| Background: With the aging process speeding up,coronary artery calcification（CAC）increases with age.Rotational atherectomy（ROTA）is one of the effective strategies in the treatment of CAC.Guidewire bias phenomena was not avoided during percutaneous coronary intervention（PCI）when coronary arteries were tortuous and angulated,if rotational atherectomy（ROTA）was performed for this kind of lesions,procedure induced complications might be higher according to operator’s experience.But,how to define a wire bias is not clear and how does wire bias influence the ROTA induced complications is not studied precisely.In the treatment of coronary calcification by ROTA,guidewire bias is often considered to lead to procedure associated coronary dissections or perforations.However,the actual meaning of guidewire bias is unclear,though it usually refers to the cross-section location of the intravascular imaging（IVI）catheter in the coronary artery.IVI includes intravascular ultrasound（IVUS）and optical coherence tomography（OCT）.Literature at home and abroad only mentioned this concept without any definite quantitative indicators.Objective: This study tentatively explores the quantitative criteria in IVI imaging of guidewire bias which may cause ROTA induced complications（coronary intimal dissection）.Methods: From October 2010 to July 2017,a total of 717 cases of ROTA were screened in database from Nanjing First Medical Hospital and finally 68 patients with severe calcified coronary lesions who has undergone ROTA treatment guided by IVI were enrolled in our study.Coronary artery angiography was performed to clarify the trajectory and range of ROTA burr movement segments and to maintain consistency with IVI analysis.These patients were detected by IVI（OCT or IVUS）successfully pre-and postROTA.All the observational coronary segments were analyzed cross-sectionally at every mm interval after manual co-registration of IVI imaging pre-and post-ROTA.ROTA related coronary dissection was the primary endpoint.Preoperative clinical baseline information and target lesion characteristics were recorded,as well as the date required for OCT and IVUS measurement as defined.Before all data were statistically analyzed,intra-and inter-observer variability of the images analysis were assessed by evaluating 50 randomly selected slides of cross section OCT or IVUS data.All statistical analyses were performed with by SPSS18.0 and all tests were 2-tailed with a significance level.Results: ALL 1754 slices IVI cross-sectional images from 68 lesions were analyzed（IVUS 1366,OCT 388）:（1）There was very good inter-and intra-observer agreement for the IVI measurement:OCT Dcib（ICC: 0.996,0.998）,Dcio（ICC: 0.990,0.999）,Dcmb（ICC: 0.992,0.992）,and Dcmo（ICC: 0.957,0.997）;and agreement for the assessment of coronary intimal dissection by OCT detection（Kappa: 0.878,0.878）,plaque characteristics（with or without calcification）at wire bias direction（Kappa: 0.961,0.985）;IVUS Dcib（ICC: 0.997,0.998）,Dcio（ICC: 0.994,0.993）,Dcmb（ICC: 0.993,0.991）,and Dcmo（ICC: 0.986,0.990）;and agreement for the assessment of coronary intimal dissection by OCT detection（Kappa: 0.871,0.877）,plaque characteristics（with or without calcification）at wire bias direction（Kappa: 0.982,0.980）.（2）Finally a total of 388 OCT cross-sectional images were effectively measured andanalyzed for distribution and characteristics of plaque and OCT catheter location preROTA,and the presence or absence of coronary dissections post-ROTA after manual coregistration.According to the receiver operating characteristic（ROC）analysis,distance from the center of OCT catheter to media at the bias direction（Dcmb）（area under the curve（AUC）: 1.000,p<0.001,95% confidence intervals（CI）: 0.999 to 1.000）and touch angle（AUC: 0.988,p<0.001,95%CI: 0.968 to 1.000）had a higher correlation with ROTA-related coronary dissection with the corresponding cutoff value of 0.720 mm and 98.2o significantly.The OCT catheter bias quadrant pre-ROTA was highly consistent with the quadrant where the ROTA-related coronary intimal dissection was present.OCT catheters are always trapped beneath the ROTA-related dissection.ROTA-related coronary intimal dissections were found in 6 layers post-ROTA from IVUS data,and could not be analyzed statistically,all IVUS data were eliminated.（3）Patients’ clinical characteristics and target coronary lesions’ location: the average age was 72±7.78 and 80.3% of patients were male;The most common target lesion for ROTA treatment was the left anterior descending artery（LAD）about 79.4% and located at proximal segment about 54.4%.Conclusions: Dcmb（distance from the center of OCT catheter to media at the bias direction）and touch angle（the arc of contact between OCT catheter and the intima of coronary artery）detected by OCT are two very valuable and convenient independent predictors of ROTA-related coronary intimal dissections caused by guidewire bias. |
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