A Single-Center Study Using IVUS to Guide Rotational Atherectomy for Chronic Renal Disease's Calcified Coronary Artery

Guangxin Hu; Xijuan Qi; Ben Li; Ting Ge; Xi Li; Zhijun Liu; Jiaxing Li; Xuemei Zhang; YinPing Li; Shichang Zhang; Yajuan Wang; Tingting Zhao; Botao Zhang; Qingbin Xu

doi:10.2147/JMDH.S405174

A Single-Center Study Using IVUS to Guide Rotational Atherectomy for Chronic Renal Disease's Calcified Coronary Artery

J Multidiscip Healthc. 2023 Apr 19:16:1085-1093. doi: 10.2147/JMDH.S405174. eCollection 2023.

Authors

Guangxin Hu^#¹, Xijuan Qi^#¹, Ben Li¹, Ting Ge¹, Xi Li¹, Zhijun Liu¹, Jiaxing Li¹, Xuemei Zhang¹, YinPing Li¹, Shichang Zhang¹, Yajuan Wang², Tingting Zhao³, Botao Zhang¹, Qingbin Xu¹

Affiliations

¹ Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People's Republic of China.
² Department of Pharmacy, General Hospital of Ningxia Medical University, Yinchuan, 750002, People's Republic of China.
³ Department of Respiratory Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750002, People's Republic of China.

^# Contributed equally.

Abstract

Objective: To assess the effectiveness and safety of an IVUS-guided rotational atherectomy (RA) percutaneous coronary intervention (PCI) in chronic renal patients with complex coronary calcification who are at risk for contrast-related acute kidney injury (AKI).

Methods: From October 2018 to October 2021, 48 patients with chronic renal disease who were receiving PCI with RA at the General Hospital of NingXia Medical University were informed for data collection for this research. They were randomly assigned to the IVUS-guided RA group and the Standard RA group, which did not use IVUS. According to a clinical expert consensus document on rotational atherectomy in China, both PCI procedures were performed. The intravascular ultrasound (IVUS) results from the study group were used to describe the morphology of the lesion and to guide the selection of burrs, balloons, and stents. IVUS and angiography were used to evaluate the outcome in the end. IVUS-guided RA PCI and Standard RA PCI groups' effects and results were contrasted.

Results: There were no appreciable differences in the clinical baseline characteristics between the IVUS-guided RA PCI group and the Standard RA PCI group. The average estimated glomerular filtration rate (eGFR) of two groups was (81.42 ± 20.22 vs 82.34 ± 22.19) mL/min/1.73 m². Most of them (45.8% vs 54.2%) was in stage 60-90 mL/min/1.73m². When compared to the standard RA PCI group, RA in IVUS-Guided group was more performed electively (87.5% vs 58.3%; p = 0.02). The IVUS-guided RA PCI group was associated with shorter fluoroscopy time (20.6 ± 8.4 vs 36 ± 22; p<0.01) and less contrast amount (32 ±16 vs 184 ±116mL; p<0.01) than Standard-RA group. Five patients in the Standard RA PCI group developed contrast-induced nephropathy, which was 5 times than the IVUS-guided RA PCI group (20.8% VS 4.1%; p=0.19).

Conclusion: In chronic renal patients with complex coronary calcification, an IVUS-guided RA PCI technique is effective and safe. It can also lower the volume of contrast and perhaps the incidence of contrast-related AKI.

Keywords: chronic renal disease; contrast-associated acute kidney injury; intravascular ultrasound; rotational atherectomy.

Grants and funding

This study was funded by the application of intravascular coronary ultrasound (IVUS) in coronary rotational atherectomy technique (No. XM2021016).