1
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Zhang Y, Wu X, Vadlamani RA, Lim Y, Kim J, David K, Gilbert E, Li Y, Wang R, Jiang S, Wang A, Sontheimer H, English DF, Emori S, Davalos RV, Poelzing S, Jia X. Submillimeter Multifunctional Ferromagnetic Fiber Robots for Navigation, Sensing, and Modulation. Adv Healthc Mater 2023; 12:e2300964. [PMID: 37473719 PMCID: PMC10799194 DOI: 10.1002/adhm.202300964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023]
Abstract
Small-scale robots capable of remote active steering and navigation offer great potential for biomedical applications. However, the current design and manufacturing procedure impede their miniaturization and integration of various diagnostic and therapeutic functionalities. Herein, submillimeter fiber robots that can integrate navigation, sensing, and modulation functions are presented. These fiber robots are fabricated through a scalable thermal drawing process at a speed of 4 meters per minute, which enables the integration of ferromagnetic, electrical, optical, and microfluidic composite with an overall diameter of as small as 250 µm and a length of as long as 150 m. The fiber tip deflection angle can reach up to 54o under a uniform magnetic field of 45 mT. These fiber robots can navigate through complex and constrained environments, such as artificial vessels and brain phantoms. Moreover, Langendorff mouse hearts model, glioblastoma micro platforms, and in vivo mouse models are utilized to demonstrate the capabilities of sensing electrophysiology signals and performing a localized treatment. Additionally, it is demonstrated that the fiber robots can serve as endoscopes with embedded waveguides. These fiber robots provide a versatile platform for targeted multimodal detection and treatment at hard-to-reach locations in a minimally invasive and remotely controllable manner.
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Affiliation(s)
- Yujing Zhang
- Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Xiaobo Wu
- Translational Biology, Medicine, and Health Graduate Program, Virginia Tech, Roanoke, VA, 24016, USA
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
| | - Ram Anand Vadlamani
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Youngmin Lim
- Department of Physics, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Jongwoon Kim
- Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Kailee David
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Earl Gilbert
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24061, USA
- School of Neuroscience, Virginia Tech, Blacksburg, VA, 24061, USA
| | - You Li
- Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Ruixuan Wang
- Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Shan Jiang
- Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Anbo Wang
- Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Harald Sontheimer
- Department of Neuroscience, University of Virginia, Charlottesville, VA, 22903, USA
| | | | - Satoru Emori
- Department of Physics, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Rafael V Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Steven Poelzing
- Translational Biology, Medicine, and Health Graduate Program, Virginia Tech, Roanoke, VA, 24016, USA
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
| | - Xiaoting Jia
- Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
- School of Neuroscience, Virginia Tech, Blacksburg, VA, 24061, USA
- Department of Materials Science and Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
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Nakano T, Ikenaga H, Takeda A, Morita Y, Higashihara T, Watanabe N, Sada Y, Nakano Y. Relationship Between Attenuated Plaque Identified by Intravascular Ultrasound and Thrombus Formation After Excimer Laser Coronary Angioplasty. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 49:15-21. [PMID: 36599747 DOI: 10.1016/j.carrev.2022.12.010] [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] [Received: 11/22/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Excimer laser coronary angioplasty (ELCA) has been reported to be a safe and effective atherectomy device in percutaneous coronary intervention (PCI). However, thrombotic complications after ELCA have been occasionally observed. In this study, we evaluated the impact of attenuated plaque on thrombus formation and transient no-reflow after ELCA. METHODS This study enrolled 58 lesions in 56 patients who underwent PCI with ELCA. It was a retrospective observational study at a single center. All lesions were imaged by intravascular ultrasound (IVUS) before and immediately after ELCA. On the plaque with ultrasound attenuation, attenuation angle per millimeter and attenuation length were measured. ELCA-induced thrombus was detected by IVUS, and transient no-reflow after ELCA was recorded. RESULTS Thrombus was detected in 14 lesions (30 %), and transient no-reflow occurred in 3 lesions (5 %). Lesions with thrombus had a higher mean attenuation angle (median [interquartile range] 142° [112°-152°] vs. 64° [0°-115°]; p = 0.001), maximum attenuation angle (209° [174°-262°] vs. 86° [0°-173°]; p < 0.001), and longer attenuation length (12 mm [8 mm-17 mm] vs. 2 mm [0 mm-5 mm]; p < 0.001). Lesions with thrombus leading to transient no-reflow had a longer lipid length and a significantly higher troponin I level after PCI. CONCLUSIONS IVUS-identified attenuated plaque was strongly correlated with ELCA-induced thrombus. Furthermore, attenuation length may predict transient no-reflow.
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Affiliation(s)
- Takayuki Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Atsushi Takeda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuichi Morita
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tasuku Higashihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshiharu Sada
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Nagamatsu H, Torii S, Aihara K, Nakazawa K, Nakamura N, Noda S, Sekino S, Yoshimachi F, Nakazawa G, Ikari Y. Histological evaluation of vascular changes after excimer laser angioplasty for neointimal formation after bare-metal stent implantation in rabbit iliac arteries. Cardiovasc Interv Ther 2023; 38:223-230. [PMID: 36609899 DOI: 10.1007/s12928-022-00905-8] [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] [Received: 11/03/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Excimer laser is used to treat coronary artery disease, especially in case of lesions with thrombus and in-stent restenosis (ISR). However, there are no in vivo preclinical studies that have evaluated the pathological reactions of the vessel wall after excimer laser ablation. METHODS Bare-metal stents were placed in the external iliac arteries of six healthy rabbits. Twenty-eight days later, excimer laser ablation was performed with low-power (45 (fluency)/25 (rate)) in one side, and high-power (60/40) in the opposite side, followed by optical coherence tomography (OCT) evaluation. Rabbits were sacrificed 15 min after the procedure, and histological assessment was performed. RESULTS Morphometry analysis of OCT showed similar stent and lumen size between low-power and high-power group. Histological evaluation suggested endothelial cell loss, fibrin deposition, and tissue loss. The low-power group showed significantly less pathological changes compared with the high-power group: angle of endothelial cell loss, 32.4° vs. 191.7° (interquartile range, 8.8°-131.7° vs. 125.7°-279.5°; p < 0.01); fibrin deposition, 1.1° vs. 59.6° (0.0°-70.4° vs. 31.4°-178.4°; p = 0.03); and tissue loss 0.0° vs. 18.2° (0.0°-8.7° vs. 0.0°-42.7°; p = 0.03). CONCLUSIONS The pathological changes in neointima were more prominent after high-power excimer laser ablation than after low-power excimer laser. To improve safety in clinical practice, understanding the pathological changes of tissues after excimer laser in lesions with ISR is essential.
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Affiliation(s)
- Hirofumi Nagamatsu
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
- Division of Cardiology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Sho Torii
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Kazuki Aihara
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Keigo Nakazawa
- Division of Clinical Engineering, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Norihito Nakamura
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Satoshi Noda
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Satsuki Sekino
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | | | - Gaku Nakazawa
- Department of Cardiology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Hennessey B, Pareek N, Macaya F, Yeoh J, Shlofmitz E, Gonzalo N, Hill J, Escaned J. Contemporary percutaneous management of coronary calcification: current status and future directions. Open Heart 2023; 10:e002182. [PMID: 36796870 PMCID: PMC9936324 DOI: 10.1136/openhrt-2022-002182] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
Severe coronary artery calcification is one of the greatest challenges in attaining success in percutaneous coronary intervention, limiting acute and long-term results. In many cases, plaque preparation is a critical prerequisite for delivery of devices across calcific stenoses and also to achieve adequate luminal dimensions. Recent advances in intracoronary imaging and adjunctive technologies now allow the operator to select the most appropriate strategy in each individual case. In this review, we will revisit the distinct advantages of a complete assessment of coronary artery calcification with imaging and application of appropriate and contemporary plaque modification technologies in achieving durable results in this complex lesion subset.
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Affiliation(s)
- Breda Hennessey
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
| | - Nilesh Pareek
- King's College Hospital NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Fernando Macaya
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
- King's College Hospital NHS Foundation Trust, London, UK
| | - Julian Yeoh
- King's College Hospital NHS Foundation Trust, London, UK
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nieves Gonzalo
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
| | - Jonathan Hill
- King's College Hospital NHS Foundation Trust, London, UK
- Royal Brompton Hospital, London, UK
| | - Javier Escaned
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
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5
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Zhang Y, Wu X, Vadlamani RA, Lim Y, Kim J, David K, Gilbert E, Li Y, Wang R, Jiang S, Wang A, Sontheimer H, English D, Emori S, Davalos RV, Poelzing S, Jia X. Multifunctional ferromagnetic fiber robots for navigation, sensing, and treatment in minimally invasive surgery. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.27.525973. [PMID: 36778450 PMCID: PMC9915472 DOI: 10.1101/2023.01.27.525973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Small-scale robots capable of remote active steering and navigation offer great potential for biomedical applications. However, the current design and manufacturing procedure impede their miniaturization and integration of various diagnostic and therapeutic functionalities. Here, we present a robotic fiber platform for integrating navigation, sensing, and therapeutic functions at a submillimeter scale. These fiber robots consist of ferromagnetic, electrical, optical, and microfluidic components, fabricated with a thermal drawing process. Under magnetic actuation, they can navigate through complex and constrained environments, such as artificial vessels and brain phantoms. Moreover, we utilize Langendorff mouse hearts model, glioblastoma microplatforms, and in vivo mouse models to demonstrate the capabilities of sensing electrophysiology signals and performing localized treatment. Additionally, we demonstrate that the fiber robots can serve as endoscopes with embedded waveguides. These fiber robots provide a versatile platform for targeted multimodal detection and treatment at hard-to-reach locations in a minimally invasive and remotely controllable manner.
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Affiliation(s)
- Yujing Zhang
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA
| | - Xiaobo Wu
- Translational Biology, Medicine, and Health Graduate Program, Virginia Tech, Roanoke, VA
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA
| | - Ram Anand Vadlamani
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
| | - Youngmin Lim
- Department of Physics, Virginia Tech, Blacksburg, VA
| | - Jongwoon Kim
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA
| | - Kailee David
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
| | - Earl Gilbert
- School of Neuroscience, Virginia Tech, Blacksburg, VA
| | - You Li
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA
| | - Ruixuan Wang
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA
| | - Shan Jiang
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA
| | - Anbo Wang
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA
| | - Harald Sontheimer
- Department of Neuroscience, University of Virginia School of Medicine, Charlottesville, VA
| | | | - Satoru Emori
- Department of Physics, Virginia Tech, Blacksburg, VA
| | - Rafael V. Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
| | - Steven Poelzing
- Translational Biology, Medicine, and Health Graduate Program, Virginia Tech, Roanoke, VA
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
| | - Xiaoting Jia
- The Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA
- School of Neuroscience, Virginia Tech, Blacksburg, VA
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6
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Golino L, Caiazzo G, Calabrò P, Colombo A, Contarini M, Fedele F, Gabrielli G, Galassi AR, Golino P, Scotto di Uccio F, Tarantini G, Argentino V, Balbi M, Bernardi G, Boccalatte M, Bonmassari R, Bottiglieri G, Caramanno G, Cesaro F, Cigala E, Chizzola G, Di Lorenzo E, Intorcia A, Fattore L, Galli S, Gerosa G, Giannotta D, Grossi P, Monda V, Mucaj A, Napodano M, Nicosia A, Perrotta R, Pieri D, Prati F, Ramazzotti V, Romeo F, Rubino A, Russolillo E, Spedicato L, Tuccillo B, Tumscitz C, Vigna C, Bertinato L, Armigliato P, Ambrosini V. Excimer laser technology in percutaneous coronary interventions: Cardiovascular laser society's position paper. Int J Cardiol 2022; 350:19-26. [PMID: 34995700 DOI: 10.1016/j.ijcard.2021.12.054] [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: 09/28/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022]
Abstract
Excimer Laser Coronary Atherectomy (ELCA) is a well-established therapy that emerged for the treatment of peripheral vascular atherosclerosis in the late 1980s, at a time when catheters and materials were rudimentary and associated with the most serious complications. Refinements in catheter technology and the introduction of improved laser techniques have led to their effective use for the treatment of a wide spectrum of complex coronary lesions, such as thrombotic lesions, severe calcific lesions, non-crossable or non-expandable lesions, chronic occlusions, and stent under-expansion. The gradual introduction of high-energy strategies combined with the contrast infusion technique has enabled us to treat an increasing number of complex cases with a low rate of periprocedural complications. Currently, the use of the ELCA has also been demonstrated to be effective in acute coronary syndrome (ACS), especially in the context of large thrombotic lesions.
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Affiliation(s)
- L Golino
- UOC Cardiologia/UTIC, Laboratorio di Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero S. Giuseppe Moscati, Aversa, Caserta, Italy.
| | - G Caiazzo
- UOC Cardiologia/UTIC, Laboratorio di Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero S. Giuseppe Moscati, Aversa, Caserta, Italy
| | - P Calabrò
- Cattedra di Cardiologia, Dipartimento di Medicina Traslazionale, Università degli Studi della Campania "Luigi Vanvitelli" - U.O.C. di Cardiologia Clinica a Direzione Universitaria A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
| | - A Colombo
- Cardiologia Interventistica, Centro Cuore Columbus, Milano, Italy
| | - M Contarini
- Cardiologia e Laboratorio di Emodinamica, Presidio Ospedaliero Umberto I° Siracusa, Italy
| | - F Fedele
- Cattedra di Cardiologia, Azienda Ospedaliero Universitaria Policlinico Umberto I°, Roma, Italy
| | - G Gabrielli
- Cardiologia Interventistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | - A R Galassi
- Cattedra di Cardiologia, Azienda Ospedaliera Universitaria, Policlinico "P. Giaccone", Palermo, Italy
| | - P Golino
- Cattedra di Cardiologia, Dipartimento di Scienze Medico-Translazionali, Università degli Studi della Campania "Luigi Vanvitelli", Sezione di Cardiologia, c/o Ospedale Monaldi, Napoli, Italy
| | | | - G Tarantini
- Unità Operativa Semplice Dipartimentale di "Emodinamica e Cardiologia Interventistica", Dipartimento Strutturale Aziendale Cardio-Toraco-Vascolare, Azienda Ospedaliera di Padova, Italy
| | - V Argentino
- Cardiologia Interventistica, Azienda Ospedaliera per l'Emergenza Cannizzaro, Catania, Italy
| | - M Balbi
- Cardiologia Interventistica, IRCCS Azienda Ospedaliera Universitaria S. Martino, Genova, Italy
| | - G Bernardi
- Associazione per la Ricerca in Cardiologia, Ospedale S. Maria degli Angeli, Pordenone, Italy
| | - M Boccalatte
- Laboratorio Emodinamica P.O. S. Maria delle Grazie ASL NA2, Pozzuoli, Napoli, Italy
| | - R Bonmassari
- Cardiologia Interventistica, Presidio Ospedaliero S. Chiara, Trento, Italy
| | - G Bottiglieri
- Cardiologia Interventistica, Ospedale "SS.Addolorata", Eboli, Salerno, Italy
| | - G Caramanno
- Cardiologia Interventistica, Presidio Ospedaliero S. Giovanni di Dio, Agrigento, Italy
| | - F Cesaro
- Cardiologia Università "Luigi Vanvitelli", Caserta, Italy
| | - E Cigala
- Cardiologia Interventistica, Azienda Ospedaliera dei Colli, Ospedale Monaldi, Napoli, Italy
| | - G Chizzola
- Cardiologia Interventistica, Azienda ospedaliera Universitaria Spedali Civili, Brescia, Italy
| | - E Di Lorenzo
- Cardiologia e Laboratorio di Emodinamica, AORN S. Giuseppe Moscati, Avellino, Italy
| | - A Intorcia
- Cardiologia e Laboratorio di Emodinamica, AORN S. Giuseppe Moscati, Avellino, Italy
| | - L Fattore
- UOC Cardiologia/UTIC, Laboratorio di Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero S. Giuseppe Moscati, Aversa, Caserta, Italy
| | - S Galli
- Cardiologia Interventistica, IRCCS Centro Cardiologico Monzino, Milano, Italy
| | - G Gerosa
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università di Padova, Italy
| | - D Giannotta
- Cardiologia, Presidio Ospedaliero Gravina e Santo Pietro, Caltagirone, Catania, Italy
| | - P Grossi
- Cardiologia e Laboratorio di Emodinamica, Presidio Ospedaliero Mazzoni, Ascoli Piceno, Italy
| | - V Monda
- Cardiologia Interventistica, Azienda Ospedaliera dei Colli, Ospedale Monaldi, Napoli, Italy
| | - A Mucaj
- Cardiologia Interventistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | - M Napodano
- Unità Operativa Semplice Dipartimentale di "Emodinamica e Cardiologia Interventistica", Dipartimento Strutturale Aziendale Cardio-Toraco-Vascolare, Azienda Ospedaliera di Padova, Italy
| | - A Nicosia
- Cardiologia Interventistica, Presidio Ospedaliero Giovanni Paolo II°, Ragusa, Italy
| | - R Perrotta
- Cardiologia Interventistica, Azienda Ospedaliera S. Anna e S. Sebastiano, Caserta, Italy
| | - D Pieri
- Cardiologia Interventistica, Presidio Ospedaliero G.F. Ingrassia, Palermo, Italy
| | - F Prati
- Cardiologia d'Urgenza ed Interventistica, Azienda Ospedaliera S. Giovanni Addolorata, Roma, Italy
| | - V Ramazzotti
- Cardiologia d'Urgenza ed Interventistica, Azienda Ospedaliera S. Giovanni Addolorata, Roma, Italy
| | - F Romeo
- UniCamillus International Medical University, Rome, Italy
| | - A Rubino
- Cardiologia Interventistica, Presidio Ospedaliero G.F. Ingrassia, Palermo, Italy
| | - E Russolillo
- Cardiologia Interventistica, Ospedale S. Giovanni Bosco, Napoli, Italy
| | - L Spedicato
- Cardiologia Interventistica, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - B Tuccillo
- Cardiologia Interventistica Ospedale del Mare, Napoli, Italy
| | - C Tumscitz
- Cattedra di Cardiologia, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - C Vigna
- Cardiologia Interventistica, IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | - L Bertinato
- Clinical Governance, Istituto Superiore di Sanità, Italy
| | - P Armigliato
- Scientific Board Cardiovascular Laser Society, Italy
| | - V Ambrosini
- Cardiologia e Laboratorio di Emodinamica, AORN S. Giuseppe Moscati, Avellino, Italy
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7
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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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8
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Tsutsui RS, Sammour Y, Kalra A, Reed G, Krishnaswamy A, Ellis S, Nair R, Khatri J, Kapadia S, Puri R. Excimer Laser Atherectomy in Percutaneous Coronary Intervention: A Contemporary Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 25:75-85. [PMID: 33158754 DOI: 10.1016/j.carrev.2020.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
Excimer laser coronary atherectomy (ELCA) during percutaneous coronary intervention (PCI) has been in use for more than twenty years. While early experiences were not favorable over balloon angioplasty alone, with improvement in operator technique, patient selection and technology, ELCA has established its own niche in contemporary PCI as a safe and effective atherectomy strategy. With growing experience in complex coronary interventions worldwide, ELCA has become one of the essential atherectomy tools offering unique advantages over other atherectomy devices. In the modern era, ELCA is commonly used for patients with in-stent restenosis, stent under expansion, balloon uncrossable lesions and chronic total occlusions. Technical success rates are reported to be >80% in most situations while procedural complication rates such as vessel dissection and perforation among others are reported to average 9% over the past 25 years with improvement over time. In this review, we provide a comprehensive systematic review of the ELCA system, its practical use, indications, and procedural techniques in the contemporary PCI era.
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Affiliation(s)
- Rayji S Tsutsui
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America; Division of Cardiology, Straub Medical Center, Hawaii Pacific Health, Honolulu, HI, United States of America
| | - Yasser Sammour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Stephen Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Ravi Nair
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America.
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9
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Simple percutaneous coronary interventions using the modification of complex coronary lesion with excimer laser. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:293-302. [DOI: 10.1016/j.carrev.2018.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/06/2018] [Accepted: 10/19/2018] [Indexed: 12/28/2022]
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10
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Tai Z. Excimer laser in contrast for the treatment of acute MI caused by thrombosis of underexpanded stent. Clin Case Rep 2018; 6:1457-1463. [PMID: 30147882 PMCID: PMC6099025 DOI: 10.1002/ccr3.1537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/20/2018] [Accepted: 02/18/2018] [Indexed: 11/09/2022] Open
Abstract
The use of excimer laser with contrast for treating an underexpanded stent in the setting of subacute stent thrombosis and hemodynamic instability is described. The patients presented with acute coronary syndromes and cardiogenic shock resulting from stent thrombosis of underexpanded stents. The stents were recalcitrant to aggressive balloon dilation and in the setting of an acute myocardial infarction; rotational atherectomy is a relative contraindication. The use of concurrent contrast during laser atherectomy resulted in plaque modification and subsequent stent expansion.
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Affiliation(s)
- Zaheed Tai
- Bostick Heart Center Winter Haven Hospital Winter Haven Florida
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11
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Rawlins J, Din JN, Talwar S, O'Kane P. Coronary Intervention with the Excimer Laser: Review of the Technology and Outcome Data. Interv Cardiol 2016; 11:27-32. [PMID: 29588701 DOI: 10.15420/icr.2016:2:2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Excimer laser coronary atherectomy (ELCA) is a long-established adjunctive therapy that can be applied during percutaneous coronary intervention (PCI). Technical aspects have evolved and there is an established safety and efficacy record across a number of clinical indications in contemporary interventional practice where complex lesions are routinely encountered. The role of ELCA during PCI for thrombus, non-crossable or non-expandable lesions, chronic occlusions and stent under-expansion are discussed in this review. The key advantage of ELCA over alternative atherectomy interventions is delivery on a standard 0.014-inch guidewire. Additionally, the technique can be mastered by any operator after a short period of training. The major limitation is presence of heavy calcification although when rotational atherectomy (RA) is required but cannot be applied due to inability to deliver the dedicated RotaWireTM (Boston Scientific), ELCA can create an upstream channel to permit RotaWire passage and complete the case with RA - the RASER technique.
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Affiliation(s)
- John Rawlins
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Jehangir N Din
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Suneel Talwar
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Peter O'Kane
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
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12
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Fracassi F, Roberto M, Niccoli G. Current interventional coronary applications of excimer laser. Expert Rev Med Devices 2014; 10:541-9. [DOI: 10.1586/17434440.2013.811846] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Tarsia G, De Michele M, Viceconte N, Takagi K, Biscione C, Del Prete G, Polosa D, Osanna R, Lisanti P. Immediate and midterm follow-up results of excimer laser application in complex percutaneous coronary interventions: Report from a single center experience. Interv Med Appl Sci 2013; 5:10-5. [PMID: 24265882 PMCID: PMC3831791 DOI: 10.1556/imas.5.2013.1.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 12/28/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of laser-assisted percutaneous coronary interventions (PCI) in an unselected population. METHODS One hundred consecutive patients, who underwent a laser assisted PCI between January 2008 and March 2012, were included in the present study. Fifty-one patients underwent laser ablation for thrombus vaporization (Group 1), 36 patients for neointima/plaque debulking (Group 2) and 13 patients for lesion compliance modification in calcified lesions (Group 3). RESULTS The rate of in-hospital serious events was 2%. The cumulative laser success was 82%, and it was significantly higher for Group 1 and Group 2 in comparison with Group 3 (p = 0.001). Furthermore, the need for repeat revascularization was significantly higher in the Group 3 compared with the others two groups (46% vs. 8% for Group 1 and 11% for Group 2, p = 0.03). The MACE rate was 14%. There was a trend toward a higher MACE rate in the Group 3 compared with others two groups (p = 0.05). CONCLUSIONS Laser ablation is an effective and safe tool for complex PCI. Patients underwent laser for thrombus vaporization or for neointima/plaque debulking had better immediate success and better outcome at follow-up than patients underwent laser for lesion compliance modification.
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14
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Shammas NW, Weissman NJ, Coiner D, Shammas GA, Dippel E, Jerin M. Treatment of subacute and chronic thrombotic occlusions of lower extremity peripheral arteries with the excimer laser: a feasibility study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 13:211-4. [PMID: 22743208 DOI: 10.1016/j.carrev.2012.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/21/2012] [Accepted: 05/30/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Thrombus is highly prevalent in patients with recent symptoms (< 6 months) of claudication or limb ischemia due to an occluded culprit lower extremity vessels. Treatment of these thrombotic occlusions is challenging. In this feasibility study, the excimer laser (Spectranetics, Colorado Springs, CO) has been tested for its safety and ability to ablate thrombus in patients with recent arterial occlusions. METHODS Angiographic operator assessment and volumetric core lab quantitation of the thrombus were performed at baseline and after excimer laser but prior to definitive treatment of the vessel to evaluate thrombus resolution. Consecutive patients were prospectively enrolled at a single site. Procedural success was defined as achieving a residual stenosis of <30% after final treatment with no intraprocedural complications requiring additional treatment. RESULTS 20 consecutive patients were enrolled in this study (8 males, mean age 69.5±11.1 years). Based on patients symptom onset, 12 patients were subacute (> 24 h, < 30 days), and 8 chronic (between 1 to 6 months). 15/20 (75%) had restenotic occlusions. Due to the long, occlusive nature of these lesions, only 8 patients had complete intravascular ultrasound images at each time point which allowed volumetric analysis by the core lab. There was no statistical difference in plaque/thrombus volume between baseline (pretreatment) and excimer laser (P=.68). There was however a significant reduction in residual angiographic stenosis post laser alone (100% vs. 66.75%±23.9%, P=.001). Procedural success was 100%. There were no deaths or amputations. Bail out stenting was performed in 10/20 (50%) patients. Embolic filters were used in 15/20 (75%) of patients. Macrodebris>2 mm were seen in 85.7% of filters. There was no in-hospital or 30-day reocclusion of the treated vessel but one patient had a vascular access complication (small AV fistula) conservatively managed. No other serious adverse events were noted. CONCLUSION Using the excimer laser appears safe in this small feasibility study of subacute and chronic thrombotic occlusions. Angiographically, there was a significant reduction in percent stenosis with the laser alone. The limited IVUS data did not show a reduction in plaque/thrombus volume but the number of interpretable ultrasounds was small. Further data are needed to address the effectiveness of the laser in treating these thrombotic occlusions and its advantages over balloon angioplasty.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation, Davenport, IA 52803, USA.
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15
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Niccoli G, Minelli S, Cosentino N, Crea F. Excimer laser coronary angioplasty with manual thrombus aspiration for a case of very late stent thrombosis of sirolimus-eluting stent. J Cardiovasc Med (Hagerstown) 2011; 13:830-2. [PMID: 21738047 DOI: 10.2459/jcm.0b013e3283498322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Very late stent thrombosis occurring after drug-eluting stent implantation is a rare complication. However, it is often associated with poor outcome. Manual thrombectomy has been shown to lower the rate of distal embolization in the case of ST-elevation myocardial infarction of native coronary arteries. However, the presence of abundant thrombus material may lead to manual thrombus aspiration failure. Here, we describe the case of a patient with acute myocardial infarction due to stent thrombosis of a sirolimus-eluting stent occurring 50 months after stent deployment showing abundant thrombus material, which led to manual thrombus aspiration failure and was then successfully treated by excimer laser coronary angioplasty. In these cases, excimer laser coronary angioplasty may be useful due to its ability to dissolve thrombus.
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Affiliation(s)
- Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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16
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Celik T, Iyisoy A, Yuksel UC, Jata B, Bugan B, Kardesoglu E. The use of laser angioplasty in patients with acute myocardial infarction: a new era. Int J Cardiol 2010; 139:93-5. [PMID: 18722679 DOI: 10.1016/j.ijcard.2008.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 06/28/2008] [Indexed: 11/17/2022]
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17
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Topaz O, Ebersole D, Dahm JB, Alderman EL, Madyoon H, Vora K, Baker JD, Hilton D, Das T. Excimer laser in myocardial infarction: a comparison between STEMI patients with established Q-wave versus patients with non-STEMI (non-Q). Lasers Med Sci 2007; 23:1-10. [PMID: 17426922 DOI: 10.1007/s10103-007-0444-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 01/10/2007] [Indexed: 11/29/2022]
Abstract
Patients sustaining acute myocardial infarction (AMI) often require urgent percutaneous revascularization within the first 24 h from onset of the infarction due to continuous ischemia and hemodynamic instability. Upon arrival to the cardiac catheterization, the electrocardiogram of AMI patients may exhibit acute ST-elevation (STEMI) with or without accompanying Q-wave or depression of the ST segment (non-STEMI or non-Q-wave infarction). Data comparing acute outcome of device application in patients presenting for urgent revascularization with established Q-wave myocardial infarction (QWMI) versus those with non-STEMI (NQMI) are sparse. Excimer laser is a revascularization modality applied for debulking of atherosclerotic plaque and vaporization of associated thrombus in the setting of AMI. One hundred fifty-one AMI patients with continuous chest pain and ischemia who enrolled into a multicenter study and underwent urgent revascularization were divided for the purpose of a retrospective analysis into two groups. One group presented with established electrocardiographic Q-wave, whereas the other had ST-depression (NQMI). In comparison with the NQMI group, the QWMI patients had a higher incidence of failed thrombolytic therapy (17% vs 3, p = 0.006), cardiogenic shock (20 vs 6%, p = 0.01), left anterior descending as a culprit infarct-related vessel (46 vs 14%, p < 0.0001), a higher incidence of TIMI 0 flow (48 vs 24%, p = 0.04), a heavier thrombus burden (grade 4 TIMI thrombus, 58 vs 23%; p = 0.0001), and higher CPK (1272 +/- 2180 vs 404 +/- 577, p = 0.001) and troponin levels (62 +/- 95 vs 14 +/- 48, p = 0.0003). Both groups underwent laser angioplasty and stenting for relief of continuous chest pain and ischemia within 24 h of infarction onset. Quantitative coronary arteriography in an independent core laboratory measured similar improvement in baseline minimal luminal diameter and percent diameter stenosis by application of laser energy in both groups. Among the QWMI patients, a significantly higher acute gain was recorded with the laser treatment in lesions containing a large/extensive thrombus burden as compared with lesions containing only a small clot burden (1.2 +/- 0.7 vs 0.8 +/- 0.5, p = 0.01). Such a phenomenon was not detected among the NQMI patients (1.0 +/- 0.5 vs 0.8 +/- 0.6, p=ns). Baseline TIMI flow grade (0.9 +/- 1.0 for QWMI vs 1.5 +/- 1.2 for NQMI, p = 0.0001) increased with laser emission to 2.8 +/- 0.5 and subsequently reached a final level of TIMI 3 in both groups. In comparison with the QWMI patients, there was a trend toward a reduced rate of major adverse coronary events among the NQMI patients (12% QWMI vs 4% NQMI, p = 0.09). Significant differences in baseline clinical characteristics, extent of myocardial damage, location of infarct related vessel, thrombus burden, and TIMI flow exist between QWMI and NQMI patients who require urgent intervention. However, application of excimer laser results in similar high procedural success and low complication rates in both groups. Maximal acute laser gain is achieved among QWMI patients whose lesions are laden with a heavy thrombus burden.
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18
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Yang CT, Hwang JJ, Lin LC, Kao HL. Initial thrombosuction with subsequent angioplasty in primary coronary intervention—comparison with conventional strategy. Int J Cardiol 2005; 102:121-6. [PMID: 15939108 DOI: 10.1016/j.ijcard.2004.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Revised: 03/30/2004] [Accepted: 05/05/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Large thrombus burden remains challenging in the setting of acute myocardial infarct. Initial thrombosuction (IT) followed by actual angioplasty may be advantageous over conventional strategy in primary percutaneous coronary intervention (PCI). METHODS With a case-control design, 22 consecutive patients receiving primary PCI with IT were designated as group 1. Another 22 well-matched patients undergoing primary PCI with conventional strategy in the same period were enrolled as group 2. Clinical and angiographic outcomes, procedural parameters and resource usage were compared. RESULTS Baseline characteristics were comparable, including the symptom onset-to-needle time (250+/-101 vs. 261+/-149 min, p = NS). Total procedure time (33+/-14 vs. 47+/-20 min, p = 0.011), fluoroscopy time (10+/-6 vs. 16+/-10 min, p = 0.014) and contrast medium consumption (140+/-40 vs. 170+/-50 ml, p = 0.024) were all significantly reduced with group 1. No-reflow occurred less frequently with group 1 (5% vs. 32%, p = 0.046) during intervention, and TIMI 3 flow was established more quickly (19+/-10 vs. 30+/-20 min, p = 0.024). Final TIMI 3 flow rates and stent rates were similar. The time to myocardial enzyme peak was shorter with group 1 (9.7+/-3.1 vs. 12.8+/-6.3 h, p = 0.048), but no difference was found in 3 months cumulative major cardiac adverse event rates. CONCLUSIONS Primary PCI with IT achieves earlier reperfusion and is more efficient in terms of time and resource, comparing to conventional strategy.
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Affiliation(s)
- Chi-Tung Yang
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University Medical College, No. 7, Chung-Shan South Road, Taipei, Taiwan
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19
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Affiliation(s)
- On Topaz
- Division of Cardiology, McGuire Veterans Affairs Medical Center, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA
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20
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Dahm JB, Ebersole D, Das T, Madyhoon H, Vora K, Baker J, Hilton D, Topaz O. Prevention of distal embolization and no-reflow in patients with acute myocardial infarction and total occlusion in the infarct-related vessel: A subgroup analysis of the cohort of acute revascularization in myocardial infarction with excimer laser?CARMEL multicenter study. Catheter Cardiovasc Interv 2004; 64:67-74. [PMID: 15619312 DOI: 10.1002/ccd.20239] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To overcome the adverse complications of percutaneous coronary interventions in thrombus laden lesions (i.e., distal embolization, platelet activation, no-reflow phenomenon), mechanical removal of the thrombus or distal embolization protection devices are frequently required. Pulsed-wave ultraviolet excimer laser light at 308 nm can vaporize thrombus, suppress platelet aggregation, and, unlike other thrombectomy devices, ablate the underlying plaque. The following multicenter registry was instituted to evaluate the safety and efficacy of laser ablation in patients presenting with acute myocardial infarction (AMI) complicated by persistent thrombotic occlusions. Patients with AMI and complete thrombotic occlusion of the infarct-related vessel were included in eight participating centers. Patients with further compromising conditions (i.e., cardiogenic shock, thrombolysis failures) were also included. Primary endpoint was procedural respective laser success; secondary combined endpoints were TIMI flow and % stenosis by quantitative coronary analysis and visual assessment at 1-month follow-up. Eighty-four percent of all patients enrolled (n = 56) had a very large thrombus burden (TIMI thrombus scale > or = 3), and 49% were compromised by complex clinical presentation, i.e., cardiogenic shock (21%), degenerated saphenous vein grafts (26%), or thrombolysis failures (5%). Laser success was achieved in 89%, angiographic success in 93%, and the overall procedural success rate was 86%. The angiographic prelaser total occlusion was reduced angiographically to 58% +/- 25% after laser treatment and to 4% +/- 13% final residual stenosis after adjunctive balloon angioplasty and/or stent placement. TIMI flow increased significantly from grade 0 to 2.7 +/- 0.5 following laser ablation (P < 0.001) and 3.0 +/- 0.2 upon completion of the angioplasty procedure (P > 0.001 vs. baseline). Distal embolizations occurred in 4%, no-reflow was observed in 2%, and perforations in 0.6% of cases. Laser-associated major dissections occurred in 4% of cases, and total MACE was 13%. The safety and efficacy of excimer laser for thrombus dissolution in a cohort of high-risk patients presenting with AMI and total thrombotic occlusion in the infarct-related vessel are encouraging and should lead to further investigation.
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Affiliation(s)
- Johannes B Dahm
- Department of Cardiology, Ernst Moritz Arndt University Greifswald, Greifswald, Germany.
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21
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Topaz O, Perin EC, Jesse RL, Mohanty PK, Carr M, Rosenschein U. Power thrombectomy in acute ischemic coronary syndromes. Angiology 2003; 54:457-68. [PMID: 12934766 DOI: 10.1177/000331970305400410] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intracoronary thrombi are commonly found in patients with acute coronary syndromes. A large thrombus burden or a platelet-rich thrombus frequently resists pharmacologic therapy ("thrombolytic ceiling"). In such cases restoration of adequate antegrade coronary flow necessitates application of a mechanical force. Power thrombectomy is a revascularization strategy incorporating a mechanical device for removal of occlusive coronary thrombi in conjunction with or following administration of either platelet glycoprotein IIb/IIIa receptor inhibitors or thrombolytic agents, or both. Mechanical devices for power thrombectomy include ultrasound sonication, rheolytic thrombectomy (Angiojet), laser, transluminal extraction catheter, aspiration catheter, and to a limited extent, balloon angioplasty. In acute coronary syndromes the strategy of power thrombectomy aims to achieve the clinical advantages of more nearly complete vessel patency, improved antegrade flow, and enhanced preservation of myocardial tissue.
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Affiliation(s)
- On Topaz
- Cardiac Catheterization Laboratories, Division of Cardiology, Medical College of Virginia Hospital, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA 23249, USA
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22
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Lorin JD, Liou MC, Sedlis SP. Rapid thrombectomy for treatment of macroembolization during percutaneous coronary intervention in the setting of acute myocardial infarction. Catheter Cardiovasc Interv 2003; 59:219-22. [PMID: 12772245 DOI: 10.1002/ccd.10448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report the use of the Export catheter as an urgent modality to aspirate thrombus that embolized down the left anterior descending artery during acute myocardial infarction.
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Affiliation(s)
- Jeffrey D Lorin
- Division of Cardiology, Department of Veterans Affairs, New York Harbor Healthcare System, New York Campus, New York, New York 10010, USA.
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