Reasons for lesion uncrossability as assessed by intravascular ultrasound
Objectives The purpose of the current study was to use intravascular ultrasound (IVUS) to clarify anatomical and morphological lesion characteristics of uncrossable lesions. Background Uncrossable lesions are not always severely calcified. The prevalence of uncrossable lesions that are nonseverely c...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2022-06, Vol.99 (7), p.2028-2037 |
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| creator | Salem, Hanan Mintz, Gary S. Matsumura, Mitsuaki Zhang, Mingyou Usui, Eisuke Seike, Fumiyasu Fujimura, Tatsuhiro Noguchi, Masahiko Hu, Xun Jin, Ge Li, Chenguang Fall, Khady N. Ali, Ziad A. Kirtane, Ajay J. Collins, Michael B. Kodali, Susheel K. Nazif, Tamim M. Leon, Martin B. Moses, Jeffrey W. Karmpaliotis, Dimitri Maehara, Akiko |
| description | Objectives
The purpose of the current study was to use intravascular ultrasound (IVUS) to clarify anatomical and morphological lesion characteristics of uncrossable lesions.
Background
Uncrossable lesions are not always severely calcified. The prevalence of uncrossable lesions that are nonseverely calcified as well as other mechanisms for uncrossability has not been well clarified.
Methods
A total of 252 de novo uncrossable lesions in native coronary arteries that underwent either rotational or orbital atherectomy due to inability of any balloon to cross the lesion and 38 lesions with severe calcium in which IVUS crossed preatherectomy were included. Severe calcium is defined as maximum arc of calcium ≥270°.
Results
Severe calcification was absent in 16% of uncrossable lesions, 83% of which had a significant vessel bend. Compared with crossable lesions with severe calcium, uncrossable lesions with severe calcium more often had a bend in the vessel (71% vs. 21%, p |
| doi_str_mv | 10.1002/ccd.30202 |
| format | Article |
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The purpose of the current study was to use intravascular ultrasound (IVUS) to clarify anatomical and morphological lesion characteristics of uncrossable lesions.
Background
Uncrossable lesions are not always severely calcified. The prevalence of uncrossable lesions that are nonseverely calcified as well as other mechanisms for uncrossability has not been well clarified.
Methods
A total of 252 de novo uncrossable lesions in native coronary arteries that underwent either rotational or orbital atherectomy due to inability of any balloon to cross the lesion and 38 lesions with severe calcium in which IVUS crossed preatherectomy were included. Severe calcium is defined as maximum arc of calcium ≥270°.
Results
Severe calcification was absent in 16% of uncrossable lesions, 83% of which had a significant vessel bend. Compared with crossable lesions with severe calcium, uncrossable lesions with severe calcium more often had a bend in the vessel (71% vs. 21%, p < 0.001) and a longer length of continuous severe calcium (median length of calcium ≥270° 3.8 mm vs. 1.9 mm, p = 0.001). Other than severe calcium (especially long continuous calcium) or a bend in the vessel, anatomical factors associated with uncrossabilty were aorto‐ostial lesion location and small vessels.
Conclusions
Uncrossable lesions are not always severely calcified. The interaction of lesion morphology (continuous long and large arcs of calcium) and vessel geometry (bend in the vessel or ostial lesion location) affect lesion crossability.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.30202</identifier><identifier>PMID: 35419936</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>atherectomy ; Calcification ; Calcium ; Coronary artery ; directional/rotational ; imaging intravascular ultrasound ; Lesions ; percutaneous coronary intervention ; Physical characteristics ; Stents ; Ultrasonic imaging ; Ultrasound</subject><ispartof>Catheterization and cardiovascular interventions, 2022-06, Vol.99 (7), p.2028-2037</ispartof><rights>2022 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3532-2bad5faf7a2d0452fbfe032676e5dfddc25913e2db38527209b296cff7b1d1c03</citedby><cites>FETCH-LOGICAL-c3532-2bad5faf7a2d0452fbfe032676e5dfddc25913e2db38527209b296cff7b1d1c03</cites><orcidid>0000-0003-4501-3449 ; 0000-0002-4982-7979 ; 0000-0002-1910-8447 ; 0000-0002-9161-2840 ; 0000-0002-2082-0247</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.30202$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.30202$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35419936$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Salem, Hanan</creatorcontrib><creatorcontrib>Mintz, Gary S.</creatorcontrib><creatorcontrib>Matsumura, Mitsuaki</creatorcontrib><creatorcontrib>Zhang, Mingyou</creatorcontrib><creatorcontrib>Usui, Eisuke</creatorcontrib><creatorcontrib>Seike, Fumiyasu</creatorcontrib><creatorcontrib>Fujimura, Tatsuhiro</creatorcontrib><creatorcontrib>Noguchi, Masahiko</creatorcontrib><creatorcontrib>Hu, Xun</creatorcontrib><creatorcontrib>Jin, Ge</creatorcontrib><creatorcontrib>Li, Chenguang</creatorcontrib><creatorcontrib>Fall, Khady N.</creatorcontrib><creatorcontrib>Ali, Ziad A.</creatorcontrib><creatorcontrib>Kirtane, Ajay J.</creatorcontrib><creatorcontrib>Collins, Michael B.</creatorcontrib><creatorcontrib>Kodali, Susheel K.</creatorcontrib><creatorcontrib>Nazif, Tamim M.</creatorcontrib><creatorcontrib>Leon, Martin B.</creatorcontrib><creatorcontrib>Moses, Jeffrey W.</creatorcontrib><creatorcontrib>Karmpaliotis, Dimitri</creatorcontrib><creatorcontrib>Maehara, Akiko</creatorcontrib><title>Reasons for lesion uncrossability as assessed by intravascular ultrasound</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description>Objectives
The purpose of the current study was to use intravascular ultrasound (IVUS) to clarify anatomical and morphological lesion characteristics of uncrossable lesions.
Background
Uncrossable lesions are not always severely calcified. The prevalence of uncrossable lesions that are nonseverely calcified as well as other mechanisms for uncrossability has not been well clarified.
Methods
A total of 252 de novo uncrossable lesions in native coronary arteries that underwent either rotational or orbital atherectomy due to inability of any balloon to cross the lesion and 38 lesions with severe calcium in which IVUS crossed preatherectomy were included. Severe calcium is defined as maximum arc of calcium ≥270°.
Results
Severe calcification was absent in 16% of uncrossable lesions, 83% of which had a significant vessel bend. Compared with crossable lesions with severe calcium, uncrossable lesions with severe calcium more often had a bend in the vessel (71% vs. 21%, p < 0.001) and a longer length of continuous severe calcium (median length of calcium ≥270° 3.8 mm vs. 1.9 mm, p = 0.001). Other than severe calcium (especially long continuous calcium) or a bend in the vessel, anatomical factors associated with uncrossabilty were aorto‐ostial lesion location and small vessels.
Conclusions
Uncrossable lesions are not always severely calcified. The interaction of lesion morphology (continuous long and large arcs of calcium) and vessel geometry (bend in the vessel or ostial lesion location) affect lesion crossability.</description><subject>atherectomy</subject><subject>Calcification</subject><subject>Calcium</subject><subject>Coronary artery</subject><subject>directional/rotational</subject><subject>imaging intravascular ultrasound</subject><subject>Lesions</subject><subject>percutaneous coronary intervention</subject><subject>Physical characteristics</subject><subject>Stents</subject><subject>Ultrasonic imaging</subject><subject>Ultrasound</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp10F1LwzAUBuAgipvTC_-AFLzRi27JSdMul1K_BgNBFLwL-YSOrp3JqvTfG9fphSAcSAIPLzkvQucETwnGMNPaTCkGDAdoTBhAWkD-dri_E57lI3QSwgpjzHPgx2hEWUY4p_kYLZ6tDG0TEtf6pLahapuka7RvQ5Cqqqttn8gQJ9g4JlF9UjVbLz9k0F0tfdLV8RXarjGn6MjJOtiz_TlBr_d3L-Vjunx6WJQ3y1RTRiEFJQ1z0hUSDM4YOOUsppAXuWXGGaOBcUItGEXnDArAXAHPtXOFIoZoTCfoasjd-Pa9s2Er1lXQtq5lY9suCMgZBpbNMxbp5R-6ajvfxN9FVVCOKedZVNeD2m3trRMbX62l7wXB4rtfEfsVu36jvdgndmptza_8KTSC2QA-q9r2_yeJsrwdIr8AWqmEcw</recordid><startdate>20220601</startdate><enddate>20220601</enddate><creator>Salem, Hanan</creator><creator>Mintz, Gary S.</creator><creator>Matsumura, Mitsuaki</creator><creator>Zhang, Mingyou</creator><creator>Usui, Eisuke</creator><creator>Seike, Fumiyasu</creator><creator>Fujimura, Tatsuhiro</creator><creator>Noguchi, Masahiko</creator><creator>Hu, Xun</creator><creator>Jin, Ge</creator><creator>Li, Chenguang</creator><creator>Fall, Khady N.</creator><creator>Ali, Ziad A.</creator><creator>Kirtane, Ajay J.</creator><creator>Collins, Michael B.</creator><creator>Kodali, Susheel K.</creator><creator>Nazif, Tamim M.</creator><creator>Leon, Martin B.</creator><creator>Moses, Jeffrey W.</creator><creator>Karmpaliotis, Dimitri</creator><creator>Maehara, Akiko</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4501-3449</orcidid><orcidid>https://orcid.org/0000-0002-4982-7979</orcidid><orcidid>https://orcid.org/0000-0002-1910-8447</orcidid><orcidid>https://orcid.org/0000-0002-9161-2840</orcidid><orcidid>https://orcid.org/0000-0002-2082-0247</orcidid></search><sort><creationdate>20220601</creationdate><title>Reasons for lesion uncrossability as assessed by intravascular ultrasound</title><author>Salem, Hanan ; Mintz, Gary S. ; Matsumura, Mitsuaki ; Zhang, Mingyou ; Usui, Eisuke ; Seike, Fumiyasu ; Fujimura, Tatsuhiro ; Noguchi, Masahiko ; Hu, Xun ; Jin, Ge ; Li, Chenguang ; Fall, Khady N. ; Ali, Ziad A. ; Kirtane, Ajay J. ; Collins, Michael B. ; Kodali, Susheel K. ; Nazif, Tamim M. ; Leon, Martin B. ; Moses, Jeffrey W. ; Karmpaliotis, Dimitri ; Maehara, Akiko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3532-2bad5faf7a2d0452fbfe032676e5dfddc25913e2db38527209b296cff7b1d1c03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>atherectomy</topic><topic>Calcification</topic><topic>Calcium</topic><topic>Coronary artery</topic><topic>directional/rotational</topic><topic>imaging intravascular ultrasound</topic><topic>Lesions</topic><topic>percutaneous coronary intervention</topic><topic>Physical characteristics</topic><topic>Stents</topic><topic>Ultrasonic imaging</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Salem, Hanan</creatorcontrib><creatorcontrib>Mintz, Gary S.</creatorcontrib><creatorcontrib>Matsumura, Mitsuaki</creatorcontrib><creatorcontrib>Zhang, Mingyou</creatorcontrib><creatorcontrib>Usui, Eisuke</creatorcontrib><creatorcontrib>Seike, Fumiyasu</creatorcontrib><creatorcontrib>Fujimura, Tatsuhiro</creatorcontrib><creatorcontrib>Noguchi, Masahiko</creatorcontrib><creatorcontrib>Hu, Xun</creatorcontrib><creatorcontrib>Jin, Ge</creatorcontrib><creatorcontrib>Li, Chenguang</creatorcontrib><creatorcontrib>Fall, Khady N.</creatorcontrib><creatorcontrib>Ali, Ziad A.</creatorcontrib><creatorcontrib>Kirtane, Ajay J.</creatorcontrib><creatorcontrib>Collins, Michael B.</creatorcontrib><creatorcontrib>Kodali, Susheel K.</creatorcontrib><creatorcontrib>Nazif, Tamim M.</creatorcontrib><creatorcontrib>Leon, Martin B.</creatorcontrib><creatorcontrib>Moses, Jeffrey W.</creatorcontrib><creatorcontrib>Karmpaliotis, Dimitri</creatorcontrib><creatorcontrib>Maehara, Akiko</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Salem, Hanan</au><au>Mintz, Gary S.</au><au>Matsumura, Mitsuaki</au><au>Zhang, Mingyou</au><au>Usui, Eisuke</au><au>Seike, Fumiyasu</au><au>Fujimura, Tatsuhiro</au><au>Noguchi, Masahiko</au><au>Hu, Xun</au><au>Jin, Ge</au><au>Li, Chenguang</au><au>Fall, Khady N.</au><au>Ali, Ziad A.</au><au>Kirtane, Ajay J.</au><au>Collins, Michael B.</au><au>Kodali, Susheel K.</au><au>Nazif, Tamim M.</au><au>Leon, Martin B.</au><au>Moses, Jeffrey W.</au><au>Karmpaliotis, Dimitri</au><au>Maehara, Akiko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reasons for lesion uncrossability as assessed by intravascular ultrasound</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2022-06-01</date><risdate>2022</risdate><volume>99</volume><issue>7</issue><spage>2028</spage><epage>2037</epage><pages>2028-2037</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><abstract>Objectives
The purpose of the current study was to use intravascular ultrasound (IVUS) to clarify anatomical and morphological lesion characteristics of uncrossable lesions.
Background
Uncrossable lesions are not always severely calcified. The prevalence of uncrossable lesions that are nonseverely calcified as well as other mechanisms for uncrossability has not been well clarified.
Methods
A total of 252 de novo uncrossable lesions in native coronary arteries that underwent either rotational or orbital atherectomy due to inability of any balloon to cross the lesion and 38 lesions with severe calcium in which IVUS crossed preatherectomy were included. Severe calcium is defined as maximum arc of calcium ≥270°.
Results
Severe calcification was absent in 16% of uncrossable lesions, 83% of which had a significant vessel bend. Compared with crossable lesions with severe calcium, uncrossable lesions with severe calcium more often had a bend in the vessel (71% vs. 21%, p < 0.001) and a longer length of continuous severe calcium (median length of calcium ≥270° 3.8 mm vs. 1.9 mm, p = 0.001). Other than severe calcium (especially long continuous calcium) or a bend in the vessel, anatomical factors associated with uncrossabilty were aorto‐ostial lesion location and small vessels.
Conclusions
Uncrossable lesions are not always severely calcified. The interaction of lesion morphology (continuous long and large arcs of calcium) and vessel geometry (bend in the vessel or ostial lesion location) affect lesion crossability.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35419936</pmid><doi>10.1002/ccd.30202</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-4501-3449</orcidid><orcidid>https://orcid.org/0000-0002-4982-7979</orcidid><orcidid>https://orcid.org/0000-0002-1910-8447</orcidid><orcidid>https://orcid.org/0000-0002-9161-2840</orcidid><orcidid>https://orcid.org/0000-0002-2082-0247</orcidid></addata></record> |
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| language | eng |
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| source | Access via Wiley Online Library |
| subjects | atherectomy Calcification Calcium Coronary artery directional/rotational imaging intravascular ultrasound Lesions percutaneous coronary intervention Physical characteristics Stents Ultrasonic imaging Ultrasound |
| title | Reasons for lesion uncrossability as assessed by intravascular ultrasound |
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