- •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.
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.
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.
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.
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.
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)
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Published online: November 11, 2022
Accepted: November 8, 2022
Received in revised form: October 13, 2022
Received: July 27, 2022
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