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Updated: Sep 9, 2025
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
OCT-based quantitative predictors of coronary dissection during rotational atherectomy in severe calcified lesions
Yu-He Zhou1, Hong-Li Zhang2, Yang Yang1
1Department of General Practice, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Insights
Guidewire bias during rotational atherectomy (ROTA) can cause coronary dissection. Optical coherence tomography (OCT) identified specific measurements, distance from the OCT catheter center to the media (Dcmb) and touch angle, as key predictors.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Rotational atherectomy (ROTA) for coronary calcification carries risks of dissection.
- Guidewire bias, related to intravascular imaging (IVI) catheter position, is implicated but poorly defined.
- Quantitative OCT criteria for guidewire bias are needed to predict ROTA-induced dissections.
Purpose of the Study:
- To explore quantitative criteria in OCT imaging for guidewire bias.
- To identify OCT-derived parameters predicting ROTA-induced coronary dissection.
- To establish objective measures for guidewire bias in ROTA procedures.
Main Methods:
- Analysis of 388 pre- and post-ROTA OCT cross-sections from 21 patients with severe calcified lesions.
- Manual coregistration of OCT images to assess plaque, IVI catheter location, and dissections.
- Receiver operating characteristic (ROC) analysis to determine predictive values of OCT parameters.
Main Results:
- The distance from the OCT catheter center to the media (Dcmb) and the touch angle were strongly correlated with ROTA-related coronary dissection (AUCs: 1.000 and 0.988, respectively).
- Optimal cutoff values were identified: Dcmb at 0.720 mm and touch angle at 98.2°.
- These OCT parameters demonstrated high diagnostic accuracy for predicting dissection.
Conclusions:
- Dcmb and touch angle are valuable, independent predictors of ROTA-induced coronary intimal dissections.
- OCT imaging provides quantitative insights into guidewire bias during ROTA.
- These findings can improve ROTA procedural safety by identifying dissection risks.
Background:
In the treatment of coronary calcification by rotational atherectomy (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-sectional location of the intravascular imaging (IVI) catheter in the coronary artery. This study tentatively explores the quantitative criteria in optical coherence tomography (OCT) imaging of guidewire bias, which may cause ROTA-induced coronary dissection.
Methods:
A total of 21 patients with severe calcified coronary lesions who underwent ROTA treatment were enrolled in our study. OCT successfully detected these patients pre-ROTA and post-ROTA. All observed coronary segments were analyzed cross-sectionally at every 1-mm interval after manual coregistration of pre-ROTA and post-ROTA OCT images. ROTA-related coronary dissection was the primary endpoint.
Results:
A total of 388 OCT cross-sectional images were effectively measured and analyzed to assess the distribution and characteristics of plaque and OCT catheter location pre-ROTA, as well as the presence or absence of coronary dissections post-ROTA after manual coregistration. According to the receiver operating characteristic (ROC) analysis, the distance from the center of OCT catheter to the media at the bias direction (Dcmb) (area under the curve (AUC): 1.000, p < 0.001, 95% confidence intervals (CI): 0.999-1.000) and the touch angle (AUC: 0.988, p < 0.001, 95%CI: 0.968 to 1.000) were strongly correlated with ROTA-related coronary dissection, with the corresponding cutoff values of 0.720 mm and 98.2° respectively.
Conclusion:
Dcmb and touch angle detected by OCT are two valuable and convenient independent predictors of ROTA-related coronary intimal dissections caused by guidewire bias.
