High-Definition Intravascular Ultrasound Versus Optical Frequency Domain Imaging for the Detection of Calcium Modification and Fracture in Heavily Calcified Coronary Lesion

Abstract

Purpose While optical frequency domain imaging (OFDI) can delineate calcium modification and fracture, the capability of high-definition intravascular ultrasound (HD-IVUS) for detecting these remains unclear. This study evaluated the diagnostic accuracy of HD-IVUS for assessing calcium modification and fracture as compared to OFDI. Methods HD-IVUS and OFDI were used during orbital or rotational atherectomy procedures conducted for 21 heavily calcified coronary lesions in 19 patients. With OFDI assessment used as the gold standard, diagnostic accuracies of HD-IVUS for calcium modification and fracture were compared every 1 mm to the matched pre-stenting images (n=1,129). Calcium modification, as assessed by OFDI, was defined as polished and concave-shaped calcium. For HD-IVUS, calcium modification was defined as the presence of reverberation with concave-shaped calcium. In both assessments, the definition of calcium fracture was defined as a slit or complete break in the calcium plate. Results Calcified plaque was found in 86.4% of analyzed OFDI images. Calcium modification and fracture were detected in 20.6% and 11.0% of detected calcified plaques. Sensitivity, specificity, positive and negative predictive values of HD-IVUS detection for calcium modification and fracture were 54.4%, 97.8%, 86.7%, 89.1% and 86.0%, 94.5%, 58.2%, 96.8%, respectively. Discordance cases between both assessments demonstrated that heterogeneous calcium visualized by OFDI, separated calcium and guide wire artifact can be misdiagnosed. Conclusion Diagnostic accuracies of HD-IVUS for assessing calcium modification and fracture were modest as compared to OFDI. These results suggest that OFDI guidance is more feasible during treatment of heavily calcified coronary lesions versus HD-IVUS guidance.

Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023

“…Imaging devices such as IVUS or OCT is useful in RA [77][78][79][80][81][82][83][84]. In this document, we recommend to use IVUS or OCT before, during, and after RA.…”