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. 2026 Aug 20;13:1895205. doi: 10.3389/fcvm.2026.1895205

Figure 2.

Diagram with six labeled panels (A–F) showing sites which are unfavorable for bias cutting (arrows, A–F) when RA is intended to debulk calcified plaques either upstream (A–B) or downstream (C–D) these site. If RA is intended to treat calcified plaques at the outer corner of acute bend (E–F), it is also not effective. Because of wire bias and bias cutting, unfavorable RA bias cutting may cut through the non-calcified inner corners (arrows) of these vulnerable sites and lead to CP if not noticed.

Unfavorable RA bias cutting. When RA bias cutting is utilized to treat thick calcium at inner corners of acute bends, the burr may go too far down and reach the calcification-free inner corner of the downstream bend (arrow, panel A) or travel though a similar lesion at an upstream bend (arrow, panel C) before it reaches the intended target lesion. Because there is no calcium at those sites, unfavorable bias cutting occurs, potentially leading to vessel perforation at these sites (arrows, panels B,D). Unfavorable bias cutting also occurs when RA is intended to treat calcified lesions located at the outer corners of acute bends, where the burr can easily cut through the non-calcified inner corners, leading to perforation (arrows, panels E,F).