OCT  guided  Rotabla0on    in  bifurca0on  lesions  

 Caress  Sapporo    

Hokko  Memorial  Hospital  Yoichi  Nozaki,  MD

 

Fibrous plaque Lipidic plaque Calcified plaque

IVUS  and  OCT/OFDI　  

LAD CPR　（LCX bif) LAD CPR　（D1 bif)

D1

LAD

LAD

LCX

Ca  plaque

Ca  plaque

Ca  plaque

Carina  shiH

Ca  plaque

Ca  plaque

Ca  plaque

Ca  plaque

Ca  plaque

Carina  shiH

Ca  plaque

Ca  plaque

Pre A*er  2.5mm  DES  +3.0mm  balloon

A*er  KBT

Representa0ve  case  of  occurring  carina  shiH  (LAD  &  D  bifurca0on  case)

OFDI  image

A*er  3.0mm  balloon A*er  3.0mm  balloon

A*er  Rota  1.5mm A*er  2.5mm  stent

AHer  KBT

LAD

D

D

LAD

RotablatorRotablatorRotablator

From  Mark  Reisman　  Guide  to  RotaGonal  atherectomy

After rotablator after ballooning

p  minimal vessel stretching and elastic recoil

p  elimination of baro-trauma of vessel

p  smoothing of inner lumen and improvement

of vessel flow

p  facilitate to crossability and expansion of

stent

Mechanism  of  AcGon  

PTCRA

24/53  

Rota Wire

Floppy Type

Extra Support Type

From  textbook　 Rotablator  Illustrated  by  Kazuo  Misumi

case1

症例

LAD#7　FFR0.74    iFR0.82

D1  FFR0.57    iFR0.42

LAD  OFDI

LAD

D1

D1  OFDI

LAD

D1

AHer  Rotablator

Pre Post  Rota  in  LAD

Pre Post  Rota  in  LAD

Pre Post  Rota  in  LAD

LAD D1

Pre Post  Rota  in  D1

Pre Post  Rota  in  D1

Main  branch  sten0ng

KBT

Final  angiogram

SUMMARY

•  Know  plaque  distribu0on  •  Know  carina  shiH  •  Know  wire  bias  •  Appropriate  debulking  (rotabla0on/DCA)    may  achieve  

good  stent  expansion  but  also    reduce  a  chance  of    compromising  of  side  branch  and  finally  avoid  complex  sten0ng  

•  OCT/OFDI  can  iden0fy  the  thickness  of  calcified  plaque,  so  we  can  recognize  the  capacity  of  abla0on  of  Rotablator  in  bifurca0on  site.  

•   OCT/OFDI  is  very  useful  imaging  guidance  for  treatment  bifurca0on  lesion,    especially  in  lesion  containing  of    hard  and  calcified  plaque  using  Rotablator    

case2　

LAD

D1

LAD

D1

LAD

D1

LAD

D1 D1

LAD

LAD

D1

LAD

D1 D1 LAD

Main  branch  sten0ng

Final  angiogram

Final  angiogram

case3

D2

LAD

D2

LAD

D2 LAD

case  4

case  5

Pre Rota1.5mm

Rota2.0mm NSE+DEB NSE+DEB

Pre

SUMMARY

•  Know  plaque  distribu0on  •  Know  carina  shiH  •  Know  wire  bias  •  Appropriate  debulking  (rotabla0on/DCA)    may  achieve  

good  stent  expansion  but  also    reduce  a  chance  of    compromising  of  side  branch  and  finally  avoid  complex  sten0ng  

•  OCT/OFDI  can  iden0fy  the  thickness  of  calcified  plaque,  so  we  can  recognize  the  capacity  of  abla0on  of  Rotablator  in  bifurca0on  site.  

•   OCT/OFDI  is  very  useful  imaging  guidance  for  treatment  bifurca0on  lesion,    especially  in  lesion  containing  of    hard  and  calcified  plaque  using  Rotablator    

Thank  you