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Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: The EXCEL Trial The Use of Sex-Specific Factors in the Assessment of Women’s Cardiovascular Risk Prognostic value of coronary artery calcium screening in subjects with and without diabetes Intravascular Ultrasound Guidance Is Associated With Better Outcome in Patients Undergoing Unprotected Left Main Coronary Artery Stenting Compared With Angiography Guidance Alone High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial Stage-dependent differential effects of interleukin-1 isoforms on experimental atherosclerosis Online Quantitative Aortographic Assessment of Aortic Regurgitation After TAVR: Results of the OVAL Study Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the sirius trial 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Letter2015 Oct;8(10):1228-9.

JOURNAL:JACC Cardiovasc Imaging. Article Link

Superficial Calcium Fracture After PCI as Assessed by OCT

Kubo T, Shimamura K, Ino Y et al. Keywords: calcium fracture; stent underexpansion; OCT

ABSTRACT


Heavily calcified lesions in coronary arteries have been known to cause stent underexpansion, which increases the risk of in-stent restenosis. Plaque modification before stent implantation is considered to be the key for treatment of calcified lesions. We hypothesized that calcium fracture by percutaneous coronary intervention (PCI) might be associated with adequate stent expansion and favorable late outcome.


From the coronary catheterization registry of Wakayama Medical University between February 1, 2010 and August 31, 2013, we retrospectively selected 61 patients with chronic stable angina who had a heavily calcified culprit lesion on coronary angiography. The heavily calcified lesion on coronary angiography was identified by radiopacities noted without cardiac motion before contrast injection, generally compromising both sides of the arterial lumen. Everolimus-eluting stent was used for PCI. PCI procedures including stent size, pre- and post-dilation, and inflation pressure were determined by each physician. Optical coherence tomography (OCT) was performed before and immediately after PCI. Maximal calcium thickness, maximal calcium arc, and maximal calcium length were measured on each candidate frame selected by visual screening in the OCT images before PCI. Calcium fracture and stent expansion were assessed in the OCT images immediately after PCI. Calcium fracture was characterized by a gap of calcium and direct exposure of calcium to the lumen at the gap. The calcium fracture thickness was measured at the edge of the fracture. The minimal stent area was measured on a candidate frame selected by visual screening. Stent expansion index was calculated as the minimal stent area divided by the average of the proximal and distal reference lumen area. Scheduled follow-up angiography was conducted 10 months after PCI.