMID: 37027104 DOI: 10.1007/s10554-023-02837-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/13/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE The association between the extent of the wire and device bias as assessed by optical coherence tomography (OCT) in the healthy portion of the vessel and the risk of coronary artery injury after orbital atherectomy (OA) has not been fully elucidated. Thus, purpose of this study is to investigate the association between pre-OA OCT findings and post-OA coronary artery injury by OCT. METHODS We enrolled 148 de novo lesions having calcified lesion required OA (max Ca angle > 90°) in 135 patients who underwent both pre- and post-OA OCT. In pre-OA OCT, OCT catheter contact angle and the presence or absences of guide-wire (GW) contact with the normal vessel intima were assessed. Also, in post-OA OCT, we assessed there was post-OA coronary artery injury (OA injury), defined as disappearance of both of intima and medial wall of normal vessel, or not. RESULTS OA injury was found in 19 lesions (13%). Pre-PCI OCT catheter contact angle with the normal coronary artery was significantly larger (median 137°; inter quartile range [IQR] 113-169 vs. median 0°; IQR 0-0, P < 0.001) and more GW contact with the normal vessel was found (63% vs. 8%, P < 0.001). Pre-PCI OCT catheter contact angle > 92° and GW contact with the normal vessel intima were associated with post-OA vascular injury (Both: 92% (11/12), Either: 32% (8/25), Neither: 0% (0/111), P < 0.001). CONCLUSION Pre-PCI OCT findings, such as catheter contact angle > 92° and guide-wire contact to the normal coronary artery, were associated with post-OA coronary artery injury.
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Affiliation(s)
- Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan.
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Tomoki Horie
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Mao Terui
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Tetsuya Kishigami
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Toru Misawa
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Yuta Taomoto
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Daigo Kachi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Michihito Naito
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Shlofmitz RA, Galougahi KK, Jeremias A, Shlofmitz E, Thomas SV, Ali ZA. Calcium Modification in Percutaneous Coronary Interventions. Interv Cardiol Clin 2022; 11:373-381. [PMID: 36243483 DOI: 10.1016/j.iccl.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Moderate-severe calcification increases procedural complications and impairs long-term prognosis post-PCI. Intravascular imaging (particularly optical coherence tomography [OCT]) is useful in guiding the treatment of calcified lesions. Weighted sum of calcium length, arc, and thickness on OCT can predict adequate stent expansion, identifying when atherectomy is required. With intravascular imaging guidance, various techniques alone or in combination may be used in an algorithmic fashion to modify calcified lesions. Calcium fracture by balloon angioplasty, cutting/scoring balloons, intravascular lithotripsy (IVL), atherectomy devices, or Excimer laser improves stent expansion. Intravascular imaging is essential in the treatment of in-stent restenosis when luminal and/or abluminal peri-strut calcium is present.
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Affiliation(s)
- Richard A Shlofmitz
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA.
| | - Keyvan Karimi Galougahi
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Allen Jeremias
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Evan Shlofmitz
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Susan V Thomas
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Ziad A Ali
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
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Yamamoto H, Sawada T, Takaya T, Kawai H. Utility of coronary orbital atherectomy with guide-extension system for distally located undilatable in-stent restenosis: A case report. Clin Case Rep 2022; 10:e05798. [PMID: 35521045 PMCID: PMC9066738 DOI: 10.1002/ccr3.5798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/08/2022] [Accepted: 04/22/2022] [Indexed: 12/03/2022] Open
Abstract
Orbital atherectomy (OA) may be effective in managing undilatable in‐stent restenosis (ISR) despite off‐label indications. We demonstrated that optical frequency domain imaging (OFDI)‐guided OA, with a guide‐extension system was effective even in distally located, undilatable ISR. However, OFDI revealed that inter‐struts calcified neoatherosclerosis remained a challenging issue.
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Affiliation(s)
- Hiroyuki Yamamoto
- Division of Cardiovascular Medicine Hyogo Brain and Heart Center Himeji Japan
| | - Takahiro Sawada
- Division of Cardiovascular Medicine Hyogo Brain and Heart Center Himeji Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine Hyogo Brain and Heart Center Himeji Japan.,Department of Exploratory and Advanced Search in Cardiology Kobe University Graduate School of Medicine Kobe Japan
| | - Hiroya Kawai
- Division of Cardiovascular Medicine Hyogo Brain and Heart Center Himeji Japan.,Department of Exploratory and Advanced Search in Cardiology Kobe University Graduate School of Medicine Kobe Japan
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Iiya M, Hikita H, Yoshikawa H, Abe F, Tsujihata S, Ito N, Kanno Y, Hishikari K, Murai T, Takahashi A, Yonetsu T, Sasano T. Impact of Hemodialysis Duration on Coronary Artery Calcification Among Hemodialysis Patients Who Underwent Percutaneous Coronary Intervention. Angiology 2022; 73:764-771. [PMID: 35313732 DOI: 10.1177/00033197211073407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our study aimed to evaluate the prevalence and impact of coronary artery calcification (CAC) on hemodialysis (HD) patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). We enrolled 211 HD patients who underwent PCI (men: n = 155, age: 71 ± 1 0 years). Severe CAC was defined as calcification with an arc of 360° on intravascular ultrasound. Multivariate analysis was performed to determine the predictors of severe CAC. The impact of severe CAC on target lesion revascularization (TLR) was evaluated. Patients with severe CAC (46%) had a higher incidence of diabetes mellitus (DM) (79 vs 59%, P = .003) and longer HD duration (7.7 vs 3.4 years, P < .001) than those with non-severe CAC. Multivariate analysis demonstrated that DM, HD duration, and angiographic calcification were significant predictors for severe CAC (odds ratio 4.42, 1.13, and 6.62; P < .001, P < .001, and P < .001, respectively). After the median follow-up period of 580 days (interquartile range, 302-730 days), Kaplan-Meier curve analysis revealed that severe CAC was associated with an increased risk for TLR (χ2 12.7; P = .002). In HD patients with CAD after PCI, DM and HD duration were significant predictors for severe CAC. Furthermore, severe CAC was associated with an increased risk for TLR.
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Affiliation(s)
- Munehiro Iiya
- Department of Cardiology, 73622Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroyuki Hikita
- Department of Cardiology, 73622Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroshi Yoshikawa
- Department of Cardiology, 73622Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Fumiyuki Abe
- Department of Cardiology, 73622Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Shihoko Tsujihata
- Department of Cardiology, 73622Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Naruhiko Ito
- Department of Cardiology, 73622Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Yoshinori Kanno
- Department of Cardiology, 73622Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Keiichi Hishikari
- Department of Cardiology, 73622Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Tadashi Murai
- Department of Cardiology, 73622Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Atsushi Takahashi
- Department of Cardiology, 73622Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | - Tetsuo Sasano
- 13100Tokyo Medical and Dental University, Tokyo, Japan
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