Highlights
- •Impact of reverberations on PCI to calcified coronary lesions remains unclear.
- •High number (≥3) of reverberations showed significantly smaller stent expansion.
- •Target lesion revascularization was significantly associated with the high number of reverberations.
Abstract
Background and aims
Intravascular ultrasound (IVUS) often allows us to observe reverberations behind calcification
in percutaneous coronary intervention (PCI) to heavily calcified lesions. However,
clinical significance of reverberations remains unknown. The aim of this study was
to assess the impact of reverberations on stent expansion and clinical outcomes after
PCI with rotational atherectomy (RA) to heavily calcified lesions.
Methods
We considered 250 calcified lesions that underwent IVUS-guided PCI with RA. According
to the number of reverberations (NR), those lesions were divided into the high NR
(≥3) group (n = 36) and the low NR (≤2) group (n = 214). Stent expansion and the cumulative
incidence of ischemia-driven target lesion revascularization (ID-TLR) were compared
between the high and low NR groups.
Results
The high NR group showed significantly smaller stent expansion rate than the low NR
group (67.7% vs. 75.9%, respectively, p=0.02). The multivariate logistic regression analysis showed that high NR and calcified
nodule were significantly associated with stent underexpansion. The incidence of ID-TLR
was significantly higher in the high NR group than in the low NR group (p=0.03). In multivariate Cox hazard analysis, high NR and acute coronary syndrome were
significantly associated with ID-TLR.
Conclusions
High NR was significantly associated with stent underexpansion and ID-TLR. When high
NR was detected by IVUS, the PCI strategy was be planned carefully to avoid stent
underexpansion. The follow-up program of the patients with high NR might need to be
scheduled prudently because of the high risk of TLR.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
ID-TLR (ischemia-driven target lesion revascularization), IVUS (intravascular ultrasound), MLA (minimal lumen area), NR (number of reverberations), PCI (percutaneous coronary intervention), RA (rotational atherectomy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 11, 2022
Accepted:
November 8,
2022
Received in revised form:
October 13,
2022
Received:
July 27,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
