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Leick J, Rheude T, Denne M, Tobias K, Cassese S, Kastrati A, Afzal S, Hug KP, Saad L, Lauterbach M, Werner N. Comparison of long-term outcome in patients with in-stent restenosis treated with intravascular lithotripsy or with modified balloon angioplasty. Clin Res Cardiol 2024; 113:1030-1040. [PMID: 38112745 DOI: 10.1007/s00392-023-02357-3] [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: 06/22/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Modified balloon angioplasty (MB) using a cutting-/scoring balloon or intravascular lithotripsy (IVL) is used in patients with in-stent restenosis (ISR). However, IVL is an off-label use in this setting. The aim of this subgroup analysis of an all-comers registry was to compare IVL to MB angioplasty in patients with ISR. METHODS The subgroup (n = 117) included all patients with an ISR treated by MB or IVL between 2019 and 2021. Primary endpoint was strategy success (< 20% residual stenosis). The secondary endpoint was cardiac death, acute myocardial infarction (AMI) and target lesion failure/revascularization (TVR). Quantitative coronary angiography was performed in all patients. RESULTS A total of n = 36 patients were treated by IVL and n = 81 patients by MB. No significant differences in baseline characteristics were observed between the groups. The primary endpoint was reached in 99 patients (84.6%). Patients in the IVL group had less residual stenosis (2.8% vs. 21.0%; p = 0.012). Multivariate regression analysis revealed that IVL had a significant positive effect on reaching the primary end point (Estimate 2.857; standard error (SE) 1.166; p = 0.014). During the follow-up period (450 days) there were no significant differences in rates of cardiac death (IVL n = 2 (1.7%) vs. MB n = 3 (2.6%); p = 0.643), AMI (IVL n = 2 (1.7%) vs. MB n = 4 (3.4%); p = 0.999) and TVR (IVL n = 5 (4.3%) vs. MB n = 14 (12%); p = 0.851). CONCLUSION IVL results in a significantly lower rate of residual stenosis than MB in patients with ISR. During the long-term follow-up, no differences in rates of cardiac death, AMI or TVR were observed.
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Affiliation(s)
- Jürgen Leick
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany.
| | - Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Michael Denne
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Krause Tobias
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Salvatore Cassese
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Shazia Afzal
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Karsten P Hug
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Louai Saad
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Michael Lauterbach
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Nikos Werner
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
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van Oort MJH, Al Amri I, Bingen BO, Cordoba-Soriano JG, Karalis I, Sanz-Sanchez J, Oliveri F, van der Kley F, Jukema JW, Jurado-Roman A, Montero-Cabezas JM. Procedural and clinical impact of intravascular lithotripsy for the treatment of peri-stent calcification. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:16-23. [PMID: 37923647 DOI: 10.1016/j.carrev.2023.10.013] [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: 08/29/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Use of intravascular lithotripsy (IVL) for treating peri-stent calcification is increasing. However, this indication remains 'off-label'. We aimed to investigate the efficacy and clinical outcomes of in-stent IVL. METHODS Patients from five European centers who underwent in-stent IVL were included between 2019 and 2023. Demographic, clinical, procedural and follow-up data were collected from electronic hospital records. Angiographic and intracoronary imaging (ICI) data were analyzed in a centralized core-laboratory. RESULTS Of 101 patients (71.2 ± 9.2 years), 56(55 %) received in-stent IVL for late stent failure (median 109 days post-PCI) due to calcific neoatherosclerosis or extra-stent calcification(late-IVL), while 45(45 %) underwent bail-out IVL due to stent infraexpasion (immediate-IVL). Both late-IVL and immediate-IVL significantly improved angiographic %diameter stenosis (73.7[59.6-89.8]% to 16.4 [10.4-26.9]%;p < 0.0001 and 28.6[22.5-43.3]% to 14.1[10.3-29.4]%;p < 0.0001, and minimum lumen area (MLA) (3.4 ± 1.2 to 8.6 ± 2.5 mm2;p < 0.002 and 5.4 ± 1.9 to 7.3 ± 1.9;p < 0.0001).Device(98 %) and procedural success(80 %) were high. MACE rates in-hospital (2 %), 30-days (3 %),6-months(5 %) and 1-year(7 %) were low and comparable in both groups. Acute diameter gain was lower in immediate-IVL (2.1 ± 0.7 mm vs. 0.5 ± 0.4 mm;p < 0.0001). This, however, was explained by significant differences in pre-IVL angiographic and ICI parameters (%diameter stenosis 73.7[59.6-89.8] vs. 28.6[22.5-43.3]%; p < 0.0001 and MLA (3.4 ± 1.2 vs 5.4 ± 1.9 mm2; p < 0.0001), whereas post-IVL percentage diameter stenosis (16.4(10.4-26.9) vs. 14.1(10.3-29.4);p = 0.914) and MLA (8.6 ± 2.5vs. 7.4 ± 1.9 mm2;p = 0.064) in late- and immediate-IVL were comparable. CONCLUSIONS IVL in-stent due to peri-stent calcification is an effective strategy, both late and immediately after stent implantation. Overall, MACE rates at short- and mid-term were low and comparable in both groups, although clinical findings should be taken with caution.
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Affiliation(s)
- Martijn J H van Oort
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Juan G Cordoba-Soriano
- Department of Cardiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Ioannis Karalis
- Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece.
| | - Jorge Sanz-Sanchez
- Department of Cardiology, Hospital Universitari I Politecnic La Fe, Valencia, Spain
| | - Federico Oliveri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
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Caminiti R, Vetta G, Parlavecchio A, Ielasi A, Magnocavallo M, Della Rocca DG, Cerrato E, Carerj S, Di Bella G, Micari A, Vizzari G. A Systematic Review and Meta-Analysis Including 354 Patients from 13 Studies of Intravascular Lithotripsy for the Treatment of Underexpanded Coronary Stents. Am J Cardiol 2023; 205:223-230. [PMID: 37611414 DOI: 10.1016/j.amjcard.2023.07.144] [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: 01/20/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/25/2023]
Abstract
Calcified coronary plaque (CCP) represents a challenging scenario for interventional cardiologists. Stent underexpansion (SU), often associated with CCP, can predispose to stent thrombosis and in-stent restenosis. To date, SU with heavily CCP can be addressed using very high-/high-pressure noncompliant balloons, off-label rotational atherectomy/orbital atherectomy, excimer laser atherectomy, and intravascular lithotripsy (IVL). In this meta-analysis, we investigated the success rate of IVL for the treatment of SU because of CCP. Studies and case-based experiences reporting on the use of IVL strategy for treatment of SU were included. The primary end point was IVL strategy success, defined as the adequate expansion of the underexpanded stent. A metanalysis was performed for the main focuses to calculate the proportions of procedural success rates with corresponding 95% confidence intervals (CIs). Random-effects models weighted by inverse variance were used because of clinical heterogeneity. This meta-analysis included 13 studies with 354 patients. The mean age was 71.3 years (95% CI 64.9 to 73.1), and 77% (95% CI 71.2% to 82.4%) were male. The mean follow-up time was 2.6 months (95% CI 1 to 15.3). Strategy success was seen in 88.7% (95% CI 82.3 to 95.1) of patients. The mean minimal stent area was reported in 6 studies, the pre-IVL value was 3.4 mm2 (95% CI 3 to 3.8), and the post-IVL value was 6.9 mm2 (95% CI 6.5 to 7.4). The mean diameter stenosis (percentage) was reported in 7 studies, the pre-IVL value was 69.4% (95% CI 60.7 to 78.2), and the post-IVL value was 14.6% (95% CI 11.1 to 18). The rate of intraprocedural complications was 1.6% (95% CI 0.3 to 2.9). In conclusion, the "stent-through" IVL plaque modification technique is a safe tool to treat SU caused by CCP, with a high success rate and a very low incidence of complications.
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Affiliation(s)
- Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alfonso Ielasi
- Cardiology Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Domenico Giovanni Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital of Orbassano and Rivoli Infermi Hospital of Rivoli, Turin, Italy
| | - Scipione Carerj
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gianluca Di Bella
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Micari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giampiero Vizzari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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Lobo TN, Ajluni S, Mogalapalli A, Kumar S, Hammad T, Abo-Salem E. Coronary Orbital Atherectomy Through Newly Deployed Left Main Coronary Stent. Cureus 2023; 15:e42821. [PMID: 37664326 PMCID: PMC10471353 DOI: 10.7759/cureus.42821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 09/05/2023] Open
Abstract
Percutaneous coronary intervention (PCI) in complex, calcified coronary lesions can be assisted with orbital atherectomy (OA). OA is generally avoided when there are lesions amendable to OA distal to a newly deployed stent due to the risk of device-stent interaction, burr entrapment, and stent avulsion. We present a case documenting the successful passage of an OA system through a recently deployed left main stent to prepare a chronically occluded left anterior descending for PCI.
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Affiliation(s)
- Tabitha N Lobo
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Steven Ajluni
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Akhil Mogalapalli
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Sundeep Kumar
- Department of Cardiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Tarek Hammad
- Department of Cardiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Elsayed Abo-Salem
- Department of Cardiology, Saint Louis University Hospital, St. Louis, USA
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5
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Wang Y, Hou AJ, Luan B, Zhang XJ, Li ZY, Pei XY. Prevalence, predictors, and management for balloon uncrossable or undilatable lesions in patients undergoing percutaneous coronary intervention with in-stent restenosis chronic total occlusion. Front Cardiovasc Med 2023; 10:1095960. [PMID: 37324628 PMCID: PMC10265741 DOI: 10.3389/fcvm.2023.1095960] [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: 11/11/2022] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Background Percutaneous coronary intervention for in-stent restenosis (ISR) chronic total occlusion (CTO) has been a great challenge. There are occasions when the balloon is uncrossable or undilatable (BUs) even though the guidewire has passed, leading to failure of the procedure. Few studies have focused on the incidence, predictors, and management of BUs during ISR-CTO intervention. Methods Patients with ISR-CTO were recruited consecutively between January 2017 and January 2022 and divided into two groups based on the presence of BUs. The clinical data of the two groups (BUs group and non-BUs group) were retrospectively analyzed and compared to explore the predictors and clinical management strategies of BUs. Results A total of 218 patients with ISR-CTO were included in this study, 23.9% (52/218) of whom had BUs. The percentage of ostial stents, stent length, CTO length, the presence of proximal cap ambiguity, moderate to severe calcification, moderate to severe tortuosity, and J-CTO score were higher in the BUs group than in the non-BUs group (p < 0.05). The technical success rate and the procedural success rate were lower in the BUs group than in the non-BUs group (p < 0.05). Multivariable logistic regression analysis showed that ostial stents (OR: 2.011, 95% CI: 1.112-3.921, p = 0.031), the presence of moderate to severe calcification (OR: 3.383, 95% CI: 1.628-5.921, p = 0.024) and moderate to severe tortuosity (OR: 4.816, 95% CI: 2.038-7.772, p = 0.033) were independent predictors of BUs. Conclusion The initial rate of BUs in ISR-CTO was 23.9%. Ostial stents, presence of moderate to severe calcification, and moderate to severe tortuosity were independent predictors of BUs.
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Affiliation(s)
- Yong Wang
- Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People’s Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China
| | - Ai-jie Hou
- Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang, China
| | - Bo Luan
- Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang, China
| | - Xiao-jiao Zhang
- Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang, China
| | - Zhao-yu Li
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-yang Pei
- Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People’s Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, China
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6
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Griffioen A, van den Oord S, van Royen N, van Geuns RJ. Shockwave lithotripsy for stent underexpansion as a result of severely calcified neoatherosclerosis and in-stent restenosis. BMJ Case Rep 2023; 16:e248302. [PMID: 36653038 PMCID: PMC9853140 DOI: 10.1136/bcr-2021-248302] [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] [Indexed: 01/19/2023] Open
Abstract
Shockwave lithotripsy is a novel therapy to treat severely calcified lesions. The effectiveness of shockwave lithotripsy to treat severely calcified lesions and stent underexpansion due to severe calcifications has been demonstrated. However, this is the first case to demonstrate the use of shockwave lithotripsy in stent underexpansion due to severely calcified in-stent restenosis. A woman in her early 50s presented with angina. The coronary angiogram showed severe three-vessel coronary artery disease with in-stent restenosis in the left anterior descending. After stent implantation in the left anterior descending, there was persisting stent underexpansion due to severely calcified in-stent restenosis. Shockwave lithotripsy contributed to the improvement of angiographic and haemodynamic results. Although evidence is still limited, shockwave lithotripsy could be a valuable tool for treatment of stent underexpansion as a result of severely calcified in-stent restenosis. More studies are needed to confirm the incremental value of shockwave lithotripsy in stent underexpansion.
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Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Allana S, Egred M, Jneid H, Mashayekhi K, Di Mario C, Krestyaninov O, Khelimski D, Milkas A, Sandoval Y, Burke MN, Brilakis ES. An algorithmic approach to balloon undilatable coronary lesions. Catheter Cardiovasc Interv 2022; 101:355-362. [PMID: 36579411 DOI: 10.1002/ccd.30531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
Balloon undilatable lesions are lesions that have been successfully crossed by both a guidewire and a balloon but cannot be expanded despite multiple high-pressure balloon inflations. Balloon undilatable lesions can be de novo or in-stent. We describe a systematic, algorithmic approach to treat both de novo and in-stent balloon undilatable lesions using various techniques, such as high-pressure balloon inflation, plaque modification balloons, intravascular lithotripsy, very high-pressure balloon inflation, coronary atherectomy, laser coronary angioplasty, and extraplaque lesion crossing. Knowledge of the various techniques can increase the efficiency, success and safety of the procedure.
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Affiliation(s)
- Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Salman Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hani Jneid
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Texas, Houston, USA
| | | | - Carlo Di Mario
- Division of Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Dmitrii Khelimski
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Anastasios Milkas
- Division of Cardiology, Athens Naval and Veterans Hospital, Athens, Greece
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
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Tovar Forero MN, Sardella G, Salvi N, Cortese B, di Palma G, Werner N, Aksoy A, Escaned J, Salazar CH, Gonzalo N, Ugo F, Cavallino C, Sheth TN, Kardys I, Van Mieghem NM, Daemen J. Coronary lithotripsy for the treatment of underexpanded stents: the international & multicentre CRUNCH registry. EUROINTERVENTION 2022; 18:574-581. [PMID: 35318955 PMCID: PMC10241293 DOI: 10.4244/eij-d-21-00545] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Stent underexpansion increases the risk of cardiac adverse events. At present, there are limited options to treat refractory stent underexpansion. In this context, the intravascular lithotripsy (IVL) system might be a safe and effective strategy. AIMS We aimed to evaluate the safety and efficacy of IVL in addressing resistant stent underexpansion due to heavy underlying calcification. METHODS This was an international multicentre registry including patients receiving IVL therapy to treat stent underexpansion from December 2017 to August 2020. Angiographic and intracoronary imaging data were collected. The efficacy endpoint was device success (technical success with a final percentage diameter stenosis <50%). The safety endpoint was in-hospital major adverse cardiac events (MACE). RESULTS Seventy patients were included, the mean age was 73±9.2 years and 76% were male. The median time from stent implantation to IVL therapy was 49 days (0-2,537). Adjuvant treatment with non-compliant balloon dilatations pre- and post-IVL was performed in 72.3% and 76.8% of patients, respectively, and additional stenting was performed in 22.4%. Device success was 92.3%. Minimum lumen diameter increased from 1.49±0.73 mm to 2.41±0.67 mm (p<0.001) and stent expansion increased by 124.93±138.19% (p=0.016). No IVL-related procedural complications or MACE were observed. The use of bailout IVL therapy directly after stenting and the presence of ostial underexpanded lesions negatively predicted lumen diameter gain. CONCLUSIONS Coronary lithotripsy is safe and effective in increasing lumen and stent dimensions in underexpanded stents secondary to heavily calcified lesions.
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Affiliation(s)
| | - Gennaro Sardella
- Policlinico Umberto I' "Sapienza" University of Rome, Rome, Italy
| | - Nicolò Salvi
- Policlinico Umberto I' "Sapienza" University of Rome, Rome, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, Clinica San Carlo, Milano, Italy and Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Gaetano di Palma
- Cardiovascular Research Team, Clinica San Carlo, Milano, Italy and Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Nikos Werner
- Heart Center, Trier, Germany
- Heart Center Bonn, University Hospital, Bonn, Germany
| | - Adem Aksoy
- Heart Center Bonn, University Hospital, Bonn, Germany
| | - Javier Escaned
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Carlos H Salazar
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | | | | | - Tej N Sheth
- McMaster University, Hamilton, Ontario, Canada
| | - Isabella Kardys
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Joost Daemen
- Erasmus University Medical Center, Rotterdam, the Netherlands
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9
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Yamamoto H, Sawada T, Takaya T, Kawai H. Utility of coronary orbital atherectomy with guide-extension system for distally located undilatable in-stent restenosis: A case report. Clin Case Rep 2022; 10:e05798. [PMID: 35521045 PMCID: PMC9066738 DOI: 10.1002/ccr3.5798] [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: 12/03/2021] [Revised: 01/08/2022] [Accepted: 04/22/2022] [Indexed: 12/03/2022] Open
Abstract
Orbital atherectomy (OA) may be effective in managing undilatable in‐stent restenosis (ISR) despite off‐label indications. We demonstrated that optical frequency domain imaging (OFDI)‐guided OA, with a guide‐extension system was effective even in distally located, undilatable ISR. However, OFDI revealed that inter‐struts calcified neoatherosclerosis remained a challenging issue.
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Affiliation(s)
- Hiroyuki Yamamoto
- Division of Cardiovascular Medicine Hyogo Brain and Heart Center Himeji Japan
| | - Takahiro Sawada
- Division of Cardiovascular Medicine Hyogo Brain and Heart Center Himeji Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine Hyogo Brain and Heart Center Himeji Japan.,Department of Exploratory and Advanced Search in Cardiology Kobe University Graduate School of Medicine Kobe Japan
| | - Hiroya Kawai
- Division of Cardiovascular Medicine Hyogo Brain and Heart Center Himeji Japan.,Department of Exploratory and Advanced Search in Cardiology Kobe University Graduate School of Medicine Kobe Japan
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10
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Fedele M, Iannone A, Bartolini D, Rubartelli P. Shockwave intravascular lithotripsy in the treatment of under-expanded coronary stent: Case Series. Clin Case Rep 2021; 9:e04961. [PMID: 34707865 PMCID: PMC8527023 DOI: 10.1002/ccr3.4961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/01/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022] Open
Abstract
Under-expanded coronary stent related to inadequate preparation of calcified lesion is associated with poor clinical outcomes.Off-label use of S-IVL to correct this clinical issue is effective and safe, probably more than other current techniques. However, this statement needs further evidence.
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Kawamura Y, Yoshimachi F, Murotani N, Karasawa Y, Nagamatsu H, Yamamoto Y, Kudo T, Ikari Y. Coronary orbital atherectomy using a five-French guiding catheter. Cardiovasc Interv Ther 2021; 37:498-505. [PMID: 34554382 DOI: 10.1007/s12928-021-00813-3] [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: 03/22/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
Recently, the efficacy was demonstrated of the Diamondback 360® Coronary Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St. Paul, MN, USA) for treating calcified coronary lesions in percutaneous coronary intervention (PCI). The safety and feasibility of OAS application through a 5-Fr guiding catheter (GC) which is less invasive and reduces access site complications were validated. This sequential, retrospective, observational study was conducted in a single center from September 2018 to May 2020. The primary endpoint was a successful PCI with the OAS. Secondary endpoints were major adverse complications related to PCI with the OAS, including coronary dissection, perforation, side branch loss, need for an unexpected cardiac assist device, access site complications, and major adverse cardiac and cerebrovascular events. 33 PCIs in 30 patients (mean age 72 ± 11 years; male, 83.3%) were surveyed. All PCIs were successfully completed with OAS application through a 5-Fr GC. Coronary perforation after the OAS procedure occurred in one case (3.0%). Severe coronary dissection occurred in three cases (9.1%), and procedural myocardial infarction in two cases (6.1%). Regarding PCIs performed with the 5-Fr GC, the OAS is a safe and feasible strategy for calcified plaque modification.
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Affiliation(s)
- Yota Kawamura
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan.
| | - Fuminobu Yoshimachi
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan
| | - Nana Murotani
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan
| | - Yuka Karasawa
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan
| | - Hirofumi Nagamatsu
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan
| | - Yoshiya Yamamoto
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan
| | - Takeaki Kudo
- Division of Cardiology, Department of Internal Medicine, Miyakonojo Medical Association Hospital, Miyakonojo, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
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Wolverine cutting balloon in the treatment of stent underexpansion in heavy coronary calcification: bench test using a three-dimensional printer and computer simulation with the finite-element method. Cardiovasc Interv Ther 2021; 37:506-512. [PMID: 34374947 DOI: 10.1007/s12928-021-00803-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Heavy coronary calcification hinders successful stent implantation, and cutting balloons can be used for post-dilation after stent deployment. However, evidence regarding its use is limited to case reports. Therefore, this study aimed to investigate in-stent dilation in circumferential coronary calcifications using Wolverine cutting balloons, compared with conventional non-compliance (NC) balloons. Circumferential coronary calcification models were designed based on the patient's intravascular ultrasound images. Three-dimensional printed models were subjected to bench tests and software analysis was performed using the finite-element method (FEM). As a result, the bench test showed that higher balloon pressure was needed to dilate the models with stent implantation, either using Wolverine (17.1 ± 2.7 atm) or NC Emerge (18.9 ± 1.8 atm), while lower pressure was needed in models without stents using Wolverine [11.7 ± 2.9 atm, analysis of variance (ANOVA) p < 0.001]. Furthermore, models without stents were all successfully cracked by Wolverine at the first dilation, while models with stent implantation needed more dilations (ANOVA p = 0.0132). The FEM showed similar results that the first principal stress was the highest in Wolverine-dilated models without stents. In conclusion, implanted stents significantly increase the difficulty of balloon dilation and adequate pretreatment is critical for successful coronary stenting.
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13
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Hamana T, Yamamoto H, Sawada T, Kawai H, Takaya T. Additional ablation effect of low-speed rotational atherectomy following high-speed rotational atherectomy on early calcified in-stent restenosis: A case report. Clin Case Rep 2021; 9:e04550. [PMID: 34306704 PMCID: PMC8294135 DOI: 10.1002/ccr3.4550] [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: 03/19/2021] [Revised: 05/13/2021] [Accepted: 06/15/2021] [Indexed: 11/11/2022] Open
Abstract
Optical frequency domain imaging-guided additional low-speed rotational atherectomy following sufficient high-speed rotational atherectomy for early calcified in-stent restenosis might be a safe and useful option for achieving additional large lumen gains and stent expansion.
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Affiliation(s)
- Tomoyo Hamana
- Division of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
| | - Hiroyuki Yamamoto
- Division of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
| | - Takahiro Sawada
- Division of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
| | - Hiroya Kawai
- Division of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
- Department of Exploratory and Advanced search in CardiologyKobe University Graduate School of MedicineKobeJapan
| | - Tomofumi Takaya
- Division of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
- Department of Exploratory and Advanced search in CardiologyKobe University Graduate School of MedicineKobeJapan
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14
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Grines CL, Yen A. Between a rock and a hard place: Orbital atherectomy for under-expanded stents. Catheter Cardiovasc Interv 2021; 97:8-9. [PMID: 33460265 DOI: 10.1002/ccd.29452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/07/2022]
Abstract
Stent under-expansion (rather than intimal hyperplasia) may be the cause of in-stent restenosis. Later expansion of coronary stents that were not fully deployed initially, can be difficult. Atherectomy is one method of facilitating late stent expansion, but too few patients have been treated to determine the risk benefit ratio.
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Affiliation(s)
- Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Andrew Yen
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
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15
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Yaginuma K, Werner GS. Resolving chronic stent under-expansion in calcified lesions by intravascular lithoplasty. J Cardiol Cases 2021; 23:136-139. [PMID: 33717380 DOI: 10.1016/j.jccase.2020.10.018] [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: 04/04/2020] [Revised: 09/23/2020] [Accepted: 10/04/2020] [Indexed: 10/22/2022] Open
Abstract
Severe coronary calcification is a common cause for stent under-expansion, which is associated with an increased risk of stent thrombosis and restenosis. Presently the devices for treatment of under-expanded stent due to severe calcification are rotational atherectomy and high-pressure non-compliant balloons with the limitation of potential balloon rupture and perforation risk. We report on a series of seven successful treatments of chronically under-expanded stents due to severe calcification using shockwave coronary intravascular lithoplasty (IVL). Our report suggests that IVL is a feasible and safe tool for such chronically under-expanded stents. <Learning objective: Severe coronary calcification is a common cause for stent under-expansion, which is associated with an increased risk of stent thrombosis and restenosis. Presently the devices for treatment of under-expanded stent due to severe calcification are rotational atherectomy and high-pressure non-compliant balloons. Our report suggests that intravascular lithoplasty is a feasible and safe tool to expand chronically under-expanded stents due to severe calcification, and that it is superior to rotational atherectomy and high-pressure balloons.>.
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Affiliation(s)
- Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Gerald S Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
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Truesdell AG, Khuddus MA, Martinez SC, Shlofmitz E. Calcified Lesion Assessment and Intervention in Complex Percutaneous Coronary Intervention: Overview of Angioplasty, Atherectomy, and Lithotripsy. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2020.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Calcific coronary artery disease intervention is associated with uniformly worse short-term procedural and long-term clinical results compared with treatment of non-calcified lesions. Multiple intravascular imaging tools currently exist to aid the identification and detailed characterization of intracoronary calcium, and guide appropriate follow-on management strategies. Several unique device therapies, to include angioplasty, atherectomy, and lithotripsy may be employed to enhance lesion preparation, stent implantation and optimization, and improve patient outcomes. Current low use of both imaging and ablative technologies in the US offers significant future opportunities for improving the comprehensive evaluation and management of these complex lesion subsets and patients.
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Affiliation(s)
- Alexander G Truesdell
- Virginia Heart, Falls Church, VA; Inova Heart and Vascular Institute, Falls Church, VA
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