ORIGINAL RESEARCH article
Front. Med.
Sec. Precision Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1640237
OCT-based quantitative predictors of coronary dissection during rotational atherectomy in severe calcified lesions
Provisionally accepted
- 1Jinling Hospital, Nanjing, China
- 2The affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
- 3Nanjing First Hospital, Nanjing, China
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BACKGROUND: In the treatment of coronary calcification by rotational atherectomy (ROTA), guidewire bias is often considered to lead to procedure associated coronary dissections or perforations. However, the actual meaning of guidewire bias is unclear, though it usually refers to the cross-section location of the intravascular imaging (IVI) catheter in the coronary artery. This study tentatively explores the quantitative criteria in optical coherence tomography (OCT) imaging of guidewire bias which may cause ROTA induced coronary dissection. METHODS: A total of twenty-one patients with severe calcified coronary lesions who has undergone ROTA treatment were enrolled in our study. These patients were detected by OCT successfully pre-and post-ROTA. All the observational coronary segments were analyzed cross-sectionally at every mm interval after manual coregistration of OCT imaging pre-and post-ROTA. ROTA related coronary dissection was the primary endpoint. RESULTS: A total of 388 OCT cross-sectional images were effectively measured and analyzed for distribution and characteristics of plaque and OCT catheter location pre-ROTA, and the presence or absence of coronary dissections post-ROTA after manual coregistration. According to the receiver operating characteristic (ROC) analysis, distance from the center of OCT catheter to media at the bias direction (Dcmb) (area under the curve (AUC): 1.000, p<0.001, 95% confidence intervals (CI): 0.999 to 1.000) and touch angle (AUC: 0.988, p<0.001, 95%CI: 0.968 to 1.000) had a higher correlation with ROTA-related coronary dissection with the corresponding cutoff value of 0.720mm and 98.2º significantly. CONCLUSIONS: Dcmb and touch angle detected by OCT are two very valuable and convenient independent predictors of ROTA-related coronary intimal dissections caused by guidewire bias.
Keywords: Rotational atherectomy, guidewire bias, coronary dissection, Optical Coherence Tomography, predictive index
Received: 03 Jun 2025; Accepted: 04 Aug 2025.
Copyright: © 2025 Zhou, Zhang, Yang, Wang, Pan, Xu, Meng, Ye and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yan-Qing Wang, Jinling Hospital, Nanjing, China
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