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Hu B, Xiao C, Wang Z, Jia D, Yang S, Jia S, Zhai G, Han H, Xu X, Shi D, Zhou Y. Relationship between Metabolic Syndrome and Clinical Outcome in Patients Treated with Drug-Eluting Stenting after Rotational Atherectomy for Complex Calcified Coronary Lesions. J Clin Med 2022; 11:jcm11144192. [PMID: 35887955 PMCID: PMC9322199 DOI: 10.3390/jcm11144192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background and aims: although an association between metabolic syndrome (MS) and cardiovascular disease risk has been documented, the relationship in patients with complex calcified coronary lesions undergoing rotational atherectomy (RA) and drug-eluting stent(DES) insertion remains controversial. Here, the influence of MS on outcomes was assessed. Methods and results: we retrospectively included 398 patients who underwent RA and DES insertion for complex calcified coronary lesions in our institution between June 2015 and January 2019. The modified Adult Treatment Plan III was used to diagnose MS. The endpoint was major adverse cardiovascular events (MACEs), comprising mortality from all causes, myocardial infarction, and target vessel revascularization (TVR). In all, 173 (43.5%) patients had MS. MS was significantly associated with MACE over the 28.32 ± 6.79-month follow-up period (HR 1.783, 95% CI from 1.122 to 2.833) even after adjustment for other possible confounders. Conclusion: MS was frequently observed in patients treated with RA with DES insertion for complex calcified coronary lesions. MS independently predicted MACE in these patients.
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Affiliation(s)
- Bin Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Changbo Xiao
- Department of Cardiovascular Surgery, Henan Chest Hospital, Zhengzhou 450001, China;
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Dean Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Shiwei Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Shuo Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Guangyao Zhai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Xiaohan Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
- Correspondence: ; Tel.: +86-10-64456489; Fax: +86-10-64456461
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Haider SA, Jawaid A, Stuver T, Naqvi SY. Aortic plaque dehiscence caused by rotational atherectomy with Kokeshi phenomenon in a patient with aortic stenosis successfully treated with transcatheter aortic valve replacement. BMJ Case Rep 2022; 15:e248598. [PMID: 35504670 PMCID: PMC9066486 DOI: 10.1136/bcr-2021-248598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/03/2022] Open
Abstract
Rotational atherectomy (RA) is an important interventional technique to facilitate effective percutaneous coronary intervention of severely calcified lesions. Despite the improved probability of better procedural outcomes during angioplasty, the use of RA is associated with an inherent risk of complications. Here, we present a case of a woman in her mid-90s with severe aortic stenosis (AS) who underwent RA facilitated angioplasty of the right coronary artery (RCA), with the procedure complicated by the Kokeshi phenomenon. Manual traction to retrieve the burr resulted in dehiscence of an aortic plaque near the ostium of the RCA. Unfortunately, the patient's risk profile precluded surgery. After a multidisciplinary discussion, a self-expanding Core Valve Evolut R prosthesis (Medtronic, Minneapolis, Minnesota, USA) was successfully implanted, with improvement in the AS and stabilisation of the aortic plaque. This is the first reported case of successful non-operative management of a mobile-aortic plaque caused by RA with a transcatheter prosthesis.
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Affiliation(s)
- Syedah Aleena Haider
- Cardiology, Hywel Dda University Health Board, Llanelli, UK
- Department of Preventive Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Anas Jawaid
- Cardiology, Strong Memorial Hospital, Rochester, New York, USA
| | - Thomas Stuver
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Bhatia KS, Sritharan HP, Allahwala U, Ward M, Bhindi R. Safety and Feasibility of Rotational Atherectomy in Severe Aortic Stenosis. Heart Lung Circ 2022; 31:666-670. [PMID: 35063383 DOI: 10.1016/j.hlc.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/20/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We aimed to evaluate the safety and feasibility of rotational atherectomy (RA) in patients with severe aortic stenosis (AS). BACKGROUND Heavily calcified coronary lesions are commonly encountered in elderly patients with severe AS who are being considered for transcatheter aortic valve implantation. The use of RA in these patients is controversial as they may be at a higher risk of complications. METHODS We retrospectively enrolled patients with severe AS who underwent RA across two hospitals from March 2010 to September 2019. Patients with severe AS prior to or within 8 weeks of RA were included. RESULTS Twenty-seven (27) consecutive patients (83±5.2 yrs 63% male) with severe AS (peak velocity 4.1±0.5 m/s, mean gradient 40.0±10.2 mmHg) were enrolled and 31 lesions were treated with RA across 30 separate procedures. Three (3) (11.1%) patients had left ventricular ejection fraction ≤30%. Nine (9) (30%) procedures involved percutaneous coronary intervention of multiple arteries, with most lesions in the right coronary artery (51.6%) and left anterior descending artery (32.3%). Three (3) (9.7%) lesions were in the left main stem. RA-facilitated stenting was successful in all lesions. There were no episodes of coronary perforation or slow-flow/no-reflow. There was one episode of coronary dissection in an artery that did not undergo RA, which was successfully treated with a drug-eluting stent. There were no deaths within 30 days and three deaths (11.1%) within 1 year. CONCLUSIONS Rotational atherectomy in patients with severe AS is feasible and has a low rate of procedural complications.
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Affiliation(s)
| | - Hari P Sritharan
- Royal North Shore Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Usaid Allahwala
- Royal North Shore Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Michael Ward
- Royal North Shore Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Ravinay Bhindi
- Royal North Shore Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia.
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Liu W, Yao Y, Jiang Z, Tian L, Song B, Liu H, Deng S, Luo R, Wei F. 3-Year outcomes in patients with heavily calcified lesions undergoing percutaneous coronary intervention using cutting balloons. BMC Cardiovasc Disord 2022; 22:187. [PMID: 35448940 PMCID: PMC9027752 DOI: 10.1186/s12872-022-02622-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of heavily calcified lesions (HCLs) is associated with higher complication rates and worse clinical outcomes. Cutting balloon (CB) has been widely used for HCLs, but patients' prognosis had not been fully clarified. The study aimed to compare 3-year clinical outcomes between patients with HCLs that are treated with CBs and those with non-HCLs. METHOD Patients who underwent PCI in Guizhou Provincial People's Hospital from June 2015 to September 2018 were retrospectively included. HCL was defined as radiopaque and high-pressure undilatable lesions. CBs were routinely used in combination with non-compliant balloons for the HCLs. Major adverse cardiac event (MACE) and target vessel failure (TVF) were assessed at 3-year follow-up. RESULT Among 2432 patients included in the study, 210(8.6%) had HCLs with a procedural success rate of 91.0%. The patients with HCLs had a higher incidence of MACE (23.3% vs. 10.8%, P < 0.001) than those with non-HCLs. By propensity score matching, 172 patients with HCLs were 1:1 paired to those with non-HCLs, and their PCI vessels were exactly matched. The MACE and TVF were significantly higher in the patients with HCLs than those with non-HCLs (MACE: 21.5% vs. 13.4%, P = 0.036; TVF: 19.8% vs. 9.9%, P = 0.008). In the Cox regression analysis, HCL is independently associated with higher risks of MACE [HR: 1.72(1.01-2.94), P = 0.047], TVF [HR: 2.10(1.15-3.81), P = 0.015] and repeat revascularization [HR: 2.20(1.07-4.52), P = 0.032]. CONCLUSION Patients with HCLs undergoing PCI using CBs in combination with non-compliant balloons had higher risks of complications, procedural failure, and worse clinical outcomes at 3 years than those with non-HCLs.
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Affiliation(s)
- Wei Liu
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Yutong Yao
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Zhi Jiang
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China.
| | - Longhai Tian
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Bo Song
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Hui Liu
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Shiyan Deng
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Rui Luo
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Fang Wei
- Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
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Bulluck H, McEntegart M. Contemporary tools and devices for coronary calcium modification. JRSM Cardiovasc Dis 2022; 11:20480040221089760. [PMID: 35401972 PMCID: PMC8990704 DOI: 10.1177/20480040221089760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022] Open
Abstract
With the aging population, up to a third of patients referred for percutaneous
coronary intervention (PCI) have moderate or severe calcified lesions assessed
by coronary angiography. The presence of coronary calcium is associated with
difficult device delivery, sub-optimal stent deployment, and prolonged
procedures, with more complications. Furthermore, it is known that sub-optimal
stent expansion is associated with poor clinical outcomes. In this manuscript we
describe how to quantify the severity of coronary calcium, review the
armamentarium of contemporary devices available for calcium modification, and
provide a systematic approach to device selection, assessment of successful
calcium modification, and stent optimization.
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Affiliation(s)
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
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Jinnouchi H, Sakakura K, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Intravascular ultrasound-factors associated with slow flow following rotational atherectomy in heavily calcified coronary artery. Sci Rep 2022; 12:5674. [PMID: 35383228 PMCID: PMC8983755 DOI: 10.1038/s41598-022-09585-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/25/2022] [Indexed: 12/18/2022] Open
Abstract
Intravascular ultrasound (IVUS) can provide useful information in patients undergoing complex percutaneous coronary intervention with rotational atherectomy (RA). The association between IVUS findings and slow flow following rotational atherectomy (RA) has not been investigated, although slow flow has been shown to be an unfavorable sign with worse outcomes. The aim of this study was to determine the IVUS-factors associated with slow flow just after RA. We retrospectively enrolled 290 lesions (5316 IVUS-frames) with RA, which were divided into the slow flow group (n = 43 with 1029 IVUS-frames) and the non-slow flow group (n = 247 with 4287 IVUS-frames) based on the presence of slow flow. Multivariate regression analysis assessed the IVUS-factors associated with slow flow. Slow flow was significantly associated with long lesion length, the maximum number of reverberations [odds ratio (OR) 1.49; 95% confidence interval (CI) 1.07–2.07, p = 0.02] and nearly circumferential calcification at minimal lumen area (MLA) (≥ 300°) (OR, 2.21; 95% CI 1.13–4.32; p = 0.02). According to the maximum number of reverberations, the incidence of slow flow was 2.2% (n = 0), 11.9% (n = 1), 19.5% (n = 2), 22.5% (n = 3), and 44.4% (n = 4). In conclusion, IVUS findings such as longer lesion length, the maximum number of reverberations, and the greater arc of calcification at MLA may predict slow flow after RA. The operators need to pay more attention to the presence of reverberations to enhance the procedure safety.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan.
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan
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Kumar P, Jino B, Shafeeq A, Roy S, Rajendran M. Retrograde percutaneous coronary intervention in a calcified and dissected left anterior descending artery using single catheter – To lose the patience is to lose the battle. J Cardiol Cases 2022; 26:70-75. [DOI: 10.1016/j.jccase.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022] Open
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Ferstl P, Drentwett AS, Bargon S, Schacher N, Tröbs M, Marwan M, Achenbach S, Gaede L. Rotational atherectomy via the transradial access: success rates, procedural parameters and complications. Heart Vessels 2022; 37:1478-1488. [PMID: 35305131 PMCID: PMC9349115 DOI: 10.1007/s00380-022-02053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
Radial access is recommended for percutaneous coronary intervention (PCI), but rotational atherectomy remains frequently performed via femoral access. Analyzing the procedural parameters, success rate and complications of rotational atherectomy, performed via radial in comparison to femoral access. We retrospectively analyzed 427 consecutive patients undergoing rotational atherectomy. Procedural parameters and outcome were determined in 171 patients, scheduled for radial and compared to 256 patients with femoral access use. In the radial access group (74 ± 9 years, 84% male), the LAD was most frequently treated (49%). Sheath size was 7F in 59% and 6F in 41%, burr size was 1.5 mm in 46% and 1.25 mm in 14% of patients. A temporary pacemaker was inserted in 14%. Procedural success rate stood at 97%. Access site complications occurred in 4% of patients, which was significantly less frequent than in in 256 patients treated via femoral access (13% p = 0.003). Compared to radial access, femoral access was associated with the use of larger sheaths (p < 0.001), more frequent treatment of non-LAD vessels (58.2% vs. 44.4%, p = 0.013) and a higher rate of temporary pacemaker use (27%; p = 0.001). No differences could be seen in procedural success (p = 0.83) and burr size (p = 0.51). Femoral access (OR 3.33; 95% CI 1.40–7.93), and female sex (OR3.40 95% CI 1.69–6.63) were independent predictors for access site complications. For coronary rotational atherectomy, radial access has a high success rate with overall use of smaller sheaths, but of equally sized burrs as well as a significant lower rate of access site-related complications than femoral access.
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Affiliation(s)
- Paul Ferstl
- Department of Cardiology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Anne-Sophie Drentwett
- Department of Cardiology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Sophie Bargon
- Department of Cardiology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Nora Schacher
- Department of Cardiology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Monique Tröbs
- Department of Cardiology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Luise Gaede
- Department of Cardiology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
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Chen YW, Lai CH, Su CS, Chang WC, Wang CY, Chen WJ, Lin TH, Liang KW, Liu TJ, Lee WL. The Procedural and Clinical Outcomes of Rotational Atherectomy in Patients Presenting With Acute Myocardial Infarction. Front Cardiovasc Med 2022; 9:846564. [PMID: 35369302 PMCID: PMC8971549 DOI: 10.3389/fcvm.2022.846564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Rotational atherectomy (RA) is an indispensable tool used for calcified lesion preparation in percutaneous coronary intervention (PCI). However, use of RA in the setting of acute myocardial infarction (AMI) is challenged with limited clinical data. Objectives This study aims to retrospectively investigate the procedural results, periprocedural complications, and clinical outcomes of RA in patients with AMI. Methods All possible consecutive patients who received RA in AMI from January 2009 to March 2018 in a single tertiary center were analyzed retrospectively. Patients without AMI during the study period were also enrolled for comparison. Results A total of 121 patients with AMI (76.0 ± 10.8 years, 63.6% males) and 290 patients without AMI were recruited. Among the AMI group, 81% of patients had non-ST-elevation myocardial infarction (NSTEMI) and 14% presented with cardiogenic shock. RA could be completed in 98.8% of patients in the AMI group and 98.3% in the non-AMI group (p = 1.00). The periprocedural complication rates were comparable between the AMI and non-AMI groups. The risks of in-hospital, 30-day, 90-day, and 1-year cardiovascular major adverse cardiac events (CV MACE) were significantly higher in the AMI group compared with the non-AMI group (in-hospital 13.2 vs. 2.8%, p < 0.001; 30-day 14.2 vs. 4.5%, p < 0.001; 90-day 20.8 vs. 6.9%, p < 0.001; 1-year 30.8 vs. 19.1%, p = 0.01). AMI at initial presentation and cardiogenic shock were predictors for both in-hospital CV MACE and 1-year CV MACE in multivariable binary logistic regression analysis. Other predictors for 1-year CV MACE included serum creatinine level and triple vessel disease. Conclusion RA in patients with AMI is feasible with a high procedural completion rate and acceptable periprocedural complications. Given unstable hemodynamics and complex coronary anatomy, the in-hospital and 1-year MACE rates remained higher in patients with AMI compared with patients without AMI.
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Affiliation(s)
- Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chun Chang
- Department of Cardiology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Chi-Yen Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wei-Jhong Chen
- Department of Cardiology, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Tzu-Hsiang Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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The Impact of Intracoronary Imaging on PCI Outcomes in Cases Utilising Rotational Atherectomy: An Analysis of 8,417 Rotational Atherectomy Cases from the British Cardiovascular Intervention Society Database. J Interv Cardiol 2022; 2022:5879187. [PMID: 35360091 PMCID: PMC8941577 DOI: 10.1155/2022/5879187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction There is increasing evidence supporting the use of intracoronary imaging to optimize the outcomes of percutaneous coronary intervention (PCI). However, there are no studies examining the impact of imaging on PCI outcomes in cases utilising rotational atherectomy (RA-PCI). Our study examines the determinants and outcomes of using intracoronary imaging in RA-PCI cases including 12-month mortality. Methods Using the British Cardiac Intervention Society database, data were analysed on all RA-PCI procedures in the UK between 2007 and 2014. Descriptive statistics and multivariate logistic regressions were used to examine baseline, procedural, and outcome associations with intravascular imaging. Results Intracoronary imaging was used in 1,279 out of 8,417 RA-PCI cases (15.2%). Baseline covariates associated with significantly more imaging use were number of stents used, smoking history, previous CABG, pressure wire use, proximal LAD disease, laser use, glycoprotein inhibitor use, cutting balloons, number of restenosis attempted, off-site surgery, and unprotected left main stem (uLMS) PCI. Adjusted rates of in-hospital major adverse cardiac/cerebrovascular events (IH-MACCE), its individual components (death, peri-procedural MI, stroke, and major bleed), or 12-month mortality were not significantly altered by the use of imaging in RA-PCI. However, subgroup analysis demonstrated a signal towards reduction in 12-month mortality in uLMS RA-PCI cases utilising intracoronary imaging (OR 0.67, 95% CI 0.44–1.03). Conclusions Intracoronary imaging use during RA-PCI is associated with higher risk of baseline and procedural characteristics. There were no differences observed in IH-MACCE or 12-month mortality with intracoronary imaging in RA-PCI.
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Qaqish O, Sharma S, Kumar A, Patel K, Mohammed K, Venigalla P, Ojha A, Sareen N, Goddla V, Dabaja A, Kondur A. Rotational atherectomy in acute coronary syndrome: A meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:143-153. [DOI: 10.1016/j.carrev.2022.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/25/2022]
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Hong XL, Li Y, Fu GS, Zhang WB. Predictors and clinical significance of periprocedural myocardial infarction following rotational atherectomy. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1440-1447. [PMID: 35077596 DOI: 10.1002/ccd.30095] [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: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the potential predictors and clinical significance of periprocedural myocardial infarction (PMI), as defined by the latest Fourth Universal Definition of Myocardial Infarction (2018), following rotational atherectomy (RA). BACKGROUND PMI is not uncommon in patients undergoing RA, although the predictors and prognostic impact are unknown. METHODS Data from 229 consecutive patients who had undergone RA before drug-eluting stent (DES) implantation in a single center were analyzed. Patients' demographic information, clinical, angiographic, and procedural characteristics, and 1-year follow-up outcomes were collected retrospectively. RESULTS The overall incidence of PMI in patients undergoing RA was 48.5%. Age (adjusted odds ratio [OR]: 1.024, 95% confidence interval [CI]: 1.001-1.047, p = 0.043) and ejection fraction (adjusted OR: 0.977, 95% CI: 0.962-0.993, p = 0.004) were independent predictors of PMI in RA, although PMI was not associated with an increased risk of major adverse cardiovascular and cerebrovascular events (MACCEs) at the 1-year follow-up in patients undergoing RA. CONCLUSION Age and ejection fraction were independently associated with an elevated risk of PMI in patients undergoing RA. However, post-RA microinfarcts were not associated with an increased risk of MACCEs over the short-term follow-up period.
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Affiliation(s)
- Xu-Lin Hong
- Department of Cardiology, Zhejiang University School of Medicine Sir Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Ya Li
- Department of Cardiology, Zhejiang University School of Medicine Sir Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Guo-Sheng Fu
- Department of Cardiology, Zhejiang University School of Medicine Sir Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Wen-Bin Zhang
- Department of Cardiology, Zhejiang University School of Medicine Sir Run Shaw Hospital, Hangzhou, Zhejiang, China
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Desta L, Jurga J, Völz S, Omerovic E, Ulvenstam A, Zwackman S, Pagonis C, Calle F, Olivecrona GK, Persson J, Venetsanos D. Transradial versus trans-femoral access site in high-speed rotational atherectomy in Sweden. Int J Cardiol 2022; 352:45-51. [PMID: 35074496 DOI: 10.1016/j.ijcard.2022.01.039] [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: 07/03/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radial artery is the preferred access site in contemporary percutaneous coronary intervention (PCI). However, limited data exist regarding utilization pattern, safety, and long-term efficacy of transradial artery access (TRA) PCI in heavily calcified lesions using high-speed rotational atherectomy (HSRA). METHODS All patients who underwent HSRA-PCI in Sweden between 2005 and 2016 were included. Outcomes were major adverse cardiac events (MACE, including death, myocardial infarction (MI) or target vessel revascularisation (TVR)), in-hospital bleeding and restenosis. Inverse probability of treatment weighting was used to adjust for the non-randomized access site selection. RESULTS We included 1479 patients of whom 649 had TRA and 782 transfemoral artery access (TFA) HSRA-PCI. The rate of TRA increased significantly by 18% per year but remained lower in HSRA-PCI (60%) than in the overall PCI population (85%) in 2016. TRA was associated with comparable angiographic success but significantly lower risk for major (adjusted OR 0.16; 95% CI 0.05-0.47) or any in-hospital bleeding (adjusted OR 0.32; 95% CI 0.13-0.78). At one year, the adjusted risk for MACE (HR 0.87; 95% CI 0.67-1.13) and its individual components did not differ between TRA and TFA patients. The risk for restenosis did not significantly differ between TRA and TFA HSRA-PCI treated lesions (adjusted HR 0.92; 95% CI 0.46-1.81). CONCLUSION HSRA-PCI by TRA was associated with significantly lower risk for in-hospital bleeding and equivalent long-term efficacy when compared with TFA. Our data support the feasibility and superior safety profile of TRA in HSRA-PCI.
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Affiliation(s)
- Liyew Desta
- Division of Cardiology, Department of Medicine, Karolinska Institute Huddinge and Karolinska University Hospital, Stockholm, Sweden
| | - Juliane Jurga
- Division of Cardiology, Department of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden
| | - Sebastian Völz
- Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Ulvenstam
- Department of Internal Medicine and Cardiology, Östersund Hospital, Östersund, Sweden
| | - Sammy Zwackman
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Linköping, Sweden
| | - Christos Pagonis
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Linköping, Sweden
| | - Fredrik Calle
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Göran K Olivecrona
- Department of Cardiology, Lund University and HSkåne University Hospital, Lund, Sweden
| | - Jonas Persson
- Department of Clinical sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Dimitrios Venetsanos
- Division of Cardiology, Department of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden.
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Malhotra G, Stewart P. Outcomes of Rotational Atherectomy in Three Large Queensland Centres Without Onsite Cardiac Surgical Backup in a Contemporary Patient Cohort – A 9-Year Experience. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hussain Y, Kearney KE, Abbott JD, Kereiakes DJ, Di Mario C, Saito S, Cristea E, Riley RF, Fajadet J, Shlofmitz RA, Ali ZA, Klein AJ, Price MJ, Hill JM, Stone GW, Lansky AJ. Sex-Specific Outcomes After Coronary Intravascular Lithotripsy: A Patient-Level Analysis of the Disrupt CAD Studies. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100011. [PMID: 39130137 PMCID: PMC11307712 DOI: 10.1016/j.jscai.2021.100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 08/13/2024]
Abstract
Background Coronary artery calcification increases the procedural complexity of percutaneous coronary intervention and is associated with worse outcomes, especially in women. Intravascular lithotripsy (IVL) has been demonstrated to be safe and effective for vessel preparation in severely calcified stenotic lesions before stent implantation. Sex-based outcomes of IVL-facilitated stenting have not been defined. Methods We performed a patient-level pooled analysis of the 4 prospective, single-arm Disrupt CAD studies that evaluated the safety and efficacy of IVL-facilitated stenting. Patient baseline and procedural characteristics and clinical outcomes were examined based on sex. The primary safety end point was 30-day major adverse cardiovascular events, defined as the composite of cardiac death, myocardial infarction, or target vessel revascularization. The primary efficacy end point was procedural success, defined as stent delivery with residual in-stent stenosis ≤30% without in-hospital major adverse cardiovascular events. Results A total of 628 patients were included, of which 144 (22.9%) were women. Women were older (P < .001) and more likely to have hyperlipidemia (P = .03), renal insufficiency (P = .05), and prior myocardial infarction (P = .05). Women had smaller mean reference vessel diameter (2.7 ± 0.4 mm vs 3.0 ± 0.5 mm, P < .001), shorter lesion length (22.4 ± 10.3 mm vs 25.0 ± 11.7 mm, P = .01), and less side branch involvement (22.9% vs 32.4%, P = .03). Severe coronary calcification defined by angiography, stent delivery success, lesion predilatation, post-IVL dilatation, and poststent dilatation was similar between groups. There were no significant differences between women and men in the primary safety end point (8.3% vs 7.1%, P = .61; adjusted odds ratio 1.66; 95% confidence interval 0.78, 3.34; P = .17) or the primary efficacy end point (91.7% vs 92.6%, P = .72; adjusted odds ratio 0.58; 95% confidence interval 0.29, 1.24; P = .15). Post-IVL serious angiographic complications (flow-limiting dissection, perforation, abrupt closure, slow flow, no reflow) were similar for women and men (1.6% vs 2.3%, P = .75). Conclusions Despite more comorbidities and smaller vessel size, IVL-facilitated stenting of severely calcified lesions achieves similar safety and efficacy in women and men.
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Affiliation(s)
- Yasin Hussain
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
| | | | | | - Dean J. Kereiakes
- The Christ Hospital and the Lindner Research Center, Cincinnati, Ohio
| | | | - Shigeru Saito
- Shonan-Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ecaterina Cristea
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
| | - Robert F. Riley
- The Christ Hospital and the Lindner Research Center, Cincinnati, Ohio
| | | | | | - Ziad A. Ali
- St. Francis Hospital, Roslyn, New York
- Cardiovascular Research Foundation, New York, New York
| | | | | | | | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra J. Lansky
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
- Barts Heart Centre, London, United Kingdom
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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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Schwarz K, Lovatt S, Borovac JA, Parasuraman S, Kwok CS. Planned versus bailout rotational atherectomy: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 39:45-51. [PMID: 34627732 DOI: 10.1016/j.carrev.2021.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/01/2021] [Accepted: 09/29/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/PURPOSE Rotational atherectomy (RA) plays a central role in the treatment of heavily calcified coronary artery lesions. Our aim was to compare periprocedural characteristics and outcomes of planned (PA) vs. bailout (BA) rotational atherectomy. METHODS We conducted a systematic review and performed a meta-analysis on studies which compared PA vs. BA strategy. RESULTS Five studies fulfilled the inclusion criteria, pooling a total of 2120 patients. There was no difference in procedural success, PA vs. BA risk ratio (RR) 1.03 and 95% confidence interval (95% CI) 0.99-1.07. Compared to BA, PA was associated with a shorter procedural time [mean difference (MD) -25.88 min, 95% CI -35.55 to -16.22], less contrast volume (MD -43.71 ml, 95% CI -69.17 to -18.25), less coronary dissections (RR 0.50, 95% CI 0.26-0.99), fewer stents (MD -0.20, 95% CI -0.29 to -0.11), and a trend favouring less periprocedural myocardial infarctions (MI) (RR 0.77, 95% CI 0.54-1.11). There was no difference in major adverse cardiovascular events on follow-up (RR 1.04, 95% CI 0.62-1.74), death (RR 0.98, 95% CI 0.59-1.64), MI (RR 1.16, 95% CI 0.62-2.18), target vessel revascularization (RR 1.40, 95% CI 0.83 to 2.36), stroke (RR 1.50, 95% CI 0.46-4.86) or stent thrombosis (RR 0.82, 95% CI 0.06-10.74); all PA vs. BA comparisons. CONCLUSIONS Compared to bailout RA, planned RA resulted in significantly shorter procedural times, less contrast use, lesser dissection rates and fewer stents used. The bailout RA approach appears to enhance periprocedural risk, but there is no difference on mid-term outcomes.
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Affiliation(s)
- Konstantin Schwarz
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria.
| | - Saul Lovatt
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Josip A Borovac
- Clinic for Cardiovascular Diseases, University Hospital Centre Split, Split, Croatia
| | | | - Chun Shing Kwok
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK; School of Medicine, Keele University, Stoke-on-Trent, UK
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Rotational Atherectomy-Assisted Crossing of a Complex Right Coronary Artery Lesion Using the Retrograde Approach. Case Rep Cardiol 2021; 2021:8832213. [PMID: 34484839 PMCID: PMC8416397 DOI: 10.1155/2021/8832213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Chronic total occlusion lesions present a major challenge for the interventional cardiologist. In this case, we report the successful use of rotational atherectomy to facilitate retrograde percutaneous coronary intervention of a complex totally occluded right coronary artery after modification of the proximal cap of the lesion to enable placement of the RotaWire in the vessel architecture.
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First United States experience with Rota-Shock: A case series. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:209-213. [PMID: 34507912 DOI: 10.1016/j.carrev.2021.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/08/2021] [Accepted: 08/31/2021] [Indexed: 11/20/2022]
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Gong ML, Mao Y, Liu JH. Pericardial Tamponade Caused by Rotational Atherectomy Ablation Grinding Through a Barrier Stent Protruding From the Diagonal Artery: A Case Report. J Med Cases 2021; 12:230-232. [PMID: 34434463 PMCID: PMC8383508 DOI: 10.14740/jmc3678] [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: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 11/11/2022] Open
Abstract
Rotational atherectomy (RA) has been described in case reports to be effective in ablating under-expanded stents. We present a case of calcified bifurcation lesion percutaneous coronary intervention (PCI), in which the branch stent protruding into main branch blocked the balloon getting through, and the following RA led to pericardial tamponade. The first stent was deployed from the proximal of left anterior descending artery (LAD) to the proximal of diagonal for an 80-year-old man who suffered from non-ST-elevation myocardial infarction to make a Culotte dual stent PCI. The operator failed to make balloon get through the struts protruding into LAD lumen anyway. After RA drill through the LAD lumen, it showed an excellent angiographic outcome. Stent deployment in LAD was successful, but pericardial tamponade occurred in a short time. After pericardiocentesis was performed under fluoroscopic guidance, the patient was uneventful. After 1 year, the follow-up coronary computed tomography (CT) angiography showed no in-stent restenosis, stent fracture or disrupted struts protruding outside of the vessel’s outline of LAD and the first diagonal (D1). This case shows stents’ RA could be dangerous in grinding across the stents’ lateral hole in an unsymmetrical lumen. Although RA could be a useful remedy in the situation of under-expansion of implanted stents, the debulking should be performed for longitudinal stent ablation and cautiously performed for bifurcation lesion in which the protruding stents from side branch were unsymmetrically blocking the path.
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Affiliation(s)
- Ming Lian Gong
- Department of Cardiology, Dalian The Fifth People's Hospital, Dalian, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yi Mao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jing Hua Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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Mukhopadhyay S, Batra V, Yusuf J, Kumar S. Rotational atherectomy in a dire situation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab153. [PMID: 34423237 PMCID: PMC8374965 DOI: 10.1093/ehjcr/ytab153] [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: 10/11/2020] [Revised: 11/10/2020] [Accepted: 04/09/2021] [Indexed: 11/13/2022]
Abstract
Background Traditionally rotablation is considered as contraindicated in presence of visible thrombus or dissection. However, clinical situations may force us to undertake rotablation in presence of thrombus or dissection. We report a case of coronary rotablation done successfully in setting of acute thrombotic occlusion over an underlying non-healed dissection. Case summary A non-dilatable lesion in proximal left anterior descending (LAD) artery after rotablation with a 1.5 mm burr resulting in non-flow limiting Type A dissection with TIMI3 flow was left on conservative management to allow it to heal. But the patient developed ST-elevation myocardial infarction on the 9th post-intervention day due to thrombotic occlusion of the LAD at the site of dissection. At this time, we were compelled to do rotablation as a lifesaving procedure in presence of both thrombus and underlying dissection with a successful outcome. Discussion Rotablation in presence of dissection can lead to entrapment of the flap in the rotating burr leading to progression of dissection distally or sometimes there can be subintimal tracking of burr leading to perforation. In thrombotic lesions, rotablation can cause further increase in platelet activation and aggregation by the spinning burr or distal embolization of the thrombotic material promoting slow or no flow. In this unusual case with limited options for achieving successful revascularization, some out of the box steps were taken with all recommended precautions and successful outcome achieved.
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Affiliation(s)
- Saibal Mukhopadhyay
- Department of cardiology, G.B. Pant institute of postgraduate medical education and research, 1- JLN Marg, 64 Khamba, Raj Ghat, New Delhi, Delhi - 110002, India
| | - Vishal Batra
- Department of cardiology, G.B. Pant institute of postgraduate medical education and research, 1- JLN Marg, 64 Khamba, Raj Ghat, New Delhi, Delhi - 110002, India
| | - Jamal Yusuf
- Department of cardiology, G.B. Pant institute of postgraduate medical education and research, 1- JLN Marg, 64 Khamba, Raj Ghat, New Delhi, Delhi - 110002, India
| | - Sravan Kumar
- Department of cardiology, G.B. Pant institute of postgraduate medical education and research, 1- JLN Marg, 64 Khamba, Raj Ghat, New Delhi, Delhi - 110002, India
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Liang B, Gu N. Evaluation of the Safety and Efficacy of Coronary Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Stenoses: Evidence From the Serial Disrupt CAD Trials. Front Cardiovasc Med 2021; 8:724481. [PMID: 34490380 PMCID: PMC8416910 DOI: 10.3389/fcvm.2021.724481] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/19/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Previous understanding holds that rotational atherectomy and modified balloons remain the default strategy for severely calcified coronary stenoses. In recent years, coronary intravascular lithotripsy (IVL) provides new ideas. This study was conducted to evaluate the safety and efficacy of IVL for the treatment of severely calcified coronary stenoses. Methods: The serial Disrupt CAD trials (Disrupt CAD I, Disrupt CAD II, Disrupt CAD III, and Disrupt CAD IV) were included in this study. The safety endpoint was freedom from major adverse cardiovascular events (MACE) in hospital, at 30 days, and at 6 months following the index procedure. The efficacy endpoints included procedural success and angiographic success. Optical coherence tomography (OCT) was used to evaluate the mechanism of action of IVL quantifying the coronary artery calcification (CAC) characteristics and calcium plaque fracture. Results: We enrolled a total of 628 patients with a mean age of 71.8 years, 77.1% males. In these patients, the left anterior descending artery and right coronary artery were the most vulnerable vessels. The diameter stenosis was 64.6 ± 11.6% and the lesion length was 24.2 ± 11.4 mm. IVL had a favorable efficacy (93.0% procedural success, 97.5% angiographic success, and 100.0% stent delivery). Among the 628 patients, 568, 568, and 60 reported MACE endpoints in hospital, at 30 days, and at 6 months, respectively. The results showed that 528, 514, and 55 patients were free from MACE in hospital, at 30 days, and at 6 months, respectively. OCT measurements demonstrated that calcium fracture was the underlying mechanism of action for coronary IVL. Conclusions: IVL is safe and efficient for severely calcified coronary stenoses, and, importantly, calcium fracture facilitated increased vessel compliance and favorable stent expansion.
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Affiliation(s)
- Bo Liang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Ning Gu
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
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73
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Hicks CW, Holscher CM, Wang P, Dun C, Abularrage CJ, Black JH, Hodgson KJ, Makary MA. Use of Atherectomy During Index Peripheral Vascular Interventions. JACC Cardiovasc Interv 2021; 14:678-688. [PMID: 33736774 DOI: 10.1016/j.jcin.2021.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/11/2020] [Accepted: 01/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to describe physician practice patterns and examine physician-level factors associated with the use of atherectomy during index revascularization for patients with femoropopliteal peripheral artery disease. BACKGROUND There are minimal data to support the routine use of atherectomy over angioplasty and/or stenting for the endovascular treatment of peripheral artery disease. METHODS Medicare fee-for-service claims (January 1 to December 31, 2019) were used to identify all beneficiaries undergoing elective first-time femoropopliteal peripheral vascular intervention (PVI) for claudication or chronic limb-threatening ischemia. Hierarchical logistic regression was used to evaluate patient- and physician-level characteristics associated with atherectomy. RESULTS A total of 58,552 patients underwent index femoropopliteal PVI by 1,627 physicians. There was a wide distribution of physician practice patterns in the use of atherectomy, ranging from 0% to 100% (median 55.1%). Independent characteristics associated with atherectomy included treatment for claudication (vs. chronic limb-threatening ischemia; odds ratio [OR]: 1.51), patient diabetes (OR: 1.09), physician male sex (OR: 2.08), less time in practice (OR: 1.41 to 2.72), nonvascular surgery specialties (OR: 2.78 to 5.71), physicians with high volumes of femoropopliteal PVI (OR: 1.67 to 3.51), and physicians working primarily at ambulatory surgery centers or office-based laboratories (OR: 2.19 to 7.97) (p ≤ 0.03 for all). Overall, $266.8 million was reimbursed by Medicare for index femoropopliteal PVI in 2019. Of this, $240.6 million (90.2%) was reimbursed for atherectomy, which constituted 53.8% of cases. CONCLUSIONS There is a wide distribution of physician practice patterns for the use of atherectomy during index PVI. There is a critical need for professional guidelines outlining the appropriate use of atherectomy in order to prevent overutilization of this technology, particularly in high-reimbursement settings.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peiqi Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kim J Hodgson
- Department of Vascular Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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74
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Gao W, Chen Y, Yang H, Yao K, Ge J. Outcomes of rotational atherectomy for severely calcified coronary lesions: A single center 5-year experience. Catheter Cardiovasc Interv 2021; 98:E254-E261. [PMID: 33964182 DOI: 10.1002/ccd.29740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the influences of accumulated experience on rotational atherectomy (RA) operation regarding to in-hospital outcomes in the drug-eluting stent (DES) era. METHODS Between 2015 and 2019, 540 de novo lesions with calcified coronary lesions treated by RA and DES implantation at our center were retrospectively assessed. In-hospital major adverse cardiac events (MACE) were defined as all cause death, cardiac death, target vessel revascularization, and stroke. RESULTS From 2015 to 2019, RA operations were 22, 60, 102, 157, and 199 cases, respectively. Rates of procedural complications were 4.5, 3.3, 11.8, 8.3, and 7.5%, respectively. Rates of in-hospital MACE were 0, 0, 3.9, 2.5, and 2.0%, respectively. Compared with planned RA, bailout RA was associated with more contrast use (207.5 ± 82.8 ml vs. 189.2 ± 70.0 ml, p = .008). As for procedural complications and in-hospital outcomes, no differences were observed between two strategies. Logistic regression revealed that hypertension was independently associated with complications (OR 5.830, 95% CI 1.382-24.591, p = .016). For MACE, independent risk factors were heart failure (OR 17.593, 95% CI 1.475-209.816, p = .023) and procedural complications (OR 127.629, 95% CI 15.135-1,076.258, p < .001). CONCLUSIONS Along with the rapid increase of RA use and accumulated experience, rates of complications and MACE went up first and then dropped down. Hypertension was found to be an independent risk factor of procedural complications. For in-hospital MACE, independent risk factors were heart failure and procedural complications.
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Affiliation(s)
- Wei Gao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Yaolin Chen
- Department of Cardiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, Fujian Province, China
| | - Hongbo Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Kang Yao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
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Han F, Zheng H, Zheng X, Jin H, Wang Z, Zeng H, Qiu C, Liu J, Zhu Y. [Efficacy of intravascular ultrasound-guided rotational atherectomy combined with cutting balloon for pretreatment of severe coronary artery calcified lesions]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1044-1049. [PMID: 34308854 DOI: 10.12122/j.issn.1673-4254.2021.07.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of intravascular ultrasound (IVUS)-guided rotational atherectomy (RA) combined with cutting balloon for pretreatment of severe calcified lesions in the coronary artery before stent placement. METHODS A total of 120 patients with severe coronary artery calcifications detected by IVUS that required percutaneous coronary intervention (PCI) were recruited from our hospital between January, 2016 to January, 2019. The patients were randomized into two groups for pretreatment of the lesions with semicompliant balloon (SB group, 60 cases) or RA combined with CB (RA+CB group, 60 cases), and drug-eluting stents were implanted after the procedure. The immediate success rate of PCI, vascular parameters detected by IVUS after PCI, and the rates of residual stenosis < 10% were compared between the two groups. The incidences of intraoperative complications and major adverse cardiac events (MACE) within 24 months after the surgery were also observed in the two groups. RESULTS The immediate success rate was significantly higher in RA+CB group than in SB group (P=0.032). After pretreatment and stent placement, the minimum stent lumen diameter (P=0.035), minimum stent lumen cross-sectional area (P=0.029), immediate lumen acquisition, immediate lumen cross-sectional area acquisition and the rate of residual stenosis < 10% were all significantly higher in RA+CB group than in SB group (P < 0.001). The patients in RA+ CB group showed obviously less residual stenosis of lumen cross-sectional area than those in SB group after the surgery (χ2= 7.859, P=0.005). The incidences of intraoperative complications (χ2=5.997, P=0.014) and MACE within 24 months after the operation (χ2=4.285, P=0.038) were significantly lower in RA+CB group than in SB group. CONCLUSION For patients with severe coronary artery calcifications eligible for PCI, RA combined with CB angioplasty can significantly improve the success rate of immediate PCI, expand the lumen diameter and cross-sectional area of the stent after PCI, enhance immediate lumen gain, and reduce the incidence of intraoperative complications and MACE after the operation.
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Affiliation(s)
- F Han
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - H Zheng
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - X Zheng
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - H Jin
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - Z Wang
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - H Zeng
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - C Qiu
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - J Liu
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - Y Zhu
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
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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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Beohar N, Chen S, Lembo NJ, Banning AP, Serruys PW, Leon MB, Morice MC, Généreux P, Kandzari DE, Kappetein AP, Sabik JF, Dressler O, McAndrew T, Zhang Z, Stone GW. Impact of lesion preparation strategies on outcomes of left main PCI: The EXCEL trial. Catheter Cardiovasc Interv 2021; 98:24-32. [PMID: 32592450 DOI: 10.1002/ccd.29116] [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: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We examined outcomes according to lesion preparation strategy (LPS) in patients with left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in the EXCEL trial. BACKGROUND The optimal LPS for LMCA PCI is unclear. METHODS We categorized LPS hierarchically (high to low) as: (a) rotational atherectomy (RA); (b) cutting or scoring balloon (CSB); (c) balloon angioplasty (BAL); and d) direct stenting (DIR). The primary endpoint was 3-year MACE; all-cause death, stroke, or myocardial infarction. RESULTS Among 938 patients undergoing LMCA PCI, RA was performed in 6.0%, CSB 9.5%, BAL 71.3%, and DIR 13.2%. In patients treated with DIR, BAL, CSB, and RA, respectively, there was a progressive increase in SYNTAX score, LMCA complex bifurcation, trifurcation or calcification, number of stents, and total stent length. Any procedural complication occurred in 10.4% of cases overall, with the lowest rate in the DIR (7.4%) and highest in the RA group (16.1%) (ptrend = .22). There were no significant differences in the 3-year rates of MACE (from RA to DIR: 17.9%, 20.2%, 14.5%, 14.7%; p = .50) or ischemia-driven revascularization (from RA to DIR: 16.8%, 10.8%, 12.3%, 14.2%; p = .65). The adjusted 3-year rates of MACE did not differ according to LPS. CONCLUSIONS The comparable 3-year outcomes suggest that appropriate lesion preparation may be able to overcome the increased risks of complex LMCA lesion morphology.
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Affiliation(s)
- Nirat Beohar
- Columbia University Division of Cardiology at the Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Nicholas J Lembo
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | | | - Patrick W Serruys
- Department of Cardiology, NUIG, National University of Ireland, Galway, Ireland.,Imperial College of Science Technology and Medicine, London, UK
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Marie-Claude Morice
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Paris, France
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.,Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | | | | | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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78
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Optical coherence tomography-versus intravascular ultrasound-guided stent expansion in calcified lesions. Cardiovasc Interv Ther 2021; 37:312-323. [PMID: 34097228 DOI: 10.1007/s12928-021-00790-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
Optical coherence tomography (OCT) has a higher resolution than intravascular ultrasound (IVUS) and enables a more precise evaluation of calcium severity. We investigated the impact of the imaging method (OCT versus IVUS) on stent expansion during intravascular imaging-guided percutaneous coronary intervention (PCI) in calcified lesions. In this single-center, retrospective, observational study, 145 lesions with moderate to severe calcification were divided into four groups: 40 IVUS-guided rotational atherectomy (RA), 38 IVUS-guided non-RA, 35 OCT-guided RA, and 32 OCT-guided non-RA. Lesions without pre-procedural intravascular imaging were excluded. OCT-guided RA was associated with greater stent expansion at the target calcium compared with IVUS-guided RA (median 88.0%, interquartile range [78.0-96.0] vs. 76.5% [71.0-84.3], P = 0.008). Furthermore, stent expansion in OCT-guided non-RA was similar to OCT-guided RA. OCT-guided RA used a larger burr compared to IVUS-guided RA (1.75 mm [1.50-2.0] vs. 1.50 mm [1.50-1.75], P = 0.004). In OCT-guided RA, the median minimum calcium thickness was significantly reduced from 800 (640-980) µm to 550 (350-680) µm (P < 0.001). There was no significant difference in the incidence of ischemia driven target lesion revascularization between the four groups (P = 0.37). By determining the indication and endpoint of lesion modification by RA based on the thickness of calcium, OCT-guided PCI was associated with significantly greater stent expansion compared with IVUS-guided PCI.
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79
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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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Affiliation(s)
- Nileshkumar J Patel
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Naotaka Okamoto
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Jonathan Murphy
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Yuliya Vengrenyuk
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
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McDonald CP, Hui DS. Commentary: Cath lab 911. JTCVS Tech 2021; 7:159-160. [PMID: 34318235 PMCID: PMC8312115 DOI: 10.1016/j.xjtc.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Connor P. McDonald
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Dawn S. Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
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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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Kassimis G, Ziakas A, Didagelos M, Theodoropoulos KC, Hadjimiltiades S. How Should I Get Prepared for and Treat Rota Burr Entrapment in a Focally Underexpanded and Restenosed Stent: A Case Report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:197-200. [PMID: 34031007 DOI: 10.1016/j.carrev.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Although high-speed rotational atherectomy has been successfully used in selected cases of stent underexpansion secondary to heavy peri-stent calcification, a higher risk of burr entrapment demands extreme caution and surgical back-up on site. The main cause of this complication is the lack of diamond dust on the back end of the burr, which prevents backward ablation of tissues when retracted. To date, only few reports of successful burr retrieval using percutaneous bailout techniques have been published. We report a case of burr entrapment within a previously implanted left circumflex artery stent which was successfully recaptured using the dual catheter technique; following the retrieval the patient underwent routine percutaneous coronary intervention.
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Affiliation(s)
- George Kassimis
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Antonios Ziakas
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos C Theodoropoulos
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Hadjimiltiades
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tomasiewicz B, Kubler P, Zimoch W, Kosowski M, Wańha W, Ładziński S, Rakotoarison O, Ochała A, Wojakowski W, Reczuch K. Acute Angulation and Sequential Lesion Increase the Risk of Rotational Atherectomy Failure. Circ J 2021; 85:867-876. [PMID: 33883385 DOI: 10.1253/circj.cj-20-1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the study was to assess anatomical and procedural predictors of clinical and procedural failure of rotational atherectomy (RA) in an all-comers population. METHODS AND RESULTS A total of 534 consecutive patients who underwent RA were included in a double-center observational study. The primary composite endpoint consisted of: rota-wire introduction failure, burr-passage failure, periprocedural complications and procedure-related major adverse events. The second primary endpoint included rota-wire introduction failure and burr-passage failure. The primary endpoint occurred in 76 (14.2%) patients and the second primary endpoint occurred in 64 (12%) Periprocedural complications occurred in 23 (4.3%) and procedure-related adverse events in 23 (4.3%) patients. Multivariable analysis revealed angulation on lesion ≤90° (HR=2.18, 95% CI: 1.21-3.94, P=0.0096) and sequential lesion (HR=1.89, 95% CI: 1.01-3.54, P=0.046) as independent predictors of no clinical success of RA. Multivariable analysis revealed again that angulation on lesion ≤90° (HR=2.26, 95% CI: 1.16-4.40, P=0.02) and sequential lesion (HR=3.77, 95% CI: 1.64-8.69, P<0.01) as independent predictors of no procedural success of RA. CONCLUSIONS The presence of an acute angulation on lesion and sequential lesion are independent determinants of clinical and procedural failure of RA. Further research is necessary to establish a score predicting RA failure, which can help in preproceduralrisk stratification of patients undergoing complex percutaneous coronary intervention with RA.
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Affiliation(s)
- Brunon Tomasiewicz
- Department of Heart Diseases, Wroclaw Medical University
- Centre for Heart Diseases, University Hospital
| | - Piotr Kubler
- Department of Heart Diseases, Wroclaw Medical University
- Centre for Heart Diseases, University Hospital
| | - Wojciech Zimoch
- Department of Heart Diseases, Wroclaw Medical University
- Centre for Heart Diseases, University Hospital
| | - Michał Kosowski
- Department of Heart Diseases, Wroclaw Medical University
- Centre for Heart Diseases, University Hospital
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Szymon Ładziński
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Oscar Rakotoarison
- Department of Heart Diseases, Wroclaw Medical University
- Centre for Heart Diseases, University Hospital
| | - Andrzej Ochała
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Krzysztof Reczuch
- Department of Heart Diseases, Wroclaw Medical University
- Centre for Heart Diseases, University Hospital
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84
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Islami ZH, Bagaswoto HP, Taufiq N, Setianto BY. Rotational Atherectomy in Sub-Acute Anterior STEMI with Cardiogenic Shock. Int Med Case Rep J 2021; 14:289-293. [PMID: 34007220 PMCID: PMC8123955 DOI: 10.2147/imcrj.s295649] [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: 12/24/2020] [Accepted: 03/25/2021] [Indexed: 11/29/2022] Open
Abstract
Rotational atherectomy (RA) is a proven technique to modify a heavily calcified coronary lesion if balloon angioplasty failed. RA is frequently avoided in ST-elevation myocardial infarction (STEMI) as it may increase the risk of slow or no-reflow. It is also considered to be relatively contraindicated in lesions with a visible thrombus, by its manufacturer. Regardless, RA may be a life-saving procedure in cases where no other percutaneous coronary intervention (PCI) technique is available to modify the lesion adequately. This case reports successful use of RA to facilitate dilation and stent delivery of a previously non-dilatable lesion in a patient with sub-acute anterior STEMI complicated by cardiogenic shock.
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Affiliation(s)
- Zaki Horizon Islami
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Hendry Purnasidha Bagaswoto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Nahar Taufiq
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Budi Yuli Setianto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta, Indonesia
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85
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Malik FTN, Kalimuddin M, Ahmed N, Badiuzzaman M, Khan AK, Dutta A, Huq TS, Banik D, Ahmed MN, Rahman MH, Iqbal MAT. Safety and effectiveness of percutaneous coronary intervention using rotational atherectomy and new-generation drug-eluting stents for calcified coronary artery lesions in patients with chronic kidney disease. Indian Heart J 2021; 73:342-346. [PMID: 34154753 PMCID: PMC8322809 DOI: 10.1016/j.ihj.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/19/2021] [Accepted: 04/24/2021] [Indexed: 11/29/2022] Open
Abstract
AIM Coronary artery calcification is an important factor influencing revascularisation outcomes in patients with chronic kidney disease (CKD). Lesion preparation using rotational atherectomy (RA) may help adequately modify calcified plaques and facilitate the achievement of optimal clinical outcomes in these patients. In this study, we assessed the safety and effectiveness of percutaneous coronary intervention (PCI) using RA followed by new-generation drug-eluting stent (DES) implantation in patients with CKD and calcified coronary artery disease (CAD). METHODS AND RESULTS From November 2014 to October 2019, a total of 203 patients with calcified CAD who underwent RA followed by second- or third-generation DES implantation at our centre were included in the study. Mild, moderate, and severe CKD was present in 38%, 55.5%, and 6.5% of the patients, respectively. Diffused coronary calcifications were present in 85%. Procedural success was 97.5% with minimal periprocedural complications. In-stent restenosis occurred in one patient (0.5%); major adverse cardiovascular and cerebrovascular events were reported in 22 patients (10.8%); cardiac death occurred in eight patients during follow-up. CONCLUSION Percutaneous coronary intervention using RA followed by second- or third-generation DES implantation is feasible and safe with high procedural success and low in-stent restenosis in CKD patients with calcified coronary lesions.
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Affiliation(s)
- Fazila-Tun-Nesa Malik
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh.
| | - Md Kalimuddin
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh
| | - Nazir Ahmed
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh
| | - Mohammad Badiuzzaman
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh
| | - Abdul Kayum Khan
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh
| | - Ashok Dutta
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh
| | - Tawfiq Shahriar Huq
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh
| | - Dhiman Banik
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh
| | - Mir Nesaruddin Ahmed
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh
| | - Md Habibur Rahman
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh
| | - Md Abu Tareq Iqbal
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Bangladesh
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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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Cui K, Liu H, Yuan F, Xu F, Zhang M, Zhang M, Wang W, Zhang D, Tian J, Lyu S, Dou K. Coronary artery bypass graft surgery versus stenting for patients with chronic kidney disease and complex coronary artery disease: a systematic review and meta-analysis. Ther Adv Chronic Dis 2021; 12:2040622321990273. [PMID: 35154627 PMCID: PMC8832329 DOI: 10.1177/2040622321990273] [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: 04/16/2020] [Accepted: 01/05/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The relative role of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stent implantation in patients with chronic kidney disease (CKD) and complex coronary artery disease (CAD) remains debatable due to the lack of randomized controlled trials (RCTs). We therefore performed this meta-analysis to compare the outcomes of the two strategies in CKD patients with multivessel and/or left main disease. METHODS Electronic databases including PubMed, EMBASE and Cochrane Library were comprehensively searched to identify the eligible subgroup analysis of RCTs and propensity-matched registries. The primary endpoint was all-cause mortality during the longest follow-up. RESULTS Five subgroup analyses of RCTs and six propensity-matched registries involving 26,441 patients were analyzed. Overall, the strategy of CABG was associated with lower risks of long-term mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.74-0.93], myocardial infarction (OR, 0.41; 95% CI, 0.27-0.62), and repeat revascularization (OR, 0.25; 95% CI, 0.16-0.39) compared with PCI in CKD patients with complex CAD. However, CABG was slightly associated with higher risk of stroke than PCI (OR, 1.33; 95% CI, 1.00-1.77). Nonetheless, the higher stroke risk in the CABG group no longer existed during long-term follow-up (OR, 0.92; 95% CI, 0.37-2.25) (>3 years). CONCLUSION This meta-analysis supports the current guideline advising CABG for patients with CKD and complex CAD. At the expense of slightly increased risk of stroke, CABG reduces the incidences of long-term all-cause death, myocardial infarction and repeat revascularization compared with PCI.
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Affiliation(s)
- Kongyong Cui
- Department of Cardiology, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, China
| | - Hong Liu
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University and Beijing Institute of Heart, Lung
and Blood Vessel Diseases, Beijing, China
| | - Fei Yuan
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University and Beijing Institute of Heart, Lung
and Blood Vessel Diseases, Beijing, China
| | - Feng Xu
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University and Beijing Institute of Heart, Lung
and Blood Vessel Diseases, Beijing, China
| | - Min Zhang
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University and Beijing Institute of Heart, Lung
and Blood Vessel Diseases, Beijing, China
| | - Mingduo Zhang
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University and Beijing Institute of Heart, Lung
and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University and Beijing Institute of Heart, Lung
and Blood Vessel Diseases, Beijing, China
| | - Dongfeng Zhang
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University and Beijing Institute of Heart, Lung
and Blood Vessel Diseases, Beijing, China
| | - Jinfan Tian
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University and Beijing Institute of Heart, Lung
and Blood Vessel Diseases, Beijing, China
| | - Shuzheng Lyu
- Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University and Beijing Institute of Heart, Lung
and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029,
China
| | - Kefei Dou
- Department of Cardiology, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng
District, Beijing 100037, China
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88
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Megaly M, Brilakis ES, Sedhom R, Tawadros M, Elbadawi A, Mentias A, Alaswad K, Kirtane AJ, Garcia S, Pershad A. Outcomes with Orbital and Rotational Atherectomy for Inpatient Percutaneous Coronary Intervention. Cardiol Ther 2021; 10:229-239. [PMID: 33710602 PMCID: PMC8126522 DOI: 10.1007/s40119-021-00214-w] [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: 12/15/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Our objective was to describe the contemporary outcomes of orbital atherectomy (OA) vs. rotational atherectomy (RA) use for inpatient percutaneous coronary intervention (PCI) in the United States. Data on the use of OA vs. RA in contemporary inpatient PCI are limited. METHODS We queried the Nationwide Readmission Database (NRD) from January to November for the years 2016-2017 to identify hospitalizations of patients who underwent PCI with atherectomy. We conducted a multivariate regression analysis to identify variables associated with in-hospital mortality. RESULTS We included 77,040 records of patients who underwent inpatient PCI with atherectomy. Of those, 71,610 (93%) had RA, and 5430 (7%) had OA. There was no significant change in the trend of using OA or RA over 2016 and 2017. OA was less utilized in patients presenting with ST-segment elevation myocardial infarction (STEMI) (4.3% vs. 46.8%, p < 0.001). In our cohort, OA was associated with lower in-hospital mortality (3.1% vs. 5%, p < 0.001) and 30-day urgent readmission (< 0.01% vs. 0.2%, p = 0.009), but a higher risk of coronary perforation (1.7% vs. 0.6%, p < 0.001) and cardiac tamponade (1% vs. 0.3%, p < 0.001) and a higher cost of index hospitalization ($28,199 vs. $23,188, p < 0.001) compared with RA. CONCLUSION RA remains the predominant atherectomy modality for inpatient PCI in the United States (93%). There was no change in the trend of use for either modality over the years 2016 and 2017. OA was noted to have a lower incidence of in-hospital death, but a higher risk of coronary perforation and a higher cost of index hospitalization for the overall unmatched cohorts.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Banner University Medical Center, UA College of Medicine, Phoenix, AZ, USA
| | - E S Brilakis
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ramy Sedhom
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | | | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Amgad Mentias
- Division of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ajay J Kirtane
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA.,Division of Cardiology, Columbia University Irving Medical Center/New York Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, NY, USA
| | - Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, UA College of Medicine, Phoenix, AZ, USA.
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Optical coherence tomography-guided percutaneous coronary intervention: a review of current clinical applications. Cardiovasc Interv Ther 2021; 36:169-177. [PMID: 33454867 DOI: 10.1007/s12928-020-00745-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/28/2022]
Abstract
Optical coherence tomography (OCT) is an emerging high-resolution intravascular imaging modality that can provide physicians with critical information, thereby enabling precise characterization of plaque morphology and luminal geometry and facilitating pre-intervention lesion assessment. As OCT has a higher sensitivity for lipid-rich plaque characterization than intravascular ultrasound, vulnerable plaque detection by OCT has thus been investigated. By evaluating both the calcium thickness and arc, OCT can be the ideal method for determining both the indication and endpoint of rotational atherectomy for calcified lesions prior to stent implantation. OCT has become applicable for the optimization of stent implantation with immediate and semi-automatic quantification of stent apposition and expansion to achieve potentially better clinical outcomes. In bifurcation lesions, OCT allows the visualization of the stent-link location overhanging the side-branch ostium and the guidewire recrossing point prior to the final kissing balloon inflation through three-dimensional reconstructed OCT images, providing us with deep insights into the mechanical optimization of stent struts. Furthermore, recent studies have reported several OCT-derived predictors of adverse clinical events. Important limitations of OCT, including the excessive contrast volume needed and observation of aorto-ostial lesions, may partially be overcome through the use of low-molecular-weight dextran and a guide extension catheter. The clinical applications of OCT have been expanding, and evidence on its clinical utility has been accumulating.
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90
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Yasumura K, Ueyama H, Jeffrey S, Vengrenyuk Y, Barman N, Suleman J, Kini AS, Sharma SK. Rotational atherectomy for the management of undilatable in-stent restenosis with single or multiple stent layers. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:32-37. [PMID: 33514489 DOI: 10.1016/j.carrev.2021.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is no consensus on the best treatment of undilatable coronary in-stent restenosis (ISR) regardless of the number of stent layers. We aimed to evaluate the procedural and clinical outcomes of rotational atherectomy (RA) to treat undilatable coronary ISR with single or multiple stent layers. METHODS We retrospectively evaluated consecutive patients treated with RA for undilatable ISR with single or multiple stent layers in the Mount Sinai catheterization laboratory between January 2016 and September 2018. Procedural success was defined as angiographic success without in-hospital major adverse cardiac events (MACE): a composite of death, myocardial infarction (MI), and target lesion revascularization (TLR). Clinical outcomes were assessed at one-year post-procedure. RESULTS A total of 26 patients were included in the study, in which 18 (69.2%) patients were with multiple stent layers. After RA, 9 (34.6%) were received a new drug-eluting stent, and 6 (23.1%) were treated with intravascular brachytherapy. Angiographic success was achieved in 24 (92.3%) patients, and procedural success was achieved in 22 (84.6%) patients. In-hospital MACE occurred in 4 (15.4%) patients, all due to periprocedural non-Q wave MI. Within one year, MACE occurred in 9 (34.6%) patients with 5 (19.2%) TLR. CONCLUSIONS RA for undilatable ISR with single or multiple stent layers was performed with favorable procedural outcomes and a relatively high MACE rate driven by TLR within one year.
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Affiliation(s)
- Keisuke Yasumura
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Hiroki Ueyama
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Selan Jeffrey
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Yuliya Vengrenyuk
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Nitin Barman
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Javed Suleman
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA.
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Hemetsberger R, Toelg R, Mankerious N, Allali A, Traboulsi H, Sulimov DS, El-Mawardy M, Byrne RA, Robinson DR, Kastrati A, Abdel-Wahab M, Richardt G. Impact of calcified lesion complexity on the success of percutaneous coronary intervention with upfront high-speed rotational atherectomy or modified balloons - A subgroup-analysis from the randomized PREPARE-CALC trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 33:26-31. [PMID: 33451925 DOI: 10.1016/j.carrev.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE In the randomized PREPARE-CALC trial, lesion preparation of calcified lesions with upfront rotational atherectomy (RA) prior to drug-eluting stent (DES) implantation resulted in higher acute success as compared to a provisional modified balloon (MB) strategy. We aimed to investigate the impact of calcified lesion complexity on the treatment effect with either MB or RA. METHODS/MATERIALS Two hundred patients were randomized to lesion preparation with either MB or RA. The study population was stratified according to lesion complexity into at least one type-C lesion or into exclusively non-type-C lesions. Endpoints were strategy success, need for bail-out RA, acute lumen gain, and late lumen loss (LLL) at 9 months. RESULTS In total, 143 patients were graded as type-C (45% patients were allocated to MB), whereas 57 patients were graded as non-type-C (61% patients were allocated to MB). In patients with at least one type-C lesion, strategy success with RA was higher than with MB (97% vs 72%, p < 0.001), but superiority of RA was not observed in patients with non-type-C lesions (100% vs 97%, p = 1.00; pinteraction = 0.001). The need for bail-out RA was higher in patients with type-C lesions (n = 15) as compared with non-type-C lesions (n = 1). Acute lumen gain, LLL, and target lesion revascularization at 9 months were not dependent on lesion complexity and upfront lesion preparation strategy. CONCLUSIONS In patients with calcified non-type-C lesions, the treatment strategy with RA or MB before DES implantation results in comparable success rates, whereas in type-C lesions upfront RA appears to be the superior upfront strategy.
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Affiliation(s)
| | - Ralph Toelg
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Nader Mankerious
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Hussain Traboulsi
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | | | - Robert A Byrne
- Cardiovascular Research Institute (CVRI) Dublin, Mater Private Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Derek R Robinson
- Department of Mathematics, University of Sussex, Brighton, United Kingdom
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | | | - Gert Richardt
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
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Utility of the SYNTAX Score in the risk stratification
of patients undergoing rotational atherectomy. Arch Med Sci Atheroscler Dis 2020; 5:e313-e319. [PMID: 34820544 PMCID: PMC8609370 DOI: 10.5114/amsad.2020.103373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction The SYNTAX Score (SS) evaluates the angiographic complexity of coronary artery disease to assess the cardiovascular risk after coronary revascularization. The aim of the study was to evaluate whether SS results are associated with in-hospital and 1-year outcomes of patients undergoing percutaneous coronary intervention (PCI) requiring rotational atherectomy (RA). Material and methods We analyzed data of 207 consecutive patients who underwent PCI with RA. Patients were divided into two groups: those with high SS (> 33 points) and those with low/intermediate SS (0–33 points). Results In 21 (10%) patients SS was high and 186 (90%) patients had low/intermediate SS. Patients with high SS were older (76 vs. 71 years, p = 0.008) and more frequently diagnosed with chronic kidney disease (38% vs. 18%, p = 0.03) and heart failure (71% vs. 30%, p = 0.0001). In patients with high SS the RA procedure was longer (p = 0.004), required more contrast (p = 0.005) and higher radiation doses (p = 0.04), and contrast-induced nephropathy was more frequent (14% vs. 2%, p = 0.001). Conclusions In our RA patients there was no significant difference between the frequency of in-hospital and 1-year adverse cardiovascular events depending on the SS result. High SS correlates only with parameters describing the extensity and technical complexity of the procedure. However, the unavailability of other risk assessment tools in this population raises the need to create a new more specific risk score for patients requiring RA.
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93
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Cubero-Gallego H, Millán R, Fuertes M, Amat-Santos I, Quiroga X, Gómez-Lara J, Salvatella N, Tizón-Marcos H, Negrete A, Santos-Martínez S, Mohandes M, Gómez-Hospital JA, Morís C, Vaquerizo B. Litoplastia coronaria en lesiones calcificadas: registro multicéntrico de la práctica clínica. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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94
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Rotational Atherectomy: Coming in Clutch at Desperate Times? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 22:42-43. [PMID: 33183983 DOI: 10.1016/j.carrev.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022]
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95
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Impact of Lesion Preparation Technique on Side Branch Compromise in Calcified Coronary Bifurcations: A Subgroup Analysis of the PREPARE-CALC Trial. J Interv Cardiol 2020; 2020:9740938. [PMID: 33223974 PMCID: PMC7673940 DOI: 10.1155/2020/9740938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/15/2020] [Accepted: 10/24/2020] [Indexed: 01/16/2023] Open
Abstract
Objectives To analyze the impact of different techniques of lesion preparation of severely calcified coronary bifurcation lesions. Background The impact of different techniques of lesion preparation of severely calcified coronary bifurcation lesions is poorly investigated. Methods We performed an as-treated analysis on 47 calcified bifurcation lesions treated with scoring/cutting balloons (SCB) and 68 lesions treated with rotational atherectomy (RA) in the PREPARE-CALC trial. Compromised side branch (SB) as assessed in the final angiogram was the primary outcome measure and was defined as any significant stenosis, dissection, or thrombolysis in myocardial infarction flow <3. Results True bifurcation lesions were present in 49% vs. 43% of cases in the SCB and RA groups, respectively. After stent implantation, SB balloon dilatation was necessary in around one-third of cases (36% vs. 38%; p = 0.82), and a two-stent technique was performed in 21.3% vs. 25% (p = 0.75). At the end of the procedure, the SB remained compromised in 15 lesions (32%) in the SCB group and 5 lesions (7%) in the RA group (p = 0.001). Large coronary dissections were more frequently observed in the SCB group (13% vs. 2%; p = 0.02). Postprocedural levels of cardiac biomarkers were significantly higher in patients with a compromised SB at the end of the procedure. Conclusions In the PREPARE-CALC trial, side branch compromise was more frequently observed after lesion preparation with SCB as compared with RA. Consequently, in calcified bifurcation lesions, an upfront debulking with an RA-based strategy might optimize the result in the side branch.
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96
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Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics. Cardiovasc Interv Ther 2020; 36:1-18. [PMID: 33079355 PMCID: PMC7829233 DOI: 10.1007/s12928-020-00715-w] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/15/2020] [Indexed: 12/12/2022]
Abstract
Rotational atherectomy (RA) has been widely used for percutaneous coronary intervention (PCI) to severely calcified lesions. As compared to other countries, RA in Japan has uniquely developed with the aid of greater usage of intravascular imaging devices such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). IVUS has been used to understand the guidewire bias and to decide appropriate burr sizes during RA, whereas OCT can also provide the thickness of calcification. Owing to such abundant experiences, Japanese RA operators modified RA techniques and reported unique evidences regarding RA. The Task Force on Rotational Atherectomy of the J apanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document to summarize the contemporary techniques and evidences regarding RA.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Interventional Cardiology, Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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97
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Kini AS, Okamoto N, Barman N, Vengrenyuk Y, Yasumura K, Chamaria S, Bhatheja S, Kapur V, Hasan C, Sweeny J, Baber U, Mehran R, Stone GW, Sharma S. Side branch fractional flow reserve after provisional stenting of calcified bifurcation lesions: The ORBID-FFR study. Catheter Cardiovasc Interv 2020; 98:658-668. [PMID: 33034419 DOI: 10.1002/ccd.29307] [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: 04/24/2020] [Accepted: 09/23/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We examined the incidence of side branch (SB) compromise after provisional stenting of calcified bifurcation lesions treated with rotational atherectomy (RA) or cutting balloon angioplasty (CBA) and the utility of optical coherence tomography (OCT) to detect functionally significant SB stenoses. BACKGROUND The comparative impact of RA versus CBA on SB compromise and functional significance remains poorly characterized. METHODS Seventy-one consecutive patients with 71 calcified bifurcation lesions with angiographically intermediate SB stenoses were randomized to RA (n = 35) or CBA (n = 36). The primary endpoint was SB compromise defined as SB diameter stenosis ≥70%, SB dissection or thrombolysis in myocardial infarction flow grade < 3 after provisional stenting. Secondary endpoints included SB FFR in noncompromised SBs and its correlation with SB ostium area (SBOA) assessed by three-dimensional OCT. RESULTS SB compromise after provisional stenting was observed in 7 (20.0%) lesions that underwent RA and in 9 (25.0%) lesions treated with CBA (p = .62). Mean SB FFR was 0.83 ± 0.08 and was similar between the study arms. Functionally significant SB stenosis (FFR ≤ 0.80) was detected in 17(30.9%) angiographically noncompromised SBs. SBOA after stenting was an independent predictor of FFR ≤ 0.80 (OR 0.002, 95% CI: 0.00-0.15, p = .002). The optimal cutoff value for SBOA to predict functionally significant SB stenosis was 0.76 mm2 (sensitivity 82%, specificity 89% and area under the curve 0.92, 95% CI: 0.84-0.99). CONCLUSIONS The rates of SB compromise and functionally significant stenosis after provisional stenting of calcified bifurcation lesions were similar between two lesion preparation strategies. OCT SBOA can detect SB branches with FFR ≤ 0.80 with high sensitivity and specificity.
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Affiliation(s)
- Annapoorna S Kini
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Naotaka Okamoto
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nitin Barman
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yuliya Vengrenyuk
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Keisuke Yasumura
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Surbhi Chamaria
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samit Bhatheja
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vishal Kapur
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Choudhury Hasan
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Sweeny
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregg W Stone
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin Sharma
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
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98
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Liu S, Neleman T, Hartman EMJ, Ligthart JMR, Witberg KT, van der Steen AFW, Wentzel JJ, Daemen J, van Soest G. Automated Quantitative Assessment of Coronary Calcification Using Intravascular Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2801-2809. [PMID: 32636052 DOI: 10.1016/j.ultrasmedbio.2020.04.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/08/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Abstract
Coronary calcification represents a challenge in the treatment of coronary artery disease by stent placement. It negatively affects stent expansion and has been related to future adverse cardiac events. Intravascular ultrasound (IVUS) is known for its high sensitivity in detecting coronary calcification. At present, automated quantification of calcium as detected by IVUS is not available. For this reason, we developed and validated an optimized framework for accurate automated detection and quantification of calcified plaque in coronary atherosclerosis as seen by IVUS. Calcified lesions were detected by training a supported vector classifier per IVUS A-line on manually annotated IVUS images, followed by post-processing using regional information. We applied our framework to 35 IVUS pullbacks from each of the three commonly used IVUS systems. Cross-validation accuracy for each system was >0.9, and the testing accuracy was 0.87, 0.89 and 0.89 for the three systems. Using the detection result, we propose an IVUS calcium score, based on the fraction of calcium-positive A-lines in a pullback segment, to quantify the extent of calcified plaque. The high accuracy of the proposed classifier suggests that it may provide a robust and accurate tool to assess the presence and amount of coronary calcification and, thus, may play a role in image-guided coronary interventions.
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Affiliation(s)
- Shengnan Liu
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tara Neleman
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eline M J Hartman
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jurgen M R Ligthart
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen T Witberg
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antonius F W van der Steen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, The Netherlands; Shenzhen Institutes of Advanced Technologies, Shenzhen, China
| | - Jolanda J Wentzel
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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99
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Taxiarchi P, Martin GP, Curzen N, Kinnaird T, Ludman P, Johnson T, Kwok CS, Rashid M, Kontopantelis E, Mamas MA. Rotational atherectomy and same day discharge: Safety and growth from a national perspective. Catheter Cardiovasc Interv 2020; 98:678-688. [PMID: 32845064 DOI: 10.1002/ccd.29228] [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: 07/10/2020] [Accepted: 08/02/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We explore whether same day discharge (SDD) is a feasible and safe practice following rotational atherectomy (ROTA) treatment during elective percutaneous coronary intervention (PCI), and examine which baseline characteristics are independently associated with SDD. BACKGROUND SDD following elective ROTA PCI is not recommended as per the recent SCAI consensus. However, reports show it is practiced and no previous study has evaluated its safety and feasibility. METHODS Our dataset included 4,591 patients undergoing elective ROTA PCI in England & Wales within an 8-years period. Independent associations with SDD were quantified via a multiple logistic regression model and the BCIS 30-day mortality risk model was used to evaluate the safety of SDD. RESULTS The majority of elective ROTA PCI cases remain at the hospital for overnight (ON) observation, although SDD rates increased substantially from 6.7% in 2007 to 35.5% in 2014. The use of glycoprotein IIb/IIIa antagonists, Q wave AMI, left main PCI and valvular heart disease were independently associated with ON, while patients operated underwent transradial PCI were more likely to be SDD (OR = 1.77, 95% CI [1.45-2.15]). Over the study period, observed mortality rates were not significantly higher than those expected from the BCIS risk model. CONCLUSIONS Our findings did not show superiority of the ON strategy over SDD for higher risk cases undergoing elective ROTA PCI, in terms of 30-day mortality. This is the first study to examine the safety of SDD after elective ROTA PCI and more should follow.
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Affiliation(s)
- Paraskevi Taxiarchi
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Center, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Center, Manchester, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton and Faculty of Medicine, University of Southampton, Southampton, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK.,Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK.,Thomas Jefferson University, Philadelphia, Pennsylvania
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100
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Krishnamoorthy P, Kini A, Sharma SK. Use of Rotational Atherectomy in Patients With LV Systolic Dysfunction "Works Better Where it Matters the Most". CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1228-1229. [PMID: 32736982 DOI: 10.1016/j.carrev.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Parasuram Krishnamoorthy
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA.
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