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Allali A, Abdel-Wahab M, Elbasha K, Mankerious N, Traboulsi H, Kastrati A, El-Mawardy M, Hemetsberger R, Sulimov DS, Neumann FJ, Toelg R, Richardt G. Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials. Clin Res Cardiol 2023; 112:1143-1163. [PMID: 35482101 PMCID: PMC10450020 DOI: 10.1007/s00392-022-02013-2] [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: 06/01/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE-CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions.
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Affiliation(s)
- Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany.
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Hussein Traboulsi
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | | | - Rayyan Hemetsberger
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Franz-Josef Neumann
- Cardiology Department, Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
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Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023. Cardiovasc Interv Ther 2023; 38:141-162. [PMID: 36642762 PMCID: PMC10020250 DOI: 10.1007/s12928-022-00906-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Abstract
The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidences regarding rotational atherectomy (RA) in 2020. Because the revascularization strategy to severely calcified lesions is the hottest topic in contemporary percutaneous coronary intervention (PCI), many evidences related to RA have been published since 2020. Latest advancements have been incorporated in this updated expert consensus document.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Interventional Cardiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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Zha B, Chen Z, Ou-yang H. Endovascular Repair for Giant Right Subclavian Artery Aneurysm With Gore Viabahn and Pull-Through Procedure: A Case Report. Front Surg 2022; 9:939818. [PMID: 35865034 PMCID: PMC9294322 DOI: 10.3389/fsurg.2022.939818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background Giant true subclavian artery aneurysms (SAAs) (>5 cm) are rare. Technical and anatomical considerations complicate the endovascular treatment of SAAs and pose some challenges. Here, we present a giant right SAA that was successfully excluded using stent grafts with the pull-through technique after two interventional steps and discuss the pull-through technique details as well as the lessons to be learned from this case. Methods A 50-year-old man presented at our department complaining of dyspnea and hoarseness. Computed tomography angiography (CTA) showed a giant right SAA with partial intraluminal thrombus and severe angulated aneurysm necks originating from the proximal right subclavian artery, approximately 70 × 71 mm in size. Outcomes An 8 × 100-mm Gore Viabahn was selected to exclude the SAA. A decision was made to stabilize the wire tension using the pull-through technique. Final angiography showed that the SAA was essentially excluded, and slight endoleak was observed. At 6 months, imaging showed that the aneurysm was not obviously shrinking, there was still an endoleak and stent graft dislodgement was observed. Angiography confirmed a type Ia endoleak, which was managed by the placement of a 10 × 50-mm Gore Viabahn, again with the assistance of the pull-through technique. At the 25-month follow-up, CTA showed that the SAA was satisfactorily excluded, with no endoleak, and the SAA was reduced in size. Conclusions Endovascular treatment of SAAs is a safe, reliable and minimally invasive approach. The pull-through technique may improve wire tension and device stabilization. Additionally, size selection and positioning should be reappraised under a severely angulated aneurysm neck.
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Dobrocky T, Lee H, Nicholson P, Agid R, Lynch J, Swaminathan SK, Krings T, Radovanovic I, Pereira VM. When Two Is Better than One : The Buddy-wire Technique in Flow-diversion Procedures. Clin Neuroradiol 2021; 32:491-498. [PMID: 34236441 PMCID: PMC9187555 DOI: 10.1007/s00062-021-01053-x] [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: 02/28/2021] [Accepted: 06/05/2021] [Indexed: 11/24/2022]
Abstract
Background Delivery of most flow diverters (FD) requires larger, and thus stiffer microcatheters (0.021–0.027in.) which can pose challenges to intracranial navigation. The concomitant use of two microwires within one microcatheter, also known as the buddy-wire technique, may be helpful for navigation and support in challenging situations. Methods We analyzed all flow diverter procedures in our prospectively collected database. We recorded all patient-related, anatomical and procedural information. We performed univariate statistics and technical descriptions. Results In total, 208 consecutive patients treated with a FD at our institution between July 2014 and August 2020 were retrospectively analyzed. In 17 patients the buddy-wire technique was used (mean age 63 years, range 31–87 years: 16 female). Aneurysms were located at the petrous, cavernous, supraophthalmic internal carotid artery, and a proximal M2 branch in 2, 7, 7 and 1 patient(s), respectively. In all cases a 0.027in. microcatheter was used for device deployment. In 14 patients with a wide-necked aneurysm the buddy-wire provided additional support to advance the microcatheter and mitigated the ledge between the aneurysm neck and the parent artery or a side branch. In two giant cavernous aneurysms treated with telescoping FDs, the buddy-wire was used to re-enter the proximal end of the foreshortened FD. Conclusion The buddy-wire is a useful technique in FD procedures to prevent herniation of the microcatheter into the aneurysm sack, in wide-necked aneurysms to mitigate the ledge effect between the aneurysm neck and the parent artery where the microcatheter tip may get stuck, or to enable re-entry into a foreshortened FD.
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Affiliation(s)
- Tomas Dobrocky
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada. .,University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Hubert Lee
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jeremy Lynch
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Saravana Kumar Swaminathan
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, M5T 2S8, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, M5T 2S8, Toronto, Ontario, Canada
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Wang HC, Lu W, Gao ZH, Xie YN, Hao J, Liu JM. Application of a rapid exchange extension catheter technique in type B2/C nonocclusive coronary intervention via a transradial approach. World J Clin Cases 2021; 9:2751-2762. [PMID: 33969058 PMCID: PMC8058684 DOI: 10.12998/wjcc.v9.i12.2751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/29/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In transradial intervention procedures, poor back-up support and noncoaxial alignment of the guide catheter (GC) may result in failure of the balloon or stent to reach the targeted lesion. Methods to provide extra back-up support using the original GC and wire can improve procedural success with reduced complications. A rapid exchange guide extension catheter provides convenient and efficient back-up support while preserving the initial GC and inserted wire.
AIM To evaluate the efficacy and safety of rapid exchange extension catheter in the treatment of type B2/C nonocclusive coronary lesions via the radial access.
METHODS A total of 135 patients with type B2/C nonocclusive lesions who were treated via the transradial approach were enrolled in the study. The clinical characteristics, indications for use of the rapid exchange extension catheter, and procedural details and results were reviewed and analyzed. All procedure-related complications and major adverse cardiovascular events were recorded during the in-hospital stay and follow-up period.
RESULTS The most common indication for the use of a rapid exchange extension catheter was vascular tortuosity (37.8%), followed by heavy calcification (28.9%), long lesions (20.0%), proximal stent (6.7%), in-stent restenosis (5.2%), and coronary origin anomalies (1.5%). The following technologies failed in passing targeted lesions before delivering the rapid exchange catheter: Multiple predilatation technique (57%), buddy wire technique (33.4%), balloon anchoring technique (5.9%), and cutting balloon modification (3.7%). The mean depth of the extension catheter intubation was 20.56 ± 13.05 mm, and the mean rapid exchange catheter service time was 18.9 ± 9.7 min. The mean length and diameter of stents were 33.5 ± 14.4 mm and 2.75 ± 0.45 mm, respectively. The total rate of technique success (balloon or stent successful crossing of the target lesion with this technique) was 94.8%.
CONCLUSION The rapid exchange extension catheter technique showed acceptable safety and efficacy in the transradial coronary interventions of type B2/C nonocclusive coronary lesions. We recommend this technique to assist in complex lesion intervention via radial access.
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Affiliation(s)
- Hong-Chao Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Wei Lu
- Department of Cardiology, The Third Hospital of Shijiazhuang City, Shijiazhuang 050000, Hebei Province, China
| | - Zi-Han Gao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Ya-Nan Xie
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jie Hao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jin-Ming Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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Balceniuk MD, Ziazadeh D, Mix DS, Prasad S, Stoner MC. Totally percutaneous endovascular repair of HeartMate 3 ventricular assistive device outflow graft pseudoaneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:505-508. [PMID: 33134631 PMCID: PMC7588804 DOI: 10.1016/j.jvscit.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/05/2020] [Indexed: 11/19/2022]
Abstract
The rate of heart failure and subsequent placement of left ventricular assistive devices (LVADs) has been increasing. The extra-anatomic placement of the LVAD and outflow graft presents a challenging problem for repair when complications arise. The present report describes a case of a 63-year-old man who had presented with acute pseudoaneurysm of the outflow graft of his recently placed LVAD. Percutaneous access of the left subclavian artery and percutaneous, transthoracic access of the outflow graft was obtained to allow for sheath placement and stent deployment within the outflow graft. The patient underwent successful endovascular repair of the defect without complications.
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Affiliation(s)
- Mark D. Balceniuk
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Daniel Ziazadeh
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY
| | - Doran S. Mix
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Sunil Prasad
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY
| | - Michael C. Stoner
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
- Correspondence: Michael C. Stoner, MD, Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box 652, Rochester, NY 14642
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Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics. Cardiovasc Interv Ther 2020; 36:1-18. [PMID: 33079355 PMCID: PMC7829233 DOI: 10.1007/s12928-020-00715-w] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/15/2020] [Indexed: 12/12/2022]
Abstract
Rotational atherectomy (RA) has been widely used for percutaneous coronary intervention (PCI) to severely calcified lesions. As compared to other countries, RA in Japan has uniquely developed with the aid of greater usage of intravascular imaging devices such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). IVUS has been used to understand the guidewire bias and to decide appropriate burr sizes during RA, whereas OCT can also provide the thickness of calcification. Owing to such abundant experiences, Japanese RA operators modified RA techniques and reported unique evidences regarding RA. The Task Force on Rotational Atherectomy of the J apanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document to summarize the contemporary techniques and evidences regarding RA.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Interventional Cardiology, Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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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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