Impact of the degree of wire bias in the vessel's healthy portion on coronary perivascular trauma in rotational atherectomy

Abstract Background In rotational atherectomy (RA), the risk of coronary perforation is considered to increase when the wire is in contact with the healthy portion of the vessel. However, the relationship between the extent of wire bias in the healthy portion of the vessel and the risk of coronary perivascular trauma (CPT) has not been reported. Methods We examined 90 consecutive cases wherein intravascular ultrasound (IVUS) was performed before and after RA. The IVUS catheter in contact with the healthy region of the vessel was defined as the healthy portion wire bias (HWB), of which we measured the bias diameter, defined as the media-to-media length between the site where the IVUS catheter was in contact and the opposite side of the vessel. The bias ratio was defined as the ratio of the bias diameter to the short diameter at the region where the wire bias was the strongest. The relationship between the bias ratio and the CPT risk was evaluated. Results CPT was significantly higher in the HWB group than in the non-HWB group (9% vs. 0%, P = 0.048). In the HWB group, the bias ratio was significantly greater in the CPT group than in the non-CPT group (1.31 ± 0.09 vs. 1.06 ± 0.06; P  Conclusions Lesions without HWB had no CPT. CPT risk increased when the bias ratio exceeded 1.2. Summary In rotational atherectomy, the risk of coronary perforation is considered to increase when the wire is in contact with the healthy portion of the vessel. In this prospective study, we found that risk of coronary perivascular trauma was significantly higher in the healthy portion wire bias (HWB) group than in the non-HWB group. Further, the risk of coronary perivascular trauma increased when the bias ratio exceeded 1.2.