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Optical Coherence Tomography-Guided Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction: A Prospective Propensity-Matched Cohort of the Thrombectomy Versus Percutaneous Coronary Intervention Alone Trial A Randomized Trial Evaluating Online 3-Dimensional Optical Frequency Domain Imaging-Guided Percutaneous Coronary Intervention in Bifurcation Lesions Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve - COMFORTABLE Retrospective Study Left main coronary artery compression in pulmonary hypertension Robustness of Fractional Flow Reserve for Lesion Assessment in Non-Infarct-Related Arteries of Patients With Myocardial Infarction Rotational Atherectomy in acute STEMI with heavily calcified culprit lesion is a rule breaking solution Optimal threshold of postintervention minimum stent area to predict in-stent restenosis in small coronary arteries: An optical coherence tomography analysis Technical aspects of the culotte technique PCI for obstructive bifurcation lesions the 14th consensus document from the european bifurcation club
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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.
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