The IVUS Characteristics Of Severely Coronary Calciifed Lesions And Evaluate The Safety And Efficacy Of Percutaneous Coronary Intervention (PCI) For These Lesions

Objective:1. Evaluatethe morphological characteristics of severely coronary calcifiedlesions and its influence for PCI results.2. Evaluate the safety and efficacy of cutting-balloon (CB) angioplastyand CBcombined with rotational atherectomy (RA) for severely calcified lesions.Methods:1.One hundred and six coronary artery disease (CHD) patients whounderwent coronary stenting with IVUS guidedwere divided into no-calcified group,light-calcified group and severe-calcified group, according to calcium arc and calciumlength ratio. IVUS was performed before and after stent implantation, to obtain lesioncharacteristics and evaluate the stent.2. A perspective study included92CHD patients with at least1severely coronarycalcified lesion confirmed byIVUS in our center. They were randomly divided intogeneral balloon (BA) groupand cutting-balloon (CB) group.After PCI, IVUS wasperformed to evaluate stent andPCI-related complications.1-month,6-month and9-month major adverse cardiac events (MACE) were analyzed.3.A retrospective study included80CHD patients with severely coronary calcifiedlesions defined by IVUS and deposed by RA. According to whether using CB or not,they were divided into RA group and CBcombined with RA (RC) group. IVUS wasused to evaluate the stent.Results:1. Minimum lumen cross sectional area (CSA), mean lumen area and minimumstent CSA were smaller in severely calcified group, P<0.05. The occurrenceof stentunder-expansion, asymmetry and malapposition, vessel dissection and side branch jailedwere more frequentin severely calcified group than other two groups, P<0.05.2. Liner regression revealed that there was a negative relationship between calcium arcand minimum lumen CSA, minimum stent CSA.Logistic regression revealed that calcium length ratio was a predictor for vessel dissection and stent asymmetry, calciumindex was a predictor for stent malapposition and stent under-expansion.3. There were no statistical differences in clinical characteristics between BA group andCB group, P>0.05. After stent implantation, the final minimum stent CSA (6.26±0.4mm2vs5.03±0.33mm2, P=0.031) and acute lumen gain (3.74±0.38mm2,2.44±0.29mm2, P=0.015)were significantly larger in the CB group than that of the BA group.There were no statistical differences in stent expansion, symmetry andmalapposition,vessel dissection and branch vessel jail between two groups. The30-day and9-monthMACE rates were also not different.4. There were no statistical differences in minimum lumen CSA between RA group andRC group, P>0.05.After stent implantation, the minimum stent CSA(6.12±0.37mm2vs5.42±0.24mm2, P=0.012) and acute lumen gain (3.66±0.34mm2vs2.90±0.24mm2,P=0.016) of RC group were significantly larger than that of the RA group. There wereno differences in PCI-related complications between two groups.Conclusion:1. Severely coronary calcified lesions are always of seriously narrowlumen area, and a higher occurrence of stent malapposition, asymmetry andunder-expansion, vessel dissection and branch vessel jail.2. Minimum lumen CSA and minimum stent CSA were mainly affected by calcium arc.Stent asymmetry and vessel dissection were mainly affected by calcium length ratio.Stent malapposition and under-expansion were mainly affected by calcium index.3.CB angioplasty and RA combined withCBbefore stent implantation in severelycalcified lesions appears to be more efficacious, including significantly larger finalstent CSA and larger acute lumen gain, without increasing PCI-related complications.