Comparison of complications with a 1.25-mm versus a 1.5-mm burr for severely calcified lesions that could not be crossed by an intravascular ultrasound catheter

Abstract

Since intravascular imaging such as intravascular ultrasound (IVUS) can provide useful information for rotational atherectomy (RA), intravascular imaging should be attempted before RA. However, some calcified lesions do not allow imaging catheters to cross before RA. Although small burrs (1.25 mm or 1.5 mm) should be selected for such tight lesions, it is unknown whether a 1.25-mm burr or 1.5-mm burr is safer as the initial burr. The aim of this study was to compare the incidence of complications with a 1.25-mm versus a 1.5-mm burr as the initial burr for IVUS-uncrossable lesions. This was a retrospective, single-center study. A total of 109 IVUS-uncrossable lesions were included, and were divided into a 1.25-mm group (n =52) and a 1.5-mm group (n =57). The incidence of slow flow just after RA was not different between the 2 groups (1.25mm group: 25%, 1.5-mm group: 31.6%, P =0.45). The incidence of peri-procedural MI with slow flow was not different and equally low in the 2 groups (1.25-mm group: 1.9%, 1.5-mm group: 3.5%, P =0.61). The use of the 1.5-mm burr as the initial burr was not significantly associated with slow flow after controlling for chronic renal failure on hemodialysis and reference diameter (vs. 1.25-mm: OR 2.34, 95% CI 0.89-6.19, P =0.09). In conclusion, the incidence of complications following RA was comparable between the 1.25-mm and the 1.5-mm burrs as the initial burr for IVUS-uncrossable lesions. The present study provides insights into the selection of an appropriate burr for IVUS-uncrossable lesions.

Comparison of the incidence of slow flow after rotational atherectomy with IVUS-crossable versus IVUS-uncrossable calcified lesions

“…RA was performed using standard techniques as previously described 11 . A nicorandil-based drug cocktail was used during RA to prevent slow flow 17 .…”

“…RA was not used as first-line therapy to treat culprit lesions in acute coronary syndrome (ACS); however, RA was used to treat culprit lesions in ACS if necessary 14 . Furthermore, an intra-aortic balloon pump (IABP) was inserted via a femoral artery before RA in high-risk cases such as those with severe left ventricular dysfunction, unprotected left main stenosis, or severe 3-vessel disease 11 . This was done because complications such as slow flow or peri-procedural myocardial infarction were more frequent in these high-risk cases 12 .…”

“…Although the usefulness of intravascular imaging devices in RA has been widely recognized, an intravascular imaging device may not cross the target lesion because of severe calcification 11 . If an IVUS catheter cannot cross the lesion, operators have to decide the strategy of RA from angiographic findings by their own experiences, which may be a difficult situation for junior RA operators.…”

Determinants of Periprocedural Myocardial Infarction in Current Elective Percutaneous Coronary Interventions

“…Rotational atherectomy was performed to moderate or severely calcified lesions, diffuse lesions expected to be difficult to stent, and ostial lesions. 18) Our university hospital had many operators, including residents with different background. However, each PCI was strictly supervised by staff operators.…”

“…21) Chronic renal failure was defined as a creatinine level "2.0 mg/dL. 18) We also calculated the estimated glomerular filtration rate (eGFR) from the serum creatinine level, age, weight, and gender using the following formula: eGFR = 194 × Cr − 1.094 × age − 0.287 (male) and eGFR = 194 × Cr − 1.094 × age − 0.287 × 0.739 (female). 20) Angiographic analysis: Quantitative coronary angiography parameters were measured using a cardiovascular angiography analysis system (QAngio XA 7.3, MEDIS Imaging Systems, Leiden, Netherlands).…”