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Patel N, Bandyopadhyay D, Agarwal G, Chakraborty S, Kumar A, Hajra A, Amgai B, Krittanawong C, Martin L, Abbott JD, Mamas MA, Naidu SS. Outcomes of rotational atherectomy followed by cutting balloon versus plain balloon before drug-eluting stent implantation for calcified coronary lesions: A meta-analysis. Catheter Cardiovasc Interv 2022; 99:1741-1749. [PMID: 35366389 DOI: 10.1002/ccd.30159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/11/2022] [Accepted: 03/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to compare outcomes of rotational atherectomy and cutting balloon (RACB) versus rotational atherectomy and plain balloon (RAPB) before drug-eluting stent (DES) implantation in calcified coronary lesions. METHODS Randomized controlled trials (RCT) and observational studies comparing RACB with RAPB were identified through a systematic search of published literature across multiple databases. Random effect meta-analysis was performed to compare the outcome between the two groups. RESULTS Four studies were included in the meta-analysis (three observational and one RCT) involving a total of 315 patients. 166 patients had RACB, and 149 patients had RAPB before DES placement with a median follow-up of 11.5 months. Compared with patients who had RAPB there was no difference in MACE (composite of death, myocardial infarction, and target vessel revascularization) (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.25-2.18], slow flow/no reflow (OR: 0.71; 95% CI: 0.23-2.16), all-cause mortality (OR: 2.02; 95% CI: 0.28-14.60), and device success rate (OR: 1.79; 95% CI: 0.28-11.18) in the RACB approach. There was a benefit towards less target lesion revascularization in the RACB group; however, this outcome was reported in two studies (OR: 0.29; 95% CI: 0.08-0.99). On meta-regression there was no association between age, sex, diabetes, or lesion location with MACE and all-cause mortality. The studies were homogenous across all outcomes. CONCLUSION RACB, as compared with RAPB, had a similar risk of MACE, all-cause mortality, device success, and complication, but a lower risk of target lesion revascularization.
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Affiliation(s)
- Neelkumar Patel
- Department of Cardiology, University of Kansas, Lawrence, Kansas, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Gaurav Agarwal
- Jersey City Medical Center, Jersey City, New Jersey, USA
| | | | - Ashish Kumar
- Crozer-Chester Medical Center, Philadelphia, Pennsylvania, USA
| | - Adrija Hajra
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Chayakrit Krittanawong
- Department of Cardiology, The Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA
| | - Lily Martin
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Dawn Abbott
- Department of Cardiology, Lifespan Cardiovascular Institute, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mamas A Mamas
- Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
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2
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Zaidan M, Alkhalil M, Alaswad K. Calcium Modification Therapies in Contemporary Percutaneous Coronary Intervention. Curr Cardiol Rev 2022; 18:e281221199533. [PMID: 34963434 PMCID: PMC9241119 DOI: 10.2174/1573403x18666211228095457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/02/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022] Open
Abstract
Coronary Artery Calcification (CAC) has been known to be associated with worse Percutaneous Coronary Intervention (PCI) short- and long-term outcomes. Nowadays, with the increased prevalence of the risk factors leading to CAC in the population and also more PCI procedures done in older patients and with the growing number of higher-risk cases of Chronic Total Occlusion (CTO) PCI and PCI after Coronary Artery Bypass Grafting (CABG), severe cases of CAC are now encountered on a daily basis in the catheterization lab and remain a big challenge to the interventional community, making it crucial to identify cases of severe CAC and plan a CAC PCI modification strategy upfront. Improved CAC detection with intravascular imaging helped identify more of these severe CAC cases and predict response to therapy and stent expansion based on CAC distribution in the vessel. Multiple available therapies for CAC modification have evolved over the years. Familiarity with the specifics and special considerations and limitations of each of these tools are essential in the choice and application of these therapies when used in severe CAC treatment. In this review, we discuss CAC pathophysiology, modes of detection, and different available therapies for CAC modification.
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Affiliation(s)
- Mohammad Zaidan
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Mohammad Alkhalil
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK.,Department of Cardiology, Vascular Biology, Newcastle University, Newcastle- upon-Tyne, UK
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
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3
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Rozenbaum Z, Takahashi T, Kobayashi Y, Bliagos D, Menegus M, Colombo A, Latib A. Contemporary technologies to modify calcified plaque in coronary artery disease. Prog Cardiovasc Dis 2021; 69:18-26. [PMID: 34252411 DOI: 10.1016/j.pcad.2021.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
With aging society, one of the more challenging obstacles in percutaneous coronary interventions are calcified coronary lesions. Calcified lesions may impede stent delivery, limit balloon and stent expansion, cause uneven drug distribution, and hinder wire advancement. Even in the setting of acceptable procedural success, vessel calcification is independently associated with increased target lesion revascularization rates at follow-up and lower survival rates. In order to effectively manage such lesions, dedicated technologies have been developed. Atherectomy aims at excising tissue and debulking plaques, as well as compressing and reshaping the atheroma, generally referred to as lesion preparation that enables further balloon and/or stent expansion in contemporary clinical practice. In the current review, we will discuss the available methods for atherectomy, including rotational, orbital, and excimer laser coronary atherectomy, as well as intravascular lithotripsy. In addition, we will review the role of imaging in calcified lesions.
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Affiliation(s)
- Zach Rozenbaum
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Tatsunori Takahashi
- Jacobi Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Yuhei Kobayashi
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Dimitrios Bliagos
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Mark Menegus
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States.
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4
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Tomasiewicz B, Kubler P, Zimoch W, Kosowski M, Wańha W, Ładziński S, Rakotoarison O, Ochała A, Wojakowski W, Reczuch K. Acute Angulation and Sequential Lesion Increase the Risk of Rotational Atherectomy Failure. Circ J 2021; 85:867-876. [PMID: 33883385 DOI: 10.1253/circj.cj-20-1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the study was to assess anatomical and procedural predictors of clinical and procedural failure of rotational atherectomy (RA) in an all-comers population.Methods and Results:A total of 534 consecutive patients who underwent RA were included in a double-center observational study. The primary composite endpoint consisted of: rota-wire introduction failure, burr-passage failure, periprocedural complications and procedure-related major adverse events. The second primary endpoint included rota-wire introduction failure and burr-passage failure. The primary endpoint occurred in 76 (14.2%) patients and the second primary endpoint occurred in 64 (12%) Periprocedural complications occurred in 23 (4.3%) and procedure-related adverse events in 23 (4.3%) patients. Multivariable analysis revealed angulation on lesion ≤90° (HR=2.18, 95% CI: 1.21-3.94, P=0.0096) and sequential lesion (HR=1.89, 95% CI: 1.01-3.54, P=0.046) as independent predictors of no clinical success of RA. Multivariable analysis revealed again that angulation on lesion ≤90° (HR=2.26, 95% CI: 1.16-4.40, P=0.02) and sequential lesion (HR=3.77, 95% CI: 1.64-8.69, P<0.01) as independent predictors of no procedural success of RA. CONCLUSIONS The presence of an acute angulation on lesion and sequential lesion are independent determinants of clinical and procedural failure of RA. Further research is necessary to establish a score predicting RA failure, which can help in preproceduralrisk stratification of patients undergoing complex percutaneous coronary intervention with RA.
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Affiliation(s)
- Brunon Tomasiewicz
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
| | - Piotr Kubler
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
| | - Wojciech Zimoch
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
| | - Michał Kosowski
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Szymon Ładziński
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Oscar Rakotoarison
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
| | - Andrzej Ochała
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Krzysztof Reczuch
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
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5
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Dong H, Hachinohe D, Nie Z, Kashima Y, Luo J, Haraguchi T, Shitan H, Watanabe T, Tadano Y, Kaneko U, Sugie T, Kobayashi K, Kanno D, Enomoto M, Sato K, Fujita T. Comparison of Drug-Eluting Stent and Plain Old Balloon Angioplasty After Rotational Atherectomy in Severe Calcified and Large Coronary. Int Heart J 2021; 62:264-273. [PMID: 33731525 DOI: 10.1536/ihj.20-538] [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] [Indexed: 11/18/2022]
Abstract
Drug-eluting stent (DES) is well known to be effective in severely calcified lesion after rotational atherectomy (ROTA). However, there are still some situations when stents should be avoided and plain old balloon angioplasty (POBA) should be the preferred option. The present study aims to explore whether POBA is comparably effective to DES in large and calcified coronary pretreated by ROTA in clinical outcomes.Consecutive patients treated for severely calcified lesions in the large (≥ 3 mm) coronary using ROTA + DES or ROTA + POBA were retrospectively analyzed. The major adverse cardiac events (MACE), including all-cause/cardiac death and target lesion revascularization (TLR) at 1 year and 2 years posttreatment, were compared between groups using the Cox regression analysis to identify independent predictors of TLR and MACE.The analysis included 285 cases in the ROTA + DES group and 47 cases in the ROTA + POBA group, without relevant differences in clinical baseline characteristics. Of note, lesion length was greater in the ROTA + DES group (37.2 versus 19.3 mm, P < 0.001); the ROTA + DES group had a higher rate of chronic total occlusion (CTO) lesions, with 8.4%, and the ROTA + POBA group had none. The inhospital/30-day mortality rate (5.3%, ROTA + DES; 6.4%, ROTA + POBA) and the 12- and 24-month all-cause/cardiac mortality rate (9.3%, ROTA + DES; 7.7%, ROTA + POBA) were not significantly different between the two groups. TLR rates were not significantly different between the two groups at 12 (4.6%, ROTA + DES; 4.3%, ROTA + POBA) and 24 (5.3%, ROTA + DES; 6.4%, ROTA + POBA) months.Outcomes were comparable for ROTA + DES and ROTA + POBA in severely calcified large coronary artery intervention with respect to midterm death or TLR rate, especially for short lesion of < 20 mm.
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Affiliation(s)
- Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Sapporo Heart Center, Sapporo Cardio Vascular Clinic
| | | | - Zhiqiang Nie
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | | | - Jianfang Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | | | | | | | - Yutaka Tadano
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic
| | | | - Takuro Sugie
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic
| | - Ken Kobayashi
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic
| | - Daitaro Kanno
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic
| | - Morio Enomoto
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic
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6
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Watanabe Y, Mitomo S, Demir OM, Liu KL, Tung YC, Chieffo A, Montorfano M, Chang CJ, Nakamura S, Colombo A. Clinical Outcomes of Dialysis Patients Treated with Drug-Eluting Stent for Left Main Distal Bifurcation Lesions. Cardiorenal Med 2021; 11:99-108. [PMID: 33657556 DOI: 10.1159/000510731] [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: 05/05/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS We assessed clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) distal bifurcation lesions using drug-eluting stents (DES) in hemodialysis (HD) patients compared to non-HD patients. METHODS AND RESULTS We identified 1,858 consecutive patients who underwent PCI for ULMCA distal bifurcation lesions at 4 high-volume centers in Japan, Italy, and Taiwan between January 2005 and December 2015. Of them, 1,416 patients were treated with DES including 113 HD patients and 1,303 non-HD patients. The primary end point was target lesion failure (TLF) defined as a composite of cardiac death, target lesion revascularization (TLR), and myocardial infarction. HD patients were more likely to be younger and have diabetes mellitus, dyslipidemia, peripheral artery disease, lower ejection fraction, and higher EuroSCORE. TLF rate at 3 years was significantly higher in HD group than in non-HD group (adjusted hazard ratio [HR] 2.43 [1.75-3.38], p < 0.001). Cardiac mortality and TLR rate were also significantly higher in HD group than in non-HD group (adjusted HR 3.85 [2.34-6.34], p < 0.001, and HR 2.10 [1.41-3.14], p < 0.001, respectively). CONCLUSIONS HD was strongly associated with adverse cardiac events after PCI for ULMCA distal bifurcation lesions with DES.
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Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy, .,Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan,
| | - Satoru Mitomo
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Ozan M Demir
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Kuan-Liang Liu
- Department of Cardiology, Landseed International Hospital, Taoyuan, Taiwan
| | - Ying-Chang Tung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Chi-Jen Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy
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7
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Cao CF, Ma YL, Li Q, Liu J, Zhao H, Lu MY, Wang WM. Comparison of bailout and planned rotational atherectomy for severe coronary calcified lesions. BMC Cardiovasc Disord 2020; 20:374. [PMID: 32799806 PMCID: PMC7429776 DOI: 10.1186/s12872-020-01645-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background To compare outcomes of bailout and planned rotational atherectomy (RA) in the treatment of severe calcified coronary lesions. Methods Data of patients treated with RA from 2017 to 2018 at a single-center registry were retrospectively analyzed. All patients were divided into planned RA and bailout RA groups, data between two groups were compared. Results A total of 190 patients were included in this study, 138 patients received planned RA and 52 patients received bailout RA. Baseline clinical characteristics had no significant differences between groups. The number of implanted stents and total stents length were similar. But the number of balloon (1.6 ± 0.8 vs. 2.7 ± 1.3, P < 0.001), procedure time (83.5 ± 26.2 vs. 100.8 ± 36.4 min, P = 0.007), fluoroscopy volume (941 ± 482 vs. 1227 ± 872 mGy, P = 0.012] and contrast amount (237 ± 62 vs. 275 ± 90 ml, P = 0.003) were all lower in planned RA group. Planned RA had a higher procedural success rate (99.3% vs. 92.3%, P = 0.007) and a lower complication incidence (4.3% vs. 17.3%, P = 0.009). But the primary outcomes at 3 years (9.2 and 16.6%, log rank p = 0.24) had no difference between groups. Conclusions For severe coronary artery calcification, although planned RA did not improved the long term prognosis compared with bailout RA, but it can improve the immediate procedural success rate, reduce the incidence of complications, the procedure time and the volume of contrast.
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Affiliation(s)
- Cheng-Fu Cao
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Yu-Liang Ma
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Qi Li
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Hong Zhao
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Ming-Yu Lu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Wei-Min Wang
- Department of Cardiology, Peking University People's Hospital, Beijing, China.
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8
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Mankerious N, Hemetsberger R, Traboulsi H, Toelg R, Abdel-Wahab M, Richardt G, Allali A. Predictors of In-Hospital Adverse Outcomes after Rotational Atherectomy: Impact of the Target Vessel SYNTAX Score. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:754-759. [PMID: 32139281 DOI: 10.1016/j.carrev.2020.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rotational atherectomy (RA) is an established treatment of calcified lesions, but has some inherent procedural hazards. However, predictors of in-hospital adverse outcomes after RA are poorly investigated. OBJECTIVE To explore the predictors of in-hospital adverse outcomes after RA and to introduce the target vessel SYNTAX score (tvSS) as a potential causal variable. METHODS Patients who underwent RA at our center (n = 323) were divided into two groups according to the occurrence of in-hospital adverse outcomes (a composite of residual stenosis ≥30%, persistent slow flow, dissection requiring additional stenting beyond the primary lesion, perforation, burr entrapment, and in-hospital major adverse cardiac events [MACE]). RESULTS In-hospital adverse outcomes were more frequent in patients with severely-tortuous target vessels or lesions >20 mm, while aorto-ostial and bifurcation lesions, as well as chronic total occlusion rates, were equally distributed among patients with and without adverse outcomes. TvSS was 18 [13-24] vs. 12 [8-17] in patients with vs. without in-hospital adverse outcomes (p < 0.001). A tvSS cut-off value of 15 showed 73% sensitivity and 62% specificity for predicting in-hospital adverse outcomes. TvSS emerged as an independent predictor for in-hospital adverse outcomes along with bailout RA and reduced left ventricular ejection fraction (LVEF). However, after one year, the occurrence of in-hospital adverse outcomes was not associated with an increase in the MACE rate (log-rank p = 0.857). CONCLUSION In-hospital adverse outcomes are higher in patients with more complex target vessel anatomies as indicated by a higher tvSS. Bailout RA and reduced LVEF emerged as additional predictors of in-hospital adverse outcomes.
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Affiliation(s)
- Nader Mankerious
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany.
| | - Rayyan Hemetsberger
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Hussein Traboulsi
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Abdelhakim Allali
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
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9
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Percutaneous coronary intervention of severely/moderately calcified coronary lesions using single-burr rotational atherectomy: A retrospective study. Anatol J Cardiol 2020; 25:395-401. [PMID: 34100726 DOI: 10.14744/anatoljcardiol.2020.81335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study evaluates the safety and efficacy of percutaneous coronary intervention in moderately and severely calcified coronary lesions, which are either not crossed or dilated using a Scoreflex balloon at nominal pressure, using single-burr rotational atherectomy (burr-artery ratio, ≤0.6) followed by scoring balloon dilatation (balloon-artery ratio, 0.9). METHODS We retrospectively identified 144 patients with severely and moderately calcified native coronary lesions, which were either not crossed or fully opened using an appropriately sized Scoreflex balloon at nominal pressure, from a tertiary care center in India. All patients underwent rotational atherectomy. The primary endpoint was angiographic and procedural success and in-hospital clinical outcomes. The secondary endpoint was the incidence of major adverse cardiac events (MACE) at one-year clinical follow-up. RESULTS The mean age of the patients was 68.75±8.37 years, and 83.33% of them were over 60 years old. Moderate calcification was present in 21.53%, and the remaining 78.47% had severe calcification. Procedural success was achieved in 139 (96.52%) patients. In-hospital death was reported in four (2.77%) patients. Multiple regression analysis revealed that in severely calcified coronary lesions, burr rotation speed and heparin dose were significantly associated with in-hospital MACE occurrence (p=0.0337). CONCLUSION A modified small-burr rotational atherectomy technique with scoring balloon angioplasty pre-dilatation is a safe and effective surgical procedure with favorable clinical outcomes for moderately and severely calcified coronary lesions.
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10
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Ponangi UP, Baveja S. Successful angioplasty of saphenous venous graft in-stent restenosis using rotational atherectomy. BMJ Case Rep 2019; 12:12/10/e230907. [PMID: 31666250 DOI: 10.1136/bcr-2019-230907] [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: 11/03/2022] Open
Abstract
An 81-year-old, functionally independent woman with a history of bypass surgery and a previous vein graft intervention presented to us with significant angina refractory to medical management. An urgent angiogram revealed severe in-stent restenosis (ISR) in the proximal stent of the right coronary artery graft. At the same time, multiple trials to predilate the tight ISR using various-sized non-compliant and cutting balloons were unsuccessful. During the second attempt the next day, rotational atherectomy was used for plaque modification as the lesion appeared fibrocalcific angiographically. A good imaging result was obtained after final dilatation with a drug-eluting balloon, and the patient also achieved immediate angina relief. Even though rotational atherectomy is contraindicated in vein graft interventions, it can be successfully used in selected cases when routine angioplasty techniques fail.
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Affiliation(s)
| | - Sugeet Baveja
- Cardiology, Townsville Hospital and Health Service, Townsville, Queensland, Australia
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11
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Allan M, Vickers D, Pitney M, Jepson N. Rotational Atherectomy Combined with Drug Coated-Balloons for in-Stent Restenosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:559-562. [DOI: 10.1016/j.carrev.2018.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/10/2018] [Accepted: 08/21/2018] [Indexed: 11/29/2022]
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12
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Shahin M, Candreva A, Siegrist PT. Rotational Atherectomy in Acute STEMI with Heavily Calcified Culprit Lesion is a Rule Breaking Solution. Curr Cardiol Rev 2018; 14:213-216. [PMID: 29788894 PMCID: PMC6131400 DOI: 10.2174/1573403x14666180523084846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Calcified coronary lesions represent technical challenges during percutaneous coronary intervention and are associated with a high frequency of restenosis and target lesion revascularization. Rotational atherectomy has been shown to increase procedural success in severely calcified lesions, facilitate stent delivery in undilatable lesions and ensure complete stent expansion. However, rotational atherectomy in ST-elevation Myocardial Infarction (STEMI) is traditionally avoided given the concern for slow or no reflow and considered a contraindication in lesions with a visible thrombus by its manufacturer (Rotablator, Boston Scientific). CONCLUSION This case demonstrates the successful use of rotational atherectomy to facilitate dilation and revascularization of a heavily calcified culprit lesions in a patient with acute anterior STEMI with ongoing chest pain.
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Affiliation(s)
- Mohammady Shahin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Patrick T Siegrist
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Watanabe Y, Naganuma T, Kawamoto H, Ishiguro H, Nakamura S. In-hospital outcomes after rotational atherectomy in patients with low ejection fraction. SCAND CARDIOVASC J 2018; 52:177-182. [PMID: 29668339 DOI: 10.1080/14017431.2018.1455988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study evaluated angiographic success and in-hospital outcomes of percutaneous coronary intervention (PCI) with rotational atherectomy (RA) in patients with low left ventricular ejection fraction (LVEF). DESIGN Between January 2010 and March 2014, 272 consecutive patients with heavily calcified lesions underwent elective PCI with RA. Of these, 33 patients had LVEF ≤35% (low LVEF group), whereas 237 patients had LVEF >35% (preserved LVEF group). The primary endpoint was angiographic success and in-hospital major adverse cardiac events (MACE). MACE included death from any cause, postprocedure onset MI, emergency coronary artery bypass grafting, and target vessel revascularization. The secondary endpoints were MACE and the components within 30days after PCI. The components of MACE were evaluated. RESULTS Angiographic success, defined as <30% residual stenosis with thrombolysis in myocardial infarction flow 3 at final angiography, was achieved in all patients without fatal complications. Intra-aortic ballon pumping (IABP) was used significantly more frequently in the low LVEF group compared with the preserved LVEF group (15.2% vs. 2.1%, p = .003). There were no significant differences between groups regarding in-hospital and clinical outcomes within 30 days following PCI. CONCLUSION If medications and mechanical support were appropriately performed, the angiographic success rate and in-hospital MACE rate of PCI with RA in patients with low LVEF could be expected to have good outcomes similar to those for patients with preserved LVEF.
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Affiliation(s)
- Yusuke Watanabe
- a New Tokyo Hospital , Interventional Cardiology Unit , Matsudo , Chiba , Japan
| | - Toru Naganuma
- a New Tokyo Hospital , Interventional Cardiology Unit , Matsudo , Chiba , Japan
| | - Hiroyoshi Kawamoto
- a New Tokyo Hospital , Interventional Cardiology Unit , Matsudo , Chiba , Japan
| | - Hisaaki Ishiguro
- a New Tokyo Hospital , Interventional Cardiology Unit , Matsudo , Chiba , Japan
| | - Sunao Nakamura
- a New Tokyo Hospital , Interventional Cardiology Unit , Matsudo , Chiba , Japan
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Januszek R, Siudak Z, Dziewierz A, Dudek D, Bartuś S. Predictors of in-hospital effectiveness and complications of rotational atherectomy (from the ORPKI Polish National Registry 2014-2016). Catheter Cardiovasc Interv 2017; 92:E278-E287. [PMID: 29068164 DOI: 10.1002/ccd.27372] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/25/2017] [Accepted: 09/17/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of the study was to assess trends in the use and periprocedural outcomes of rotational atherectomy (RA) in Poland between January 2014 and December 2016. BACKGROUND In recent years, due to the aging population, RA is becoming more commonly used to treat heavily calcified coronary artery stenoses. METHODS Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry on all percutaneous coronary intervention (PCI) procedures performed in Poland. In total, 1,175 RA procedures were recorded from 317,175 PCI procedures (incidence of 0.37%). RESULTS Patients undergoing RA were older (71.7 ± 9.7 vs. 66.9 ± 10.8, P < 0.00001) and less often males (68.3% vs. 76.4%, P < 0.00001). The complication rate was significantly higher in the RA group (P = 0.0012) with the leading coronary artery perforation (CAP) (P < 0.0001). Complication frequency decreased significantly in the last 3 years and was accompanied by an increase in the percentage of radial access and patients with stable angina. Among several predictors of the use of RA during PCI in multivariate analysis, the strongest one was previous coronary artery by-pass grafting (P < 0.0001), whereas the strongest, predictor of CAP was the RA procedure (P = 0.00004). The increase in RA frequency over the last 3 years may reflect population aging, some fluctuations in indications for RA and reimbursement policies. CONCLUSIONS We observed a substantial increase in the utilization of RA during PCIs performed in Poland; however, it still needs to be increased. Decreased frequency of RA procedures follows change in indications for RA and vascular access. Periprocedural complication rates significantly decreased over the last 3 years.
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Affiliation(s)
- Rafał Januszek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Zbigniew Siudak
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Fogarty TJ, Arko FR, Zarins CK. Ten Years of Advancements in Interventional Cardiology. J Endovasc Ther 2016; 11 Suppl 2:II192-9. [PMID: 15760266 DOI: 10.1177/15266028040110s604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The past decade has seen the evolution of an exciting technology that has changed forever the treatment of aortic aneurysmal disease. From rather crude homemade stent-grafts constructed in the surgical suite to elegant commercially manufactured devices in a variety of configurations and sizes, the aortic endograft has experienced a meteoric rise in popularity to become a beneficial, minimally invasive therapy that can obviate the risk of rupture and death. There are now 3 approved endovascular devices on the market for infrarenal abdominal aortic aneurysm repair, and it is likely that additional and improved devices will become available in the future. This review revisits the developmental history of the aortic endograft, noting the ongoing refinements that have arisen from our experiences with the growing population of stent-graft patients. Although research continues to search for solutions to the problems of endoleak and migration, long-term results even with the earlier second and third-generation devices are better than has been achieved with open surgical repair.
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Affiliation(s)
- Thomas J Fogarty
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, California 94305, USA
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Sekimoto T, Akutsu Y, Hamazaki Y, Sakai K, Kosaki R, Yokota H, Tsujita H, Tsukamoto S, Kaneko K, Sakurai M, Kodama Y, Li HL, Sambe T, Oguchi K, Uchida N, Kobayashi S, Aoki A, Gokan T, Kobayashi Y. Regional calcified plaque score evaluated by multidetector computed tomography for predicting the addition of rotational atherectomy during percutaneous coronary intervention. J Cardiovasc Comput Tomogr 2016; 10:221-8. [DOI: 10.1016/j.jcct.2016.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 12/10/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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Farag M, Costopoulos C, Gorog DA, Prasad A, Srinivasan M. Treatment of calcified coronary artery lesions. Expert Rev Cardiovasc Ther 2016; 14:683-90. [PMID: 26924773 DOI: 10.1586/14779072.2016.1159513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heavily calcified coronary plaques represent a complex lesion subset and a challenge to the interventional cardiologist, as they are often resistant to simple plaque modification with conventional balloon angioplasty. Inadequate plaque modification can lead to stent underdeployment, which itself predisposes to in-stent restenosis and stent thrombosis. Over the years, a number of mechanical devices ranging from modified angioplasty balloons to atherectomy devices have become available in order to tackle such lesions. Here we review these devices concentrating on the evidence behind their use.
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Affiliation(s)
- Mohamed Farag
- a Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Charis Costopoulos
- a Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK.,b Department of Cardiovascular Medicine , University of Cambridge , Cambridge , UK
| | - Diana A Gorog
- c Faculty of Medicine, National Heart and Lung Institute, Imperial College London , London , UK
| | - Abhiram Prasad
- d Department of Cardiology, St George's University Hospitals NHS Trust , London , UK
| | - Manivannan Srinivasan
- a Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
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de Waha S, Allali A, Büttner HJ, Toelg R, Geist V, Neumann FJ, Khattab AA, Richardt G, Abdel-Wahab M. Rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: Two-year clinical outcome of the randomized ROTAXUS trial. Catheter Cardiovasc Interv 2015; 87:691-700. [PMID: 26525804 DOI: 10.1002/ccd.26290] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/29/2015] [Accepted: 10/03/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND In the randomized ROTAXUS trial, routine lesion preparation of complex calcified coronary lesions using rotational atherectomy (RA) prior to paclitaxel-eluting stent implantation did not reduce the primary endpoint of angiographic late lumen loss at 9 months compared to stenting without RA. So far, no long-term data of prospective head-to-head comparisons between both treatment strategies have been reported. METHODS AND RESULTS ROTAXUS randomly assigned patients with complex calcified coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120). The primary endpoint of the current analysis was the occurrence of major adverse cardiac events (MACE) at 2-year follow-up defined as the composite of death, myocardial infarction, and target vessel revascularization (TVR). At 2 years, MACE occurred in 32 patients in the RA group and 37 patients in the standard therapy group (29.4% vs. 34.3%, P = 0.47). The rates of death (8.3% vs. 7.4%, P = 1.00), myocardial infarction (8.3% vs. 6.5%, P = 0.80), target lesion revascularization (TLR, 13.8% vs. 16.7%, P = 0.58), and TVR (19.3% vs. 22.2%, P = 0.62) were similar in both groups. CONCLUSION Despite high rates of initial angiographic success, nearly one third of patients enrolled in ROTAXUS experienced MACE within 2-year follow-up, with no differences between patients treated with or without RA.
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Affiliation(s)
- Suzanne de Waha
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Heinz-Joachim Büttner
- Department of Cardiology, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ralph Toelg
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Volker Geist
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ahmed A Khattab
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Gert Richardt
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
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Mota P, de Belder A, Leitão-Marques A. Rotational atherectomy: Technical update. Rev Port Cardiol 2015; 34:271-8. [PMID: 25843308 DOI: 10.1016/j.repc.2014.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 11/16/2014] [Accepted: 11/25/2014] [Indexed: 11/16/2022] Open
Abstract
Percutaneous coronary intervention is currently the most common form of revascularization for symptomatic coronary artery disease. In elderly, diabetic and renal patients, there is an increased prevalence of calcified coronary disease. Rotational atherectomy (RA) can be useful in the treatment of these lesions. Plaque removal was initially proposed as an alternative to balloon angioplasty, hence RA required high-velocity protocols with large-sized burrs (over 2.0 mm). With a high incidence of acute complications and disappointing restenosis rates, the use of RA dwindled. However, the advent of drug-eluting stents, which significantly decreased the rate of restenosis, led to the repositioning of RA as an adjunctive technique in the preparation of densely calcified lesions, improving stent delivery and expansion. In recent years, a better understanding of the mechanism of action of RA has changed it from a plaque debulking to a compliance modifying technique. As a result, RA has become less aggressive, using smaller size burrs and lower rotational speeds. This conservative approach has improved immediate results, with increased safety and better long-term outcomes. In this review paper, the technique of RA is explained in the light of current knowledge.
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Affiliation(s)
- Paula Mota
- Cardiovascular Intervention Unit, Coimbra University Hospital Centre, Coimbra, Portugal.
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, East Sussex, United Kingdom
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Clinical outcomes of first- and second-generation drug-eluting stents in patients undergoing rotational atherectomy for heavily calcified coronary lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:147-50. [DOI: 10.1016/j.carrev.2015.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/23/2022]
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Bourantas CV, Zhang YJ, Garg S, Mack M, Dawkins KD, Kappetein AP, Mohr FW, Colombo A, Holmes DR, Ståhle E, Feldman T, Morice MC, de Vries T, Morel MA, Serruys PW. Prognostic implications of severe coronary calcification in patients undergoing coronary artery bypass surgery: An analysis of the SYNTAX Study. Catheter Cardiovasc Interv 2014; 85:199-206. [DOI: 10.1002/ccd.25545] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/17/2014] [Accepted: 05/11/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Christos V. Bourantas
- Department of Interventional Cardiology; Erasmus University Medical Centre; Thoraxcenter Rotterdam the Netherlands
| | - Yao-Jun Zhang
- Department of Interventional Cardiology; Erasmus University Medical Centre; Thoraxcenter Rotterdam the Netherlands
| | - Scot Garg
- Department of Cardiology; East Lancashire Hospitals NHS Trust; Blackburn Lancashire United Kingdom
| | | | | | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery; Erasmus University Medical Centre; Thoraxcenter Rotterdam the Netherlands
| | | | | | | | | | | | | | | | | | - Patrick W. Serruys
- Department of Interventional Cardiology; Erasmus University Medical Centre; Thoraxcenter Rotterdam the Netherlands
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23
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Coronary Artery Calcification. J Am Coll Cardiol 2014; 63:1703-14. [DOI: 10.1016/j.jacc.2014.01.017] [Citation(s) in RCA: 300] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 01/04/2023]
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Colombo A, Panoulas VF. After 3 Decades, at Long Last, a New Device to Deal With Calcific Lesions. JACC Cardiovasc Interv 2014; 7:519-20. [DOI: 10.1016/j.jcin.2014.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
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Ischemic Outcomes After Coronary Intervention of Calcified Vessels in Acute Coronary Syndromes. J Am Coll Cardiol 2014; 63:1845-54. [DOI: 10.1016/j.jacc.2014.01.034] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 01/05/2014] [Accepted: 01/06/2014] [Indexed: 12/22/2022]
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Cockburn J, Hildick-Smith D, Cotton J, Doshi S, Hanratty C, Ludman P, Robinson D, Redwood S, de Belder M, de Belder A. Contemporary clinical outcomes of patients treated with or without rotational coronary atherectomy — An analysis of the UK central cardiac audit database. Int J Cardiol 2014; 170:381-7. [DOI: 10.1016/j.ijcard.2013.11.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 10/13/2013] [Accepted: 11/02/2013] [Indexed: 11/28/2022]
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Cohen MG, Ghatak A, Kleiman NS, Naidu SS, Massaro JM, Kirtane AJ, Moses J, Magnus Ohman E, Džavík V, Palacios IF, Heldman AW, Popma JJ, O'Neill WW. Optimizing rotational atherectomy in high-risk percutaneous coronary interventions: Insights from the PROTECT ΙΙ study. Catheter Cardiovasc Interv 2013; 83:1057-64. [DOI: 10.1002/ccd.25277] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/12/2013] [Accepted: 10/23/2013] [Indexed: 12/31/2022]
Affiliation(s)
| | - Abhijit Ghatak
- University of Miami Miller School of Medicine; Miami Florida
| | - Neal S. Kleiman
- Methodist DeBakey Heart and Vascular Institute; Houston Texas
| | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital; New York New York
| | - Jeffrey Moses
- Columbia University Medical Center/New York-Presbyterian Hospital; New York New York
| | | | - Vladimír Džavík
- Peter Munk Cardiac Centre; University Health Network; Toronto ON Canada
| | - Igor F. Palacios
- Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | - Alan W. Heldman
- University of Miami Miller School of Medicine; Miami Florida
| | - Jeffrey J. Popma
- Beth Israel Medical Deaconess Harvard Medical School; Boston Massachusetts
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Chiang MH, Yi HT, Tsao CR, Chang WC, Su CS, Liu TJ, Liang KW, Ting CT, Lee WL. Rotablation in the treatment of high-risk patients with heavily calcified left-main coronary lesions. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2013; 10:217-25. [PMID: 24133507 PMCID: PMC3796693 DOI: 10.3969/j.issn.1671-5411.2013.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/06/2013] [Accepted: 07/09/2013] [Indexed: 12/12/2022]
Abstract
Objective Heavily calcified left-main coronary diseases (LMCA) remain a formidable challenge for percutaneous interventions (PCI). This study was to investigate the safety and efficacy of using rotational atherectomy (RA) in treating such lesions in actual practice. Methods From February 2004 to March 2012, all consecutive patients who received RA for heavily-calcified LMCA lesions in our cath lab were enrolled. The relevant clinical and angiographic characteristics at the time of index PCI, as well as the clinical follow-up outcomes, were retrieved and analyzed. Results A total of 34 consecutive patients were recruited with a mean age 77.2 ± 10.2 years. There were 82.4% presented with acute coronary syndrome and 11.8% with cardiogenic shock. Chronic renal disease and diabetes were seen in 64.7% and 52.9%, respectively. Triple-vessel coronary disease was found in 76.5% of them. The mean SYNTAX score was 50 ± 15 and EuroSCORE II scale 5.6 ± 4.8. The angiographic success rate was 100% with a procedural success rate of 91.2%. The mean number of burrs per patient was 1.7 ± 0.5. Crossing-over stenting was used in 64.7%. Most stents were drug-eluting (67.6%). Intra-aortic ballon pump was used in 20.6% of the procedures. Three patients died during hospitalization, all due to presenting cardiogenic shock. No major complication occurred. Among 31 hospital survivors, the major adverse cardiac events (MACE) rate was 16.1%, all due to target lesion revascularization or target vessel revascularization. Conclusions In high-surgical-risk elderly patients, plaque modification with RA in PCI of heavily-calcified LMCA could be safely accomplished with a minimal complication rate and low out-of-hospital MACE.
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Affiliation(s)
- Meng-Hsiu Chiang
- Division of Cardiology, Saint Mary's Hospital, 160 Zhongzheng South Road, Luodong, Yilan 26546, Taiwan, China
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Abdel-Wahab M, Richardt G, Joachim Büttner H, Toelg R, Geist V, Meinertz T, Schofer J, King L, Neumann FJ, Khattab AA. High-Speed Rotational Atherectomy Before Paclitaxel-Eluting Stent Implantation in Complex Calcified Coronary Lesions. JACC Cardiovasc Interv 2013; 6:10-9. [DOI: 10.1016/j.jcin.2012.07.017] [Citation(s) in RCA: 298] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 07/04/2012] [Indexed: 12/13/2022]
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Naito R, Sakakura K, Wada H, Funayama H, Sugawara Y, Kubo N, Ako J, Momomura SI. Comparison of long-term clinical outcomes between sirolimus-eluting stents and paclitaxel-eluting stents following rotational atherectomy. Int Heart J 2012; 53:149-53. [PMID: 22790681 DOI: 10.1536/ihj.53.149] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rotational atherectomy (RA) can facilitate smooth stent delivery and stent expansion through lesion modification for a calcified coronary lesion. Several studies reported that sirolimus-eluting stent (SES) implantation following RA showed a lower rate of revascularization compared with bare-metal stents (BMS). However, there are limited data that compared the clinical outcomes between SES and paclitaxel-eluting stents (PES) after RA. We compared the long-term clinical outcomes of SES and PES following RA. Two hundred and thirty-three consecutive patients (SES n = 179, PES n = 54) who were treated with SES or PES following RA between 10<sup>th</sup> September 2004 and 13<sup>th</sup> April 2010 were investigated. Follow-up data for clinical outcomes were obtained in 91.4% of all subjects. The median follow-up period was 630 days (interquartile range, 300 to 1170 days) in the SES group, and 625 days (interquartile range, 285 to 900 days) in the PES group. Clinical outcomes including target lesion revascularization (TLR) (SES 4.9% versus PES 9.8%, P = 0.31), target vessel revascularization (TVR) (SES 6.8% versus PES 11.8%, P = 0.25), and major adverse cardiac events (MACE) (SES 14.8% versus PES 13.7%, P = 0.8) were not statistically different between the groups. The unadjusted cumulative event rates estimated by the Kaplan-Meier method and the log-rank test showed no significant differences between the two groups for time to event for TLR, cardiovascular death, all-cause death, or MACE. In conclusion, there was no significant difference in the long-term clinical outcomes between SES and PES following RA.
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Affiliation(s)
- Ryo Naito
- Division of Cardiology, Department of Integrated Medicine I, Saitama Medical Center, Jichi Medical University School of Medicine
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Fujimoto H, Nakamura M, Yokoi H. Impact of Calcification on the Long-Term Outcomes of Sirolimus-Eluting Stent Implantation - Subanalysis of the Cypher Post-Marketing Surveillance Registry -. Circ J 2012; 76:57-64. [DOI: 10.1253/circj.cj-11-0738] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Masato Nakamura
- Department of Cardiology, Toho University Ohashi Medical Center
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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1719] [Impact Index Per Article: 132.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 896] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kimmelstiel C. Confined distally: a novel method for retrieving a trapped burr. Catheter Cardiovasc Interv 2011; 78:565-6. [PMID: 21953752 DOI: 10.1002/ccd.23363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mohiddin SA, Rothman MT. Rotational Atherectomy. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schiele F, Mrabet K, Meneveau N. Rationale for the association of rotational atherectomy and drug-eluting stents. Interv Cardiol 2010. [DOI: 10.2217/ica.10.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mezilis N, Dardas P, Ninios V, Tsikaderis D. Rotablation in the Drug Eluting Era: Immediate and Long-Term Results from a Single Center Experience. J Interv Cardiol 2010; 23:249-53. [PMID: 20459456 DOI: 10.1111/j.1540-8183.2010.00542.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
MESH Headings
- Aged
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/methods
- Angioplasty, Balloon, Laser-Assisted/adverse effects
- Angioplasty, Balloon, Laser-Assisted/methods
- Aspirin/therapeutic use
- Atherectomy, Coronary/adverse effects
- Atherectomy, Coronary/methods
- Clopidogrel
- Coronary Artery Disease/drug therapy
- Coronary Artery Disease/therapy
- Drug-Eluting Stents
- Female
- Humans
- Male
- Platelet Aggregation Inhibitors/therapeutic use
- Retrospective Studies
- Ticlopidine/analogs & derivatives
- Ticlopidine/therapeutic use
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Nick Mezilis
- St. Luke's Hospital, Cardiology Department, Thessaloniki, Greece.
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Kawaguchi R, Tsurugaya H, Hoshizaki H, Toyama T, Oshima S, Taniguchi K. Impact of lesion calcification on clinical and angiographic outcome after sirolimus-eluting stent implantation in real-world patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2009; 9:2-8. [PMID: 18206630 DOI: 10.1016/j.carrev.2007.07.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 07/23/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies have demonstrated similar efficacy of the drug-eluting stent (DES) in patients with and without calcified lesions. However, most of the randomized trials have excluded patients with severe calcified lesions. This study aimed to examine the impact of lesion calcium on clinical and angiographic outcome after sirolimus-eluting stent (SES) implantation in real-world patients. METHODS Consecutive 380 patients with 556 lesions treated with SES were enrolled. Lesions were divided into Calc lesions (moderate or sever calcification; 195 lesions) and non-Calc lesions (none or mild calcification; 361 lesions) according to the lesion calcium. Quantitative coronary angiography (QCA) parameters, binary restenosis rate (%restenosis), target lesion revascularization (TLR) rate, and major adverse cardiac events (MACE) during follow-up were compared between the two groups. All patients were contacted at 1, 6, and 12 months after the procedure. RESULTS Lesion success rate was similar in the two groups. %Restenosis (9.2% vs. 3.6%; P<.05) and TLR (7.3% vs. 2.8%; P<.05) were significantly higher in Calc lesions. Stent thrombosis was observed in 0.7% of overall lesions with no difference between the two groups. The MACE rate in Calc patients (13.8%) was significantly higher than in non-Calc patients (6.1%). By multivariate analysis, hemodialysis (HD) and requirement of rotational atherectomy (RA) were predictive factors of TLR in the Calc lesions. CONCLUSIONS Coronary lesions with calcification comprise a high-risk cohort and are associated with a higher TLR and binary restenosis rates in real-world patients treated with SES. Moreover, patients with calcified lesions and on HD are associated with higher MACE rate.
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Affiliation(s)
- Ren Kawaguchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi 371-0004, Japan.
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Adgey AA, Mathew TP, Harbinson MT. Periprocedural creatine kinase-MB elevations: long-term impact and clinical implications. Clin Cardiol 2009; 22:257-65. [PMID: 10198735 PMCID: PMC6655971 DOI: 10.1002/clc.4960220403] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Since the introduction of percutaneous transluminal coronary angioplasty (PTCA), percutaneous intervention with balloon catheters, stents, and atherectomy devices has become a widely accepted practice. The persistent complication of non-Q-wave myocardial infarction (MI), as evidenced by increased cardiac enzyme levels after intervention, has aroused only moderate concern because its incidence was perceived to be small and not clinically relevant. With more systematic assessments of cardiac enzymes--specifically, creatine kinase (CK) and its MB isoform--evidence has begun to clarify both the incidence and the prognosis of periprocedural non-Q-wave MI: It appears to occur nearly three times more often than is clinically evident across all device types (8 to 9% of all interventions) and is directly and continuously associated with adverse outcomes, including late death. Although directional and rotational atherectomy improve angiographic outcome compared with PTCA, periprocedural infarction occurs at least twice as often with these newer technologies; the incidence associated with stent placement is comparable to and possibly higher than that of PTCA. Factors that may cause elevated CK-MB levels include distal embolization, side branch occlusion, thrombus, and coronary spasm. Analyses of the major trials of platelet glycoprotein (GP) IIb/IIIa receptor inhibitors, a class of potent antiplatelet agents, show striking effectiveness of these drugs in reducing the incidence of "enzyme-only" or "silent" MI and in improving long-term clinical outcomes. The findings implicate platelet mediation in the occurrence of periprocedural infarction and suggest an important role for antiplatelet therapy, particularly GP IIb/IIIa receptor inhibition, in protecting patients undergoing percutaneous intervention.
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Affiliation(s)
- A A Adgey
- Royal Victoria Hospital, Belfast, Northern Ireland
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Wexberg P, Gottsauner-Wolf M, Kiss K, Steurer G, Glogar D. An iatrogenic coronary arteriovenous fistula causing a steal phenomenon: an intracoronary Doppler study. Clin Cardiol 2009; 24:630-2. [PMID: 11558847 PMCID: PMC6654971 DOI: 10.1002/clc.4960240912] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We present the case of a 67-year-old man in whom a guidewire broke at rotablation of the right coronary artery, creating an iatrogenic aneurysmal arteriovenous fistula to the coronary sinus. Successful Doppler wire-guided fistula occlusion by percutaneous coil embolization lead to normalization of coronary blood flow and relief of the patient's symptoms. Myocardial ischemia in this patient may have been due to a steal phenomenon caused by coronary artery fistulae, as suggested by blood flow velocity data obtained before and after fistula occlusion.
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Affiliation(s)
- P Wexberg
- Department of Cardiology, Clinic for Internal Medicine II, University of Vienna, Austria.
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Kondo T, Kawaguchi K, Awaji Y, Mochizuki M. Immediate and chronic results of cutting balloon angioplasty: a matched comparison with conventional angioplasty. Clin Cardiol 2009; 20:459-63. [PMID: 9134278 PMCID: PMC6655938 DOI: 10.1002/clc.4960200511] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND At the initial stages of percutaneous transluminal coronary angioplasty (PTCA), several studies reported on the feasibility of coronary artery incision and dilatation leading to the extension of the PTCA technique. HYPOTHESIS This study was designed to determine the immediate and chronic results of cutting balloon (CB) angioplasty. METHODS This procedure was performed on 127 lesions in 110 patients (male 83%, age 61.8 +/- 9.3 years). RESULTS The overall procedural success rates for the CB were 93.7% (119 lesions) and 92.7% (102 patients), while solitary CB without pre- and/or postdilatation was 76.4% (91 lesions). There was one major in-hospital complication (Q-wave myocardial infarction, 0.9%), but there were no deaths or emergency coronary artery bypass graftings. Significant angiographic dissections (> or = grade C) occurred in four patients, and coronary perforation occurred in one. The successfully treated CB group (95 lesions) was matched with the successful conventional angioplasty group (PTCA group) for chronic result assessment in regard to reference vessel size and lesion characteristics. In the CB group, postprocedural minimal luminal diameters were significantly larger and the percentage of stenosis at the stenotic site was significantly lower compared with the PTCA group. Restenosis occurred in 22 lesions (23.1%). This showed a significantly lower restenosis rate compared with the PTCA group (42.1%). In addition, the restenosis rate of the CB without inclusion of the pre- and/or postdilatation-treated lesions was 19.7%. CONCLUSIONS (1) Cutting balloon angioplasty procedures can be performed with high success rates with few major inhospital events. (2) The restenosis rate in the CB group was significantly lower compared with the PTCA group.
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Affiliation(s)
- T Kondo
- Department of Cardiology, Komaki City Hospital, Aichi Prefecture, Japan
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Hara M, Nishino M, Matsuoka K, Yamada Y. Heavily calcified chronic total occlusion of common iliac artery successfully treated with Tornus microcatheter and rotational atherectomy. J Vasc Surg 2008; 48:758-60. [PMID: 18727978 DOI: 10.1016/j.jvs.2008.05.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Revised: 04/21/2008] [Accepted: 05/15/2008] [Indexed: 11/25/2022]
Abstract
A 58-year-old man who required long-term hemodialysis was referred to our institution for the management of life-limiting intermittent claudication of the right lower extremity. The diagnostic arteriography demonstrated heavily calcified chronic total occlusion in the right common iliac artery. The lesion was successfully treated with the combination of a Tornus microcatheter (Asahi Intecc, Aichi, Japan) and rotational atherectomy. We describe in this article a niche application of the Tornus microcatheter and the effect of the combination technique of it with rotational atherectomy in peripheral interventions.
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Affiliation(s)
- Masahiko Hara
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
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44
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Lee HG, Chun KJ, Cho KI, Lee DW, Oh JH, Ahn BJ, Kim SH, Lee JS, Kim MY, Bae WH, Ko WS, Jeong JH, Kim TI, Lee HC, Kim J, Kim JH, Hong TJ, Shin YW. Impact of Drug-Eluting Stents on Clinical Outcomes in Patients With Diffuse Coronary Lesions. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.11.612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hyeon Gook Lee
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Kook Jin Chun
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Kyoung Im Cho
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Dong Won Lee
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Jun Hyuk Oh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Byung Jae Ahn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Seong Ho Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Joon Sang Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Moo Young Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Woo Hyung Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Woo Seog Ko
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Joon Hoon Jeong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Tae Ik Kim
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Han Cheol Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Jun Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - June Hong Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Yung Woo Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
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Khattab AA, Otto A, Hochadel M, Toelg R, Geist V, Richardt G. Drug-Eluting Stents Versus Bare Metal Stents Following Rotational Atherectomy for Heavily Calcified Coronary Lesions: Late Angiographic and Clinical Follow-Up Results. J Interv Cardiol 2007; 20:100-6. [PMID: 17391217 DOI: 10.1111/j.1540-8183.2007.00243.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To study the effectiveness of drug-eluting stents following rotablation of severely calcified lesions. BACKGROUND Drug-eluting stents are increasingly showing promising results in complex lesions and high-risk patients. Heavily calcified stenoses have not been adequately studied, and form a challenge both for the immediate and late outcomes. METHODS Single-center prospective study among 27 patients treated by rotablation followed by a drug-eluting stent implantation for angiographically heavily calcified lesions, compared with a historical control of 34 patients treated by rotablation followed by bare stent implantation for the same indication. The primary endpoint was the late lumen loss at 9 months; secondary endpoints were binary restenosis and major adverse cardiac events at 9 months. A 2-year follow-up directed to death and myocardial infarction was added. RESULTS Both groups were comparable regarding baseline and procedural characteristics. Angiographic success was 100% for both groups. At 9 months, there was a significant difference in the late lumen loss (0.11 +/- 0.7 mm in the DES group and 1.11 +/- 0.9 mm in the BMS group, P = 0.001). This difference was manifest in the clinical event rates at late follow-up (combined incidence of death due to any cause, MI, and TLR was 7.4% in the DES group and 38.2% in the BMS group; P = 0.004). At 2 years, there were 5 deaths in each group (P = 0.5) and 2 infarctions in the BMS group versus none in the DES group (P = 1.0). CONCLUSION The combination of rotablation and drug-eluting stent implantation (Rota-DES) has a favorable effect on clinical and angiographic outcomes at 9 months when treating heavily calcified lesions compared to rotablation followed by bare metal stent implantation. No safety concerns are observed at 2 years.
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Affiliation(s)
- Ahmed A Khattab
- Herz-Kreislauf-Zentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany.
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Clavijo LC, Steinberg DH, Torguson R, Kuchulakanti PK, Chu WW, Fournadjiev J, Satler LF, Kent KM, Suddath WO, Waksman R, Pichard AD. Sirolimus-eluting stents and calcified coronary lesions: clinical outcomes of patients treated with and without rotational atherectomy. Catheter Cardiovasc Interv 2007; 68:873-8. [PMID: 17086529 DOI: 10.1002/ccd.20615] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study examined the outcomes of patients who underwent sirolimus-eluting stent (SES) implantation for the treatment of heavily calcified coronary lesions (HCCL) with and without the use of rotational atherectomy (rotablator). We investigated 150 consecutive patients with angiographic evidence of HCCL who underwent SES implantation. Sixty-nine patients underwent SES implantation without the need of rotablator (SES), and 81 patients required rotational atherectomy to modify the plaque and facilitate the delivery of the stent (SES + rotational atherectomy). Clinical success was equivalent in both groups (>98%) and there were no in-hospital outcome differences. At 6 months, the target lesion revascularization rate was 4.9% in SES vs. 4.2% in SES + rotational atherectomy groups, respectively (P = NS). Mortality at 6 months was 7.9% in the SES group vs. 6.8% in the SES + rotational atherectomy group (P = NS). SES performs well in patients with complex HCCL, with a relative low event rate. Lesions requiring rotational atherectomy to facilitate dilation and stenting had similar outcomes after SES implantation to those that could be stented without the need for rotablator.
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Affiliation(s)
- Leonardo C Clavijo
- Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA
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Kume T, Okura H, Kawamoto T, Akasaka T, Toyota E, Neishi Y, Watanabe N, Sukmawan R, Yamada R, Sadahira Y, Yoshida K. Assessment of the Histological Characteristics of Coronary Arterial Plaque With Severe Calcification. Circ J 2007; 71:643-7. [PMID: 17456985 DOI: 10.1253/circj.71.643] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Several studies have shown that rotational atherectomy (RA) is associated with higher rates of the slow-flow phenomenon and that ablated particles may be the possible cause. Intravascular ultrasound (IVUS) has an intrinsic limitation in assessing plaque morphology behind the calcification because of acoustic shadowing. Therefore, the purpose of this study was to investigate plaque characteristics behind severe calcification by histological examination. METHODS AND RESULTS One hundred eight coronary arterial segments from 40 human cadavers (24 males, 16 females, mean age 74+/-7 years) were examined. Serial images of IVUS were obtained and 18 severe calcified lesions were collected. Experienced observers quantitatively analyzed the lesions by computerized planimetry for fibrous, fibrofatty, calcification, and necrotic tissue area. Histologically, 15 of 18 severely calcified lesions (83%) had an extensive necrotic tissue containing large numbers of cholesterol crystals and microcalcifications; 16 of same 18 severely calcified lesions (89%) had fibrofatty tissue as well as calcification. The necrotic tissue occupied 14+/-13% and fibrofatty tissue occupied 13+/-11% of severely calcified lesions. CONCLUSION Necrotic core and fibrofatty tissue components "hidden" behind calcification might cause emboli-induced thrombus formation and distal flow disturbance during RA.
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Affiliation(s)
- Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan.
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Iwasaki K, Samukawa M, Furukawa H. Comparison of the effects of nicorandil versus verapamil on the incidence of slow flow/no reflow during rotational atherectomy. Am J Cardiol 2006; 98:1354-6. [PMID: 17134628 DOI: 10.1016/j.amjcard.2006.06.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Revised: 06/13/2006] [Accepted: 06/13/2006] [Indexed: 11/19/2022]
Abstract
In rotational atherectomy, the slow-flow/no-reflow phenomenon is a common complication, which usually results in myocardial injury. We prospectively randomized 111 patients with successful rotational atherectomy into a verapamil group (group V, n = 56) and a nicorandil group (group N, n = 55). We compared final burr size, total ablation time, maximum decrease in revolutions per minute, incidence of slow flow/no reflow, creatine kinase-MB increase, and cardiac troponin T increase between the 2 groups. Patient and procedural characteristics were not significantly different between groups. The incidence of no reflow/slow flow was significantly lower in group N than in group V (3.6% vs 17.9%, respectively, p <0.05). The incidence of a minor increase in cardiac markers was also significantly lower in group N than in group V (creatine kinase-MB 3.6% vs 16.1%, p <0.05; cardiac troponin T 5.5% vs 21.4%, p <0.05). In conclusion, our results showed that nicorandil decreases the incidence of slow flow/no reflow during rotational atherectomy.
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Smith SC, Feldman TE, Hirshfeld JW, Jacobs AK, Kern MJ, King SB, Morrison DA, O'Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006; 47:e1-121. [PMID: 16386656 DOI: 10.1016/j.jacc.2005.12.001] [Citation(s) in RCA: 309] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
The introduction and widespread use of coronary stents have been the most important advancement in the percutaneous treatment of coronary artery disease since the introduction of balloon angioplasty. Coronary artery stents reduce the rate of angiographic and clinical restenosis compared to balloon angioplasty. This angiographic restenosis was further reduced with the introduction of drug-eluting stents and hence further reduction in the frequency of major adverse cardiac events. Herein we present a comprehensive and up-to-date review about the use of drug-eluting stents in the treatment of coronary artery disease.
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