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Aggressive plaque modification with rotational atherectomy and cutting balloon
for optimal stent expansion in calcified lesions
#MMPMID28321242
Tang Z
; Bai J
; Su SP
; Lee PW
; Peng L
; Zhang T
; Sun T
; Nong JG
; Li TD
; Wang Y
J Geriatr Cardiol
2016[Dec]; 13
(12
): 984-991
PMID28321242
show ga
OBJECTIVE: To evaluate the factors affecting optimal stent expansion in calcified
lesions treated by aggressive plaque modification with rotational atherectomy
(RA) and a cutting balloon (CB). METHODS: From January 2014 to May 2015, 92
patients with moderate to severe coronary calcified lesions underwent rotational
atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital
(Beijing, China) were included in this study. They were divided into a rotational
artherectomy combined with cutting balloon (RACB) group (46 patients treated with
RA followed by CB angioplasty) and an RA group (46 patients treated with RA
followed by plain balloon angioplasty). Another 40 patients with similar severity
of their calcified lesions treated with plain old balloon angioplasty (POBA) were
demographically matched to the other groups and defined as the POBA group. All
patients received a drug-eluting stent after plaque preparation. Lumen diameter
and lumen diameter stenosis (LDS) were measured by quantitative coronary
angiography at baseline, after RA, after dilatation, and after stenting. Optimal
stent expansion was defined as the final LDS < 10%. RESULTS: The initial and
post-RA LDS values were similar among the three groups. However, after
dilatation, the LDS significantly decreased in the RACB group (from 54.5% ± 8.9%
to 36.1% ± 7.1%) but only moderately decreased (from 55.7% ± 7.8% to 46.9% ±
9.4%) in the RA group (time × group, P < 0.001). After stenting, there was a
higher rate of optimal stent expansion in the RACB group (71.7% in the RACB
group, 54.5% in the RA group, and 15% in the POBA group, P < 0.001), and the
final LDS was significantly diminished in the RACB group compared to the other
two groups (6.0% ± 2.3%, 10.8% ± 3.3%, 12.7% ± 2.1%, P < 0.001). Moreover, an LDS
? 40% after plaque preparation (OR = 2.994, 95% CI: 1.297-6.911) was associated
with optimal stent expansion, which also had a positive correlation with the
appearance of a calcified ring split (r = 0.581, P < 0.001). CONCLUSIONS:
Aggressive plaque modification with RA and CB achieve more optimal stent
expansion. An LDS ? 40% after plaque modification was a predictive factor for
optimal stent expansion in calcified lesions. This parameter was also associated
with the presence of calcified ring split.
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