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Parikh PB, Weber-Fishkin S, George S, Kane J, Pyo R. Balloon Aortic Valvuloplasty With Same-Setting Complex Percutaneous Coronary Intervention in the TAVR Era: A Case Series. THE JOURNAL OF INVASIVE CARDIOLOGY 2021; 33:E479-E482. [PMID: 34077385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The use of balloon aortic valvuloplasty (BAV) prior to same-setting complex percutaneous coronary intervention (PCI) in patients with severe aortic stenosis (AS) and concomitant severe coronary artery disease (CAD) has not been well studied in the era of transcatheter aortic valve replacement (TAVR). METHODS We reviewed 379 BAVs performed between January 2016 and April 2020 at an academic tertiary-care medical center. Overall, 327 BAVs were performed in the setting of TAVR. Of the remaining 52 BAVs, 20 were performed immediately prior to same-setting complex PCI. We examined the baseline and procedural data, and clinical outcomes of these cases. RESULTS Mean patient age was 81 ± 9 years and 70% were men. Chronic kidney disease (40%), diabetes mellitus (35%), and atrial fibrillation (35%) were the most prevalent comorbidities. Rotational atherectomy was performed in 75% of cases and Impella device was utilized in 15%. PCI of distal left main coronary artery and proximal left anterior descending coronary artery was performed in 30% and 80% of cases, respectively. Mean contrast volume was 149 ± 61 mL, fluoroscopy time was 37 ± 20 minutes, total skin dose was 2821 ± 1931 mGy, and total area dose was 18651 ± 12090 μGy/m². Rate of in-hospital complications was low, with a 0% mortality and stroke rate. Eighty percent of patients were referred for TAVR; 70% went on to undergo successful TAVR and 10% deferred TAVR due to improvement in symptoms. CONCLUSIONS BAV with same-setting complex PCI is safe and feasible in patients with severe AS and severe CAD awaiting TAVR.
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Azzalini L, Baber U, Johal GS, Farhan S, Barman N, Kapur V, Hasan C, Vijay P, Jhaveri V, Mehran R, Kini AS, Sharma SK. One-year outcomes of patients undergoing complex percutaneous coronary intervention with three contemporary drug-eluting stents. Catheter Cardiovasc Interv 2021; 97:1341-1351. [PMID: 32478459 DOI: 10.1002/ccd.28996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We aimed to evaluate the 1-year outcomes of three everolimus-eluting stents (EES) for complex percutaneous coronary intervention (PCI). BACKGROUND It is controversial whether contemporary bioresorbable-polymer drug-eluting stents (BP-DES) are associated with better outcomes compared with durable-polymer DES (DP-DES). METHODS Patients undergoing PCI with cobalt-chromium (CoCr)-DP-EES (Xience), platinum-chromium (PtCr)-DP-EES (Promus), or PtCr-BP-EES (Synergy) at one high-volume institution between 2015 and 2017 were included. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target-vessel revascularization. Associations were also examined in patients undergoing complex PCI. Multivariable analysis was conducted to adjust for baseline differences across groups. RESULTS We included n = 5,446 patients (CoCr-DP-EES, n = 3,177; PtCr-DP-EES, n = 1,555; PtCr-BP-EES, n = 714). Patients treated with PtCr-BP-EES had higher comorbidity burden and procedural complexity. At 1 year, MACE rates were 8.9% for CoCr-DP-EES versus 8.9% for PtCr-DP-EES versus 8.6% for PtCr-BP-EES (p = .97). The incidence of definite/probable stent thrombosis (ST) was also similar (0.6 vs. 0.4 vs. 0.3%, p = .69). Complex PCI was performed in n = 2,894/5,446 (53.1%). At 1 year, MACE rates were 11.5 versus 10.7 versus 10.3%, respectively (p = .83). The incidence of definite/probable ST was also similar (0.9 vs. 0.3 vs. 0.3%, p = .22). On multivariable analysis, stent type was not an independent predictor of MACE either in the overall or in the complex PCI population. CONCLUSIONS We observed comparable 1-year rates of MACE and definite/probable ST in patients undergoing PCI with CoCr-DP-EES, PtCr-DP-EES, and PtCr-BP-EES. Results were unchanged among patients undergoing complex PCI. Future multicenter randomized studies should confirm and extend our findings.
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Patel NJ, Okamoto N, Murphy J, Vengrenyuk Y, Sharma SK, Kini AS. Management of calcified coronary artery bifurcation lesions. Catheter Cardiovasc Interv 2021; 97:1407-1416. [PMID: 32776696 DOI: 10.1002/ccd.29148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/03/2020] [Indexed: 11/09/2022]
Abstract
Calcified coronary artery bifurcation lesions (CBL) remain a challenge for the interventional cardiologist. Evidence regarding treatment of CBL is minimal. Optimal plaque modification is the most important step prior to stent deployment. Provisional stenting is the preferred strategy for most bifurcation lesions. However, two-stent strategy should be considered for BL with compromised large SB (>2.5 mm) supplying a large territory, >70% SB stenosis and lesions more than 5 mm long. In this contemporary review article, we present a simplified approach to treating CBL and demonstrate the approach to specific case examples using our newly developed mobile application, BifurcAID.
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Kirtane AJ, Finn MT. Absorbing the Aftershocks of a New Device for Coronary Calcification. JACC Cardiovasc Interv 2021; 14:1349-1351. [PMID: 34167674 DOI: 10.1016/j.jcin.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
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Karrowni W, Zaeiter H, Mansour S, Nassar P. Tip fracture of the crown of orbital atherectomy device in angulated left circumflex lesion. Catheter Cardiovasc Interv 2021; 97:1399-1401. [PMID: 33314613 DOI: 10.1002/ccd.29428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022]
Abstract
Atherectomy, whether rotational or orbital, is an essential and established method for treatment of calcified coronary lesions. By modifying the plaque, atherectomy lessens the risk of plaque shift and facilities stent delivery and stent expansion. Atherectomy technique is meticulous and challenging especially in tortuous and angulated coronary arteries. Herein, we describe the rare case of occurrence and the management of fracture of the tip of the crown of CSI Diamondback orbital atherectomy device during treatment of severely angulated and calcified ostial left circumflex lesion.
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White CJ, Beckman JA. Making Lemonade Out of the Lemons of Lesion Preparation. JACC Cardiovasc Interv 2021; 14:1362-1363. [PMID: 34167676 DOI: 10.1016/j.jcin.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
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Kwon Y, Kim J, Won JH, Kim SH, Kim JE, Park SJ. [ Atherectomy in Peripheral Artery Disease: Current and Future]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:551-561. [PMID: 36238795 PMCID: PMC9432436 DOI: 10.3348/jksr.2021.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/22/2021] [Accepted: 04/02/2021] [Indexed: 11/15/2022]
Abstract
Atherectomy has become a promising treatment option for peripheral artery disease caused by diabetes mellitus or end-stage renal disease. Atherectomy refers to the removal of atheromatous tissue by mechanical method, resulting in an enlarged lumen of the treated blood vessel. Based on this method, the term is limited to the percutaneous minimally invasive approach, and there are currently two types of atherectomy devices available in Korea. The increased prevalence of atherectomy has led to the concept of "vascular preparation" and a new treatment concept of "leave nothing behind." Various studies have proven the safety and effectiveness of atherectomy; however, there are some limitations. We need to remain focused on patient selection and subsequent large-scale research.
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Kim M, Cho SB. [Interventional Treatments for Femoropopliteal Arterial Disease and Recent Updates]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:527-540. [PMID: 36238772 PMCID: PMC9432457 DOI: 10.3348/jksr.2021.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
Peripheral arterial occlusive disease (PAOD) of the femoropopliteal artery is commonly caused by atherosclerosis. It can present with varying clinical symptoms depending on the degree of disease, ranging from intermittent claudication to critical limb ischemia and tissue loss. Therefore, appropriate and timely treatment is required to improve symptoms and salvage the affected limbs. Interventional approaches for femoropopliteal arterial disease commonly include percutaneous transluminal angioplasty, atherectomy, and stent placement. Over the years, endovascular recanalization has been widely performed for treating PAOD due to continuous developments in its techniques and availability of dedicated devices with the inherent advantage of being minimal invasive. In this review, we introduce various types of endovascular treatment methods, discuss the results of clinical research from existing literature, and illustrate the treatment procedures using representative images.
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Han D, Shin D, Kang M, Rae Cho J, Choi S, Lee N, Lee J, Haeng Cho Y. Complications associated with the Rotarex ® wire in a patient with peripheral artery disease. Clin Case Rep 2021; 9:e03195. [PMID: 34084469 PMCID: PMC8142799 DOI: 10.1002/ccr3.3195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/28/2020] [Accepted: 07/10/2020] [Indexed: 11/25/2022] Open
Abstract
The Rotarex® device is used for thrombectomy as well as atherectomy in patients with PAD. It is important to carefully consider the wire position of the Rotarex® device during the procedure. As possible as the wire should be located in a lesion-free area.
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Korosoglou G, Giusca S, Antaredja M, Schmidt A, Blessing E. Distal retrieval of dislodged and migrated guidewires after retrograde puncture of the deep femoral and dorsal pedal artery. A case series. Clin Case Rep 2021; 9:2077-2082. [PMID: 33936643 PMCID: PMC8077260 DOI: 10.1002/ccr3.3948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/21/2020] [Accepted: 01/30/2021] [Indexed: 01/22/2023] Open
Abstract
We report on retrograde retrieval of the soft end of dislodged guidewires during complex interventions. Interventionalists may consider this as an option for the endovascular management of this complication if an antegrade retrieval is not possible or fails.
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Loffroy R, Qanadli SD. Editorial: Modern Endovascular Therapy for Peripheral Arterial Disease. Front Cardiovasc Med 2021; 8:651489. [PMID: 33816580 PMCID: PMC8017154 DOI: 10.3389/fcvm.2021.651489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
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Hemetsberger R, Gori T, Toelg R, Byrne R, Allali A, El-Mawardy M, Rheude T, Weissner M, Sulimov DS, Robinson DR, Richardt G, Abdel-Wahab M. Optical Coherence Tomography Assessment in Patients Treated With Rotational Atherectomy Versus Modified Balloons: PREPARE-CALC OCT. Circ Cardiovasc Interv 2021; 14:e009819. [PMID: 33641372 DOI: 10.1161/circinterventions.120.009819] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Yasumura K, Benhuri B, Vengrenyuk Y, Petrov A, Barman N, Sweeny J, Kapur V, Suleman J, Baber U, Mehran R, Stone GW, Kini AS, Sharma SK. Procedural and 1-year clinical outcomes of orbital atherectomy for treatment of coronary in-stent restenosis: A single-center, retrospective study. Catheter Cardiovasc Interv 2021; 97:E280-E287. [PMID: 32558218 DOI: 10.1002/ccd.28983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We evaluated the procedural and 1-year clinical outcomes of orbital atherectomy (OA) for treatment of coronary in-stent restenosis (ISR). BACKGROUND The optimal treatment for ISR remains uncertain. While rotational and laser atherectomy have been used as neointimal debulking techniques for ISR, there have been few reports on OA for ISR. METHODS This is a retrospective observational study of consecutive patients who underwent percutaneous coronary intervention (PCI) for ISR with OA in Mount Sinai catheterization laboratory between November 2013 and January 2018. Procedural success was defined as angiographic success without in-hospital major adverse cardiac events (MACE; the composite of all-cause death, myocardial infarction [MI], or target vessel revascularization). Clinical outcomes were assessed at 1 month and 12 months postprocedure. RESULTS A total of 87 patients were included in the study. All 87 patients were treated with OA, after which 49 (56.3%) patients also received new drug-eluting stents. Angiographic success was achieved in 87 (100%) patients and procedural success was achieved in 79 (90.8%) patients. In-hospital MACE occurred in 8 (9.2%) patients, all due to periprocedural non-Q-wave MI. Acute lumen gain was 1.19 ± 0.57 mm after OA plus balloon angioplasty and 1.75 ± 0.50 mm after stent placement. MACE within 1 year occurred in 17 (19.5%) patients. CONCLUSIONS OA for ISR was performed with favorable procedural and 1-year clinical outcomes. Randomized trials are warranted to determine whether OA improves the poor prognosis of patients with ISR treated without debulking.
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Shammas NW. Peripheral Arterial Vessel Prepping With Intravascular Ultrasound and Atherectomy: An Interventionalist's Perspective. THE JOURNAL OF INVASIVE CARDIOLOGY 2021; 33:E95-E98. [PMID: 33443489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Vessel prepping is an essential component of an optimal strategy in treating infrainguinal peripheral arterial disease. Vessel prepping with atherectomy can be aggressive in certain lesion morphologies, such as severe calcium, total occlusion, or in-stent restenosis, or can target vessel compliance without aggressive debulking. Drug elution is likely to be enhanced by vessel prepping. Optimal vessel prepping requires precise imaging of the vessel size, plaque morphology, and lesion severity/length which cannot be assessed adequately by angiography. Also, intravascular ultrasound provides information post treatment on minimal luminal area gain, residual dissections, geometric miss, and stent apposition and expansion.
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Fan LM, Tong D, Mintz GS, Mamas MA, Javed A. Breaking the deadlock of calcified coronary artery lesions: A contemporary review. Catheter Cardiovasc Interv 2021; 97:108-120. [PMID: 32865328 DOI: 10.1002/ccd.29221] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/02/2020] [Indexed: 01/01/2023]
Abstract
Percutaneous coronary intervention (PCI) of severely calcified lesions is known to result in lower procedural success rates, higher complication rates, and worse long-term clinical outcomes compared to noncalcified lesions. Adequate lesion preparation through calcium modification is crucial in ensuring procedural success and reducing adverse cardiovascular outcomes. There are numerous calcium modification devices currently available whose usefulness depends on the nature of the calcific disease and its anatomical distribution. It can be challenging for the interventionists to decide which device is best suited for their patient. There is also emerging evidence for intravascular imaging in guiding selection of calcium modification devices using parameters such as calcium distribution and depth that directly impact on procedural success and clinical outcomes. In this review we aim to discuss the pathophysiology of coronary calcification, evaluate strategies and technologies of calcium modification and propose an A-M-A-S-A algorithm in managing calcified coronary lesions.
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Loffroy R, Falvo N, Galland C, Fréchier L, Ledan F, Midulla M, Chevallier O. Intravascular Ultrasound in the Endovascular Treatment of Patients With Peripheral Arterial Disease: Current Role and Future Perspectives. Front Cardiovasc Med 2020; 7:551861. [PMID: 33344512 PMCID: PMC7738328 DOI: 10.3389/fcvm.2020.551861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Over the last decade, intravascular ultrasound (IVUS) has emerged as a useful adjunctive tool to angiography in an increasing number of catheter-based procedures for peripheral arterial disease (PAD). IVUS catheters offer accurate cross-sectional imaging of arterial vessels with high dimensional accuracy and provide accurate information about lesion morphology. IVUS enables assessment of the plaque morphology, vessel diameter, and the presence of arterial dissections. Furthermore, IVUS is able to properly guide the best choice of appropriate percutaneous transluminal angioplasty (PTA) technique, guide the delivery of different devices, and assess the immediate result of any endovascular intervention. In the present review, the role of IVUS for PAD will be discussed, specifically the applications of IVUS technology during interventional procedures including PTA, stent sizing, crossing total occlusion, assessing residual narrowing and stent apposition and expansion, and atherectomy. Future perspectives of IVUS-guided treatments and cost-effectiveness of the systematic use of IVUS during endovascular interventions will be also discussed.
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Loffroy R, Falvo N, Galland C, Fréchier L, Ledan F, Midulla M, Chevallier O. Percutaneous Rotational Mechanical Atherectomy Plus Thrombectomy Using Rotarex S Device in Patients With Acute and Subacute Lower Limb Ischemia: A Review of Safety, Efficacy, and Outcomes. Front Cardiovasc Med 2020; 7:557420. [PMID: 33195452 PMCID: PMC7642033 DOI: 10.3389/fcvm.2020.557420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/24/2020] [Indexed: 01/14/2023] Open
Abstract
Acute and subacute ischemia of lower limbs is associated with high risk of amputation and potential severe life-threatening complications. Despite a lack of clear therapeutic recommendations, surgical treatments such as thrombectomy or bypass and/or catheter-directed thrombolysis (CDT) have been first-line procedures in both acute and subacute limb ischemia, but each therapy may lead to significant morbidity and mortality. Such situations demand fast restoration of appropriate flow to preclude limb loss and other complications. Percutaneous mechanical atherectomy plus thrombectomy (MATH) represents a minimally invasive approach for quickly recanalizing thrombus-containing lesions whatever the age of thrombus. Indeed, many chronic patients can present with critical limb ischemia, with thrombus-containing occlusive lesions triggered by underlying atherosclerotic disease. MATH offers various advantages over surgery and CDT, with lower invasiveness, faster recanalization, and the possibility to immediately treat the underlying lesions, with a lower rate of bleeding complications and no need for intensive care unit stay. Currently, several mechanical thrombectomy devices are offered as an alternative therapy and can be divided into pure rotational MATH systems and rheolytic thrombectomy devices. The only pure rotational MATH device currently available on the market is the Rotarex S device. We aimed to review contemporary clinical data regarding the safety, efficacy, and outcomes of MATH therapy using Rotarex S catheter in acute and subacute thrombus-containing arterial lesions of lower limbs. Future perspectives of Rotarex S MATH treatment and cost-effectiveness of its routine use will be also discussed.
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Infrapopliteal Artery Occlusive Disease: An Overview of Vessel Preparation and Treatment Options. J Clin Med 2020; 9:jcm9103321. [PMID: 33081117 PMCID: PMC7602832 DOI: 10.3390/jcm9103321] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 01/01/2023] Open
Abstract
Critical limb ischemia (CLI) is defined as chronic rest pain and/or the presence of tissue loss (ulcers or gangrene) in the lower extremities secondary to ischemia. CLI is a limb and potentially life-threatening disease associated with a poor prognosis with only 50% of patients being able to preserve both limbs within 12 months of diagnosis. CLI related to diabetes is often more extensive with multi-level long segmental arterial disease resulting in a 5–30-fold increased rate of amputation. As the incidence and prevalence of diabetes mellitus increases within our aging society, the rate of infrapopliteal artery occlusive disease (IPOD) and the need for intervention rises with it. The aim of this manuscript is to provide the reader with an overview of the various devices available for vessel preparation (VP) and treatment of IPOD in order to optimize patency rates, symptom resolution, healing of wounds, and minimize complications.
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Ansari A, Shah MA, Shah MA, Ansari Z. Safety of day-case endovascular interventions for peripheral arterial disease in a rural, underserved area. Ther Adv Cardiovasc Dis 2020; 14:1753944720948651. [PMID: 32885724 PMCID: PMC7475785 DOI: 10.1177/1753944720948651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: We aimed to investigate the safety of endovascular procedures undertaken in a single outpatient center located in a rural, underserved area. Endovascular procedures for Peripheral Arterial Disease (PAD) have become increasingly common in outpatient settings; their safety is yet to be determined in a rural, underserved area with no stand-by vascular surgeon on site. Methods: We undertook a retrospective case review of endovascular procedures for the investigation and management of lower extremity PAD between December 2012 and August 2015. Patients were classified by Rutherford score, degree of stenosis and length of lesions. Complications were major (requiring hospitalization) or minor, including perforation, distal embolization, hematoma, and allergic reactions, which could be treated immediately in the catheterization laboratory with no sequelae. Patients were monitored in the facility and followed up using clinical, biochemical and radiological parameters at 24 h and 1 month. Results: A total of 692 patients underwent endovascular procedures for the investigation and/or treatment of PAD, of which 608 were interventional. Of these patients, 10.20% experienced procedural complications, of which 0.66% were classified as major, including wire retention and retroperitoneal hemorrhage. In total, 99.34% were discharged safely on the same day as the procedure. No adverse events were reported at follow up. Conclusion: Endovascular procedures for PAD can be performed safely in a rural outpatient setting with low complication rates. Most complications are minor and do not require hospitalization. Outpatient procedures for PAD are safe and may widen access to specialist procedures in areas of socio-economic deprivation.
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Shammas NW, Petruzzi N, Henao S, Armstrong EJ, Shimshak T, Banerjee S, Latif F, Eaves B, Brothers T, Golzar J, Shammas GA, Jones-Miller S, Christensen L, Shammas WJ. JetStream Atherectomy for the Treatment of In-Stent Restenosis of the Femoropopliteal Segment: One-Year Results of the JET-ISR Study. J Endovasc Ther 2020; 28:107-116. [PMID: 32885736 DOI: 10.1177/1526602820951916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the results of a study evaluating JetStream atherectomy for the treatment of in-stent restenosis (ISR). MATERIALS AND METHODS The JetStream XC atherectomy device, a rotational cutter with aspiration capacity, was evaluated in a prospective, multicenter study (JET-ISR) of 60 patients (mean age 70.2±10.8 years; 40 men) with femoropopliteal ISR (ClinicalTrials.gov identifier NCT02730234). Lesion length was 19.9±13.5 cm; 33 (55%) were chronic total occlusions and 26 (45%) were TransAtlantic Inter-Society Consensus class D. No drug-bearing device was allowed, and stenting was performed only for bailout. Lesion characteristics and stent integrity were evaluated by an independent core laboratory. The primary endpoint was target lesion revascularization (TLR) at 6 months with bailout stenting considered as TLR. Secondary endpoints included TLR (without bailout stenting) and clinical patency (no restenosis or TLR) at 1 year. The Kaplan-Meier method was employed to evaluate time-to-event endpoints; estimates are given with 95% confidence interval (CI). RESULTS Bailout stenting was required in 6 of 60 limbs (10%). There were no stent fractures or deformities after atherectomy + adjunctive angioplasty reported by the core laboratory. Kaplan-Meier estimates of freedom from TLR at 6 months and 1 year were 79.3% (95% CI 68.9% to 89.8%) and 60.7% (95% CI 47.8% to 73.6%), respectively. When bailout stenting at the index procedure was not considered a TLR event, freedom from TLR estimates at 6 months and 1 year were 89.3% (95% CI 81.2% to 97.4%) and 66.8% (95% CI 54.3% to 74.2%), respectively. Clinical patency rates at 6 months and 1 year were 77.5% (31/40) and 51.7% (15/29), respectively. CONCLUSION JetStream atherectomy using the XC device and no drug-eluting devices is feasible, with good clinical patency and 1-year freedom from TLR.
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Bacharach T, Panneton JM. Commentary: The OEIS National Registry Has the Potential to Change Office-Based Endovascular Practice: Is That a Cause for Celebration or Trepidation? J Endovasc Ther 2020; 27:964-966. [PMID: 32856517 DOI: 10.1177/1526602820952054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ahn SS, Tahara RW, Jones LE, Carr JG, Blebea J. Preliminary Results of the Outpatient Endovascular and Interventional Society National Registry. J Endovasc Ther 2020; 27:956-963. [PMID: 32813592 PMCID: PMC8685594 DOI: 10.1177/1526602820949970] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose To present a new outcomes-based registry to collect data on outpatient endovascular
interventions, a relatively new site of service without adequate historical data to
assess best clinical practices. Quality data collection with subsequent outcomes
analysis, benchmarking, and direct feedback is necessary to achieve optimal care. Materials and Methods The Outpatient Endovascular and Interventional Society (OEIS) established the OEIS
National Registry in 2017 to collect data on safety, efficacy, and quality of care for
outpatient endovascular interventions. Since then, it has grown to include a peripheral
artery disease (PAD) module with plans to expand to include cardiac, venous, dialysis
access, and other procedures in future modules. As a Qualified Clinical Data Registry
approved by the Centers for Medicare and Medicaid Services, this application also
supports new quality measure development under the Quality Payment Program. All
physicians operating in an office-based laboratory or ambulatory surgery center can use
the Registry to analyze de-identified data and benchmark performance against national
averages. Major adverse events were defined as death, stroke, myocardial infarction,
acute onset of limb ischemia, index bypass graft or treated segment thrombosis, and/or
need for urgent/emergent vascular surgery. Results Since Registry inception in 2017, 251 participating physicians from 64 centers located
in 18 states have participated. The current database includes 18,134 peripheral
endovascular interventions performed in 12,403 PAD patients (mean age 72.3±10.2 years;
60.1% men) between January 2017 and January 2020. Cases were performed primarily in an
office-based laboratory (85.1%) or ambulatory surgery center setting (10.4%). Most
frequently observed procedure indications from 16,086 preprocedure form submissions
included claudication (59%), minor tissue loss (16%), rest pain (9%), acute limb
ischemia (5%), and maintenance of patency (3%). Planned diagnostic procedures made up
12.2% of cases entered, with the remainder indicated as interventional procedures
(87.6%). The hospital transfer rate was 0.62%, with 88 urgent/emergent transfers and 24
elective transfers. The overall complication rate for the Registry was 1.87% (n=338),
and the rate of major adverse events was 0.51% (n=92). Thirty-day mortality was 0.03%
(n=6). Conclusion This report describes the current structure, methodology, and preliminary results of
OEIS National Registry, an outcomes-based registry designed to collect quality
performance data with subsequent outcome analysis, benchmarking, and direct feedback to
aid clinicians in providing optimal care.
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Redfors B, Sharma SK, Saito S, Kini AS, Lee AC, Moses JW, Ali ZA, Feldman RL, Bhatheja R, Stone GW. Novel Micro Crown Orbital Atherectomy for Severe Lesion Calcification: Coronary Orbital Atherectomy System Study (COAST). Circ Cardiovasc Interv 2020; 13:e008993. [PMID: 32757661 PMCID: PMC7434218 DOI: 10.1161/circinterventions.120.008993] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Supplemental Digital Content is available in the text. Percutaneous coronary intervention of severely calcified lesions carries a high risk of adverse events despite the use of contemporary devices. The Classic Crown Orbital Atherectomy System (OAS) was safe and effective for severely calcified lesion preparation in the ORBIT II study (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) but was not optimized for tight lesions. COAST (Coronary Orbital Atherectomy System Study) evaluated the safety and efficacy of calcified lesion preparation before stent implantation with the Diamondback 360 Micro Crown Coronary OAS, designed for use in tighter lesions.
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Jain K. Commentary: Orbital Atherectomy in Perspective. J Endovasc Ther 2020; 27:726-727. [PMID: 32744120 DOI: 10.1177/1526602820944610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chan YC, Cheung GC, Cheng SW. Lumivascular Optical Coherence Tomography-Guided Atherectomy in Recurrent Femoropopliteal Occlusive Diseases Associated with In-Stent Restenosis: Case-Series Report. Vasc Health Risk Manag 2020; 16:325-329. [PMID: 32982261 PMCID: PMC7491569 DOI: 10.2147/vhrm.s260190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
Lumivascular optical coherence tomography (OCT) is a novel adjunct in the field of medicine. It offers clear real-time imaging of artery walls before and during endovascular intervention. This study reports our initial experience on the use of lumivascular OCT-guided atherectomy in the management of two patients with recurrent restenosis in their femoropopliteal arteries associated with in-stent restenosis. Endovascular procedures were successful with a Pantheris atherectomy device (Avinger, Redwood City, CA, USA) and drug-eluting balloons. The OCT images clearly distinguished normal anatomy from plaque pathology, were of great advantage in both the accurate diagnosis and treatment of target lesions, and may reduce radiation during the endovascular procedure. However, the price of the device and its need for contrast infusion limit its routine clinical use.
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