Research Article
Effect of Crack Patterns in Calcified Plaque on Lumen Area after Stenting for a Severe Calcified Coronary Artery (from the Optical Frequency Domain Imaging-Guided Percutaneous Coronary Artery Intervention for Calcified Lesion Registry)
Figure 4
Representative cases of those who underwent optical frequency domain imaging (OFDI)-guided percutaneous coronary intervention (PCI) for severely calcified coronary disease. (a–d) A 69-year-old male with LAD lesion. Serial OFDI images obtained the same cross-section. (a) Initial OFDI image showed all rounded calcified plaque. (b) Postrotational atherectomy using a 1.5 mm and 2.0 mm burr; the calcium almost disappeared within the circumference (yellow arrowhead). The lumen area was 3.5 mm2 and the lumen perimeter 6.6 mm. (c) Postballooning using a cutting balloon (diameter, 3.0 mm; dilatation atmosphere, 10 atm; perimeter, 10.2 mm). Blue arrowheads show the medial dissection between calcified plaque and vessel wall. (d) Final OFDI image after stenting (DES diameter was 3.5 mm). The lumen area was 8.1 mm2, and the expansion ratio (final lumen area/lumen area before ballooning) was 231%. (e–g) A 74-year-old female with LAD lesion. Serial OFDI images obtained the same cross-section. Fast view catheter (TERUMO) did not pass the lesion. Thus, there was no initial OFDI image before rotational atherectomy. (e) Postrotational atherectomy using a 1.5 mm and 2.0 mm burr; the lumen was totally surrounded by thick calcium. The lumen area was 3.3 mm2 and the lumen perimeter 6.4 mm. (f) Postballooning using a cutting balloon (diameter, 2.25 mm; dilatation atmosphere, 8 atm; perimeter, 7.3 mm). The sheet calcium was cracked without medial dissection (blue arrowhead). (g) Final OFDI image after stenting (DES diameter was 2.5 mm). The lumen area was 4.6 mm2 and the expansion ratio (final lumen area/lumen area before ballooning) was 139%. DES, drug-eluting stent; LAD, left anterior descending artery; OFDI, optical frequency domain imaging; PCI, percutaneous coronary intervention.