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Ford TJ, Khan A, Docherty KF, Jackson A, Morrow A, Sidik N, Rocchiccioli P, Good R, Eteiba H, Watkins S, Shaukat A, Lindsay M, Robertson K, Petrie M, Berry C, Oldroyd KG, McEntegart M. Sex differences in procedural and clinical outcomes following rotational atherectomy. Catheter Cardiovasc Interv 2020; 95:232-241. [PMID: 31264314 PMCID: PMC7027486 DOI: 10.1002/ccd.28373] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/16/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022]
Abstract
AIM Evaluate sex differences in procedural net adverse clinical events and long-term outcomes following rotational atherectomy (RA). METHODS AND RESULTS From August 2010 to 2016, 765 consecutive patients undergoing RA PCI were followed up for a median of 4.7 years. 285 (37%) of subjects were female. Women were older (mean 76 years vs. 72 years; p < .001) and had more urgent procedures (64.6 vs. 47.3%; p < .001). Females received fewer radial procedures (75.1 vs. 85.1%; p < .001) and less intravascular imaging guidance (16.8 vs. 25.0%; p = .008). After propensity score adjustment, the primary endpoint of net adverse cardiac events (net adverse clinical events: all-cause death, myocardial infarction, stroke, target vessel revascularization plus any procedural complication) occurred more often in female patients (15.1 vs. 9.0%; adjusted OR 1.81 95% CI 1.04-3.13; p = .037). This was driven by an increased risk of procedural complications rather than procedural major adverse cardiac events (MACE). Specifically, women were more likely to experience coronary dissection (4.6 vs. 1.3%; p = .008), cardiac tamponade (2.1 vs. 0.4%; p = .046) and significant bleeding (BARC ≥2: 5.3 vs. 2.3). Despite this, overall MACE-free survival was similar between males and females (adjusted HR 1.03; 95% CI 0.80-1.34; p = .81). Procedural complications during RA were associated with almost double the incidence of MACE at long-term follow-up (HR 1.92; 95% CI 1.34-2.77; p < .001). CONCLUSION Women may be at greater risk of procedural complications following rotational atherectomy. These include periprocedural bleeding episodes and coronary perforation leading to cardiac tamponade. Despite this, the adjusted overall long-term survival free of major adverse cardiac events was similar between males and females.
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Affiliation(s)
- Thomas J. Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
- Gosford HospitalNSWAustralia
| | - Adnan Khan
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Kieran F. Docherty
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Alice Jackson
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Andrew Morrow
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Novalia Sidik
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Mark Petrie
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Keith G. Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
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Armstrong EJ, Stanislawski MA, Kokkinidis DG, Plomondon ME, Barón AE, Giri J, Shunk KA, Banerjee S, Maddox TM, Waldo SW. Coronary atherectomy is associated with improved procedural and clinical outcomes among patients with calcified coronary lesions: Insights from the VA CART program. Catheter Cardiovasc Interv 2017; 91:1009-1017. [DOI: 10.1002/ccd.27213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/13/2017] [Accepted: 06/25/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Ehrin J. Armstrong
- Division of Cardiology; Denver VA, University of Colorado; Denver Colorado
| | | | | | - Mary E. Plomondon
- Division of Cardiology; Denver VA, University of Colorado; Denver Colorado
| | - Anna E. Barón
- Division of Cardiology; Denver VA, University of Colorado; Denver Colorado
| | - Jay Giri
- Division of Cardiology; Corporal Michael C. Crescenz VA Medical Center, Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center; Philadelphia Pennsylvania
| | - Kendrick A. Shunk
- Division of Cardiology; San Francisco VA, University of California; San Francisco San Francisco California
| | - Subhash Banerjee
- Division of Cardiology; Dallas VA, University of Texas Southwestern; Dallas Texas
| | - Thomas M. Maddox
- Division of Cardiology; Denver VA, University of Colorado; Denver Colorado
| | - Stephen W. Waldo
- Division of Cardiology; Denver VA, University of Colorado; Denver Colorado
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Barbato E, Shlofmitz E, Milkas A, Shlofmitz R, Azzalini L, Colombo A. State of the art: evolving concepts in the treatment of heavily calcified and undilatable coronary stenoses – from debulking to plaque modification, a 40-year-long journey. EUROINTERVENTION 2017; 13:696-705. [DOI: 10.4244/eij-d-17-00473] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kim CY, Lee AC, Wiedenbeck TL, Lee MS, Chambers JW. Gender differences in acute and 30-day outcomes after orbital atherectomy treatment ofde novo, severely calcified coronary lesions. Catheter Cardiovasc Interv 2015; 87:671-7. [DOI: 10.1002/ccd.26163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/29/2015] [Accepted: 07/27/2015] [Indexed: 12/29/2022]
Affiliation(s)
| | - Arthur C. Lee
- Interventional Cardiologists of Gainesville, PA; Gainesville Florida
| | | | | | - Jeff W. Chambers
- Metropolitan Heart and Vascular Institute-Mercy Hospital; Minneapolis Minnesota
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Chambers JW, Feldman RL, Himmelstein SI, Bhatheja R, Villa AE, Strickman NE, Shlofmitz RA, Dulas DD, Arab D, Khanna PK, Lee AC, Ghali MG, Shah RR, Davis TP, Kim CY, Tai Z, Patel KC, Puma JA, Makam P, Bertolet BD, Nseir GY. Pivotal Trial to Evaluate the Safety and Efficacy of the Orbital Atherectomy System in Treating De Novo, Severely Calcified Coronary Lesions (ORBIT II). JACC Cardiovasc Interv 2014; 7:510-8. [DOI: 10.1016/j.jcin.2014.01.158] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/18/2013] [Accepted: 01/04/2014] [Indexed: 12/24/2022]
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DAHDOUH ZIAD, ROULE VINCENT, DUGUÉ AUDREYEMMANUELLE, SABATIER RÉMI, LOGNONÉ THÉRÈSE, GROLLIER GILLES. Rotational Atherectomy for Left Main Coronary Artery Disease in Octogenarians: Transradial Approach in a Tertiary Center and Literature Review. J Interv Cardiol 2013; 26:173-82. [DOI: 10.1111/joic.12026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- ZIAD DAHDOUH
- CHU de Caen; Department of Interventional Cardiology; Caen France
- Université de Caen Basse-Normandie; Medical School; Caen France
| | - VINCENT ROULE
- CHU de Caen; Department of Interventional Cardiology; Caen France
- Université de Caen Basse-Normandie; Medical School; Caen France
| | - AUDREY EMMANUELLE DUGUÉ
- Université de Caen Basse-Normandie; Medical School; Caen France
- CHU de Caen; Department of Biostatistics and Clinical Research; Caen France
| | - RÉMI SABATIER
- CHU de Caen; Department of Interventional Cardiology; Caen France
- Université de Caen Basse-Normandie; Medical School; Caen France
| | - THÉRÈSE LOGNONÉ
- CHU de Caen; Department of Interventional Cardiology; Caen France
- Université de Caen Basse-Normandie; Medical School; Caen France
| | - GILLES GROLLIER
- CHU de Caen; Department of Interventional Cardiology; Caen France
- Université de Caen Basse-Normandie; Medical School; Caen France
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García de Lara J, Pinar E, Ramón Gimeno J, Hurtado JA, Lacunza J, Valdesuso R, Valdés Chávarri M. Percutaneous coronary intervention in heavily calcified lesions using rotational atherectomy and paclitaxel-eluting stents: outcomes at one year. Rev Esp Cardiol 2010; 63:107-10. [PMID: 20089233 DOI: 10.1016/s1885-5857(10)70016-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Heavily calcified lesions present a challenge for percutaneous coronary intervention. With rotational atherectomy, it is possible to treat these lesions and paclitaxel-eluting stents (PESs) reduce the risk of restenosis over the long term. This retrospective study investigated clinical outcomes with rotational atherectomy and PESs in 50 consecutive patients with heavily calcified lesions. Mortality and target lesion revascularization at 1 year (median, 14 months; interquartile range, 8.75-25.5 months) were recorded. Some 52% of patients were aged over 70 years, 68% were male, 52% had acute coronary syndrome, 80% had multivessel disease and 44% were receiving abciximab. Two patients died in hospital, three died during follow-up (one cardiac death) and 3 (6%) underwent target lesion revascularization. At 1 year, the survival rate free of cardiac death was 94% and the survival rate free of target lesion revascularization was 94%. These findings demonstrate that the combination of rotational atherectomy and PESs gives excellent results in heavily calcified lesions.
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Affiliation(s)
- Juan García de Lara
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
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Intervencionismo coronario en lesiones severamente calcificadas mediante aterectomía rotacional y stent liberador de paclitaxel: resultados tras un año de seguimiento. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70016-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tran T, Brown M, Lasala J. An evidence-based approach to the use of rotational and directional coronary atherectomy in the era of drug-eluting stents: when does it make sense? Catheter Cardiovasc Interv 2009; 72:650-62. [PMID: 18942126 DOI: 10.1002/ccd.21676] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advances in percutaneous interventions have profoundly changed the way we manage patients with coronary and peripheral arterial disease. Though the use of stents, particularly drug-eluting stents, is the preferred method for revascularization because of ease of use and lower restenosis rates, there are many short comings. Ostial and bifurcation lesions as well as heavily calcified and tortuous arteries remain problematic. Mechanical debulking with rotational and direct coronary atherectomy may be beneficial in these situations. In this review, we present the general concepts of mechanical debulking and attempt to summarize the available data on its use in the setting of drug-eluting stents. In addition, we will discuss its special role in the management of peripheral arterial disease.
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Affiliation(s)
- Trung Tran
- Division of Cardiology, Washington University Medical School, St. Louis, Missouri 63110-1093, USA
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Sardella G, De Luca L, Di Roma A, Fedele F. Rotational atherectomy in the distal left anterior descending coronary artery through an internal mammary artery graft. J Cardiovasc Med (Hagerstown) 2006; 7:368-72. [PMID: 16645418 DOI: 10.2459/01.jcm.0000223262.39556.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the case of a 53-year-old white man who began complaining of dyspnoea and angina 19 months after coronary artery bypass graft surgery. Coronary angiography revealed the presence of a long and critical stenosis in the native left anterior descending coronary artery, shortly after distal anastomosis of the left internal mammary artery. After failed predilatations with standard or cutting balloons, we successfully used the rotablator system, which allowed us to implant a bare-metal stent in the native left anterior descending coronary artery. However, stent deployment caused long linear graft dissection, which was reduced by drug-eluting stent implantation in the proximal and distal segments of the left internal mammary artery.
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Affiliation(s)
- Gennaro Sardella
- Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy.
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Safian RD, Feldman T, Muller DW, Mason D, Schreiber T, Haik B, Mooney M, O'Neill WW. Coronary angioplasty and Rotablator atherectomy trial (CARAT): immediate and late results of a prospective multicenter randomized trial. Catheter Cardiovasc Interv 2001; 53:213-20. [PMID: 11387607 DOI: 10.1002/ccd.1151] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mechanical rotational atherectomy with the Rotablator is widely used for percutaneous coronary revascularization, but the ideal debulking strategy remains unknown. The purpose of this study was to compare the immediate and late results after Rotablator using two treatment strategies: Large burrs (burr/artery ratio of >0.7) to achieve maximal debulking (lesion debulking strategy) or small burrs (burr/artery ratio < or = 0.7) to modify lesion compliance (lesion modification strategy). Two hundred twenty-two patients at six centers were prospectively enrolled in this study and randomly assigned to large (n = 104 patients with 118 lesions) or small (n = 118 patients with 136 lesions) burrs. The primary endpoint was final diameter stenosis at the end of the procedure, and secondary endpoints included inhospital angiographic and clinical complications, and target lesion revascularization at 6 months. Baseline demographic and angiographic characteristics were similar. There were no differences in procedural success, the extent of immediate lumen enlargement, inhospital ischemic complications, or late target vessel revascularization. However, compared with small burrs, patients randomized to large burrs were more likely to experience serious angiographic complications (5.1% vs. 12.7%, P < 0.05) immediately after atherectomy. This study suggests that a routine lesion modification strategy employing small burrs (burr/artery ratio < or = 0.7) achieves similar immediate lumen enlargement and late target vessel revascularization compared with a more aggressive debulking strategy (burr/artery ratio >0.7), but with fewer angiographic complications.
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Affiliation(s)
- R D Safian
- Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan,
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Jahnke T, Link J, Müller-Hülsbeck S, Grimm J, Heller M, Brossman J. Treatment of infrapopliteal occlusive disease by high-speed rotational atherectomy: initial and mid-term results. J Vasc Interv Radiol 2001; 12:221-6. [PMID: 11265887 DOI: 10.1016/s1051-0443(07)61829-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assess the effectiveness and patency rates of high-speed rotational atherectomy (HSRA) for the treatment of infrapopliteal arterial occlusive disease. MATERIAL AND METHODS During an 18-month period, a total of 19 infrapopliteal lesions in 15 consecutive patients were treated primarily by HSRA with use of the Rotablator device. Patients were followed up with documentation of clinical symptoms, standardized treadmill exercise, and Doppler sonography at 1, 3, and 6 months. Control angiography was performed 6 months after primary treatment. RESULTS HSRA was initially successful in 14 of 15 patients, yielding an initial technical success rate of 94%. Percutaneous treatment induced an improvement of the ankle-brachial index (ABI) from 0.6 +/- 0.09 to 0.86 +/- 0.2 after intervention (P < .0001). Doppler analysis showed a mean ABI of 0.85 +/- 0.2 (P < .001) at 1 month, 0.72 +/- 0.2 (P = .012) at 3 months, and 0.7 +/- 0.2 (P = .08) at 6 months after initial therapy. Although six patients were lost to follow-up at various times, control angiography at 6 months was carried out in nine of 15 patients, allowing direct assessment of 12 of 19 treated lesions. Among six high-grade restenoses and five total occlusions in the treated vascular segments, only one arterial lumen (of 12) remained patent without presenting a hemodynamically relevant restenosis. These results led to termination of the study. CONCLUSION Although HSRA for the treatment of infrapopliteal occlusive disease yields a very high initial technical success rate, mid-term results are extremely poor. Therefore, HSRA cannot be recommended for primary treatment of this type of lesion.
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Affiliation(s)
- T Jahnke
- Klinik für Diagnostiche Radiologie, Christian-Albrechts-Universität zu Kiel, Uniklinik Regensburg, Germany
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