1
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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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Wolverine cutting balloon in the treatment of stent underexpansion in heavy coronary calcification: bench test using a three-dimensional printer and computer simulation with the finite-element method. Cardiovasc Interv Ther 2021; 37:506-512. [PMID: 34374947 DOI: 10.1007/s12928-021-00803-5] [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: 05/07/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Heavy coronary calcification hinders successful stent implantation, and cutting balloons can be used for post-dilation after stent deployment. However, evidence regarding its use is limited to case reports. Therefore, this study aimed to investigate in-stent dilation in circumferential coronary calcifications using Wolverine cutting balloons, compared with conventional non-compliance (NC) balloons. Circumferential coronary calcification models were designed based on the patient's intravascular ultrasound images. Three-dimensional printed models were subjected to bench tests and software analysis was performed using the finite-element method (FEM). As a result, the bench test showed that higher balloon pressure was needed to dilate the models with stent implantation, either using Wolverine (17.1 ± 2.7 atm) or NC Emerge (18.9 ± 1.8 atm), while lower pressure was needed in models without stents using Wolverine [11.7 ± 2.9 atm, analysis of variance (ANOVA) p < 0.001]. Furthermore, models without stents were all successfully cracked by Wolverine at the first dilation, while models with stent implantation needed more dilations (ANOVA p = 0.0132). The FEM showed similar results that the first principal stress was the highest in Wolverine-dilated models without stents. In conclusion, implanted stents significantly increase the difficulty of balloon dilation and adequate pretreatment is critical for successful coronary stenting.
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Outcomes With Combined Laser Atherectomy and Intravascular Brachytherapy in Recurrent Drug-Eluting Stent In-Stent Restenosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 22:29-33. [DOI: 10.1016/j.carrev.2020.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 11/24/2022]
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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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Treatment of In-Stent Restenosis by Excimer Laser Coronary Atherectomy and Drug-Coated Balloon: Serial Assessment with Optical Coherence Tomography. J Interv Cardiol 2019; 2019:6515129. [PMID: 31772538 PMCID: PMC6739785 DOI: 10.1155/2019/6515129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives We aimed to compare the results of neointimal modification before drug-coated balloon (DCB) treatment with excimer laser coronary atherectomy (ELCA) plus scoring balloon predilation versus scoring balloon alone in patients presenting with in-stent restenosis (ISR). Background Treatment of ISR with ELCA typically results in superior acute gain by neointima debulking. However, the efficacy of combination therapy of ELCA and DCB remains unknown. Methods A total of 42 patients (44 ISR lesions) undergoing DCB treatment with ELCA plus scoring balloon (ELCA group, n = 18) or scoring balloon alone (non-ELCA group, n = 24) were evaluated via serial assessment by optical coherence tomography (OCT) performed before, after intervention, and at 6 months. Results Although there was significantly greater frequency of diffuse restenosis and percent diameter stenosis (%DS) after intervention in the ELCA group, comparable result was shown in %DS, late lumen loss, and binary angiographic restenosis at follow-up. On OCT analysis, a decreased tendency in the minimum lumen area and a significant decrease in the minimum stent area were observed in the ELCA group between 6-month follow-up and after intervention (-0.89 ± 1.36 mm2 vs. -0.09 ± 1.25 mm2, p = 0.05, -0.49 ± 1.48 mm2 vs. 0.28 ± 0.78 mm2, p = 0.03, respectively). The changes in the neointimal area were similar between the groups, and target lesion revascularization showed comparable rates at 1 year (11.1% vs. 11.4%, p = 0.85). Conclusions Despite greater %DS after intervention, ELCA before DCB had possible benefit for late angiographic and clinical outcome.
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Hernández-Enríquez M, Campelo-Parada F, Lhermusier T, Bouisset F, Roncalli J, Elbaz M, Carrié D, Boudou N. Long-term outcomes of rotational atherectomy of underexpanded stents. A single center experience. J Interv Cardiol 2018; 31:465-470. [PMID: 29372576 PMCID: PMC6099470 DOI: 10.1111/joic.12491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To analyze the procedural and long-term outcomes of the use of rotational atherectomy (RA) in underexpanded stents in our cohort and to provide an overview of currently available data on this technique. BACKGROUND Stent underexpansion (SU) has been related to stent thrombosis and restenosis. RA has been used to treat undilatable SU as a bail-out strategy with encouraging results. METHODS This is an observational, single-center study. We included patients who underwent stentablation between 2013 and 2017. Baseline demographics, procedural results, in-hospital major adverse cardiac events (MACE), and long-term follow-up MACE were retrospectively collected. RESULTS A total of 11 patients (90.9% males, mean age 65.4 ± 18.6) were included in this study. Median left ventricle ejection fraction was 53.5% [46.2-55]. Median calculated Syntax score was 16 [9-31] and 45.5% of patients were admitted for acute coronary syndrome. Radial approach was used in 63.6% of cases. Most patients only required one burr (45% used a 1.5 mm diameter burr) during the intervention. Procedural success was achieved in 90.9% of the cases. Acute lumen gain was 42.7% [30.7-61.49]. There were no in-hospital deaths or MACE. At a median follow-up of 26 months, only one patient (9.1%) suffered MACE in the context of acute coronary syndrome, and two patients (18.2%) required non-target lesion revascularization. No deaths were reported. CONCLUSIONS RA of under expanded stents is a feasible option with a high rate of procedural success. At long-term follow-up, all of them were alive and 90.9% of patients remained free from MACE.
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Affiliation(s)
- Marco Hernández-Enríquez
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | | | | | - Frédéric Bouisset
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Jérôme Roncalli
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Nicolas Boudou
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
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Tajti P, Karmpaliotis D, Alaswad K, Toma C, Choi JW, Jaffer FA, Doing AH, Patel M, Mahmud E, Uretsky B, Karatasakis A, Karacsonyi J, Danek BA, Rangan BV, Banerjee S, Ungi I, Brilakis ES. Prevalence, Presentation and Treatment of 'Balloon Undilatable' Chronic Total Occlusions: Insights from a Multicenter US Registry. Catheter Cardiovasc Interv 2018; 91:657-666. [PMID: 29359452 DOI: 10.1002/ccd.27510] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/08/2017] [Accepted: 01/03/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence, treatment and outcomes of balloon undilatable chronic total occlusions (CTOs) have received limited study. METHODS We examined the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable CTOs in a contemporary multicenter US registry. RESULTS Between 2012 and 2017 data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients in whom guidewire crossing was successful: 52 of 425 CTOs were balloon undilatable (12%). Mean patient age was 65 ± 10 years and most patients were men (84%). Patients with balloon undilatable CTOs were more likely to be diabetic (67 vs. 41%, P < 0.001) and have heart failure (44 vs. 28%, P = 0.027). Balloon undilatable CTOs were longer (40 mm [interquartile range, IQR 20-50] vs. 30 [IQR 15-40], P = 0.016), more likely to have moderate/severe calcification (87 vs. 54%, P < 0.001), and had higher J-CTO score (3.2 ± 1.1 vs. 2.5 ± 1.3, P < 0.001) and PROGRESS-CTO complications score (3.9 ± 1.7 vs. 3.1 ± 2.0, P < 0.005). They were associated with lower technical and procedural success (92 vs. 98%, P = 0.024; and 88 vs. 96%, P = 0.034, respectively) and higher risk for in-hospital major adverse events (8 vs. 2%, P = 0.008) due to higher perforation rates. The most frequent treatments for balloon undilatable CTOs were high pressure balloon inflations (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%). CONCLUSIONS Balloon undilatable CTOs are common and are associated with lower success and higher complication rates.
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Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.,Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.,VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James W Choi
- Baylor Heart and Vascular Hospital, Dallas, Texas
| | | | | | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - Ehtisham Mahmud
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - Barry Uretsky
- VA Central Arkansas Healthcare System, Little Rock, Arkansas
| | - Aris Karatasakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Judit Karacsonyi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.,VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Barbara A Danek
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bavana V Rangan
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Imre Ungi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.,VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
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Successful removal of entrapped Burr with sheathless guiding during stent rotablation. Anatol J Cardiol 2017; 17:156-157. [PMID: 28209930 PMCID: PMC5336757 DOI: 10.14744/anatoljcardiol.2017.7519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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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Kawata M, Kato Y, Takada H, Kamemura K, Matsuura A, Sakamoto S. Successful rotational atherectomy for a repetitive restenosis lesion with underexpansion of double layer drug-eluting stents due to heavily calcified plaque. Cardiovasc Interv Ther 2015; 31:65-9. [PMID: 25666528 DOI: 10.1007/s12928-015-0319-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/26/2015] [Indexed: 11/25/2022]
Abstract
A 72-year-old male was treated. First percutaneous coronary intervention (PCI) for chronic total occlusion of proximal left anterior descending artery was performed after rotational atherectomy with 1.5-mm burr. Focal underexpansion of Promus stent occurred due to the heavily calcified plaque. After first restenosis, OCT-guided PCI was performed with 26 atm balloon dilatation. After second restenosis, Resolute Integrity was implanted. After third restenosis, rotational atherectomy with 1.5-, 1.75- and 2.15-mm burrs was performed. All stent struts disappeared at the lesion and Promus Element was implanted. No restenosis occurred after 6 months. Cautious rotational atherectomy could ablate double layer drug-eluting stents effectively.
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Affiliation(s)
- Masahito Kawata
- Department of Cardiology, Akashi Medical Center, 743-33, Yagi, Ohkubo-cho, Akashi, Hyogo, 674-0063, Japan.
| | - Yukinori Kato
- Department of Cardiology, Akashi Medical Center, 743-33, Yagi, Ohkubo-cho, Akashi, Hyogo, 674-0063, Japan
| | - Hiroki Takada
- Department of Cardiology, Akashi Medical Center, 743-33, Yagi, Ohkubo-cho, Akashi, Hyogo, 674-0063, Japan
| | - Kohei Kamemura
- Department of Cardiology, Akashi Medical Center, 743-33, Yagi, Ohkubo-cho, Akashi, Hyogo, 674-0063, Japan
| | - Akira Matsuura
- Department of Cardiology, Akashi Medical Center, 743-33, Yagi, Ohkubo-cho, Akashi, Hyogo, 674-0063, Japan
| | - Susumu Sakamoto
- Department of Cardiology, Akashi Medical Center, 743-33, Yagi, Ohkubo-cho, Akashi, Hyogo, 674-0063, Japan
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Kadohira T, Schwarcz AI, De Gregorio J. Successful retrieval of an entrapped guide wire between a deployed coronary stent and severely calcified vessel wall using excimer laser coronary atherectomy. Catheter Cardiovasc Interv 2015; 85:E39-42. [PMID: 25195662 DOI: 10.1002/ccd.25664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/19/2014] [Accepted: 09/02/2014] [Indexed: 11/10/2022]
Abstract
We report the successful retrieval of an entrapped interventional guide wire between a newly deployed coronary stent and severely calcified vessel wall. Using a buddy wire technique, the stent was deployed at high pressure in a culprit lesion of the left anterior descending (LAD) artery. The buddy wire in the LAD artery was entrapped between the deployed stent and severely calcified vessel wall, as it was not removed before stent deployment, and could not be retrieved. Neither balloon catheters nor a microcatheter were able to be advanced behind the stent over the entrapped guide wire. Excimer laser coronary atherectomy (ELCA) was performed within the stent to modify and soften the calcification behind the deployed stent. Consequently, the entrapped guide wire was retrieved successfully and safely. This case illustrates that ELCA can be utilized to retrieve an entrapped guide wire between a deployed stent and calcified vessel wall.
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Affiliation(s)
- Tadayuki Kadohira
- Department of Invasive Cardiology, Englewood Hospital and Medical Center, Englewood, New Jersey
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Vales L, Coppola J, Kwan T. Successful expansion of an underexpanded stent by rotational atherectomy. Int J Angiol 2014; 22:63-8. [PMID: 24436587 DOI: 10.1055/s-0033-1333869] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The current routine use of intracoronary stents in percutaneous coronary intervention (PCI) has significantly reduced rates of restenosis, compared with balloon angioplasty alone. On the contrary, small post-stenting luminal dimensions due to undilatable, heavily calcified plaques have repeatedly been shown to significantly increase the rates of in-stent restenosis. Rotational atherectomy of lesions is an alternative method to facilitate PCI and prevent underexpansion of stents, when balloon angioplasty fails to successfully dilate a lesion. Stentablation, using rotational atherectomy to expand underexpanded stents deployed in heavily calcified plaques, has also been reported. We report a case via the transradial approach of rotational-atherectomy-facilitated PCI of in-stent restenosis of a severely underexpanded stent due to a heavily calcified plaque. We review the literature and suggest rotational atherectomy may have a role in treating a refractory, severely underexpanded stent caused by a heavily calcified plaque through various proposed mechanisms.
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Affiliation(s)
- Lori Vales
- Division of Cardiology, Department of Medicine, NYU Langone Medical Center, New York, New York
| | - John Coppola
- Division of Cardiology, Department of Medicine, NYU Langone Medical Center, New York, New York
| | - Tak Kwan
- Division of Cardiology, Department of Medicine, Beth Israel Medical Center, New York, New York
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Lam SCC, Bertog S, Sievert H. Excimer laser in management of underexpansion of a newly deployed coronary stent. Catheter Cardiovasc Interv 2013; 83:E64-8. [DOI: 10.1002/ccd.25030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/03/2013] [Accepted: 05/12/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Simon Cheung Chi Lam
- CardioVascular Center Frankfurt; Seckbacher Landstrasse 65 60389 Frankfurt Germany
| | - Stefan Bertog
- CardioVascular Center Frankfurt; Seckbacher Landstrasse 65 60389 Frankfurt Germany
| | - Horst Sievert
- CardioVascular Center Frankfurt; Seckbacher Landstrasse 65 60389 Frankfurt Germany
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The use of excimer laser for complex coronary artery lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 12:69.e1-8. [PMID: 21241980 DOI: 10.1016/j.carrev.2010.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 06/21/2010] [Accepted: 06/21/2010] [Indexed: 11/20/2022]
Abstract
Excimer laser coronary atherectomy (ELCA) has been used for coronary intervention for more than 20 years. Advances in delivery systems for laser energy using the xenon-chlorine pulsed laser catheter deliver higher energy density with lower heat production. The Spectranetics CVX-300 (Spectranetics, Colorado Springs, CO, USA) excimer laser catheter system has been used for the treatment of complex coronary lesions. We report our experience with the use of this advanced system for stenoses for which were unsuitable for standard percutaneous coronary intervention; for example, balloon-resistant lesions, chronic total occlusions, and for underexpanded stents in calcified lesions. ELCA may also be valuable for thrombus-containing lesion. We find ELCA to be indispensable in the catheterization laboratory for specific complex or calcified lesions. Its role should be explored in a large randomized trial of thrombus containing lesions and saphenous vein grafts.
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