{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T20:25:55Z","timestamp":1789503955848,"version":"build-2803163510"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>A combined strategy of atherectomy followed by intravascular lithotripsy (dual-prep strategy) for severely calcified lesions may optimize stent deployment, but mechanistic evidence from prospective optical coherence tomography (OCT) imaging is limited. This study was designed to comprehensively characterize patterns of calcium modification during a dual-preparation strategy and to explore imaging determinants of calcium fracture and stent expansion using serial and 3-dimensional OCT assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This was a prespecified, multicenter, single-arm OCT substudy of the DUAL-PREP (atherectomy Devices and intravascUlAr Lithotripsy for the PREParation of heavy calcified coronary lesions) registry, enrolling patients with severely calcified lesions for whom combined treatment with atherectomy and intravascular lithotripsy was deemed preferable based on imaging findings. OCT was analyzed by an independent core laboratory. Multivariable models examined predictors of fracture and stenting performance, including calcium thickness, length, angle, calcified nodules, and morphology (circumferential, eccentric spiral, and eccentric straight types).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      OCT images were available for 114 of 118 patients (116 lesions; age, 75.9\u00b19.1 years; 69.3% male). All lesions had an OCT calcium score of 4. Calcium fractures were uncommon after atherectomy (2\/106 lesions [1.9%]) but markedly increased following intravascular lithotripsy (89\/106 lesions [84.0%]; 2.05\u00b11.59 fractures per lesion), with a further increase after stent implantation (101\/109 lesions [92.7%]; 2.89\u00b11.67 fractures per lesion). Final stent expansion index was 0.81\u00b10.15 (eccentricity, 0.72\u00b10.09; asymmetry, 0.39\u00b10.15). Eccentric straight-type calcification was associated with a lower likelihood of fracture at final OCT (odds ratio, 0.07 [95% CI, 0.00\u20130.77];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.029), whereas eccentric spiral and circumferential types showed higher fracture occurrence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>This OCT analysis demonstrated a stepwise increase in calcium fracture during a dual-preparation strategy, with minimal fracture after atherectomy, a marked increase following intravascular lithotripsy, and a further increase after stent implantation. Calcium morphology may provide additional insight into fracture occurrence, supporting the potential value of 3-dimensional assessment in severely calcified lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: jRCT1032230384.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.126.016686","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T09:00:15Z","timestamp":1783501215000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Optical Coherence Tomography Characterization of Coronary Lithotripsy Following Atherectomy for Treatment of Severely Calcified Lesions"],"prefix":"10.1161","volume":"19","clinical-trial-number":[{"clinical-trial-number":"jrct1032230384","registry":"10.18810\/jprn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7564-2978","authenticated-orcid":true,"given":"Yohei","family":"Sotomi","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, The University of Osaka Graduate School of Medicine, Japan (Y.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6673-0167","authenticated-orcid":true,"given":"Nehiro","family":"Kuriyama","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Miyazaki Medical Association Hospital, Japan (N.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3646-075X","authenticated-orcid":true,"given":"Yutaka","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shonan Kamakura General Hospital, Japan (Y.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiji","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Japan (S.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4795-7745","authenticated-orcid":true,"given":"Tomohiro","family":"Kawasaki","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tenjinkai Shin-Koga Hospital, Fukuoka, Japan (T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2845-9561","authenticated-orcid":true,"given":"Kazushige","family":"Kadota","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine and Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan (K. Kadota)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5925-2489","authenticated-orcid":true,"given":"Takashi","family":"Muramatsu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Fujita Health University Hospital, Japan (T.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4906-2328","authenticated-orcid":true,"given":"Akihiko","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sakurakai Takahashi Hospital, Japan (A.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Ashikaga","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0699-4248","authenticated-orcid":true,"given":"Kenji","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (K.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4434-883X","authenticated-orcid":true,"given":"Satoru","family":"Otsuji","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Higashi Takarazuka Satoh Hospital, Japan (S.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5960-7806","authenticated-orcid":true,"given":"Masaru","family":"Ishida","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Japan (M.I.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeru","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kyoto Katsura Hospital, Japan (S.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Saiseikai Yokohamashi Tobu Hospital, Japan (Y.I.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7129-4155","authenticated-orcid":true,"given":"Raisuke","family":"Iijima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (R.I.), Toho University Ohashi Medical Center, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6721-1342","authenticated-orcid":true,"given":"Gaku","family":"Nakazawa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kindai University Hospital, Osaka, Japan (G.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0094-4258","authenticated-orcid":true,"given":"Junya","family":"Shite","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan (J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8915-1566","authenticated-orcid":true,"given":"Junko","family":"Honye","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kikuna Memorial Hospital, Japan (J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6645-6404","authenticated-orcid":true,"given":"Junya","family":"Ako","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kitasato University Hospital, Japan (J.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4972-3723","authenticated-orcid":true,"given":"Hiroyoshi","family":"Yokoi","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Fukuoka Sanno Hospital, Japan (H.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Kozuma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Teikyo University Hospital, Japan (K. 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