Skip to main content
SpringerLink
Log in

Prediction of optimal debulking segments before rotational atherectomy based on pre-procedural intravascular ultrasound findings

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

This study evaluated whether intravascular ultrasound (IVUS) examination before rotational atherectomy (RA) can predict the optimal route of passage of the RA burr along the vessel. 30 patients with calcified lesions who underwent IVUS before and immediately after RA were enrolled. IVUS analyses were performed at the minimum lumen area (MLA) site and at 0.5 mm intervals. Each IVUS cross-section was divided into 4 quadrants around the center of the lumen, and pre- and post-RA IVUS cross-section images were merged. Of 1140 cross-sections, 498 (44%) contained debulked regions. When the guidewire and IVUS were located within the same quadrant, the debulked region were distributed within the same quadrant in 96% of cross-sections. The debulked region and the guidewire were distributed within the same quadrant in 81% and the debulked region and the IVUS in 72% of cross-sections, in case the guidewire and IVUS were located in different quadrants. When the guidewire and the IVUS was apart > 1.0 mm, the debulked regions were distributed within the same quadrant as the guidewire in 100% and the IVUS in 0% of cross-sections. The position of the guidewire rather than that of the IVUS catheter on pre-RA IVUS images could predict the course of the RA burr’s passage, especially when the guidewire and IVUS catheter were located apart from each other.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lee MS, Shah N (2016) The impact and pathophysiologic consequences of coronary artery calcium deposition in percutaneous coronary interventions. J Invasive Cardiol 28:160–167

    PubMed  Google Scholar 

  2. Madhavan MV, Tarigopula M, Mintz GS, Maehara A, Stone GW, Généreux P (2014) Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol 63:1703–1714

    Article  CAS  Google Scholar 

  3. Sakakura K, Inohara T, Kohsaka S, Amano T, Uemura S, Ishii H, Kadota K, Nakamura M, Funayama H, Fujita H et al (2016) Incidence and determinants of complications in rotational atherectomy: insights from the national clinical data (J-PCI Registry). Circ Cardiovasc Interv 9:e004278. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004278

    Article  PubMed  Google Scholar 

  4. Sonoda S, Hibi K, Okura H, Fujii K, Honda Y, Kobayashi Y (2019) Current clinical use of intravascular ultrasound imaging to guide percutaneous coronary interventions. Cardiovasc Interv Ther 35:30–36

    Article  Google Scholar 

  5. Saito Y, Kobayashi Y, Fujii K, Sonoda S, Tsujita K, Hibi K, Morino Y, Okura H, Ikari Y, Honye J (2020) Clinical expert consensus document on standards for measurements and assessment of intravascular ultrasound from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 35:1–12

    Article  CAS  Google Scholar 

  6. Hermiller JB, Cusma JT, Spero LA, Fortin DF, Harding MB, Bashore TM (1992) Quantitative and qualitative coronary angiographic analysis: review of methods, utility, and limitations. Cathet Cardiovasc Diagn 25:110–131

    Article  CAS  Google Scholar 

  7. Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, Pinto FJ, Rosenfield K, Siegel RJ, Tuzcu EM et al (2001) American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 37:1478–1492

    Article  CAS  Google Scholar 

  8. Kusama I, Hibi K, Kosuge M, Sumita S, Tsukahara K, Okuda J, Ebina T, Umemura S, Kimura K (2012) Intravascular ultrasound assessment of the association between spatial orientation of ruptured coronary plaques and remodeling morphology of culprit plaques in ST-elevation acute myocardial infarction. Heart Vessels 27:541–547

    Article  Google Scholar 

  9. Jeremias A, Huegel H, Lee DP, Hassan A, Wolf A, Yeung AC, Yock PG, Fitzgerald PJ (2000) Spatial orientation of atherosclerotic plaque in non-branching coronary artery segments. Atherosclerosis 152:209–215

    Article  CAS  Google Scholar 

  10. Zhang J, Gao X, Kan J, Ge Z, Han L, Lu S, Tian N, Lin S, Lu Q, Wu X et al (2018) Intravascular ultrasound versus angiography-guided drug-eluting stent implantation: the ULTIMATE trial. J Am Coll Cardiol 72:3126–3137

    Article  Google Scholar 

  11. Hong SJ, Kim BK, Shin DH, Nam CM, Kim JS, Ko YG, Choi D, Kang TS, Kang WC, Her AY et al (2015) Effect of intravascular ultrasound-guided vs angiography-guided everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial. JAMA 314:2155–2163

    Article  CAS  Google Scholar 

  12. Kobayashi Y, Okura H, Kume T, Yamada R, Fukuhara K, Koyama T, Nezuo S, Neishi Y, Hayashida A, Kawamoto T et al (2014) Impact of target lesion coronary calcification on stent expansion. Circ J 78:2209–2214

    Article  Google Scholar 

  13. Abdel-Wahab M, Richardt G, Joachim Büttner H, Toelg R, Geist V, Meinertz T, Schofer J, King L, Neumann FJ, Khattab AA (2013) High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: the randomized ROTAXUS (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease) trial. JACC Cardiovasc Interv 6:10–19

    Article  Google Scholar 

  14. Wiemer M, Butz T, Schmidt W, Schmitz KP, Horstkotte D, Langer C (2010) Scanning electron microscopic analysis of different drug eluting stents after failed implantation: from nearly undamaged to major damaged polymers. Catheter Cardiovasc Interv 75:905–911

    PubMed  Google Scholar 

  15. Teirstein PS, Warth DC, Haq N, Jenkins NS, McCowan LC, Aubanel-Reidel P, Morris N, Ginsburg R (1991) High speed rotational coronary atherectomy for patients with diffuse coronary artery disease. J Am Coll Cardiol 18:1694–1701

    Article  CAS  Google Scholar 

  16. Ali ZA, Brinton TJ, Hill JM, Maehara A, Matsumura M, Karimi Galougahi K, Illindala U, Götberg M, Whitbourn R, Van Mieghem N et al (2017) Optical coherence tomography characterization of coronary lithoplasty for treatment of calcified lesions: first description. JACC Cardiovasc Imaging 10:897–906

    Article  Google Scholar 

  17. Chambers JW, Feldman RL, Himmelstein SI, Bhatheja R, Villa AE, Strickman NE, Shlofmitz RA, Dulas DD, Arab D, Khanna PK et al (2014) Pivotal trial to evaluate the safety and efficacy of the orbital atherectomy system in treating de novo, severely calcified coronary lesions (ORBIT II). JACC Cardiovasc Interv 7:510–518

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank the staffs in the catheterization laboratory at Kansai Medical University for their excellent assistance during the study.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata-city, Osaka, 5731010, Japan

    Kenta Hashimoto, Kenichi Fujii, Hiroki Shibutani, Satoshi Tsujimoto, Shun Morishita & Ichiro Shiojima

  2. Department of Cardiology, Kansai Medical University Medical Center, Moriguchi, Japan

    Koichiro Matsumura & Munemitsu Otagaki

Authors
  1. Kenta Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenichi Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroki Shibutani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koichiro Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Satoshi Tsujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Munemitsu Otagaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shun Morishita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ichiro Shiojima
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by KH, KF, HS, KM, ST, MO, SM, IS. The first draft of the manuscript was written by KH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kenichi Fujii.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 3496kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hashimoto, K., Fujii, K., Shibutani, H. et al. Prediction of optimal debulking segments before rotational atherectomy based on pre-procedural intravascular ultrasound findings. Int J Cardiovasc Imaging 37, 803–812 (2021). https://doi.org/10.1007/s10554-020-02080-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-020-02080-4

Keywords

Search

Navigation