Guidewire Bias in Rotational Atherectomy in the Angled Lesion. Evaluation Based on the Thickness of the Ablated Intima and Media.

Oishi, Yoshihiko; Okamoto, Masahiro; Sueda, Takashi; Hashimoto, Masaki; Karakawa, Shuhei; Kambe, Masayuki

doi:10.1253/circj.66.659

Cited by 11 publications

(3 citation statements)

References 13 publications

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“…If bias to relatively normal coronary wall occurs, iatrogenic injury to intima or media may result and deeper cutting action could lead to more complications: such as dissection or even perforation). 5,21,23 no quantitative data have been reported before. In this study, we used a novel method to analyze the distribution characteristics of coronary cross-sectional plaques, location of OCT catheters, and their relationship with the coronary dissection post-ROTA by IVI technique at 1mm intervals after manual co-registration pre-, post-ROTA and angiographic data.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] Guidewire bias position in an angled or tortuous coronary artery is inevitable: a divergence from the central axis of the vessel or the lumen and may result in ablation on the bias side of the coronary wall occurs, iatrogenic injury to intima or media may result and deeper cutting action could lead to more complications: such as dissection or even perforation). 5,21,23 In our retrospective study, we analyzed for the rst time the quantitative indicators that guide wire bias caused the motion path bias of ROTA burrs and further led to the occurrence of iatrogenic coronary dissection. Guidewire position bias in an angled or tortuous coronary artery is inevitable; a divergence from the central axis of the vessel or the lumen and may result in ablation on the bias side of the coronary wall.…”

Section: Discussionmentioning

confidence: 99%

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Study On Coronary Dissection Complication Caused by Uneven Rotational Atherectomy Due To Guidewire Bias for Severe Calcified Lesions

You

Zhang

et al. 2021

Preprint

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BACKGROUND In the treatment of coronary calcification by rotational atherectomy (ROTA), guidewire bias is often considered to lead to procedure associated coronary dissections or perforations. However, the actual meaning of guidewire bias is unclear, though it usually refers to the cross-section location of the intravascular imaging (IVI) catheter in the coronary artery. OBJECTIVES This study tentatively explores the quantitative criteria in optical coherence tomography (OCT) imaging of guidewire bias which may cause ROTA induced coronary dissection. METHODS A total of twenty-one patients with severe calcified coronary lesions who has undergone ROTA treatment were enrolled in our study. These patients were detected by OCT successfully pre- and post-ROTA. All the observational coronary segments were analyzed cross-sectionally at every mm interval after manual coregistration of OCT imaging pre- and post-ROTA. ROTA related coronary dissection was the primary endpoint. RESULTS A total of 388 OCT cross-sectional images were effectively measured and analyzed for distribution and characteristics of plaque and OCT catheter location pre-ROTA, and the presence or absence of coronary dissections post-ROTA after manual coregistration. According to the receiver operating characteristic (ROC) analysis, distance from the center of OCT catheter to media at the bias direction (Dcmb) (area under the curve (AUC): 1.000, p<0.001, 95% confidence intervals (CI): 0.999 to 1.000) and touch angle (AUC: 0.988, p<0.001, 95%CI: 0.968 to 1.000) had a higher correlation with ROTA-related coronary dissection with the corresponding cutoff value of 0.720mm and 98.2º significantly. CONCLUSIONS Dcmb and touch angle detected by OCT are two very valuable and convenient independent predictors of ROTA-related coronary intimal dissections caused by guidewire bias.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Study On Coronary Dissection Complication Caused by Uneven Rotational Atherectomy Due To Guidewire Bias for Severe Calcified Lesions

You

Zhang

et al. 2021

Preprint

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“…15 Similarly, Oishi et al reported differential directional ablation by RA in angled lesions with elliptical enlargement. 16 The IVUS transducer assumed the same location before and after RA.…”

Section: Discussionmentioning

confidence: 99%

Reasons for lesion uncrossability as assessed by intravascular ultrasound

Salem

Mintz

Matsumura

et al. 2022

Cathet Cardio Intervent

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Objectives: The purpose of the current study was to use intravascular ultrasound (IVUS) to clarify anatomical and morphological lesion characteristics of uncrossable lesions.Background: Uncrossable lesions are not always severely calcified. The prevalence of uncrossable lesions that are nonseverely calcified as well as other mechanisms for uncrossability has not been well clarified.Methods: A total of 252 de novo uncrossable lesions in native coronary arteries that underwent either rotational or orbital atherectomy due to inability of any balloon to cross the lesion and 38 lesions with severe calcium in which IVUS crossed preatherectomy were included. Severe calcium is defined as maximum arc of calcium ≥270°.Results: Severe calcification was absent in 16% of uncrossable lesions, 83% of which had a significant vessel bend. Compared with crossable lesions with severe calcium, uncrossable lesions with severe calcium more often had a bend in the vessel (71% vs. 21%, p < 0.001) and a longer length of continuous severe calcium (median length of calcium ≥270°3.8 mm vs. 1.9 mm, p = 0.001). Other than severe calcium (especially long continuous calcium) or a bend in the vessel, anatomical factors associated with uncrossabilty were aorto-ostial lesion location and small vessels.Conclusions: Uncrossable lesions are not always severely calcified. The interaction of lesion morphology (continuous long and large arcs of calcium) and vessel geometry (bend in the vessel or ostial lesion location) affect lesion crossability.

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Optical coherence tomography assessment of calcified plaque modification after rotational atherectomy

Attizzani

Patrício

Bezerra

2011

Cathet Cardio Intervent

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Rotational atherectomy (RA) facilitates stent delivery in highly calcified coronary plaques (CCP). However, lesion ablation by RA in angulated segments may be affected by guidewire bias, leading to a non-uniform plaque modification. Intravascular optical coherence tomography (iOCT) is the highest resolution (∼10 μm axial) intravascular imaging modality available for clinical use; furthermore, near infrared light easily penetrates calcium, with significantly fewer artifacts, including no "blooming effect" as seen by intravascular ultrasound. Therefore, it may pose as a unique tool for serial calcium quantification, as related in this article with pre- and post-RA assessment, allowing accurate characterization of plaque modification, as well as quality of stent deployment. The effects of guidewire bias in the debulking process have not been well documented by iOCT. We present a case of lesion preparation by RA affected by guidewire bias in which iOCT revealed unique insights into CCP modification.

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Guidewire Bias in Rotational Atherectomy in the Angled Lesion. Evaluation Based on the Thickness of the Ablated Intima and Media.

Cited by 11 publications

References 13 publications

Study On Coronary Dissection Complication Caused by Uneven Rotational Atherectomy Due To Guidewire Bias for Severe Calcified Lesions

Study On Coronary Dissection Complication Caused by Uneven Rotational Atherectomy Due To Guidewire Bias for Severe Calcified Lesions

Reasons for lesion uncrossability as assessed by intravascular ultrasound

Optical coherence tomography assessment of calcified plaque modification after rotational atherectomy

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