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Observational Study
. 2020 Nov 5;15(11):e0241836.
doi: 10.1371/journal.pone.0241836. eCollection 2020.

Comparison of clinical outcomes of intravascular ultrasound-calcified nodule between percutaneous coronary intervention with versus without rotational atherectomy in a propensity-score matched analysis

Yusuke Watanabe  1 , Kenichi Sakakura  1 , Yousuke Taniguchi  1 , Kei Yamamoto  1 , Masaru Seguchi  1 , Takunori Tsukui  1 , Hiroyuki Jinnouchi  1 , Hiroshi Wada  1 , Shin-Ichi Momomura  1 , Hideo Fujita  1
Affiliations
Observational Study

Comparison of clinical outcomes of intravascular ultrasound-calcified nodule between percutaneous coronary intervention with versus without rotational atherectomy in a propensity-score matched analysis

Yusuke Watanabe et al. PLoS One. .

Abstract

Objectives: This study aimed to compare the mid-term clinical outcomes of intravascular ultrasound (IVUS)-calcified nodules between percutaneous coronary intervention (PCI) with and without rotational atherectomy (RA).

Background: There has been a debate whether to use RA for the revascularization of calcified nodule. Although RA can ablate the calcified structure within calcified nodule and may facilitate adequate stent expansion, RA may provoke severe coronary perforation, because calcified nodule typically shows eccentric calcification.

Methods: We included 204 lesions with IVUS-calcified nodule, and divided into 73 lesions treated with RA (RA group) and 131 lesions without RA (non-RA group). After propensity-score matching, 42 lesions with RA (matched RA group) and 42 lesions without RA (matched non-RA group) were selected. We compared the clinical characteristics and outcomes between the 2 groups before and after propensity-score matching. The primary endpoint was ischemia-driven target vessel revascularization (TVR) within 1 year.

Results: Acute lumen area gain on IVUS was comparable between the matched RA group and matched non-RA group (3.9 ± 2.1 mm2 vs. 3.4 ± 1.6 mm2, p = 0.18). The stent malapposition at calcified nodules was frequently observed in both groups. The ischemia-driven TVR was not different between the 2 groups before (p = 0.82) and after propensity score-matching (p = 0.87).

Conclusions: The use of RA could not reduce the incidence of ischemia-driven TVR in lesions with IVUS-calcified nodule. Our results do not support the routine use of RA for lesions with IVUS-calcified nodule.

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Conflict of interest statement

Dr. Sakakura has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic Cardiovascular, Terumo, OrbusNeich, Japan Lifeline, Kaneka, and NIPRO; he has served as a proctor for Rotablator for Boston Scientific, and he has served as a consultant for Abbott Vascular and Boston Scientific. Prof. Fujita has served as a consultant for Mehergen Group Holdings, Inc. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. The classification of IVUS-calcified nodules.
Upper panels show the schemes of calcified nodules, and lower panels show the corresponding IVUS images. Type 1 was an eccentric calcified nodule without calcification at the opposite site of calcified nodule. Type 2 was an eccentric calcified nodule with broad (≥180° arc) superficial calcification at the opposite site of calcified nodule. Type 3 was an eccentric calcified nodule with narrow (<180° arc) superficial calcification pattern at the opposite site of calcified nodule. Type 4 was multiple calcified nodules within the lumen. Type 5 was a calcified nodule with visible luminal thrombus. Black represents calcification, yellow represents non-calcified plaques, orange represents visible thrombus, white represents vessel lumen, and red represents vessel wall (media).
Fig 2
Fig 2. Study flow chart.
IVUS = Intravascular ultrasound, RA = rotational atherectomy.
Fig 3
Fig 3. Kaplan-Meier curves of cumulative survival free of ischemia-driven TVR events within one year between two groups before and after propensity score matching.
Survival curves of ischemia-driven TVR are shown for the non-RA and the RA groups, and for the matched non-RA group and the matched RA group. A log-rank test showed no significant difference between the two groups in before (p = 0.82) and after propensity-score matching (p = 0.87).
See this image and copyright information in PMC

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