TY - JOUR
T1 - Optical coherence tomography-derived predictors of stent expansion in calcified lesions
AU - Ziedses des Plantes, Annemieke C.
AU - Scoccia, Alessandra
AU - Neleman, Tara
AU - Groenland, Frederik T.W.
AU - van Zandvoort, Laurens J.C.
AU - Ligthart, Jurgen M.R.
AU - Witberg, Karen T.
AU - Liu, Shengnan
AU - Boersma, Eric
AU - Nuis, Rutger Jan
AU - den Dekker, Wijnand K.
AU - Wilschut, Jeroen
AU - Diletti, Roberto
AU - Zijlstra, Felix
AU - Van Mieghem, Nicolas M.
AU - Daemen, Joost
N1 - Funding Information:
The authors thank Dr. Jouke Dijkstra for providing dedicated OCT analysis software (QCU-CMS, Leiden University Medical Centre, LKEB, Division of Image Processing, version 4.69).
Publisher Copyright:
© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Background: Severe coronary artery calcification is associated with stent underexpansion and subsequent stent failure. Aims: We aimed to identify optical coherence tomography (OCT)-derived predictors of absolute (minimal stent area [MSA]) and relative stent expansion in calcified lesions. Methods: This retrospective cohort study included patients who underwent percutaneous coronary intervention (PCI) with OCT assessment before and after stent implantation between May 2008 and April 2022. Pre-PCI OCT was used to assess calcium burden and post-PCI OCT was used to assess absolute and relative stent expansion. Results: A total of 361 lesions in 336 patients were analyzed. Target lesion calcification (defined as OCT-detected maximum calcium angle ≥ 30°) was present in 242 (67.0%) lesions. Following PCI, median MSA was 5.37 mm2 in calcified lesions and 6.24 mm2 in noncalcified lesions (p < 0.001). Median stent expansion was 78% in calcified lesions and 83% in noncalcified lesions (p = 0.325). In the subset of calcified lesions, average stent diameter, preprocedural minimal lumen area, and total calcium length were independent predictors of MSA in multivariable analysis (mean difference 2.69 mm2/mm2, 0.52 mm2/mm, and −0.28 mm2/5 mm, respectively, all p < 0.001). Total stent length was the only independent predictor of relative stent expansion (mean difference −0.465% per mm, p < 0.001). Calcium angle, thickness, and the presence of nodular calcification were not significantly associated with MSA or stent expansion in multivariable analyses. Conclusion: Calcium length appeared to be the most important OCT-derived predictor of MSA, whereas stent expansion was mainly determined by total stent length.
AB - Background: Severe coronary artery calcification is associated with stent underexpansion and subsequent stent failure. Aims: We aimed to identify optical coherence tomography (OCT)-derived predictors of absolute (minimal stent area [MSA]) and relative stent expansion in calcified lesions. Methods: This retrospective cohort study included patients who underwent percutaneous coronary intervention (PCI) with OCT assessment before and after stent implantation between May 2008 and April 2022. Pre-PCI OCT was used to assess calcium burden and post-PCI OCT was used to assess absolute and relative stent expansion. Results: A total of 361 lesions in 336 patients were analyzed. Target lesion calcification (defined as OCT-detected maximum calcium angle ≥ 30°) was present in 242 (67.0%) lesions. Following PCI, median MSA was 5.37 mm2 in calcified lesions and 6.24 mm2 in noncalcified lesions (p < 0.001). Median stent expansion was 78% in calcified lesions and 83% in noncalcified lesions (p = 0.325). In the subset of calcified lesions, average stent diameter, preprocedural minimal lumen area, and total calcium length were independent predictors of MSA in multivariable analysis (mean difference 2.69 mm2/mm2, 0.52 mm2/mm, and −0.28 mm2/5 mm, respectively, all p < 0.001). Total stent length was the only independent predictor of relative stent expansion (mean difference −0.465% per mm, p < 0.001). Calcium angle, thickness, and the presence of nodular calcification were not significantly associated with MSA or stent expansion in multivariable analyses. Conclusion: Calcium length appeared to be the most important OCT-derived predictor of MSA, whereas stent expansion was mainly determined by total stent length.
UR - http://www.scopus.com/inward/record.url?scp=85159690928&partnerID=8YFLogxK
U2 - 10.1002/ccd.30687
DO - 10.1002/ccd.30687
M3 - Article
C2 - 37210611
AN - SCOPUS:85159690928
SN - 1522-1946
VL - 102
SP - 25
EP - 35
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 1
ER -