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Association between debulking area of rotational atherectomy and platform revolution speed-Frequency domain optical
Kazuki Mizutani1, Masahiko Hara2, Kazuhiro Nakao1
1Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Insights
Lowering rotational atherectomy (RA) speed below 150,000 rpm significantly increases calcium debulking in severe calcified coronary lesions, as shown by frequency domain-optical coherence tomography (FD-OCT). This finding optimizes treatment for complex coronary artery disease.
Area of Science:
- Cardiovascular Interventions
- Medical Imaging Technology
- Interventional Cardiology
Background:
- Increasing prevalence of severe calcified coronary artery disease necessitates effective ablation techniques.
- Rotational atherectomy (RA) is a key treatment, but optimal parameters for debulking remain under investigation.
- Limited evidence exists on the relationship between RA revolution speed and lesion debulking efficacy.
Purpose of the Study:
- To investigate the association between rotational atherectomy (RA) revolution speed and the degree of calcium debulking.
- To assess the impact of RA speed on lumen gain in severely calcified coronary lesions.
- To provide guidance on optimizing RA settings for improved procedural outcomes.
Main Methods:
- Retrospective analysis of 30 severely calcified coronary lesions in 29 patients undergoing RA.
- Guidance and assessment using frequency domain-optical coherence tomography (FD-OCT).
- Evaluation of the relationship between RA revolution speed and burr size-corrected debulking area using multivariable regression with nonlinear restricted-cubic-spline analysis.
Main Results:
- Significant increase in post-procedural minimum lumen area (1.64 mm² to 2.45 mm², p < .001).
- Burr size-corrected debulking area significantly increased as RA revolution speed decreased (p = .018).
- The greatest debulking effect was observed at speeds below 150,000 rpm.
Conclusions:
- Lowering RA revolution speed to below 150,000 rpm enhances calcium debulking in severe calcified coronary lesions.
- FD-OCT imaging confirms the benefit of reduced speed for achieving greater lumen gain.
- Optimizing RA speed is crucial for effective treatment of complex calcified coronary artery disease.
Objectives:
In this study, we sought to investigate the association between revolution speed of rotational atherectomy (RA) and debulking area assessed by frequency domain-optical coherence tomography (FD-OCT).
Background:
The number of patients with severe calcified coronary artery disease requiring treatment with calcium ablation, such as RA, is increasing. However, there is little evidence available regarding the association between debulking area and revolution speed during RA.
Methods:
We retrospectively investigated 30 consecutive severely calcified coronary lesions in 29 patients who underwent RA under FD-OCT guidance. The association between preset revolution speed of RA and burr size-corrected debulking area of the calcified lesion was evaluated using a multivariable regression model with nonlinear restricted-cubic-spline, which can help assess nonlinear associations between variables.
Results:
The median age of study participants was 73 years (quartile 65-78); 82.8% were male. The median burr size was 1.5 mm (1.5-1.75); median total duration of ablation was 120 s (100-180). FD-OCT revealed that the post-procedural minimum lumen area increased significantly from 1.64 mm2 (1.40-2.09) to 2.45 mm2 (2.11-2.98) (p < .001). In addition, the burr size-corrected debulking area increased significantly as the preset revolution speed decreased (p = .018), especially when the revolution speed was less than 150,000 rpm. This result implies that additional lumen gain will be obtained by decreasing rpm when the burr speed is set at <150,000 rpm.
Conclusions:
FD-OCT demonstrated that RA with lower revolution speed, below 150,000 rpm, has the potential to achieve greater calcium debulking effect in patients with severe calcified coronary lesions.
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