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.