ABSTRACT
OBJECTIVES: In this study, we sought to investigate the association between revolution speed of rotational atherectomy (RA) and debulking area assessed by frequency domain-optical coherence tomography (FD-OCT). BACKGROUND: The number of patients with severe calcified coronary artery disease requiring treatment with calcium ablation, such as RA, is increasing. However, there is little evidence available regarding the association between debulking area and revolution speed during RA. METHODS: We retrospectively investigated 30 consecutive severely calcified coronary lesions in 29 patients who underwent RA under FD-OCT guidance. The association between preset revolution speed of RA and burr size-corrected debulking area of the calcified lesion was evaluated using a multivariable regression model with nonlinear restricted-cubic-spline, which can help assess nonlinear associations between variables. RESULTS: The median age of study participants was 73 years (quartile 65-78); 82.8% were male. The median burr size was 1.5 mm (1.5-1.75); median total duration of ablation was 120 s (100-180). FD-OCT revealed that the post-procedural minimum lumen area increased significantly from 1.64 mm2 (1.40-2.09) to 2.45 mm2 (2.11-2.98) (p < .001). In addition, the burr size-corrected debulking area increased significantly as the preset revolution speed decreased (p = .018), especially when the revolution speed was less than 150,000 rpm. This result implies that additional lumen gain will be obtained by decreasing rpm when the burr speed is set at <150,000 rpm. CONCLUSIONS: FD-OCT demonstrated that RA with lower revolution speed, below 150,000 rpm, has the potential to achieve greater calcium debulking effect in patients with severe calcified coronary lesions.
Subject(s)
Atherectomy, Coronary , Coronary Artery Disease/therapy , Coronary Vessels/diagnostic imaging , Tomography, Optical Coherence , Vascular Calcification/therapy , Aged , Atherectomy, Coronary/adverse effects , Atherectomy, Coronary/instrumentation , Coronary Artery Disease/diagnostic imaging , Female , Humans , Male , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Treatment Outcome , Vascular Calcification/diagnostic imagingABSTRACT
The dependence of the grain boundary character distribution for a Cu-4 at. % Ti polycrystal alloy (average grain size: 100 µm) on the nucleation of cellular discontinuous precipitates was systematically investigated. In an alloy over-aged at 723 K, cellular discontinuous precipitates consisted of a terminal Cu solid solution and a stable ß-Cu4Ti lamellae nucleated at grain boundaries. Electron backscatter diffraction analysis revealed that the discontinuous precipitation reaction preferentially occurred at random grain boundaries with a Σ value of more than 21 according to the coincidence site lattice theory. On the other hand, few cellular discontinuous precipitates nucleated at low-angle and low-Σ boundaries, particularly twin (Σ 3) boundaries. These findings suggest that the nucleation of discontinuous precipitates is closely correlated with grain boundary character and structure, and hence energy and/or diffusibility. It should therefore be possible to suppress the discontinuous precipitation reaction through control of the alloy's grain boundary energy, by means of texture control and third elemental addition.
