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Tabata T, Abe M, Uehara H. Impact of stentablation with rotational atherectomy in coronary microcirculatory function. Clin Case Rep 2024; 12:e9212. [PMID: 39055084 PMCID: PMC11266114 DOI: 10.1002/ccr3.9212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/25/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024] Open
Abstract
Key Clinical Message Stentablation (SA) has been used as a bailout method for undilated, under-expanded stents, but one reason that SA is associated with a high rate of major adverse cardiac events may be its adverse effect on microcirculation. Consequently, appropriate lesion preparation should always be considered for heavily calcified lesions to avoid such complications. Abstract Under-expansion of the coronary stent is associated with increased rates of in-stent restenosis and thrombosis. Stentablation (SA) with rotational atherectomy is used in the treatment of undilatable, under-expanded coronary stents; however, its effect on coronary microcirculatory function remains unclear. This novel report compares microcirculation indices before and after SA.
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Affiliation(s)
| | - Masami Abe
- Urasoe General HospitalUrasoeOkinawaJapan
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Samy M, Alali A, Elbasha K, Amoey D, Hemetsberger R, Kandil N, Elawady M, Allali A, Nef H, Toelg R, Richardt G, Mankerious N. Clinical outcomes of single- versus two-stent PCI technique in severely calcified true bifurcation lesions after rotational atherectomy. Clin Res Cardiol 2024; 113:1070-1080. [PMID: 38832996 DOI: 10.1007/s00392-024-02461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Severely calcified coronary bifurcations complicate percutaneous coronary interventions (PCI) and often necessitate dedicated lesion preparation. We compared the outcomes of single- versus two-stent techniques for treating heavily calcified true bifurcation lesions following rotational atherectomy (RA). METHODS Among patients receiving RA for severely calcified true bifurcations at a single center, 59 were treated with a single stent, and another 59 received two stents. We analyzed in-hospital adverse outcomes and 1-year rates of the bifurcation-oriented composite endpoint (BOCE), defined as cardiac death, target bifurcation myocardial infarction (TB-MI), or target bifurcation revascularization (TBR). RESULTS The single-stent arm was associated with more in-hospital adverse outcomes (adj. OR, 6.13; 95% CI, 1.34-28.0; p = 0.019), driven by higher peri-procedural MI rates (18.6% vs. 5.1%, p = 0.043) and more side branch compromise (13.6% vs. 0%, p = 0.006). After 1 year, both techniques had comparable 1-year BOCE (adj. HR, 0.38; 95% CI, 0.12-1.23; p = 0.106). We observed a significant interaction between the treatment technique and the presence of LM bifurcation (p interaction = 0.012), favoring single-stent technique in patients with non-LM bifurcations (HR 0.14, 95% CI 0.03-0.68; p = 0.015). Notably, the single-stent technique had lower rates of TBR (2% vs. 15%, p log-rank = 0.026) after 1 year. CONCLUSION Patients with severely calcified true bifurcation lesions, treated with RA followed by a single stent implantation, had more in-hospital adverse outcomes compared to those treated with two stents. However, the superior outcomes of the two-stent technique did not translate into improved long-term results. In fact, the two-stent technique was even associated with higher rates of revascularization after 1 year.
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Affiliation(s)
- Mohamed Samy
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt
| | - Ahmad Alali
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt
| | - Danial Amoey
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Rayyan Hemetsberger
- Cardiology Department, Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Nader Kandil
- Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt
| | - Mohamed Elawady
- Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt
| | - Abdelhakim Allali
- Cardiology Department, University Heart Center Lübeck, Lübeck, Germany
| | - Holger Nef
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Medical Faculty of the Christian-Albrechts-University of Kiel, Kiel, Germany
- Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt.
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3
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Zhao Y, Wang P, Zheng Z, Shi Y, Liu J. Comparison of intravascular lithotripsy versus rotational atherectomy for the treatment of severe coronary artery calcification. BMC Cardiovasc Disord 2024; 24:311. [PMID: 38898393 PMCID: PMC11186212 DOI: 10.1186/s12872-024-03965-1] [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: 02/02/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Calcified lesions are one of the most challenging cases for PCI, where optimal angiographic results and satisfying outcomes are hard to achieve. METHODS We evaluated the baseline clinical, procedures characteristics and outcomes of patients with severe coronary artery calcification (CAC) who underwent coronary intravascular lithotripsy (IVL) and rotational atherectomy (RA). RESULTS Respectively 152 and 238 patients who underwent IVL and RA are enrolled from January 2023 to November 2023. Regarding demographic characteristics, the gender proportion, medical history of PCI and smoke history among groups reach statistical significance. Left anterior descending and right coronary artery were the main vessels treated in both groups. The 2.5 and 3.0 mm IVL balloons and 1.5 mm burr were the most commonly used. 99.3% cases were successfully implanted drug-eluting stents after IVL balloon pre-treatment, which was higher than in the group treated with RA. During hospitalization, there were no serious adverse events in the IVL group, but there were two adverse events in the RA group. Procedural complications were higher in the RA group than the IVL group (5.5% vs. 0.7%, P = 0.027). CONCLUSIONS IVL appears to be safe and effective for the treatment of severe CAC lesions compared to RA.
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Affiliation(s)
- Yuhao Zhao
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ping Wang
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ze Zheng
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yuchen Shi
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
| | - Jinghua Liu
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
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Aboloyoun H, Zaki HM, Hasaballa A, Elbadawy A. Dichotomous grouping of peripheral arterial calcification grades: A practical predictor of outcome after endovascular therapy in peripheral arterial disease. Vascular 2023:17085381231214313. [PMID: 37937717 DOI: 10.1177/17085381231214313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND There is a general agreement that arterial calcification affects the results of endovascular therapy for peripheral arterial disease (PAD). In addition to lacking evidence for their impact, existing calcification scores are complex, and not practical in everyday decision making. The global limb anatomic staging system (GLASS) adopted dichotomous grouping of calcification grades. OBJECTIVE In this study we aim to investigate the impact of peripheral arterial calcification scoring after dichotomous grouping on midterm outcomes following endovascular therapy for PAD. METHODS This prospective study included all consecutive patients with PAD indicated for endovascular therapy procedure who presented to our tertiary referral center in the period between October 2020 and October 2021. Patients were grouped into Group A (n = 40): with no-to mild calcification (PACSS grade 0,1 and 2), and Group B (n = 53): with severe calcification (PACSS grades 3 and 4). Primary endpoints included technical success rate, primary patency rates, and major adverse limb events rate (MALE) during 2 years of follow-up. RESULTS The mean age of the studied cases (n = 93) was 59.31 ± 6.46 years (range 50-75). 70 patients (75.3%) were males, and 23 (24.7%) were females. There was no statistically significant difference between the two groups regarding technical success rate (97.5% in group A versus 94.33% in Group B, p = .457). The Primary patency rate after 1 year was lower in group B (74%) compared to group A (89.7%), but this difference was not statistically significant (p = .059). However, the 2-year primary patency rate was significantly lower in group B compared to group A (64% versus 84.6% respectively, p = .034). MALE rate after 2 years was significantly higher in group B (28%) as compared to group A (10.4%), P = .048. Studying suspected risk factors revealed that severe calcification was more common in patients with ischemic heart disease (34%) and chronic kidney disease (11%), P= .003 and .002 respectively. Logistic regression analysis showed that patients suffered from IHD and those with length of lesion ≥ 5 cm are about five times more likely to have severe calcification compared to their counterparts (OR = 4.875, 95%CI = 1.293-18.383, p = .019, and OR = 4.513, 95% CI = 11.138-17.893, p = .032), respectively. CONCLUSION The presence of severe calcification is associated with significantly lower midterm primary patency rates and higher rate of major adverse limb events after endovascular intervention for lower limb denovo arterial lesions.
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Affiliation(s)
- Hesham Aboloyoun
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Hazem Mohamed Zaki
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Ayman Hasaballa
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Ahmed Elbadawy
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
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Lee MS, Kereiakes DJ, Shlofmitz RA, Shlofmitz E, Mintz GS, Ali ZA, Park DW, Park SJ. Intravascular Lithotripsy for Calcified Left Main Artery Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101126. [PMID: 39129890 PMCID: PMC11308112 DOI: 10.1016/j.jscai.2023.101126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2024]
Abstract
Left main coronary artery disease subtends a large area of potentially jeopardized myocardium. Percutaneous coronary intervention for severe left main coronary artery disease is a reasonable treatment option for select patients. Severe coronary artery calcium of the left main artery increases the complexity of percutaneous coronary intervention and is associated with increased risk of periprocedural complications and worse long-term clinical outcomes. Intravascular lithotripsy (IVL) utilizes sonic pressure waves to modify severe coronary artery calcium and has emerged as a safe and effective alternative to coronary atherectomy. However, left main lesions were excluded from regulatory approval clinical trials of IVL. Herein, we review all available data regarding the use of IVL treatment for severe left main coronary artery disease.
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Affiliation(s)
| | - Dean J. Kereiakes
- The Carl and Edyth Lindner Research Center at The Christ Hospital, Cincinnati, Ohio
| | | | | | - Gary S. Mintz
- Cardiovascular Research Foundation, New York, New York
| | - Ziad A. Ali
- St. Francis Hospital & Heart Center, Roslyn, New York
- Cardiovascular Research Foundation, New York, New York
- New York Institute of Technology, Glen Head, New York
| | - Duk-Woo Park
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Ayoub M, Tajti P, Akin I, Behnes M, Schupp T, Forner J, Omran H, Westermann D, Rudolph V, Mashayekhi K. Safety and Long-Term Outcomes of Rotablation in Patients with Reduced (<50%) Left Ventricular Ejection Fraction (rEF) (The Rota-REF Study). J Clin Med 2023; 12:5640. [PMID: 37685706 PMCID: PMC10488397 DOI: 10.3390/jcm12175640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Clinical outcomes in patients with reduced left ventricular systolic function undergoing rotational atherectomy (RA) for percutaneous coronary intervention (PCI) remain understudied. Our study sought to evaluate the impact of RA-PCI in patients with LV systolic dysfunction on long-term outcomes. Between 2015 and 2019, 4941 patients with reduced LV function (rEF) undergoing PCI (with or without RA) were included in the hospital database. The primary endpoint was in-hospital major adverse cardiovascular and cerebral events (MACCE). The secondary endpoint was 3-year MACCE. In-hospital MACCE rates were significantly higher in RA-PCI compared to standard PCI without RA (PCI) (7.6% vs. 3.9%, p = 0.0009). However, 3-years MACCE rates were similar in RA-PCI and PCI (26.40% vs. 26.6%, p = 0.948). In conclusion, RA-PCI in patients with rEF is feasible, safe, and shows similar long-term results to PCI.
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Affiliation(s)
- Mohamed Ayoub
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Péter Tajti
- Gottsegen György National Cardiovascular Center, 1096 Budapest, Hungary
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Hazem Omran
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
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Bhogal S, Garcia-Garcia HM, Klein A, Benzuly K, Mangalmurti S, Moses J, Alaswad K, Jaffer F, Yong C, Nanjundappa A, Ben-Dor I, Mintz GS, Hashim H, Waksman R. Intravascular Lithotripsy for the Treatment of Severely Calcified Coronary Artery Disease: A DISRUPT CAD III Intravascular Ultrasound Substudy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53:22-27. [PMID: 36934007 DOI: 10.1016/j.carrev.2023.03.003] [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: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Coronary intravascular lithotripsy (IVL) has emerged as a novel technique for the treatment of severely calcified coronary lesions. We evaluated the mechanism and efficacy of IVL in facilitating optimal stent implantation in heavily calcified coronary lesions using intravascular ultrasound (IVUS). METHODS Forty-six patients were initially enrolled as a part of the Disrupt CAD III study. Of these, 33 had pre-IVL, 24 had post-IVL, and 44 had post-stent IVUS evaluation. The final analysis was performed on 18 patients who had IVUS images interpretable at all three intervals. The primary endpoint was increase in minimum lumen area (MLA) from pre-IVL to post-IVL treatment to post-stenting. RESULTS Pre-IVL, MLA was 2.75 ± 0.84 mm2, percent area stenosis was 67.22 % ± 20.95 % with maximum calcium angle of 266.90° ± 78.30°, confirming severely calcified lesions. After IVL, MLA increased to 4.06 ± 1.41 mm2 (p = 0.0003), percent area stenosis decreased to 54.80 % ± 25.71 % (p = 0.0009), and maximum calcium angle decreased to 239.40° ± 76.73° (p = 0.003). There was a further increase in MLA to 6.84 ± 2.18 mm2 (p < 0.0001) and decrease in percent area stenosis to 30.33 % ± 35.08 % (p < 0.0001) post-stenting with minimum stent area of 6.99 ± 2.14 mm2. The success rate of stent delivery, implantation, and post-stent dilation was 100 % post-IVL. CONCLUSION In this first study evaluating the mechanism of IVL using IVUS, the primary endpoint of increase in MLA from pre-IVL to post-IVL treatment to post-stenting was successfully achieved. Our study showed that the use of IVL-assisted percutaneous coronary intervention is associated with improved vessel compliance, facilitating optimal stent implantation in de novo severely calcified lesions.
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Affiliation(s)
- Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
| | | | | | | | - Jeffrey Moses
- Columbia University Medical Center, New York, NY, USA
| | | | | | - Celina Yong
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | | | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Gary S Mintz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hayder Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Doan KH, Liu TL, Yun WS, Kim YS, Yun KH, Oh SK, Park JP, Rhew JY, Lee SR. Intravascular Ultrasound Guided Intervention in Calcified Coronary Lesions Showed Good Clinical Outcomes during One Year Follow-Up. J Clin Med 2023; 12:4073. [PMID: 37373765 DOI: 10.3390/jcm12124073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Calcified coronary lesions can cause stent under-expansion, malapposition, and polymer degradation, hence increasing the risk of adverse clinical outcomes. Percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) has been used regularly to improve outcomes. Our primary aim was to evaluate the clinical efficacy of IVUS-guided PCI in calcified coronary lesions. METHODS From August 2018 to December 2021, we prospectively included 300 patients in the CAPIRO study (CAlcified plaque in patients receiving Resolute Onyx®) at three educational hospitals in Jeonbuk Province. We studied 243 patients (265 lesions) who were followed up for over a year. Based on coronary calcification by IVUS analysis, the patient population was categorized into two groups (Group I: non/mild calcification; Group II: moderate/severe calcification (maximum calcium arc >180° and calcium length > 5 mm)). One-to-one Propensity Score Matching was used to match the baseline characteristics. The stent expansion rate was analyzed by recent criteria. The primary clinical outcome was Major Adverse Cardiac Events (MACE), which included Cardiac death, Myocardial Infarction (MI), and Target Lesion Revascularization (TLR). RESULTS After follow-up time, the MACE rate in Group I was 1.99%, comparable to Group II's 1.09% (p = 0.594). The components of MACE did not significantly differ between the two groups. Based on absolute MSA or MSA/MVA at MSA site criteria, the stent expansion rate in Group II was lower than that of Group I. Nevertheless, based on recent relative criteria, the stent expansion rate in both groups was comparable. CONCLUSIONS After more than a year of follow-up, IVUS-guided PCI in moderate/severe calcification lesions was associated with good clinical outcomes, which was comparable with non/mild calcification lesions. Future studies with a larger sample size and a more extended follow-up period are required to clarify our findings.
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Affiliation(s)
- Khanh-Hung Doan
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Tai-Li Liu
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Won-Sik Yun
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Yi-Sik Kim
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Kyeong Ho Yun
- Division of Cardiology, Wonkwang University Hospital, Iksan 54538, Republic of Korea
| | - Seok Kyu Oh
- Division of Cardiology, Wonkwang University Hospital, Iksan 54538, Republic of Korea
| | - Jong-Pil Park
- Division of Cardiology, Presbyterian Medical Center, Jeonju 54987, Republic of Korea
| | - Jay Young Rhew
- Division of Cardiology, Presbyterian Medical Center, Jeonju 54987, Republic of Korea
| | - Sang-Rok Lee
- Division of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea
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Clinical Outcomes of Rotational Atherectomy in Heavily Calcified Lesions: Evidence From the Largest Cardiac Center in Thailand. Glob Heart 2022; 17:77. [DOI: 10.5334/gh.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
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10
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Rola P, Kulczycki JJ, Włodarczak A, Barycki M, Włodarczak S, Szudrowicz M, Furtan Ł, Jastrzębski A, Pęcherzewski M, Lesiak M, Doroszko A. Intravascular Lithotripsy as a Novel Treatment Method for Calcified Unprotected Left Main Diseases-Comparison to Rotational Atherectomy-Short-Term Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159011. [PMID: 35897381 PMCID: PMC9330248 DOI: 10.3390/ijerph19159011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 02/04/2023]
Abstract
Background: The unprotected calcified Left Main disease represents a high-risk subset for percutaneous coronary intervention (PCI), and it is associated with a higher number of periprocedural complications and an increased rate of in-stent thrombosis and restenosis. Adequate lesion preparation plays a crucial role in achieving a favorable PCI outcome. Rotational Atherectomy (RA) is a well-established plaque-modifying method; nevertheless, the data regarding the effectiveness of RA in LM diseases is scarce. Recently, the novel ShockWave-Intravascular-Lithotripsy(S-IVL) device has been introduced to the PCI armamentarium in order to modify the calcified plaque. Methods: We performed a retrospective evaluation of 44 consecutive subjects who underwent the LM-PCI, and who were supported by either the RA or S-IVL. Results: The Rota group consisted of 29 patients with a mean syntax score of 28.0 ± 7.5. The S-IVL group was composed of 15 subjects with a syntax score of 23.3 ± 13.0 There were no statistical differences regarding MACE between the RA and Shockwave arms of the in-hospital group (10.3% vs. 6.7%), or in the six month (17.2% vs. 13.3%) follow-up group. Conclusions: RA and S-IVL could be safe and effective therapeutic strategies for calcified LM disease. Further studies with a higher number of participants and longer follow-up times are warranted to establish the potential benefits of RA and S-IVL for the management of LM stenosis.
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Affiliation(s)
- Piotr Rola
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland;
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
- Correspondence:
| | - Jan Jakub Kulczycki
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (J.J.K.); (S.W.); (M.S.); (A.J.); (M.P.)
| | - Adrian Włodarczak
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland;
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (J.J.K.); (S.W.); (M.S.); (A.J.); (M.P.)
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (J.J.K.); (S.W.); (M.S.); (A.J.); (M.P.)
| | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (J.J.K.); (S.W.); (M.S.); (A.J.); (M.P.)
| | - Łukasz Furtan
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | - Artur Jastrzębski
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (J.J.K.); (S.W.); (M.S.); (A.J.); (M.P.)
| | - Maciej Pęcherzewski
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (J.J.K.); (S.W.); (M.S.); (A.J.); (M.P.)
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, 61-848 Poznan, Poland;
| | - Adrian Doroszko
- Clinical Department of Internal Medicine and Occupational Diseases, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland;
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Jung J, Her SH, Lee K, Jung JH, Yoo KD, Moon KW, Moon D, Lee SN, Jang WY, Choi IJ, Lee JH, Lee JH, Lee SR, Lee SW, Yun KH, Lee HJ. Impact of Diabetes Duration on Clinical Outcome in Patients Receiving Rotational Atherectomy in Calcified Lesions in Korea-Results from ROCK Registry. Life (Basel) 2022; 12:993. [PMID: 35888082 PMCID: PMC9324660 DOI: 10.3390/life12070993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023] Open
Abstract
There are limited data regarding the clinical impact of diabetes duration for patients with heavy calcified coronary lesions. We sought to determine the clinical impact of diabetes duration on clinical outcomes in patients with heavily calcified lesions who required rotational atherectomy during percutaneous coronary intervention (PCI). A total of 540 diabetic patients (583 lesions) were enrolled between January 2010 and October 2019. Patients were classified into three subgroups: patients with no diabetes mellitus (non-DM), shorter duration (S-DM), and longer duration (L-DM), of which duration was divided at 10 years. During 18 months of follow-up-duration, diabetes duration was significantly associated with the primary outcome. The incidence rate of target-vessel failure (TVF), the primary outcome, was significantly higher in the L-DM group compared with non-DM or S-DM. Among secondary outcomes, any repeat revascularization (RR) was frequently observed in the L-DM compared with other groups. In multivariate analysis, the risk of TVF and any RR was 1.9 times and 2.4 times higher in L-DM than in non-DM, respectively. This study firstly demonstrated that there is an association between a longer DM duration and poor clinical outcomes in patients with severe calcified CAD after PCI. More careful monitoring for recurrence is needed during follow-up in those patients.
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Affiliation(s)
- Jin Jung
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Sung-Ho Her
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Kyusup Lee
- Department of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 34943, Korea
| | - Ji-Hoon Jung
- Korea Institute of Toxicology, Daejeon 34114, Korea;
| | - Ki-Dong Yoo
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Keon-Woong Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Donggyu Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Su-Nam Lee
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Won-Young Jang
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea; (J.J.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Ik-Jun Choi
- Department of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Korea;
| | - Jae-Hwan Lee
- Department of Cardiology in Internal Medicine, Chungnam National University School of Medicine, Daejeon 35015, Korea;
| | - Jang-Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu 41944, Korea;
| | - Sang-Rok Lee
- Department of Cardiology, Chonbuk National University Hospital, Jeonju 54907, Korea;
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Kyeong-Ho Yun
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan 54538, Korea;
| | - Hyun-Jong Lee
- Department of Internal Medicine, Sejong General Hospital, Bucheon 14754, Korea;
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12
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Chandra S, Choudhary R, Chaudhary G, Sharma A, Pradhan A, Bhandari M, Vishwakarma P, Sethi R, Narain VS, Dwivedi SK. Evaluation of only heparin-based rota-flush solution against alternative rota-flush solution in patients with severe coronary artery calcification undergoing rotational atherectomy. Indian Heart J 2021; 74:22-27. [PMID: 34883110 PMCID: PMC8891009 DOI: 10.1016/j.ihj.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/03/2021] [Indexed: 02/08/2023] Open
Abstract
Objective There is limited evidence on feasibility and safety of only heparin rota-flush(OHRF)solution in rotational atherectomy (RA). We compared the safety and efficacy of OHRF solution with alternative rota-flush (ARF) solution in patients who underwent RA. Methods A total of 48 patients who underwent RA were enrolled in the study. In 25 patients OHRF solution and in 23 patients ARF solution was utilized. The study end points were procedural success rateandrota-related adverse cardiovascular event (RRAE) including slow flow, no reflow, bradycardia, and hemodynamic instability. Results Procedural success was achieved in all patients in both the OHRF and ARF groups. There was no statistically significant difference in RRAE between the two groups(32.0% vs. 34.7%, p = 0.83). Conclusion OHRF solution appears a more simplistic solution while performing rotablation as compared to ARF solution. Side effects such as hypotension and bradycardia can be circumvented with OHRF solution during rotablation.
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Affiliation(s)
- Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Rajeev Choudhary
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Gaurav Chaudhary
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Akhil Sharma
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Monika Bhandari
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Varun Shankar Narain
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Sudhanshu Kumar Dwivedi
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
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13
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Kassimis G, Theodoropoulos KC, Didagelos M, Ziakas A. Successful off-label use of rotational atherectomy in ST-segment elevation myocardial infarction: A case report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:272-275. [PMID: 34801421 DOI: 10.1016/j.carrev.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/31/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Rotational atherectomy (RA) in ST-segment elevation myocardial infarction (STEMI) is uncommon and its use in a thrombotic lesion is labelled a contraindication by its manufacturer due to the concern for further increase in platelet activation and aggregation by the spinning burr or distal embolization of the thrombotic material promoting no-reflow (NR). However, thrombus burden varies significantly in the STEMI setting and can be classified according to the thrombolysis in myocardial infarction (TIMI) thrombus grade (TG). This case demonstrates the successful off-label use of RA-assisted primary percutaneous coronary intervention to facilitate treatment of a heavily calcified ostial right coronary artery lesion with low thrombotic burden (TIMI TG 0) in an octogenarian STEMI patient. Atherectomy drug cocktails, intracoronary vasodilators, short burr runs and avoidance of rotating the burr at slower than minimum approved rotational speed contribute to atherectomy success and decrease the chances of NR.
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Affiliation(s)
- George Kassimis
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos C Theodoropoulos
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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14
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Gao W, Chen Y, Yang H, Yao K, Ge J. Outcomes of rotational atherectomy for severely calcified coronary lesions: A single center 5-year experience. Catheter Cardiovasc Interv 2021; 98:E254-E261. [PMID: 33964182 DOI: 10.1002/ccd.29740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the influences of accumulated experience on rotational atherectomy (RA) operation regarding to in-hospital outcomes in the drug-eluting stent (DES) era. METHODS Between 2015 and 2019, 540 de novo lesions with calcified coronary lesions treated by RA and DES implantation at our center were retrospectively assessed. In-hospital major adverse cardiac events (MACE) were defined as all cause death, cardiac death, target vessel revascularization, and stroke. RESULTS From 2015 to 2019, RA operations were 22, 60, 102, 157, and 199 cases, respectively. Rates of procedural complications were 4.5, 3.3, 11.8, 8.3, and 7.5%, respectively. Rates of in-hospital MACE were 0, 0, 3.9, 2.5, and 2.0%, respectively. Compared with planned RA, bailout RA was associated with more contrast use (207.5 ± 82.8 ml vs. 189.2 ± 70.0 ml, p = .008). As for procedural complications and in-hospital outcomes, no differences were observed between two strategies. Logistic regression revealed that hypertension was independently associated with complications (OR 5.830, 95% CI 1.382-24.591, p = .016). For MACE, independent risk factors were heart failure (OR 17.593, 95% CI 1.475-209.816, p = .023) and procedural complications (OR 127.629, 95% CI 15.135-1,076.258, p < .001). CONCLUSIONS Along with the rapid increase of RA use and accumulated experience, rates of complications and MACE went up first and then dropped down. Hypertension was found to be an independent risk factor of procedural complications. For in-hospital MACE, independent risk factors were heart failure and procedural complications.
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Affiliation(s)
- Wei Gao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Yaolin Chen
- Department of Cardiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, Fujian Province, China
| | - Hongbo Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Kang Yao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
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15
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Patel NJ, Okamoto N, Murphy J, Vengrenyuk Y, Sharma SK, Kini AS. Management of calcified coronary artery bifurcation lesions. Catheter Cardiovasc Interv 2021; 97:1407-1416. [PMID: 32776696 DOI: 10.1002/ccd.29148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/03/2020] [Indexed: 11/09/2022]
Abstract
Calcified coronary artery bifurcation lesions (CBL) remain a challenge for the interventional cardiologist. Evidence regarding treatment of CBL is minimal. Optimal plaque modification is the most important step prior to stent deployment. Provisional stenting is the preferred strategy for most bifurcation lesions. However, two-stent strategy should be considered for BL with compromised large SB (>2.5 mm) supplying a large territory, >70% SB stenosis and lesions more than 5 mm long. In this contemporary review article, we present a simplified approach to treating CBL and demonstrate the approach to specific case examples using our newly developed mobile application, BifurcAID.
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Affiliation(s)
- Nileshkumar J Patel
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Naotaka Okamoto
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Jonathan Murphy
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Yuliya Vengrenyuk
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
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16
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Yaliang T, Guohui L, Cheng Z, Beibei D, Yanan Z, Yuquan H, Ping Y. Successful double-layer metal stents rotational ablation under 2-dimensional and 3-dimensional optical coherence tomography guidance: a case report. BMC Cardiovasc Disord 2021; 21:173. [PMID: 33849433 PMCID: PMC8042855 DOI: 10.1186/s12872-021-01965-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background Stent ablation with rotational atherectomy has been considered a bail-out strategy for the treatment of severe stent underexpansion. Only a few reports have yet shown rotational ablation for double-layer metal struts. Case presentation We present a case of 80-year-old female patient presented to our hospital because of worsening effort angina. Coronary angiography revealed severe in-stent restenosis in the proximal left anterior descending artery. Optical coherence tomography (OCT) examinations found that severe stenosis occurred at the overlap region with 2-layer underexpanded stents and circumferential calcification beneath them. Under the guidance of 2-dimensional (2D) and 3-dimensional (3D) OCT, we successfully performed percutaneous coronary intervention (PCI) of this lesion after adequate stent ablation, high-pressure balloon dilatation, and subsequent everolimus-eluting stent implantation. The patient recovered well uneventfully and discharged from hospital 7 days later. No restenosis occurred after 12 months. Conclusions We report a very rare case of in-stent restenosis due to double-layer underexpanded stents. The entire percutaneous coronary intervention procedure was performed step by step under the guidance of high-resolution OCT. Our findings highlight the specific value of 2D and 3D OCT guidance in double-layer stents rotational ablation. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01965-z.
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Affiliation(s)
- Tong Yaliang
- Department of Cardiology , China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin, China
| | - Liu Guohui
- Department of Cardiology , China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin, China
| | - Zhang Cheng
- Department of Cardiology , China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin, China
| | - Du Beibei
- Department of Cardiology , China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin, China
| | - Zhao Yanan
- Department of Cardiology , China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin, China
| | - He Yuquan
- Department of Cardiology , China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China.,Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin, China
| | - Yang Ping
- Department of Cardiology , China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China. .,Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin, China. .,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin, China.
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17
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Megaly M, Brilakis ES, Sedhom R, Tawadros M, Elbadawi A, Mentias A, Alaswad K, Kirtane AJ, Garcia S, Pershad A. Outcomes with Orbital and Rotational Atherectomy for Inpatient Percutaneous Coronary Intervention. Cardiol Ther 2021; 10:229-239. [PMID: 33710602 PMCID: PMC8126522 DOI: 10.1007/s40119-021-00214-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Our objective was to describe the contemporary outcomes of orbital atherectomy (OA) vs. rotational atherectomy (RA) use for inpatient percutaneous coronary intervention (PCI) in the United States. Data on the use of OA vs. RA in contemporary inpatient PCI are limited. METHODS We queried the Nationwide Readmission Database (NRD) from January to November for the years 2016-2017 to identify hospitalizations of patients who underwent PCI with atherectomy. We conducted a multivariate regression analysis to identify variables associated with in-hospital mortality. RESULTS We included 77,040 records of patients who underwent inpatient PCI with atherectomy. Of those, 71,610 (93%) had RA, and 5430 (7%) had OA. There was no significant change in the trend of using OA or RA over 2016 and 2017. OA was less utilized in patients presenting with ST-segment elevation myocardial infarction (STEMI) (4.3% vs. 46.8%, p < 0.001). In our cohort, OA was associated with lower in-hospital mortality (3.1% vs. 5%, p < 0.001) and 30-day urgent readmission (< 0.01% vs. 0.2%, p = 0.009), but a higher risk of coronary perforation (1.7% vs. 0.6%, p < 0.001) and cardiac tamponade (1% vs. 0.3%, p < 0.001) and a higher cost of index hospitalization ($28,199 vs. $23,188, p < 0.001) compared with RA. CONCLUSION RA remains the predominant atherectomy modality for inpatient PCI in the United States (93%). There was no change in the trend of use for either modality over the years 2016 and 2017. OA was noted to have a lower incidence of in-hospital death, but a higher risk of coronary perforation and a higher cost of index hospitalization for the overall unmatched cohorts.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Banner University Medical Center, UA College of Medicine, Phoenix, AZ, USA
| | - E S Brilakis
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ramy Sedhom
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | | | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Amgad Mentias
- Division of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ajay J Kirtane
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA.,Division of Cardiology, Columbia University Irving Medical Center/New York Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, NY, USA
| | - Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, UA College of Medicine, Phoenix, AZ, USA.
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18
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Amabile A, Geirsson A. Commentary: When the going gets… stuck. JTCVS Tech 2021; 7:157-158. [PMID: 34318234 PMCID: PMC8311986 DOI: 10.1016/j.xjtc.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
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19
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Jia S, Li J, Zhang C, Liu Y, Yuan D, Xu N, Zhao X, Gao R, Yang Y, Xu B, Gao Z, Yuan J, Zhang Y. Long-Term Prognosis of Moderate to Severe Coronary Artery Calcification in Patients Undergoing Percutaneous Coronary Intervention. Circ J 2020; 85:50-58. [PMID: 33298633 DOI: 10.1253/circj.cj-20-0761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Moderate/severe coronary artery calcification (CAC) predicts worse clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). However, to date most studies have been modest in size and with limited follow-up. We aimed to assess the association between calcification severity and long-term clinical outcomes in a large cohort undergoing PCI.Methods and Results:In total, 10,068 consecutive patients who underwent PCI at Fuwai Hospital were enrolled in this prospective observational study. Patients were categorized as none/mild or moderate/severe CAC according to the severity of the target lesion by visual assessment of coronary angiography. Major adverse cardiovascular events (MACE), a composite event of death, myocardial infarction and revascularization, at 5 years were assessed. None/mild CAC was observed in 8,229 (81.7%) patients, and moderate/severe CAC was observed in 1,839 (18.3%) patients. Patients with moderate/severe CAC had a significantly higher rate of 5-year unplanned revascularization (15.2% vs. 13.2%, P=0.022) and MACE (20.7% vs. 17.9%, P=0.005). After propensity score matching, the moderate/severe CAC group still had a higher rate of 5-year unplanned revascularization (15.2% vs. 12.6%, P=0.019). Cox regression analysis using clinically significant variables revealed moderate/severe calcification was independently associated with higher risk of 2-year unplanned target vessel revascularization (hazard ratio (HR)=1.287, 95% confidence interval (CI): 1.036-1.600, P=0.023) and MACE (HR=1.242, 95% CI: 1.039-1.484, P=0.017), but not 5-year unplanned revascularization and MACE. CONCLUSIONS In patients undergoing PCI, moderate/severe coronary calcification increases the risk of long-term MACE.
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Affiliation(s)
- Sida Jia
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Jianxin Li
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Ce Zhang
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Yue Liu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Deshan Yuan
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Na Xu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Xueyan Zhao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Yuejin Yang
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Bo Xu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Zhan Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Jinqing Yuan
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
| | - Yin Zhang
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences
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20
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Impact of Lesion Preparation Technique on Side Branch Compromise in Calcified Coronary Bifurcations: A Subgroup Analysis of the PREPARE-CALC Trial. J Interv Cardiol 2020; 2020:9740938. [PMID: 33223974 PMCID: PMC7673940 DOI: 10.1155/2020/9740938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/15/2020] [Accepted: 10/24/2020] [Indexed: 01/16/2023] Open
Abstract
Objectives To analyze the impact of different techniques of lesion preparation of severely calcified coronary bifurcation lesions. Background The impact of different techniques of lesion preparation of severely calcified coronary bifurcation lesions is poorly investigated. Methods We performed an as-treated analysis on 47 calcified bifurcation lesions treated with scoring/cutting balloons (SCB) and 68 lesions treated with rotational atherectomy (RA) in the PREPARE-CALC trial. Compromised side branch (SB) as assessed in the final angiogram was the primary outcome measure and was defined as any significant stenosis, dissection, or thrombolysis in myocardial infarction flow <3. Results True bifurcation lesions were present in 49% vs. 43% of cases in the SCB and RA groups, respectively. After stent implantation, SB balloon dilatation was necessary in around one-third of cases (36% vs. 38%; p = 0.82), and a two-stent technique was performed in 21.3% vs. 25% (p = 0.75). At the end of the procedure, the SB remained compromised in 15 lesions (32%) in the SCB group and 5 lesions (7%) in the RA group (p = 0.001). Large coronary dissections were more frequently observed in the SCB group (13% vs. 2%; p = 0.02). Postprocedural levels of cardiac biomarkers were significantly higher in patients with a compromised SB at the end of the procedure. Conclusions In the PREPARE-CALC trial, side branch compromise was more frequently observed after lesion preparation with SCB as compared with RA. Consequently, in calcified bifurcation lesions, an upfront debulking with an RA-based strategy might optimize the result in the side branch.
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Bouisset F, Barbato E, Reczuch K, Dobrzycki S, Meyer-Gessner M, Bressollette E, Cayla G, Lhermusier T, Zajdel W, Palazuelos Molinero J, Ferenc M, Ribichini FL, Carrié D. Clinical outcomes of PCI with rotational atherectomy: the European multicentre Euro4C registry. EUROINTERVENTION 2020; 16:e305-e312. [DOI: 10.4244/eij-d-19-01129] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Guedeney P, Claessen BE, Mehran R, Mintz GS, Liu M, Sorrentino S, Giustino G, Farhan S, Leon MB, Serruys PW, Smits PC, von Birgelen C, Ali ZA, Généreux P, Redfors B, Madhavan MV, Ben-Yehuda O, Stone GW. Coronary Calcification and Long-Term Outcomes According to Drug-Eluting Stent Generation. JACC Cardiovasc Interv 2020; 13:1417-1428. [DOI: 10.1016/j.jcin.2020.03.053] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
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Dong P, Mozafari H, Prabhu D, Bezerra HG, Wilson DL, Gu L. Optical Coherence Tomography-Based Modeling of Stent Deployment in Heavily Calcified Coronary Lesion. J Biomech Eng 2020; 142:051012. [PMID: 31654052 PMCID: PMC7104774 DOI: 10.1115/1.4045285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/27/2019] [Indexed: 12/12/2022]
Abstract
In this work, a heavily calcified coronary artery model was reconstructed from optical coherence tomography (OCT) images to investigate the impact of calcification characteristics on stenting outcomes. The calcification was quantified at various cross sections in terms of angle, maximum thickness, and area. The stent deployment procedure, including the crimping, expansion, and recoil, was implemented. The influence of calcification characteristics on stent expansion, malapposition, and lesion mechanics was characterized. Results have shown that the minimal lumen area following stenting occurred at the cross section with the greatest calcification angle. The calcification angle constricted the stretchability of the lesion and thus resulted in a small lumen area. The maximum principal strain and von Mises stress distribution patterns in both the fibrotic tissue and artery were consistent with the calcification profiles. The radially projected region of the calcification tends to have less strain and stress. The peak strain and stress of the fibrotic tissue occurred near the interface with the calcification. It is also the region with a high risk of tissue dissection and strut malapposition. In addition, the superficial calcification with a large angle aggregated the malapposition at the middle of the calcification arc. These detailed mechanistic quantifications could be used to provide a fundamental understanding of the role of calcification in stent expansions, as well as to exploit their potential for enhanced pre- and post-stenting strategies.
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Affiliation(s)
- Pengfei Dong
- Department of Mechanical and Materials Engineering,University
of Nebraska-Lincoln,Lincoln, NE 68588
| | - Hozhabr Mozafari
- Department of Mechanical and Materials Engineering,University
of Nebraska-Lincoln,Lincoln, NE 68588
| | - David Prabhu
- Department of Biomedical Engineering,Case Western Reserve
University,Cleveland, OH 44106
| | - Hiram G. Bezerra
- Department of Medicine-Cardiovascular Medicine, Cardiovascular
Imaging Core Laboratory, Harrington Heart & Vascular Institute,
University Hospitals Cleveland Medical Center, Cleveland, OH
44106
| | - David L. Wilson
- Department of Biomedical Engineering,Case Western Reserve
University,Cleveland, OH 44106
| | - Linxia Gu
- Department of Mechanical and Materials Engineering,University
of Nebraska-Lincoln,Lincoln, NE 68588;Department of Biomedical and
Chemical Engineering and Sciences,Florida Institute of
Technology,Melbourne, FL 32901
e-mail:
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Morofuji T, Kuramitsu S, Shinozaki T, Jinnouchi H, Sonoda S, Domei T, Hyodo M, Shirai S, Ando K. Clinical impact of calcified nodule in patients with heavily calcified lesions requiring rotational atherectomy. Catheter Cardiovasc Interv 2020; 97:10-19. [PMID: 32259392 DOI: 10.1002/ccd.28896] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES We sought to evaluate the incidence and clinical impact of calcified nodule (CN) in patients with heavily calcified lesions requiring rotational atherectomy (RA). BACKGROUND It remains unclear whether CN impacts adversely on clinical outcomes in patients with heavily calcified lesions. METHODS Between January 2011 and February 2014, 264 patients after second-generation drug-eluting stent (DES) implantation following RA were retrospectively enrolled. CN was defined as a convex shape of the luminal side of calcium as assessed by intravascular ultrasound. The primary endpoint was the cumulative 5-year incidence of major adverse cardiac events (MACE), defined as a composite of cardiac death, clinically driven target lesion revascularization (CDTLR), and definite stent thrombosis (ST). RESULTS CN was observed in 128 patients (48.5%) with heavily calcified lesions. Cumulative 5-year incidence of MACE was significantly higher in the CN group than in the non-CN group, mainly driven by a higher rate of CDTLR and ST (35.4% vs. 18.8%, p < .001; 23.2% vs. 7.9%, p < .001; 7.0% vs. 0.93%, p = .009, respectively). Independent risk factors of 5-year MACE included hemodialysis (hazard ratio [HR] = 3.39, 95% confidence intervals [CI]: 2.00-5.73, p < .001), CN (HR = 2.53, 95% CI: 1.49-4.27, p < .001), ostial lesion (HR = 3.02, 95% CI: 1.58-5.78, p = .001), left ventricular ejection fraction ≤40% (HR = 2.17, 95% CI: 1.27-3.70, p = .005), and right coronary artery lesion (HR = 1.82, 95% CI: 1.07-3.11, p = .03). CONCLUSIONS CN was observed in 48.5% of heavily calcified lesions, resulting in unfavorable long-term clinical outcomes after second-generation DES implantation following RA.
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Affiliation(s)
- Toru Morofuji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | | | - Shinjo Sonoda
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan School of Medicine, Kitakyushu, Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Makoto Hyodo
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Orbital Atherectomy for the Treatment of Long (≥25–40 mm) Severely Calcified Coronary Lesions: ORBIT II Sub-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:164-170. [DOI: 10.1016/j.carrev.2019.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 12/27/2022]
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Gupta T, Weinreich M, Greenberg M, Colombo A, Latib A. Rotational Atherectomy: A Contemporary Appraisal. ACTA ACUST UNITED AC 2019; 14:182-189. [PMID: 31867066 PMCID: PMC6918488 DOI: 10.15420/icr.2019.17.r1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
Rotational atherectomy (RA) is an atheroablative technology that enables percutaneous coronary intervention for complex, calcified coronary lesions. RA works on the principle of 'differential cutting' and preferentially ablates hard, inelastic, calcified plaque. The objective of RA use has evolved from plaque debulking to plaque modification to enable balloon angioplasty and optimal stent expansion. The clinical experience over the past 30 years has informed the current best practices for RA with use of smaller burr sizes, short ablation runs a 'pecking' motion, and avoidance of sudden decelerations. This has led to significant improvements in procedural safety and a reduced rate of associated complications. This article reviews the principles, clinical indications, contemporary evidence, technical considerations and complications associated with the use of RA.
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Affiliation(s)
- Tanush Gupta
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US.,Department of Cardiology, Columbia University Medical Center New York, NY, US
| | - Michael Weinreich
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US
| | - Mark Greenberg
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Cotignola Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US.,Division of Cardiology, Department of Medicine, University of Cape Town Cape Town, South Africa
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Quillot M, Carrié D, Lhermusier T, Bouisset F, André R, Elbaz M, Roncalli J, Campelo-Parada F, Boudou N. Short- and Mid-Term Prognosis of Patients Undergoing Rotational Atherectomy in Aortoostial Coronary Lesions in Left Main or Right Coronary Arteries. J Interv Cardiol 2019; 2019:9012787. [PMID: 31772550 PMCID: PMC6739796 DOI: 10.1155/2019/9012787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/12/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine short-term and mid-term prognosis in patients with calcified ostial coronary lesions who underwent rotational atherectomy (RA). BACKGROUND RA was developed to facilitate stenting in complex lesions. Treatment of calcified aortoostial coronary lesions with RA appears to have poorer procedure outcomes than nonostial lesions; yet the literature on this topic is scarce. METHODS Of 498 consecutive patients who underwent RA, a total of 80 (16.1%) presented with aortoostial lesions. A comparative, monocentric study was performed between patients with aortoostial and nonaortoostial stenosis, in a retrospective registry. The primary endpoint was the procedural success rate. Secondary endpoints were the rates of major adverse cardiac and cardiovascular events (MACE) at 30 days and 24 months. RESULTS The procedural success rate was high and similar in patients with and without ostial lesions (96.3% vs 94.7%, p=0.78), as was the rate of angiographic complications (7.5% vs 8.4%, p=0.80). However, the 30-day mortality rate was significantly higher in the aortoostial group (11.3% vs 4.8%, p=0.04), as was the 24-month rate of MACE (43.8% vs 31.8%, p=0.04). The aortoostial location of the lesion was an independent factor associated with the occurrence of cardiovascular events at 24 months (HR = 1.52, 95% CI, 1.03-2.26, p=0.035). CONCLUSION Procedural success and complication rates were similar in patients with and without aortoostial lesions. Despite a poor short- and mid-term prognosis, rotational atherectomy appears to be a feasible and safe treatment option for calcified aortoostial coronary lesions.
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Affiliation(s)
- Marine Quillot
- Cardiology Department, University Hospital of Toulouse, Toulouse, France
| | - Didier Carrié
- Cardiology Department, University Hospital of Toulouse, Toulouse, France
| | | | - Frédéric Bouisset
- Cardiology Department, University Hospital of Toulouse, Toulouse, France
| | - Romain André
- Cardiology Department, University Hospital of Toulouse, Toulouse, France
| | - Meyer Elbaz
- Cardiology Department, University Hospital of Toulouse, Toulouse, France
| | - Jérôme Roncalli
- Cardiology Department, University Hospital of Toulouse, Toulouse, France
| | | | - Nicolas Boudou
- Cardiology Department, University Hospital of Toulouse, Toulouse, France
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Acute and Long-Term Outcomes of Patients with Impaired Left Ventricular Systolic Function Undergoing Rotational Atherectomy: A Single-Center Observational Retrospective Study. Cardiol Ther 2019; 8:267-281. [PMID: 31350729 PMCID: PMC6828855 DOI: 10.1007/s40119-019-0143-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Rotational atherectomy (RA) historically was contraindicated in patients with impaired left ventricular (LV) function due to inherent cardio-depressive effects. Contemporary RA practice is less aggressive than traditional RA and no longer withheld from patients with reduced ejection fraction (EF). The aim of this analysis is to explore the outcomes of rotational atherectomy (RA) in patients with reduced left ventricular ejection fraction (LVEF). Methods Patients undergoing RA (n = 644) were divided into three groups according to LVEF (severely reduced ≤ 35%, n = 82; moderately reduced 36–54%, n = 170; and preserved LVEF ≥ 55%, n = 392). Results Compared to patients with preserved LVEF, those with severely reduced LVEF had higher rates of angiographic failure (12.2 vs. 3.3%, p = 0.003) and in-hospital major adverse cardiac events (MACE: 9.8 vs. 2.3%, p = 0.004) driven by more peri-procedural myocardial infarction (MI: 6.1 vs. 1.5%, p = 0.049). In-hospital outcomes were similar between patients with preserved and moderately reduced LVEF. At 5-year follow-up, a stepwise increase in all-cause death was observed with lower LVEF (preserved: 15%, moderately reduced: 23%, severely reduced: 43%; p < 0.001). On the other hand, revascularization and MI rates at 5 years were not affected by LVEF. Conclusions Compared to patients with preserved LVEF, those with severely reduced LVEF have worse acute outcomes after RA, whereas a moderate reduction of LVEF poses no additional acute hazard after RA. Up to 5 years, the extent of left ventricular dysfunction was associated with a stepwise increase in mortality. Electronic supplementary material The online version of this article (10.1007/s40119-019-0143-4) contains supplementary material, which is available to authorized users.
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Sharma SK, Tomey MI, Teirstein PS, Kini AS, Reitman AB, Lee AC, Généreux P, Chambers JW, Grines CL, Himmelstein SI, Thompson CA, Meredith IT, Bhave A, Moses JW. North American Expert Review of Rotational Atherectomy. Circ Cardiovasc Interv 2019; 12:e007448. [DOI: 10.1161/circinterventions.118.007448] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Samin K. Sharma
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., M.I.T., A.S.K.)
| | - Matthew I. Tomey
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., M.I.T., A.S.K.)
| | - Paul S. Teirstein
- Scripps Prebys Cardiovascular Institute, Scripps Health, La Jolla, CA (P.S.T.)
| | - Annapoorna S. Kini
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., M.I.T., A.S.K.)
| | | | - Arthur C. Lee
- The Cardiac and Vascular Institute, Gainesville, FL (A.C.L.)
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | | | - Cindy L. Grines
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (C.L.G.)
| | | | - Craig A. Thompson
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine (C.A.T.)
| | | | - Aparna Bhave
- Boston Scientific Corporation, Natick, NA (A.B.)
| | - Jeffrey W. Moses
- Center for Interventional Vascular Therapies, Columbia University Medical Center, New York, NY (J.W.M.)
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Whiteside HL, Nagabandi A, Kapoor D. Stentablation with Rotational Atherectomy for the Management of Underexpanded and Undilatable Coronary Stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1203-1208. [PMID: 30842041 DOI: 10.1016/j.carrev.2019.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
Stentablation with rotational atherectomy for the management of undilatable underexpanded coronary stents is a unique application associated with excellent periprocedural and in-hospital outcomes. Data regarding long-term outcomes remains limited, however the procedure appears to be associated with high prevalence of target lesion revascularization. Given the complexity of such lesions and few available interventional remedies; it is a reasonably safe and widely available approach of which operators should be aware. When stentablation is performed, the principles which guide contemporary rotational atherectomy and percutaneous coronary intervention, including intravascular imaging, should be applied.
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Affiliation(s)
- Hoyle L Whiteside
- Division of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.
| | - Arun Nagabandi
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Deepak Kapoor
- Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Lee MS, Shlofmitz RA, Shlofmitz E, Behrens AN, Revtyak G, Martinsen BJ, Chambers JW. Procedural and Long-Term Ischemic Outcomes of Tight Subtotal Occlusions Treated with Orbital Atherectomy: An ORBIT II Subanalysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:563-568. [PMID: 30243964 DOI: 10.1016/j.carrev.2018.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND/PURPOSE Orbital atherectomy is an effective treatment strategy to modify severely calcified coronary lesions prior to stent placement. Traversing a severely calcified subtotal occlusion with the crown may be more challenging compared with a less severely stenotic lesion. The purpose of this ORBIT II subanalysis was to evaluate outcomes post-orbital atherectomy (OA) treatment of lesions with ≥95% stenosis. METHODS/MATERIALS ORBIT II, a single-arm, prospective, multicenter trial, enrolled 443 subjects with severely calcified coronary lesions. Patients with chronic total occlusions were excluded from the trial. Subjects with the OA device activated were stratified based on pre-procedure percent stenosis: ≥95% stenosis (N = 91) and <95% stenosis (N = 341). Procedural success and 3-year major adverse cardiac event (MACE) rates were compared. RESULTS The severe angiographic complications rates were 6.6% and 6.7% in the ≥95% and <95% stenosis groups, respectively. There was no significant difference in procedural success (94.5% vs. 88.3%, p = 0.120). 3-year MACE rates were similar (27.1% vs. 22.5%, p = 0.548), as were the rates of cardiac death (5.7% vs. 7.1%, p = 0.665) and MI (7.9% vs. 12.1%, p = 0.244). The TVR rate was higher in the ≥95% stenosis group (19.1% vs. 7.5%, p = 0.004). CONCLUSIONS In ORBIT II, OA treatment of lesions with ≥95% stenosis resulted in a high rate of procedural success. Although the 3-year revascularization rate was higher in the ≥95% stenosis group, it is not unexpected given the challenge of treating such complex lesions. The results of this analysis suggest that OA may be a reasonable treatment strategy for tight, severely calcified subtotal occlusions. SUMMARY The purpose of this ORBIT II subanalysis was to evaluate outcomes post-orbital atherectomy (OA) treatment of lesions with ≥95% stenosis. In ORBIT II, OA treatment of lesions with ≥95% stenosis resulted in a high rate of procedural success. Although the 3-year revascularization rate was higher in the ≥95% stenosis group, it is not unexpected given the challenge of treating such complex lesions. The results of this analysis suggest that OA may be a reasonable treatment strategy for tight, severely calcified subtotal occlusions.
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Affiliation(s)
- Michael S Lee
- UCLA Medical Center, 100 Medical Plaza Suite 630, Los Angeles, CA 90095, USA.
| | - Richard A Shlofmitz
- St. Francis Hospital-The Heart Center, 100 Port Washington Blvd., Suite 105, Roslyn, NY 11576, USA
| | - Evan Shlofmitz
- Cardiovascular Research Foundation, 1700 Broadway, 8th Floor, New York, NY 10017, USA
| | - Ann N Behrens
- Scientific Affairs, Cardiovascular Systems, Inc., 1225 Old Highway 8 NW, St. Paul, MN 55112, USA.
| | - George Revtyak
- IU Health Physicians Cardiology, 1801 N. Senate Blvd., Suite 310, Indianapolis, IN 46202, USA.
| | - Brad J Martinsen
- Scientific Affairs, Cardiovascular Systems, Inc., 1225 Old Highway 8 NW, St. Paul, MN 55112, USA.
| | - Jeffrey W Chambers
- Metropolitan Heart and Vascular Institute, Mercy Hospital, 4040 Coon Rapids Blvd, Minneapolis, MN 55433, USA.
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Outcomes of rotational atherectomy in patients with severe left ventricular dysfunction without hemodynamic support. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018. [DOI: 10.1016/j.carrev.2018.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lee MS, Shlofmitz RA, Martinsen BJ, Sethi S, Chambers JW. Impact of age following treatment of severely calcified coronary lesions with the orbital atherectomy system: 3-year follow-up. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:655-659. [DOI: 10.1016/j.carrev.2018.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/11/2018] [Accepted: 01/19/2018] [Indexed: 11/29/2022]
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Efficacy of a heparin based rota-flush solution in patients undergoing rotational atherectomy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:333-337. [DOI: 10.1016/j.carrev.2017.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 11/20/2022]
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Sakamoto A, Virmani R, Finn AV, Gupta A. Calcified Nodule as the Cause of Acute Coronary Syndrome: Connecting Bench Observations to the Bedside. Cardiology 2018; 139:101-104. [DOI: 10.1159/000485119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/19/2022]
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Lee MS, Shlofmitz E, Lluri G, Kong J, Neverova N, Shlofmitz R. Outcomes of patients with myocardial infarction who underwent orbital atherectomy for severely calcified lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:497-500. [DOI: 10.1016/j.carrev.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 11/16/2022]
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Li N, Pan Z, Zhang D, Wang HX, Yu B, Zhao SP, Guo JJ, Wang JW, Yao L, Cao WG. Chemical Components, Biological Activities, and Toxicological Evaluation of the Fruit (Aril) of Two Precious Plant Species from Genus Taxus. Chem Biodivers 2017; 14. [PMID: 28921887 DOI: 10.1002/cbdv.201700305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/12/2017] [Indexed: 11/05/2022]
Abstract
The fruit (aril) of the endangered genus Taxus plants is an abandoned herbal resource. Traditionally, people enthusiastically focus on its bark, its renewable, tremendous arils fall into the soil with seeds after they are mature. The present research investigated the fruit of two species from the genus Taxus, Taxus chinensis var. mairei, and Taxus media, with regards to their antioxidant and antihyperglycaemic activities, safety, and bioactive constituents. Results showed that T. chinensis var. mairei and T. media both had certain biological activities with T. chinensis var. mairei better in antioxidant activity and T. media better in antihyperglycaemic activity. Correlation analysis revealed that the differences in bioactivities depended on content of their mainly chemical components. The mice acute oral toxicity test indicated that the methanol extracts of the two biotypes of Taxus were safe. And nineteen compounds were tentatively assigned from the two varieties, via tandem mass spectrometry using a LC-ESI-Q-TOF-MS instrument, which included phenols, flavonoids, and terpenes. These results indicate a possible application of Taxus fruit extracts in various fields like in food industry, however, this still needs further investigations.
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Affiliation(s)
- Na Li
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Zheng Pan
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Dan Zhang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Hua-Xing Wang
- Chongqing Bo Cao Cottage Technology Co., Ltd., Chongqing, 400016, P. R. China
| | - Bao Yu
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Sheng-Ping Zhao
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Jia-Jia Guo
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Jian-Wei Wang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Ling Yao
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Wei-Guo Cao
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China.,The Lab of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, P. R. China
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Lee MS, Shlofmitz E, Kong J, Srivastava PK, Al Yaseen S, Sosa FA, Gallant M, Shlofmitz R. Outcomes of patients with severely calcified aorto-ostial coronary lesions who underwent orbital atherectomy. J Interv Cardiol 2017; 31:15-20. [DOI: 10.1111/joic.12432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- Michael S. Lee
- Division of Cardiology; UCLA Medical Center; Los Angeles California
| | | | - Jeremy Kong
- Division of Cardiology; UCLA Medical Center; Los Angeles California
| | | | - Saif Al Yaseen
- Division of Cardiology; UCLA Medical Center; Los Angeles California
| | | | - Melissa Gallant
- Department of Cardiology; St. Francis Hospital-The Heart Center; Roslyn New York
| | - Richard Shlofmitz
- Department of Cardiology; St. Francis Hospital-The Heart Center; Roslyn New York
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Impact of diabetes mellitus on procedural and one year clinical outcomes following treatment of severely calcified coronary lesions with the orbital atherectomy system: A subanalysis of the ORBIT II study. Catheter Cardiovasc Interv 2017; 91:1018-1025. [DOI: 10.1002/ccd.27208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/03/2017] [Accepted: 06/17/2017] [Indexed: 11/07/2022]
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Shlofmitz E, Meraj P, Jauhar R, Sethi SS, Shlofmitz RA, Lee MS. Safety of orbital atherectomy in patients with left ventricular systolic dysfunction. J Interv Cardiol 2017; 30:415-420. [DOI: 10.1111/joic.12405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/11/2017] [Accepted: 06/16/2017] [Indexed: 11/30/2022] Open
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Lee M, Généreux P, Shlofmitz R, Phillipson D, Anose BM, Martinsen BJ, Himmelstein SI, Chambers JW. Orbital atherectomy for treating de novo , severely calcified coronary lesions: 3-year results of the pivotal ORBIT II trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:261-264. [DOI: 10.1016/j.carrev.2017.01.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/18/2017] [Indexed: 11/30/2022]
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Kim MC, Ahn Y, Sim DS, Hong YJ, Kim JH, Jeong MH, Gwon HC, Kim HS, Rha SW, Yoon JH, Jang Y, Tahk SJ, Seung KB. Impact of calcified bifurcation lesions in patients undergoing percutaneous coronary intervention using drug-eluting stents: results from the COronary BIfurcation Stent (COBIS) II registry. EUROINTERVENTION 2017; 13:338-344. [DOI: 10.4244/eij-d-16-00264] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lee M, Martinsen B, Shlofmitz R, Shlofmitz E, Lee A, Chambers J. Orbital atherectomy treatment of severely calcified coronary lesions in patients with impaired left ventricular ejection fraction: one-year outcomes from the ORBIT II study. EUROINTERVENTION 2017; 13:329-337. [DOI: 10.4244/eij-d-16-00301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ielasi A, Kawamoto H, Latib A, Boccuzzi GG, Sardella G, Garbo R, Meliga E, D'Ascenzo F, Presbitero P, Nakamura S, Colombo A. In-Hospital and 1-Year Outcomes of Rotational Atherectomy and Stent Implantation in Patients With Severely Calcified Unprotected Left Main Narrowings (from the Multicenter ROTATE Registry). Am J Cardiol 2017; 119:1331-1337. [PMID: 28274573 DOI: 10.1016/j.amjcard.2017.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
Abstract
Heavily calcified unprotected left main (ULM) disease continues to be a challenging situation and represent a high-risk subset for interventional cardiologist. To date, there are limited data investigating the results after rotational atherectomy (RA) in this setting. The aim of this study was to investigate the in-hospital and 1-year outcomes after RA of heavily calcified ULM lesions. A retrospective cohort analysis was performed on all calcified patients with ULM (n = 86) enrolled in the multicenter international ROTATE registry (overall patients, n = 962). End points of the study were the in-hospital and 1-year incidence of major adverse cardiovascular events (MACE): a composite of death, myocardial infarction, and target-vessel revascularization in the ULM versus non-ULM group. Patients in the ULM group were older (p = 0.01) and more frequently with diabetes (p = 0.001) compared with the non-ULM group, whereas intravascular ultrasound guidance was higher, even if not systematic, in the ULM group (p <0.001). No difference was reported between ULM versus non-ULM groups in terms of in-hospital MACE (5.8% vs 8%). At 1 year, MACE rate was higher in ULM versus non-ULM (26.4% vs 14.9%, p = 0.002) mostly driven by target-vessel revascularization (20.3% vs 12.7%, p = 0.05). Even definite/probable stent thrombosis rate was higher in the ULM group (3.9% vs 0.8%). All these events were subacute and 2/3 (75%) were fatal. In conclusion, our multicenter experience shows that RA followed by stent implantation in patients with heavily calcified ULM narrowing is feasible and associated with good in-hospital results. Patient (age and diabetes) and procedural aspects (relatively low intravascular ultrasound guidance) may affect the worse subacute mid-term prognosis in the more complex ULM group.
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Lee MS, Park KW, Shlofmitz E, Shlofmitz RA. Comparison of Rotational Atherectomy Versus Orbital Atherectomy for the Treatment of Heavily Calcified Coronary Plaques. Am J Cardiol 2017; 119:1320-1323. [PMID: 28258729 DOI: 10.1016/j.amjcard.2017.01.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/19/2022]
Abstract
We evaluated the outcomes of patients with severe coronary artery calcification (CAC) who underwent rotational atherectomy (RA) and orbital atherectomy (OA). Severe CAC increases the complexity of percutaneous coronary intervention (PCI) because of the difficulty in optimizing stent expansion, leading to worse clinical outcomes. Both devices are effective treatment strategies for severe CAC. No comparisons have been performed to evaluate the clinical outcomes after RA and OA. The outcomes of 67 patients with severe CAC who underwent RA from July 2012 to June 2015 and 60 patients who underwent OA from February 2014 to September 2016 were evaluated. The primary end point was the rate of 30-day major adverse cardiac and cerebrovascular events, comprising cardiac death, myocardial infarction, target vessel revascularization, and stroke. The primary end point was similar in the RA and OA groups (6% vs 6%, p >0.9), as were the individual end points of death (0% vs 2%, p = 0.8), myocardial infarction (6% vs 4%, p = 0.7), target vessel revascularization (0% vs 0%, p >0.9), and stroke (0% vs 0%, p >9). Procedural success was achieved in all patients. Angiographic complications were uncommon in both groups. No patient had stent thrombosis. In conclusion, both RA and OA are safe and effective for the treatment of severe CAC as they provided similar clinical outcomes at short-term follow-up.
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Affiliation(s)
- Michael S Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, California.
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Evan Shlofmitz
- Department of Cardiology, Northwell Health, Manhasset, New York
| | - Richard A Shlofmitz
- Cardiology Department, St. Francis Hospital-The Heart Center, Roslyn, New York
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Ohya M, Kadota K, Sotomi Y, Kozuma K, Tanabe K, Uematsu M, Kawasaki T, Morino Y, Tobaru T, Nakao K, Tachibana K, Kishi K, Shibata Y, Ying S, Kusano H, Stone GW, Popma JJ, Onuma Y, Serruys PW, Kimura T. Impact of lesion calcification on angiographic outcomes after Absorb everolimus-eluting bioresorbable vascular scaffold implantation: an observation from the ABSORB Japan trial. EUROINTERVENTION 2017; 12:1738-1746. [PMID: 27821375 DOI: 10.4244/eij-d-16-00359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to investigate the impact of lesion calcification on angiographic outcomes after Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) implantation in comparison with those after cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation. METHODS AND RESULTS The present post hoc analysis of the ABSORB Japan randomised trial compared post-procedure and 13-month angiographic outcomes between patients implanted with BVS and CoCr-EES based on the presence or absence of calcification, excluding extremely heavily calcified lesions or lesions requiring rotational atherectomy. The study population comprised 384 patients with 384 lesions (including 114 lesions [29.7%] with moderate or severe calcification), classified into two subgroups: calcification, 114 (BVS: n=72 and CoCr-EES: n=42) and non-calcification, 270 (BVS: n=181 and CoCr-EES: n=89). Follow-up angiography was performed in 94.8% of patients. Both post-procedure and follow-up in-device minimal lumen diameters were comparable in both the BVS arm (calcification vs. non-calcification: 2.43±0.32 mm vs. 2.43±0.39 mm, p=0.91 and 2.17±0.49 mm vs. 2.27±0.47 mm, p=0.17) and in the CoCr-EES arm (2.68±0.34 mm vs. 2.65±0.42 mm, p=0.62 and 2.57±0.52 mm vs. 2.47±0.53 mm, p=0.36). CONCLUSIONS Moderate or severe lesion calcification (excluding patients with extremely heavily calcified lesions or lesions requiring rotational atherectomy) does not negatively affect angiographic outcomes at both post-procedure and 13-month follow-up after BVS implantation.
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Lee MS, Shlofmitz E, Lluri G, Shlofmitz RA. Outcomes in Elderly Patients With Severely Calcified Coronary Lesions Undergoing Orbital Atherectomy. J Interv Cardiol 2017; 30:134-138. [PMID: 28116818 DOI: 10.1111/joic.12362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES We evaluated the clinical outcomes of elderly patients who underwent orbital atherectomy for the treatment of severe coronary artery calcification (CAC) prior to stenting. BACKGROUND Percutaneous coronary intervention (PCI) of severe CAC is associated with worse clinical outcomes including death, myocardial infarction (MI), and target vessel revascularization (TVR). The elderly represents a high-risk group of patients, often have more comorbid conditions, and have worse outcomes after PCI compared to younger patients. Clinical trials and a large multicenter registry have demonstrated the safety and efficacy of orbital atherectomy for the treatment of severe CAC. Clinical outcomes of elderly patients who undergo orbital atherectomy are unknown. METHODS Of the 458 patients, 229 were ≥75 years old (elderly) and 229 were <75 years old (younger). The primary endpoint was rate of 30-day major adverse cardiac and cerebrovascular events (MACCE), comprised of cardiac death, MI, TVR, and stroke. RESULTS The primary endpoint was similar in the elderly and younger groups (2.2% vs. 2.2%, P = 1), as were the individual endpoints of death (2.2% vs. 0.4%, P = 0.1), MI (0.9% vs. 1.3%, P = 0.65), TVR (0% vs. 0%, P = 1), and stroke (0% vs. 0.4%, P = 0.32). The rates of angiographic complications and stent thrombosis were similarly low in both groups. CONCLUSIONS The elderly represented a sizeable number of patients who underwent orbital atherectomy. It is a safe and effective treatment strategy for elderly patients with severe CAC as the clinical outcomes were similar to their younger counterparts. A randomized trial should further clarify the role of orbital atherectomy in these patients.
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Danek BA, Brilakis ES. Serenity, courage, and wisdom: The keys to successful coronary calcification treatment. Catheter Cardiovasc Interv 2016; 88:897-898. [DOI: 10.1002/ccd.26833] [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: 10/09/2016] [Accepted: 10/12/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Barbara Anna Danek
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
- Minneapolis Heart Institute; Minneapolis Minnesota
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Lee MS, Shlofmitz E, Nguyen H, Shlofmitz RA. Outcomes in Diabetic Patients Undergoing Orbital Atherectomy System. J Interv Cardiol 2016; 29:491-495. [DOI: 10.1111/joic.12321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Okuno S, Iida O, Shiraki T, Fujita M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Takahara M, Uematsu M. Impact of Calcification on Clinical Outcomes After Endovascular Therapy for Superficial Femoral Artery Disease. J Endovasc Ther 2016; 23:731-7. [DOI: 10.1177/1526602816656612] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To investigate whether the severity of lesion calcification assessed by the novel peripheral artery calcification scoring system (PACSS) was associated with clinical outcomes after endovascular therapy (EVT) for superficial femoral artery (SFA) lesions. Methods: A retrospective analysis was conducted of 394 consecutive patients (mean age 72±8 years; 290 men) with intermittent claudication [223 (57%) with diabetes, 81 (21%) on hemodialysis] who underwent successful EVT for de novo SFA lesions [length 152.1±95.7 mm; 199 (50%) TransAtlantic Inter-Society Consensus II class C/D] between January 2010 and December 2013. The patients were retrospectively categorized using the PACSS classification (grades 0–4: no visible calcification of the target lesion, unilateral wall calcification <5 cm, unilateral calcification ≥5 cm, bilateral wall calcification <5 cm, and bilateral calcification ≥5 cm, respectively). The main outcome was primary patency, while the secondary outcome measures were mortality and major adverse limb events [MALE: any intervention (repeat EVT or surgical revision) or major (above ankle) amputation]. Cox proportional hazards analysis was used to explore whether the PACSS classification was an independent predictor of clinical outcomes. Results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: The distribution of PACSS grades was 0 in 54%, grade 1 in 16%, grade 2 in 12%, grade 3 in 9%, and grade 4 in 9%. The 2-year primary patency rates in these grades, respectively, were 70.0%, 66.6%, 72.1%, 55.6%, and 36.3% (p<0.001). After multivariate analysis, PACSS grade 4 (HR 2.74, 95% CI 1.56 to 4.83, p<0.001), diabetes (HR 1.52, 95% CI 1.06 to 2.20, p=0.022), lesion length (HR 1.04, 95% CI 1.01 to 1.07, p=0.006), and vessel diameter (HR 0.80, 85% CI 0.65 to 0.98, p=0.038) were associated with loss of primary patency. PACSS grade 4 was also associated with MALE and mortality (p=0.048 and 0.011, respectively). Bare metal stent use (HR 0.47, 95% CI 0.30 to 0.73, p<0.001) was positively associated with primary patency. Conclusion: PACSS grade 4 calcification was independently associated with clinical outcomes after EVT for de novo SFA lesions.
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Affiliation(s)
- Shota Okuno
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Tatsuya Shiraki
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Masashi Fujita
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaaki Uematsu
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
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