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White thrombi on optical coherence tomography after rotational atherectomy of severely calcified coronary lesions

Nachweis weißer Thromben in der optischen Kohärenztomographie nach Rotationsatherektomie von stark kalzifizierten Koronarläsionen

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Abstract

Purpose

Rotational atherectomy (RA) has improved percutaneous treatment of severely calcified coronary lesions, but the “no-reflow” phenomenon remains a serious complication. Platelet activation by RA may contribute to no-reflow, and the use of optical coherence tomography (OCT) to test the effect of RA on white thrombus could confirm platelet activation indirectly.

Methods

We analyzed 53 consecutive patients with severely calcified lesions on coronary angiography. All patients were examined with OCT. In total, 20 patients who received RA and for whom OCT imaging was performed before and after RA and stent implantation comprised the RA group. The remaining 33 patients formed the control group, for whom OCT imaging was performed before balloon dilatation and after stent implantation.

Results

The patients in the RA group were older and had a higher incidence of diabetes mellitus. In the control group, there was no thrombogenesis during the procedure, whereas in the RA group, all the target vessels had white thrombi on OCT after RA. The average number of white thrombi per lesion after RA was 7.23 ± 4.4, and the average length of white thrombus was 0.51 ± 0.33 mm. Statistical analysis with Pearson’s correlation coefficient showed that thrombus load was related to burr size (r = 0.575, p = 0.040) and number of rotations (r = 0.599, p = 0.031).

Conclusion

White thrombi during RA can be verified by performing OCT. Treating calcified lesions with RA may enhance thrombogenesis. These data suggest using appropriate therapy to avoid no-reflow during RA.

Zusammenfassung

Ziel

Mit der Rotationsatherektomie (RA) wurde die perkutane Behandlung stark kalzifizierter Koronarläsionen verbessert, aber das „No-Reflow-Phänomen“ bleibt eine schwerwiegende Komplikation. Die Plättchenaktivierung durch die RA trägt möglicherweise zum No-Reflow-Phänomen bei, und der Einsatz der optischen Kohärenztomographie (OCT) zur Untersuchung der Auswirkungen der RA auf die Bildung weißer Thromben könnte indirekt die Plättchenaktivierung bestätigen.

Methoden

Es wurden die Daten von 53 konsekutiven Patienten mit stark kalzifizierten Läsionen in der Koronarangiographie ausgewertet. Alle Patienten wurden mittels OCT untersucht. Insgesamt umfasste die RA-Gruppe 20 Patienten, bei denen eine RA erfolgte und eine OCT-Bildgebung vor und nach RA und Stentimplantation durchgeführt wurde. Die übrigen 33 Patienten bildeten die Kontrollgruppe, bei denen eine bildgebende Untersuchung mittels OCT vor der Ballondilatation und nach Stentimplantation erfolgte.

Ergebnisse

Die Patienten in der RA-Gruppe waren älter und wiesen eine höhere Inzidenz von Diabetes mellitus auf. In der Kontrollgruppe trat keine Thrombogenese bei der Intervention auf, während in der RA-Gruppe alle Zielgefäße weiße Thromben in der OCT nach RA zeigten. Die durchschnittliche Anzahl weißer Thromben pro Läsion nach RA betrug 7,23 ± 4,4 und die durchschnittliche Länge eines weißen Thrombus 0,51 ± 0,33 mm. In der statistischen Analyse mit dem Korrelationskoeffizienten nach Pearson zeigte sich, dass die Thrombuslast in Zusammenhang mit der Bohrergröße (r = 0,575; p = 0,040) und der Anzahl der Rotationen (r = 0,599; p = 0;031) stand.

Schlussfolgerung

Weiße Thromben während einer RA können mittels Durchführung einer OCT nachgewiesen werden. Durch die Therapie kalzifizierter Läsionen mittels RA kommt es möglicherweise zu einer verstärkten Thrombogenese. Diese Daten legen eine entsprechende Therapie zur Verhinderung eines No-Reflow-Phänomens während der RA nahe.

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Funding

This study was supported by The National Key Research and Development Program of China (No. 2016YFC1301105) and The National Natural Science Foundation of China (No. 81800316). These funds designed the study, collection, and analysis of the data.

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Authors and Affiliations

  1. Department of Cardiology, Peking University People’s Hospital, No.11 Xizhimen South Street, Beijing, China

    Cheng-fu Cao, Yu-liang Ma, Qi Li, Jian Liu, Hong Zhao, Ming-yu Lu & Wei-min Wang

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  1. Cheng-fu Cao
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  2. Yu-liang Ma
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  3. Qi Li
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  4. Jian Liu
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  5. Hong Zhao
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  7. Wei-min Wang
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Contributions

C.-f. Cao and Y.-l. Ma were the major contributors in writing the manuscript. Q. Li analyzed and interpreted the patient data, J. Liu, H. Zhao, and M.-y. Lu collected the patient data, W.-m. Wang is the corresponding author. All authors read and approved the final manuscript

Corresponding author

Correspondence to Wei-min Wang.

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Conflict of interest

C.-f. Cao, Y.-l. Ma, Q. Li, J. Liu, H. Zhao, M.-y. Lu and W.-m. Wang declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

The authors Cheng-fu Cao and Yu-liang Ma contributed equally to the manuscript.

Availability of data and material (data transparency)

The datasets used during the current study are available from the corresponding author on reasonable request.

Code availability (software application or custom code)

Not applicable

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Cao, Cf., Ma, Yl., Li, Q. et al. White thrombi on optical coherence tomography after rotational atherectomy of severely calcified coronary lesions. Herz 47, 536–542 (2022). https://doi.org/10.1007/s00059-021-05073-8

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  • DOI: https://doi.org/10.1007/s00059-021-05073-8

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