Prediction of medial damage by rotational atherectomy using intravascular ultrasound

This study evaluated whether intravascular ultrasound (IVUS) images before rotational atherectomy (RA) can predict medial injury caused by RA burr passage in advance.

Thirty-three patients with de-novo lesions located in the left anterior descending coronary artery (LAD) who underwent IVUS before and immediately after RA were enrolled. The spatial axes of the two matched pre- and post-RA IVUS cross-sectional images were merged. The segment was considered to have medial damage when the continuity of the intimal layer was disrupted and the medial layer was in direct contact with the lumen on post-RA IVUS.

Medial injuries on post-RA IVUS were identified in seven segments of five patients. All segments with medial injury were located near the bifurcation of the LAD and the diagonal branch, and the spatial orientations of the medial injury region were mostly distributed in the lateral side with a diagonal branch take-off. The lumen area was significantly smaller in segments with medial injury than in those without medial injury (P < 0.01). The IVUS catheter was in contact with the healthy side of the arterial wall on pre-RA IVUS images for more than 1 mm in length in all segments with medial injury.

When the guidewire and IVUS catheter are close to the healthy side of the arterial wall on pre-RA IVUS images, there is a higher risk of medial injury due to the RA procedure, especially near the bifurcation of the LAD and diagonal branch.