A Single-Center Study Using IVUS to Guide Rotational Atherectomy for Chronic Renal Disease’s Calcified Coronary Artery

Figures & data

Table 1 Baseline Clinical Characteristics of the IVUS-Guided RA PCI Group and Standard-RA PCI Group

	IVUS-Guided-RA Group (n=24 Patients)	Standard-RA Group (n=24 Patients)	P value
Age (years)	72.3 ± 7.1	71.6 ± 7.7	0.74
Males	21 (80.9%)	17 (64.4%)	0.16
BMI (kg/m^2)	26.9 ± 4.8	26.4 ± 4.6	0.71
Hypertention	23 (95.8%)	23 (95.8%)	1.00
Diabetes mellitus	14 (58.3%)	13 (54.2%)	0.77
Dyslipidemia	19 (79.2%)	18 (75.0%)	0.73
History of smoking	21 (80.9%)	20 (83.3%)	0.68
Previous CABG	2 (8.3%)	2 (8.3%)	1.00
Clinical presentation			0.73
Chronic coronary syndrome	19 (79.2%)	18 (75.0%)
Acute coronary syndrome	5 (20.8%)	6 (25%)
Number of coronary atery disease			0.83
1	2 (8.3%)	1 (4.2%)
2	5 (20.8%)	5 (20.8%)
3	17 (70.8%)	18 (75.0%)
EF (%)	43 ± 13	45 ± 12	0.58
Creatinine (µmol/l)	163[129–348]	154[132–298]	0.92
Mean eGFR (mL/min/1.73m^2)	81.42 ± 20.22	82.34 ± 22.19	0.88
eGFR stage			0.80
eGFR 60–90 mL/min/1.73m^2	11 (45.8%)	13 (54.2%)
eGFR 30–59 mL/min/1.73m^2	5 (20.8%)	6 (25%)
eGFR 15–29 mL/min/1.73m^2	6 (25%)	4 (16.7%)
eGFR <15 mL/min/1.73m^2	2 (8.3%)	1 (4.2%)
History of CIN	7 (29.2%)	6 (25%)	0.75

Note: Values are n (%), median [IQR] or mean ± SD.

Abbreviations: BMI, body mass index; CABG, coronary artery bypass graft; LVEF, left ventricular ejection fraction; eGFR, estimated glomerular filtration rate; CIN, contrast-induced nephropathy.

Table 2 Angiographic and Procedural Characteristics of the IVUS-Guided RA Group and Standard-RA Group

	IVUS-Guided-RA Group (n=24 Patients)	Standard-RA Group (n=24 Patients)	P value
Target RA PCI vessel			0.99
Left main	1 (4.2%)	0%
Left anterior descending	12 (50%)	13 (54.1%)
Left circumflex	2 (8.2%)	3 (12.5%)
Right coronary artery	9 (37.5%)	8 (33.3%)
Diameter stenosis (%)	88 ± 8	89 ± 9	0.69
Bifurcation lesion	13 (54.1%)	14 (58.3%)	0.77
Bifurcation technique
Crush technique	3 (23.1%)	1 (4.2%)	0.30
Culotte technique	2 (15.4%)	0%	0.49
T and protrusion	0%	1 (4.2%)	0.99
Provisional	8 (61.5%)	12 (85.7%)	0.24
Procedural access			0.48
Radial artery access	20 (83.3%)	18 (75%)
Femoral artery access	4 (16.7%)	6 (25%)
Guiding diameter			0.70
6 French	3 (12.5%)	5 (20.8%)
7 French	21 (87.5%)	19 (79.2%)
Use of Guidezilla	5 (20.8%)	2 (8.3%)	0.41
Number of burrs			0.60
1 burr	23 (95.8%)	21 (87.5%)
≥2 burrs	1 (4.2%)	3 (12.5%)
Burr diameter
1.25 mm	8 (32%)	9 (33.3%)	0.76
1.5 mm	14 (56%)	12 (44.4%)	0.34
1.75 mm	3 (12%)	5 (18.5%)	0.70
2 mm	0%	1 (3.7%)	1.00
Rotational speed (RPM)	162,141 ± 4,245	164,862 ± 43,28	0.03
Burr to artery ratio	0.49 ± 0.08	0.48 ± 0.09	0.64
Indication of RA
Elective-RA	21 (87.5%)	14 (58.3%)	0.02
Bailout-RA	3 (12.5%)	10 (41.7%)
Balloon pre-dilatation
Max pre-dilation balloon size, mm	3.04 ± 0.5	2.89 ± 0.40	<0.01
Max pre-dilation pressure, atm	20 ± 3.7	17 ± 3.4	<0.01
Stent implantation
Number of stents implanted	2.1 ± 0.6	2.0 ± 0.6	0.57
Mean stent diameter, mm	3.16 ± 0.3	2.92 ± 0.4	0.02
Total stent length (mm)	61.8 ± 22.7	63.6 ± 20.4	0.77
Max. stent diameter (mm)	3.5± 0.5	3.2 ± 0.4	0.03
Max. stent implantation pressure (atm)	16 ± 2	14 ± 2	<0.01
Balloon post-dilatation
Post-dilation balloon size, mm	3.5 ± 0.5	3.2 ± 0.6	0.07
Max. postdil. balloon pressure (atm)	22.6 ± 2.7	20.7 ± 2.9	0.02

Note: Values are n (%), mean ± SD.

Abbreviation: RPM, rotations per minute.

Table 3 Procedural and In-Hospital Outcome of the IVUS-Guided RA Group and Standard RA Group

	IVUS-Guided-RA Group (n=24 Patients)	Standard-RA Group (n=24 Patients)	P value
Procedural duration (min)	85 ± 31	79 ± 43	0.58
Fluoroscopic time (min)	20.6 ± 8.4	36 ± 22	<0.01
Dose area product (cGy/cm^2)	1347 ±1044	1511± 1139	0.62
Contrast amount (mL)	32 ±16	184 ±116	<0.01
Angiographic success*	100%	100%
RA PCI complications
Slow flow/no flow	1 (4.2%)	1 (4.2%)	1.00
Perforation/rupture	0%	0%
Pericardial effusion	0%	0%
Stent thrombosis	1 (4.2%)	0%
Dissection	3 (12.5%)	4 (16.7%)	0.92
Cardiac arrest	0%	1 (4.2%)	0.87
Mean eGFR 48h after PCI (mL/min/1.73 m^2)	81.12 ± 20.74	76.84 ± 20.69	0.48
Contrast-induced nephropath	1 (4.1%)	5 (20.8%)	0.22
Renal replacement therapy	0%	2 (8.3%)	0.47
In-hospital TVR	0%	0%
In-hospital death	0%	0%

Notes: Values are n (%), mean ± SD or median. *Angiographic success was defined as TIMI 3 flow at the end of the procedure with <30% residual stenosis.

Abbreviation: TVR, target vessel revascularization.