Scholarlink

<p>Coronary artery calcification (CAC), one of the greatest challenges of percutaneous coronary intervention (PCI), is associated with a poor prognosis. We therefore conducted a wire-derived physiological evaluation to investigate the influence of CAC modification using intravascular lithotripsy (IVL) and rotational atherectomy (RA) on the coronary circulation. A total of 154 patients with CAC requiring IVL or RA were enrolled in this single-center, retrospective study. Physiological assessments, particularly Index of microcirculatory resistance (IMR), coronary flow reserve (CFR), resistive reserve ratio (RRR), and microvascular resistance reserve (MRR) were performed using a temperature-sensor guidewire (Pressure Wire X, Abbott) pre- and post-PCI and compared between IVL and RA. Procedural and 30-day clinical outcomes were also evaluated. Seventy patients were treated with IVL and 84 with RA. IVL and RA demonstrated comparable lumen expansion. In the physiological assessments, RA significantly increased post-IMR compared to IVL (17.0 [10.5–32.8] vs.12.0 [9.00–19.0], p = 0.03), which was correlated with severity of periprocedural myocardial Infarction (MI) (Spearman’s ρ = 0.40, p = 0.01). Post-CFR, post-RRR, and post-MRR were significantly higher with IVL than RA (3.20 [2.00—4.60] vs. 1.55 [1.20—2.10], p &lt; 0.01, 2.90 [2.10—4.70] vs. 1.60 [1.20–2.42], p &lt; 0.01, 2.77 [2.05—4.54] vs. 1.50 [1.20—2.37], p &lt; 0.01, respectively). Use of RA was associated with post-PCI coronary microvascular dysfunction (OR: 4.77, 95% CI:1.51–17.56). Slow flow phenomenon and procedure-related MI were more frequently observed with RA than IVL (19.1% vs. 4.3%, p &lt; 0.01, 35.7% vs. 7.1%, p &lt; 0.01, respectively). In patients with severely calcified coronary lesions, IVL and RA achieved comparable epicardial results, whereas IVL was associated with more favorable post-procedural microvascular physiological indices than RA. Although RA was associated with increased procedural MI, this was not accompanied by a significant difference in short-term major adverse events. Further studies with large populations and long-term follow-up are warranted to determine the clinical significance of these physiological differences.</p> Graphical Abstract <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Physiological assessment of coronary microvascular dysfunction and short-term outcomes in severely calcified coronary lesions: a comparison between rotational atherectomy and intravascular lithotripsy

  • 期刊论文

  • 发表日期：

    2026年7月25日

查看全文
  • Hirofumi Kusumoto,
  • Daisuke Shishikura,
  • Kenta Sakaguchi,
  • Simpei Fujioka,
  • Yohei Yamauchi,
  • Tomohiro Fujisaka,
  • Yumiko Kanzaki,
  • Mariko Harada-Shiba,
  • Hideaki Morita

摘要

Coronary artery calcification (CAC), one of the greatest challenges of percutaneous coronary intervention (PCI), is associated with a poor prognosis. We therefore conducted a wire-derived physiological evaluation to investigate the influence of CAC modification using intravascular lithotripsy (IVL) and rotational atherectomy (RA) on the coronary circulation. A total of 154 patients with CAC requiring IVL or RA were enrolled in this single-center, retrospective study. Physiological assessments, particularly Index of microcirculatory resistance (IMR), coronary flow reserve (CFR), resistive reserve ratio (RRR), and microvascular resistance reserve (MRR) were performed using a temperature-sensor guidewire (Pressure Wire X, Abbott) pre- and post-PCI and compared between IVL and RA. Procedural and 30-day clinical outcomes were also evaluated. Seventy patients were treated with IVL and 84 with RA. IVL and RA demonstrated comparable lumen expansion. In the physiological assessments, RA significantly increased post-IMR compared to IVL (17.0 [10.5–32.8] vs.12.0 [9.00–19.0], p = 0.03), which was correlated with severity of periprocedural myocardial Infarction (MI) (Spearman’s ρ = 0.40, p = 0.01). Post-CFR, post-RRR, and post-MRR were significantly higher with IVL than RA (3.20 [2.00—4.60] vs. 1.55 [1.20—2.10], p < 0.01, 2.90 [2.10—4.70] vs. 1.60 [1.20–2.42], p < 0.01, 2.77 [2.05—4.54] vs. 1.50 [1.20—2.37], p < 0.01, respectively). Use of RA was associated with post-PCI coronary microvascular dysfunction (OR: 4.77, 95% CI:1.51–17.56). Slow flow phenomenon and procedure-related MI were more frequently observed with RA than IVL (19.1% vs. 4.3%, p < 0.01, 35.7% vs. 7.1%, p < 0.01, respectively). In patients with severely calcified coronary lesions, IVL and RA achieved comparable epicardial results, whereas IVL was associated with more favorable post-procedural microvascular physiological indices than RA. Although RA was associated with increased procedural MI, this was not accompanied by a significant difference in short-term major adverse events. Further studies with large populations and long-term follow-up are warranted to determine the clinical significance of these physiological differences.

Graphical Abstract