Optical coherence tomography-guided versus intravascular ultrasound-guided rotational atherectomy in patients with calcified coronary lesions.

AIMS We aimed to evaluate whether optical coherence tomography (OCT)-guided rotational atherectomy (RA) improves stent expansion and clinical outcomes compared to intravascular ultrasound (IVUS)-guided RA. METHODS AND RESULTS From our database, we identified 247 de novo calcified coronary lesions that underwent RA between September 2013 and December 2017. Of these, lesions with no intravascular imaging data (n=11), poor image quality (n=7), balloon angioplasty alone (n=16), and complications (two burr entrapments, two perforations) were excluded. Finally, 88 and 121 lesions that underwent OCT-guided and IVUS-guided RA, respectively, were included in the study. The primary endpoint of the present study was percent stent expansion. Burr upsizing was more frequently performed (55% vs 32%, p=0.001) and the final burr size was significantly larger (1.75 [1.50-1.75] vs 1.50 [1.50-1.75] mm, p<0.001) in the OCT-guided RA group. Percent stent expansion was significantly larger in the OCT-guided RA group (83±15% vs 72±16%, p=0.0004). Although TLR at one year was lower in the OCT-guided RA group, there was no statistical difference (6.8% vs 11.6%, p=0.25). CONCLUSIONS OCT-guided RA for calcified coronary lesions resulted in larger percent stent expansion compared to IVUS-guided RA. OCT-guided RA may be ideal for treating calcified coronary lesions.