Superficial coronary calcium analysis by OCT: Looking forward an imaging algorithm for an automatic 3D quantification

摘要

Coronary artery calcium (CAC) is a sign of significant coronary artery disease [1]. Superficial calcium [2] may be associated to several procedural and long term complications of percutaneous coronary intervention (PCI) [3]. The reduced wall compliance in a calcific lesion may lead to inadequate (incomplete and asymmetrical) stent expansion, which is associated to thrombosis [4] and restenosis [5]. Since calcifications are very often eccentric, an inhomogeneous stiffness distribution within the vessel wall occurs; this structural setting is the harbinger of dissection and of the vessel perforation when high pressure balloon dilations are performed to prepare the lesion for stent implantation, due to a non uniform distribution of the shear stress generated by the balloon catheter inflation. The detection, localization and quantification of CAC is therefore a key point to guide PCI, leading to the choice of alternative devices, such as rotational atherectomy, which selectively ablates calcium [6], reducing the stiffness of the lesion and facilitating an optimal stent expansion.