Coronary disease & ACSSecondary analysis
Optical Coherence Tomography Characterization of Coronary Lithotripsy Following Atherectomy for Treatment of Severely Calcified Lesions
- prespecified, multicenter, single-arm optical coherence tomography (OCT) substudy of the DUAL-PREP (atherectomy Devices and intravascUlAr Lithotripsy for the PREParation of heavy calcified coronary lesions) registry
- OCT analyzed by an independent core laboratory
Authors' conclusion
This OCT analysis demonstrated a stepwise increase in calcium fracture during a dual-preparation strategy, with minimal fracture after atherectomy, a marked increase following intravascular lithotripsy, and a further increase after stent implantation. Calcium morphology may provide additional insight into fracture occurrence, supporting the potential value of 3-dimensional assessment in severely calcified lesions.
Study context
- Population
- Patients with severely calcified lesions for whom combined treatment with atherectomy and intravascular lithotripsy was deemed preferable based on imaging findingsOCT images available for 114 of 118 patients (116 lesions)
- Participants
- 114 patients
- Comparison
- Serial OCT assessment of calcium modification after atherectomy, intravascular lithotripsy and stent implantation (dual-prep strategy)
Primary result
As reported in the abstract
lesions with fracture
2/106 lesions [1.9%]
Further findings
Calcium fractures · following intravascular lithotripsy
- lesions with fracture
- 89/106 lesions [84.0%]
- fractures per lesion
- 2.05±1.59
Calcium fractures · after stent implantation
- lesions with fracture
- 101/109 lesions [92.7%]
- fractures per lesion
- 2.89±1.67
Final stent expansion
- stent expansion index
- 0.81±0.15
- eccentricity
- 0.72±0.09
- asymmetry
- 0.39±0.15
Fracture at final OCT by calcium morphology
- Eccentric straight-type calcification, odds ratio for fracture
- 0.07 [95% CI, 0.00-0.77]; P =0.029
- eccentric spiral and circumferential types showed higher fracture occurrence
- multivariable model
Baseline characteristics
- age
- 75.9±9.1 years
- male
- 69.3%
- OCT calcium score of 4
- All lesions
Original publication
Summarised from the published abstract; every number is checked against it