Impact of target lesion calcification on coronary stent expansion after rotational atherectomy

Background Calcified lesions carry the risk of suboptimal stent expansion. The purpose of this study was to investigate the impact of target lesion ca lcification on intracoronary ultrasound (ICUS) guided stent expansion after rotational atherectomy. Methods stent expansion was assessed by ICUS in 39 patients with the aid of the proximal stent/proximal reference lumen, the minimal stent/mean refere nce lumen, and the minimal stent/minor reference lumen ratios as well as th e symmetry index. Thirty-nine stent implantations in uncalcified lesions se rved for comparison. Results Relative stent expansion ranged between 76.3% +/- 6.7% and 98.4% +/ - 16.4%. Categorization according to an ICUS-derived are of superficial les ion calcium of <180 degrees (average 102 +/- 74 degrees) or >180 degrees (a verage 248 +/- 71 degrees) revealed decreased stent symmetry in calcified l esions >180 degrees compared with the control group (P < .05). Despite a tr end toward less expansion with increasing calcium load, no significant diff erences of the lumen area ratios between the study groups was present. Conclusion Rotational atherectomy before ICUS-guided stent implantation ena bles adequate stent expansion even in significant superficial target lesion calcification.