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Chandra S, Choudhary R, Chaudhary G, Sharma A, Pradhan A, Bhandari M, Vishwakarma P, Sethi R, Narain VS, Dwivedi SK. Evaluation of only heparin-based rota-flush solution against alternative rota-flush solution in patients with severe coronary artery calcification undergoing rotational atherectomy. Indian Heart J 2021; 74:22-27. [PMID: 34883110 PMCID: PMC8891009 DOI: 10.1016/j.ihj.2021.12.001] [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: 08/04/2021] [Accepted: 12/03/2021] [Indexed: 02/08/2023] Open
Abstract
Objective There is limited evidence on feasibility and safety of only heparin rota-flush(OHRF)solution in rotational atherectomy (RA). We compared the safety and efficacy of OHRF solution with alternative rota-flush (ARF) solution in patients who underwent RA. Methods A total of 48 patients who underwent RA were enrolled in the study. In 25 patients OHRF solution and in 23 patients ARF solution was utilized. The study end points were procedural success rateandrota-related adverse cardiovascular event (RRAE) including slow flow, no reflow, bradycardia, and hemodynamic instability. Results Procedural success was achieved in all patients in both the OHRF and ARF groups. There was no statistically significant difference in RRAE between the two groups(32.0% vs. 34.7%, p = 0.83). Conclusion OHRF solution appears a more simplistic solution while performing rotablation as compared to ARF solution. Side effects such as hypotension and bradycardia can be circumvented with OHRF solution during rotablation.
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Affiliation(s)
- Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Rajeev Choudhary
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Gaurav Chaudhary
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Akhil Sharma
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Monika Bhandari
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Varun Shankar Narain
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Sudhanshu Kumar Dwivedi
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
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52
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Ishii H. Coronary stent infection: A catastrophic complication after percutaneous coronary intervention. Int J Cardiol 2021; 344:82-83. [PMID: 34662669 DOI: 10.1016/j.ijcard.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
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53
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Kawaguchi Y, Tamura T, Masuda S, Unno K, Okazaki A, Miyajima K, Takashima Y, Watanabe T, Wakabayashi Y, Maekawa Y. Impact of the degree of wire bias in the vessel's healthy portion on coronary perivascular trauma in rotational atherectomy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:123-131. [PMID: 35101372 DOI: 10.1016/j.carrev.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 12/31/2022]
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 < 0.0001). The cutoff value of the bias ratio for CPT was 1.2, which was the maximum value of the sum of sensitivity 100% and specificity 97%. CONCLUSIONS Lesions without HWB had no CPT. CPT risk increased when the bias ratio exceeded 1.2.
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Affiliation(s)
- Yoshitaka Kawaguchi
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
| | - Takumi Tamura
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Sakito Masuda
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Kyoko Unno
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Ayako Okazaki
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Keisuke Miyajima
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yasuyo Takashima
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tomoyuki Watanabe
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yasushi Wakabayashi
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yuichiro Maekawa
- Department of Internal Medicine-III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Wongpraparut N, Bakoh P, Anusonadisai K, Wongsawangkit N, Tresukosol D, Chotinaiwattarakul C, Phankingthongkum R, Tungsubutra W, Chunhamaneewat N, Towashiraporn K, Phichaphop A, Panchavinnin P, Pongakasira R, Panchavinnin P. Intravascular Imaging Guidance Reduce 1-Year MACE in Patients Undergoing Rotablator Atherectomy-Assisted Drug-Eluting Stent Implantation. Front Cardiovasc Med 2021; 8:768313. [PMID: 34778419 PMCID: PMC8578321 DOI: 10.3389/fcvm.2021.768313] [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: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aimed to investigate the incidence of 1-year major adverse cardiac events (MACE) compared between intravascular imaging guidance and angiographic guidance in patients undergoing rotablator atherectomy (RA)-assisted percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. Methods: This retrospective analysis included 265 consecutive patients with heavy calcified lesion who underwent RA-assisted PCI with DES implantation at our institution during the January 2016-December 2018 study period. This study was approved by the Siriraj Institutional Review Board. Patients were divided into either the angiographic guidance PCI group or the imaging guidance PCI group, which was defined as intravascular ultrasound or optical coherence tomography. The primary endpoint was 1-year MACE. Results: Two hundred and sixty-five patients were enrolled, including 188 patients in the intravascular imaging guidance group, and 77 patients in the angiographic guidance group. One-year MACE was significantly lower in the imaging guidance group compared to the angiographic guidance group (4.3 vs. 28.9%, respectively; odds ratio (OR): 9.06, 95% CI: 3.82–21.52; p < 0.001). The 1-year rates of all-cause death (OR: 8.19, 95% CI: 2.15–31.18; p = 0.002), myocardial infarction (MI) (OR: 6.13, 95% CI: 2.05–18.3; p = 0.001), and target vessel revascularization (TVR) (OR: 3.67, 95% CI: 1.13–11.96; p = 0.031) were also significantly lower in the imaging guidance group compared with the angiographic guidance group. The rate of stroke was non-significantly different between groups. Conclusion: In patients with heavy calcified lesion undergoing RA-assisted DES implantation, the intravascular imaging guidance significantly reduced the incidence of 1-year MACE, all-cause death, MI, and TVR compared to the angiographic guidance.
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Affiliation(s)
- Nattawut Wongpraparut
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paroj Bakoh
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kawin Anusonadisai
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Namthip Wongsawangkit
- Faculty of Medicine Siriraj Hospital, Her Majesty's Cardiac Center, Mahidol University, Bangkok, Thailand
| | - Damras Tresukosol
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Rewat Phankingthongkum
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wiwun Tungsubutra
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narathip Chunhamaneewat
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Korakoth Towashiraporn
- Faculty of Medicine Siriraj Hospital, Her Majesty's Cardiac Center, Mahidol University, Bangkok, Thailand
| | - Asa Phichaphop
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pariya Panchavinnin
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungtiwa Pongakasira
- Faculty of Medicine Siriraj Hospital, Her Majesty's Cardiac Center, Mahidol University, Bangkok, Thailand
| | - Pradit Panchavinnin
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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55
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Shinohara H, Kodera S, Ninomiya K, Nakamoto M, Katsushika S, Saito A, Minatsuki S, Kikuchi H, Kiyosue A, Higashikuni Y, Takeda N, Fujiu K, Ando J, Akazawa H, Morita H, Komuro I. Automatic detection of vessel structure by deep learning using intravascular ultrasound images of the coronary arteries. PLoS One 2021; 16:e0255577. [PMID: 34351974 PMCID: PMC8341597 DOI: 10.1371/journal.pone.0255577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 07/19/2021] [Indexed: 11/18/2022] Open
Abstract
Intravascular ultrasound (IVUS) is a diagnostic modality used during percutaneous coronary intervention. However, specialist skills are required to interpret IVUS images. To address this issue, we developed a new artificial intelligence (AI) program that categorizes vessel components, including calcification and stents, seen in IVUS images of complex lesions. When developing our AI using U-Net, IVUS images were taken from patients with angina pectoris and were manually segmented into the following categories: lumen area, medial plus plaque area, calcification, and stent. To evaluate our AI's performance, we calculated the classification accuracy of vessel components in IVUS images of vessels with clinically significantly narrowed lumina (< 4 mm2) and those with severe calcification. Additionally, we assessed the correlation between lumen areas in manually-labeled ground truth images and those in AI-predicted images, the mean intersection over union (IoU) of a test set, and the recall score for detecting stent struts in each IVUS image in which a stent was present in the test set. Among 3738 labeled images, 323 were randomly selected for use as a test set. The remaining 3415 images were used for training. The classification accuracies for vessels with significantly narrowed lumina and those with severe calcification were 0.97 and 0.98, respectively. Additionally, there was a significant correlation in the lumen area between the ground truth images and the predicted images (ρ = 0.97, R2 = 0.97, p < 0.001). However, the mean IoU of the test set was 0.66 and the recall score for detecting stent struts was 0.64. Our AI program accurately classified vessels requiring treatment and vessel components, except for stents in IVUS images of complex lesions. AI may be a powerful tool for assisting in the interpretation of IVUS imaging and could promote the popularization of IVUS-guided percutaneous coronary intervention in a clinical setting.
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Affiliation(s)
- Hiroki Shinohara
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kota Ninomiya
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Mitsuhiko Nakamoto
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Susumu Katsushika
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihito Saito
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hironobu Kikuchi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Arihiro Kiyosue
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasutomi Higashikuni
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Jiro Ando
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroshi Akazawa
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
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56
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Rozenbaum Z, Takahashi T, Kobayashi Y, Bliagos D, Menegus M, Colombo A, Latib A. Contemporary technologies to modify calcified plaque in coronary artery disease. Prog Cardiovasc Dis 2021; 69:18-26. [PMID: 34252411 DOI: 10.1016/j.pcad.2021.07.003] [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: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
With aging society, one of the more challenging obstacles in percutaneous coronary interventions are calcified coronary lesions. Calcified lesions may impede stent delivery, limit balloon and stent expansion, cause uneven drug distribution, and hinder wire advancement. Even in the setting of acceptable procedural success, vessel calcification is independently associated with increased target lesion revascularization rates at follow-up and lower survival rates. In order to effectively manage such lesions, dedicated technologies have been developed. Atherectomy aims at excising tissue and debulking plaques, as well as compressing and reshaping the atheroma, generally referred to as lesion preparation that enables further balloon and/or stent expansion in contemporary clinical practice. In the current review, we will discuss the available methods for atherectomy, including rotational, orbital, and excimer laser coronary atherectomy, as well as intravascular lithotripsy. In addition, we will review the role of imaging in calcified lesions.
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Affiliation(s)
- Zach Rozenbaum
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Tatsunori Takahashi
- Jacobi Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Yuhei Kobayashi
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Dimitrios Bliagos
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Mark Menegus
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States.
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57
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Hamana T, Yamamoto H, Sawada T, Kawai H, Takaya T. Additional ablation effect of low-speed rotational atherectomy following high-speed rotational atherectomy on early calcified in-stent restenosis: A case report. Clin Case Rep 2021; 9:e04550. [PMID: 34306704 PMCID: PMC8294135 DOI: 10.1002/ccr3.4550] [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: 03/19/2021] [Revised: 05/13/2021] [Accepted: 06/15/2021] [Indexed: 11/11/2022] Open
Abstract
Optical frequency domain imaging-guided additional low-speed rotational atherectomy following sufficient high-speed rotational atherectomy for early calcified in-stent restenosis might be a safe and useful option for achieving additional large lumen gains and stent expansion.
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Affiliation(s)
- Tomoyo Hamana
- Division of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
| | - Hiroyuki Yamamoto
- Division of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
| | - Takahiro Sawada
- Division of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
| | - Hiroya Kawai
- Division of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
- Department of Exploratory and Advanced search in CardiologyKobe University Graduate School of MedicineKobeJapan
| | - Tomofumi Takaya
- Division of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
- Department of Exploratory and Advanced search in CardiologyKobe University Graduate School of MedicineKobeJapan
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58
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Mizuno Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of the incidence of periprocedural myocardial infarction between percutaneous coronary intervention with versus without rotational atherectomy using propensity score-matching. Sci Rep 2021; 11:11140. [PMID: 34045490 PMCID: PMC8160267 DOI: 10.1038/s41598-021-90042-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/06/2021] [Indexed: 02/04/2023] Open
Abstract
Complications such as slow flow are frequently observed in percutaneous coronary intervention (PCI) with rotational atherectomy (RA). However, it remains unclear whether the high incidence of slow flow results in the high incidence of periprocedural myocardial infarction (PMI), reflecting real myocardial damage. The aim of this study was to compare the incidence of PMI between PCI with versus without RA using propensity score-matching. We included 1350 elective PCI cases, which were divided into the RA group (n = 203) and the non-RA group (n = 1147). After propensity score matching, the matched RA group (n = 190) and the matched non-RA group (n = 190) were generated. The primary interest was to compare the incidence of PMI between the matched RA and non-RA groups. Before propensity score matching, the incidence of slow flow and PMI was greater in the RA group than in the non-RA group. After matching, the incidence of slow flow was still greater in the matched RA group than in the matched non-RA group (16.8% vs. 9.5%, p = 0.048). However, the incidence of PMI was similar between the matched RA and matched non-RA group (7.4% vs. 5.3%, p = 0.528, standardized difference: 0.086). In conclusion, although use of RA was associated with greater risk of slow flow, use of RA was not associated with PMI after a propensity score-matched analysis. The fact that RA did not increase the risk of myocardial damage in complex lesions would have an impact on revascularization strategy for severely calcified coronary lesions.
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Affiliation(s)
- Yusuke Mizuno
- grid.416093.9Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503 Japan
| | - Kenichi Sakakura
- grid.416093.9Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503 Japan
| | - Hiroyuki Jinnouchi
- grid.416093.9Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503 Japan
| | - Yousuke Taniguchi
- grid.416093.9Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503 Japan
| | - Takunori Tsukui
- grid.416093.9Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503 Japan
| | - Kei Yamamoto
- grid.416093.9Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503 Japan
| | - Masaru Seguchi
- grid.416093.9Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503 Japan
| | - Hiroshi Wada
- grid.416093.9Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503 Japan
| | - Hideo Fujita
- grid.416093.9Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, 330-8503 Japan
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59
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Sakakura K. Lesion Preparation for Severely Calcified Coronary Artery Disease - Intravascular Lithotripsy as a New Option. Circ J 2021; 85:834-836. [PMID: 33583927 DOI: 10.1253/circj.cj-20-1272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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60
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Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Jinnouchi H, Seguchi M, Wada H, Fujita H. Modifiable and unmodifiable factors associated with slow flow following rotational atherectomy. PLoS One 2021; 16:e0250757. [PMID: 33901249 PMCID: PMC8075266 DOI: 10.1371/journal.pone.0250757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although several groups reported the risk factors for slow flow during rotational atherectomy (RA), they did not clearly distinguish modifiable factors, such as burr-to-artery ratio from unmodifiable ones, such as lesion length. The aim of this retrospective study was to investigate the modifiable and unmodifiable factors that were associated with slow flow. Methods We included 513 lesions treated with RA, which were classified into a slow flow group (n = 97) and a non-slow flow group (n = 416) according to the presence or absence of slow flow just after RA. The multivariate logistic regression analysis was performed to find factors associated with slow flow. Results Slow flow was inversely associated with reference diameter [Odds ratio (OR) 0.351, 95% confidence interval (CI) 0.205–0.600, p<0.001], primary RA strategy (OR 0.224, 95% CI 0.097–0.513, p<0.001), short single run (≤15 seconds) (OR 0.458, 95% CI 0.271–0.776, p = 0.004), and systolic blood pressure (BP) ≥ 140 mmHg (OR 0.501, 95% CI 0.297–0.843, p = 0.009). Lesion length (every 5 mm increase: OR 1.193, 95% CI 1.093–1.301, p<0.001), angulation (OR 2.054, 95% CI 1.171–3.601, p = 0.012), halfway RA (OR 2.027, 95% CI 1.130–3.635, p = 0.018), initial burr-to-artery ratio (OR 1.451, 95% CI 1.212–1.737, p<0.001), and use of beta blockers (OR 1.894, 95% CI 1.004–3.573, p = 0.049) were significantly associated with slow flow. Conclusions Slow flow was positively associated with several unmodifiable factors including lesion length and angulation, and inversely associated with reference diameter. In addition, slow flow was positively associated with several modifiable factors including initial burr-to-artery ratio and use of beta blockers, and inversely associated with primary RA strategy, short single run, and systolic blood pressure just before RA. Application of this information could help to improve RA procedures.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
- * E-mail:
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
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