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A Combined Optical Coherence Tomography and Intravascular Ultrasound Study on Plaque Rupture, Plaque Erosion, and Calcified Nodule in Patients With ST-Segment Elevation Myocardial Infarction: Incidence, Morphologic Characteristics, and Outcomes After Percutaneous Coronary Intervention Comparison of safety and periprocedural complications of transfemoral aortic valve replacement under local anaesthesia: minimalist versus complete Heart Team Longitudinal Change in Galectin-3 and Incident Cardiovascular Outcomes Heart Failure With Recovered Left Ventricular Ejection Fraction: JACC Scientific Expert Panel Prognostic implications of baseline 6‐min walk test performance in intermediate risk patients undergoing transcatheter aortic valve replacement Colchicine Reduces Cardiovascular Events in Chronic Coronary Disease The Evolution of β-Blockers in Coronary Artery Disease and Heart Failure (Part 1/5) Incidence and Outcomes of Surgical Bailout During TAVR : Insights From the STS/ACC TVT Registry Impact of Positive and Negative Lesion Site Remodeling on Clinical Outcomes : Insights From PROSPECT From organic and inorganic phosphates to valvular and vascular calcifications
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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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