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<p>The original intravascular ultrasound (IVUS) calcium score in percutaneous coronary intervention (PCI) applies only to lesions with a maximum calcium angle &gt; 270°, distinguishing it from the optical coherence tomography (OCT) calcium score. We aimed to investigate a new IVUS-derived calcium score to predict stent underexpansion in moderately to severely calcified lesions. We retrospectively analyzed 238 IVUS-guided PCI cases with moderate to severe calcification visible on angiography, including 136 cases with IVUS-guided PCI as a derivation cohort and 102 cases with both IVUS- and OCT-guided PCI as a validation cohort, excluding cases in which atherectomy was used. In the derivation cohort, IVUS-derived maximum calcium angle showed significant area under the curve (AUC) to predict stent underexpansion (&lt; 70%) at the maximum superficial calcium site (cutoff value: 228°, AUC: 0.72). A multivariable linear regression model showed that maximum calcium angle of 225° (regression coefficient: -11.69; <i>p</i> = 0.023) and the presence of calcified nodule (regression coefficient: -4.913; <i>p</i> = 0.004) were associated with stent expansion. A new IVUS calcium score (0–4 points) was defined as 3 points for maximum calcium angle &gt; 225°, and 1 point for presence of a calcified nodule. A cutoff of ≥ 3 showed a good AUC (0.751) and an excellent negative predictive value (0.963) to predict stent underexpansion. In the validation cohort, the incidence of stent underexpansion was 0%, 0%, 8.6%, and 33.3% in patients with the new IVUS calcium score of 0, 1, 3, and 4, respectively (<i>p</i> = 0.004). The new IVUS-derived calcium score can effectively predict stent expansion in moderately to severely calcified lesions.</p> Graphical Abstract <p></p>

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Intravascular ultrasound–derived calcium score to predict stent underexpansion in moderately to severely calcified lesions

  • 期刊论文

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  • 发表日期：

    2026年7月31日

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  • Masaomi Gohbara,
  • Masahiko Noguchi,
  • Yasuhiro Nakano,
  • Yohei Sotomi,
  • Kouji Yamamoto,
  • Kyoko Hattori,
  • Shun Kitajima,
  • Yohei Hanajima,
  • Katsuhiko Tsutsumi,
  • Hidekuni Kirigaya,
  • Jin Kirigaya,
  • Shinnosuke Kikuchi,
  • Hidefumi Nakahashi,
  • Kensuke Matsushita,
  • Kozo Okada,
  • Noriaki Iwahashi,
  • Masami Kosuge,
  • Teruyasu Sugano,
  • Toshiaki Ebina,
  • Kiyoshi Hibi

摘要

The original intravascular ultrasound (IVUS) calcium score in percutaneous coronary intervention (PCI) applies only to lesions with a maximum calcium angle > 270°, distinguishing it from the optical coherence tomography (OCT) calcium score. We aimed to investigate a new IVUS-derived calcium score to predict stent underexpansion in moderately to severely calcified lesions. We retrospectively analyzed 238 IVUS-guided PCI cases with moderate to severe calcification visible on angiography, including 136 cases with IVUS-guided PCI as a derivation cohort and 102 cases with both IVUS- and OCT-guided PCI as a validation cohort, excluding cases in which atherectomy was used. In the derivation cohort, IVUS-derived maximum calcium angle showed significant area under the curve (AUC) to predict stent underexpansion (< 70%) at the maximum superficial calcium site (cutoff value: 228°, AUC: 0.72). A multivariable linear regression model showed that maximum calcium angle of 225° (regression coefficient: -11.69; p = 0.023) and the presence of calcified nodule (regression coefficient: -4.913; p = 0.004) were associated with stent expansion. A new IVUS calcium score (0–4 points) was defined as 3 points for maximum calcium angle > 225°, and 1 point for presence of a calcified nodule. A cutoff of ≥ 3 showed a good AUC (0.751) and an excellent negative predictive value (0.963) to predict stent underexpansion. In the validation cohort, the incidence of stent underexpansion was 0%, 0%, 8.6%, and 33.3% in patients with the new IVUS calcium score of 0, 1, 3, and 4, respectively (p = 0.004). The new IVUS-derived calcium score can effectively predict stent expansion in moderately to severely calcified lesions.

Graphical Abstract