Prediction of optimal debulking segments before rotational atherectomy based on pre-procedural intravascular
Kenta Hashimoto1, Kenichi Fujii2, Hiroki Shibutani1
1Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata-city, Osaka, 5731010, Japan.
Insights
Pre-procedural intravascular ultrasound (IVUS) of guidewire position effectively predicts rotational atherectomy (RA) burr trajectory. This helps optimize the RA burr
Area of Science:
- Cardiovascular Interventions
- Medical Imaging
- Vascular Surgery
Background:
- Rotational atherectomy (RA) is used for calcified lesions.
- Predicting the optimal burr path is crucial for RA success.
- Intravascular ultrasound (IVUS) offers detailed vessel imaging.
Purpose of the Study:
- To determine if pre-procedural IVUS can predict the RA burr's passage route.
- To assess the correlation between IVUS findings and actual burr trajectory.
Main Methods:
- 30 patients with calcified lesions undergoing RA were studied.
- IVUS imaging was performed before and after RA.
- Cross-sections were analyzed for debulked regions and guidewire/IVUS positions.
Main Results:
- 44% of cross-sections showed debulking.
- Guidewire position in pre-RA IVUS predicted burr trajectory with high accuracy (96% when co-located).
- Guidewire position was a better predictor than IVUS catheter position, especially when separated by >1.0 mm.
Conclusions:
- Pre-procedural IVUS assessment of guidewire location can predict RA burr path.
- This imaging guidance can optimize rotational atherectomy procedures.
- Guidewire position is a key factor for successful burr navigation.
Abstract:
This study evaluated whether intravascular ultrasound (IVUS) examination before rotational atherectomy (RA) can predict the optimal route of passage of the RA burr along the vessel. 30 patients with calcified lesions who underwent IVUS before and immediately after RA were enrolled. IVUS analyses were performed at the minimum lumen area (MLA) site and at 0.5 mm intervals. Each IVUS cross-section was divided into 4 quadrants around the center of the lumen, and pre- and post-RA IVUS cross-section images were merged. Of 1140 cross-sections, 498 (44%) contained debulked regions. When the guidewire and IVUS were located within the same quadrant, the debulked region were distributed within the same quadrant in 96% of cross-sections. The debulked region and the guidewire were distributed within the same quadrant in 81% and the debulked region and the IVUS in 72% of cross-sections, in case the guidewire and IVUS were located in different quadrants. When the guidewire and the IVUS was apart > 1.0 mm, the debulked regions were distributed within the same quadrant as the guidewire in 100% and the IVUS in 0% of cross-sections. The position of the guidewire rather than that of the IVUS catheter on pre-RA IVUS images could predict the course of the RA burr's passage, especially when the guidewire and IVUS catheter were located apart from each other.
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