1
|
Ji B, Liu XB. Coronary artery calcification: concepts and clinical applications. Ann Med Surg (Lond) 2024; 86:2848-2855. [PMID: 38694287 PMCID: PMC11060298 DOI: 10.1097/ms9.0000000000002016] [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: 12/19/2023] [Accepted: 03/18/2024] [Indexed: 05/04/2024] Open
Abstract
Vascular calcification is an important hallmark of atherosclerosis. Coronary artery calcification (CAC) implies the presence of coronary artery disease (CAD), irrespective of risk factors or symptoms, is concomitant with the development of advanced atherosclerosis. Coronary thrombosis is the most common clinical end event leading to acute coronary syndrome (ACS). The least common type of pathology associated with thrombosis is the calcified nodule (CN). It usually occurs in elderly patients with severely calcified and tortuous arteries. The prevalence of calcified nodules in patients with ACS may be underestimated due to the lack of easily recognisable diagnostic methods. In this review, the authors will focus on the classification, clinical significance, pathogenesis, and diagnostic evaluation and treatment of CAC to further explore the clinical significance of CN.
Collapse
Affiliation(s)
| | - Xue-Bo Liu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
2
|
Takase Y, Tanaka T, Anai S, Kyaw MP, Michiwaki Y, Itokawa H, Yamane F, Abe T, Matsuno A. Usefulness of non-slip element percutaneous transluminal angioplasty scoring balloons in treating severe calcified lesions of the carotid artery for carotid artery stenting: A case report. Surg Neurol Int 2024; 15:91. [PMID: 38628518 PMCID: PMC11021079 DOI: 10.25259/sni_923_2023] [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: 11/17/2023] [Accepted: 02/21/2024] [Indexed: 04/19/2024] Open
Abstract
Background Treatment of calcified lesions with conventional angioplasty balloons can be difficult due to insufficient lumen expansion, high dissection rates, and repeated revascularization. We report a case in which a scoring balloon was used in lesions resistant to angioplasty with a semi-compliant balloon. Case Description A 72-year-old man presented with severe stenosis and a highly calcified lesion in the right cervical internal carotid artery. Right carotid artery stenting (CAS) was planned to prevent future ischemic stroke events. Conventional semi-compliant balloon angioplasty was unsuccessful. Three inflations of a non-slip element (NSE) percutaneous transluminal angioplasty (PTA) scoring balloon (Nipro, Osaka, Japan) successfully achieved CAS without complications. Conclusion This is the first report to describe the use of this scoring balloon in de novo carotid artery disease. NSE PTA scoring balloon catheters can be a useful option for refractory, highly calcified stenosis.
Collapse
Affiliation(s)
- Yukinori Takase
- Department of Neurosurgery, Kouhoukai Takagi Hospital, Fukuoka, Japan
| | - Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Chiba, Japan
| | - Satoshi Anai
- Department of Neurosurgery, Kouhoukai Takagi Hospital, Fukuoka, Japan
| | - May Pyae Kyaw
- Department of Neurosurgery, Kouhoukai Takagi Hospital, Fukuoka, Japan
| | - Yuhei Michiwaki
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Chiba, Japan
| | - Hiroshi Itokawa
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Chiba, Japan
| | - Fumitaka Yamane
- Department of Neurosurgery, International University of Health and Welfare, Narita, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Akira Matsuno
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita City, Chiba, Japan
| |
Collapse
|
3
|
Lis P, Rajzer M, Klima Ł. The Significance of Coronary Artery Calcification for Percutaneous Coronary Interventions. Healthcare (Basel) 2024; 12:520. [PMID: 38470631 PMCID: PMC10931248 DOI: 10.3390/healthcare12050520] [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: 01/09/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalence of calcium deposits in coronary arteries grows with age. Risk factors include, e.g., diabetes and chronic kidney disease. There are several underlying pathophysiological mechanisms of calcium deposition. Severe calcification increases the complexity of percutaneous coronary interventions. Invasive techniques to modify the calcified atherosclerotic plaque before stenting have been developed over the last years. They include balloon- and non-balloon-based techniques. Rotational atherectomy has been the most common technique to treat calcified lesions but new techniques are emerging (orbital atherectomy, intravascular lithotripsy, laser atherectomy). The use of intravascular imaging (intravascular ultrasound and optical coherence tomography) is especially important during the procedures in order to choose the optimal strategy and to assess the final effect of the procedure. This review provides an overview of the role of coronary calcification for percutaneous coronary interventions.
Collapse
Affiliation(s)
| | | | - Łukasz Klima
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, 30-688 Kraków, Poland; (P.L.); (M.R.)
| |
Collapse
|
4
|
Shin ES, Ann SH, Jang MH, Kim B, Kim TH, Sohn CB, Choi BJ. Impact of Scoring Balloon Angioplasty on Lesion Preparation for DCB Treatment of Coronary Lesions. J Clin Med 2023; 12:6254. [PMID: 37834898 PMCID: PMC10573989 DOI: 10.3390/jcm12196254] [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: 08/30/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of scoring balloon angioplasty for drug-coated balloon (DCB) treatment in percutaneous coronary intervention. BACKGROUND The scoring balloon angioplasty may play a pivotal role in enhancing the outcomes of DCB treatment. METHODS A total of 259 patients (278 lesions) with coronary artery disease successfully treated with DCB were retrospectively enrolled. The mean age of the patients was 62.2 ± 11.1 years, and the majority of patients were men (68.7%). The study's endpoint was defined as achieving an optimal angiographic result, which consisted of Thrombolysis in Myocardial Infarction (TIMI) flow grade 3, residual diameter stenosis ≤ 30%, and dissection less than type C after the procedure. RESULTS Angioplasty was performed for 61 lesions with a scoring balloon and 217 lesions with a non-scoring balloon. All lesions were TIMI flow grade 3 except two lesions in the non-scoring balloon group. The scoring balloon group had a higher prevalence of residual diameter stenosis ≤ 30% (68.9% vs. 39.6%, p < 0.001), while severe dissection, defined as type C or greater, was observed less frequently (9.8% vs. 31.8%, p = 0.001). Moreover, the scoring balloon group achieved a superior rate of optimal angiographic results (60.7% vs. 28.6%, p < 0.001). In multivariable analysis, scoring balloon (OR: 3.08 [95% confidence interval, 1.47-6.58], p = 0.003) and DCB balloon-to-artery ratios (OR: 5.46 [95% confidence interval, 1.43-21.93], p = 0.014) were independent factors in the increasing rate of optimal angiographic result. CONCLUSIONS The application of a scoring balloon catheter for lesion preparation, aiming to make them suitable for DCB treatment, was associated with a decreased risk of severe dissection and a greater occurrence of optimal angiographic outcomes compared with non-scoring balloon angioplasty.
Collapse
Affiliation(s)
- Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (S.H.A.); (M.H.J.); (B.K.)
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (S.H.A.); (M.H.J.); (B.K.)
| | - Mi Hee Jang
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (S.H.A.); (M.H.J.); (B.K.)
| | - Bitna Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (S.H.A.); (M.H.J.); (B.K.)
| | - Tae-Hyun Kim
- Department of Cardiology, Ulsan Medical Center, Ulsan 44686, Republic of Korea; (T.-H.K.); (C.-B.S.); (B.J.C.)
| | - Chang-Bae Sohn
- Department of Cardiology, Ulsan Medical Center, Ulsan 44686, Republic of Korea; (T.-H.K.); (C.-B.S.); (B.J.C.)
| | - Byung Joo Choi
- Department of Cardiology, Ulsan Medical Center, Ulsan 44686, Republic of Korea; (T.-H.K.); (C.-B.S.); (B.J.C.)
| |
Collapse
|
5
|
Cialdella P, Sergi SC, Zimbardo G, Donahue M, Talarico GP, Lombardi d’Aquino UM, Di Fusco P, Calò L. Calcified coronary lesions. Eur Heart J Suppl 2023; 25:C68-C73. [PMID: 37125323 PMCID: PMC10132609 DOI: 10.1093/eurheartjsupp/suad009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The treatment of calcific coronary lesions is still a major interventional issue in haemodynamics laboratories. The prevalence of the disease is even increasing, considering the general ageing of the population undergoing coronarography, as well as the often associated comorbidities. In recent years, new devices have been developed that allow both better identification and also better treatment of these lesions. The aim of this review is to summarize both imaging modalities and dedicated techniques and materials, thus providing a kind of compendium for the treatment approach.
Collapse
Affiliation(s)
- Pio Cialdella
- Corresponding author. Tel: +39 623188207, Fax: +39 623188408,
| | - Sonia Cristina Sergi
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Giuseppe Zimbardo
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Michael Donahue
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | | | | | - Paolo Di Fusco
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| |
Collapse
|
6
|
Wopperer SB, Kotronias R, Marin F, Benenati S, Della Mora F, Portolan L, Banning AP, De Maria GL. The role of invasive and non-invasive imaging technologies and calcium modification therapies in the evaluation and management of coronary artery calcifications. Front Cardiovasc Med 2023; 10:1133510. [PMID: 37089880 PMCID: PMC10118029 DOI: 10.3389/fcvm.2023.1133510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/20/2023] [Indexed: 04/09/2023] Open
Abstract
The treatment of coronary artery disease (CAD) has advanced significantly in recent years due to improvements in medical therapy and percutaneous or surgical revascularization. However, a persistent obstacle in the percutaneous management of CAD is coronary artery calcification (CAC), which portends to higher rates of procedural challenges, post-intervention complications, and overall poor prognosis. With the advent of novel multimodality imaging technologies spanning from intravascular ultrasound to optical coherence tomography to coronary computed tomography angiography combined with advances in calcium debulking and modification techniques, CACs are now targets for intervention with growing success. This review will summarize the most recent developments in the diagnosis and characterization of CAC, offer a comparison of the aforementioned imaging technologies including which ones are most suitable for specific clinical presentations, and review the CAC modifying therapies currently available.
Collapse
Affiliation(s)
- Samuel B. Wopperer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Rafail Kotronias
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Federico Marin
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Stefano Benenati
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Francesco Della Mora
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Leonardo Portolan
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Adrian P. Banning
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
- Correspondence: Giovanni Luigi De Maria
| |
Collapse
|
7
|
Dayco JS, Osman H, Almas T, Manasrah N, Saleem A, Alhusain R, Awadelkarim A, Dirani K, Sokolowski C, Lakkis N, Alraies MC. Major Complications and Failure Modes of the Angiosculpt Scoring Balloon Catheter: Analysis of the MAUDE Database. Curr Probl Cardiol 2023; 48:101557. [PMID: 36528205 DOI: 10.1016/j.cpcardiol.2022.101557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
Since its Food and Drug Administration approval in January 2007, the Angiosculpt scoring balloon catheter has been widely utilized in severely calcified stenotic vascular lesions. We sought to characterize the complication rates, failure modes, and outcomes associated with the Angiosculpt catheter. Using queried events from October 2013 to December 2020 from the Food and Drug Administration Manufacturer and User Facility Device Experience database, we analyzed the Angiosculpt scoring balloon catheter complication rates and mode of failure. A total of 248 complications were reported. Most reported complications occurred in the superficial femoral artery (SFA) (19.4%, n = 48), followed by the left anterior descending artery (8.1%, n = 20). Severe vessel calcifications were reported in (26.6%, n = 66) of the complications. Most complications occurred with damage to the device, such as tip break (44.8%, n = 111) and balloon rupture (26.6%, n = 66). Some complications were due to difficulties in the withdrawal of the catheter (23.8%, n = 59). Balloon rupture is observed at a significantly higher rate amongst calcified vessels (60.6% vs 14.8%), P = < 0.001, and in cases involving the SFA (39.4% vs 11.3%), P = < 0.001. All-cause complications in calcified vessels are associated with the SFA (39.4% vs 12.5%), P = < 0.001, and left anterior descending artery (16.7% vs 5.1%), P = < 0.001. The Angiosculpt scoring balloon catheter has a relatively low complication rate. Most complications were associated with a device tip break, balloon rupture, and difficulties in withdrawal in severely calcified vessels.
Collapse
Affiliation(s)
- John S Dayco
- Wayne State University, Detroit Medical Center, MI
| | - Heba Osman
- Wayne State University, Detroit Medical Center, MI
| | | | | | | | | | | | - Karim Dirani
- Wayne State University, Detroit Medical Center, MI
| | | | | | | |
Collapse
|
8
|
Li J, Cao H, Li M, Shu L, Lin C. A study of balloon type on calcified coronary lesion predilation: A finite element analysis. Proc Inst Mech Eng H 2023; 237:443-450. [PMID: 36927166 PMCID: PMC10020853 DOI: 10.1177/09544119231157853] [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: 03/18/2023]
Abstract
Calcified coronary lesions have been one of the more difficult types of lesion for interventional treatment, and angioplasty is required to break the calcification before stent implantation so that the stent can expand smoothly, however, it remains unclear which type of angioplasty is optimal for different calcified lesions. In this study, a finite element approach was used to model normal balloons, cutting balloons, and AngioSculpt balloons. In addition, calcified lesions of different degrees, thicknesses, and lengths were modeled according to Intravascular ultrasound (IVUS) calcification grade. The above three balloons were used to pretreat calcified lesions, and the brittle fracture module for calcification was used to detect fracture success, to facilitate virtual stent implantation after predilation. The simulation results showed that with a thickness of less than 0.3 mm, balloons were unable to deal with calcified plaques in lesions of less than 120°, for 180° calcified lesions the cutting balloon fractured the calcified material at 1.2 MPa, the AngioSculpt balloon produced multiple fractures at 0.8 MPa for 270° calcified plaques, but was unable to fracture calcified lesions with a thickness of 0.4 mm. Based on these results, we conclude that the length of the lesion did not affect calcification fracture, while the thickness of the lesion did. In calcified lesions of approximately 180°, the cutting balloon showed the best predilation results, while the AngioSculpt balloon was optimal for 270°. In annular calcification, all three balloons were unable to fracture the lesion.
Collapse
Affiliation(s)
- Jiasong Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Beijing, China
| | - Hongshuai Cao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Meng Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lixia Shu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changyan Lin
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Beijing, China
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Lazar FL, Ielasi A, Cortese B. Safety and efficacy of systematic lesion preparation with a novel generation scoring balloon in complex percutaneous interventions: results from a prospective registry. Minerva Cardiol Angiol 2022; 70:689-696. [PMID: 35343174 DOI: 10.23736/s2724-5683.22.06061-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Coronary lesions predilatation with semicompliant (SC) or non-compliant balloons (NC) may be insufficient to obtain an optimal stent expansion, which can lead to in-stent restenosis or thrombosis. Moreover, increasing evidence supporting an optimal lesion preparation is mandatory when drug coated balloons (DCB) are used. To this extent, more "aggressive tools" such as cutting/scoring balloons, atherectomy or lithotripsy may play an important role and improve outcomes. METHODS We enrolled 78 consecutive patients from March 2020 to October 2020 with calcific/fibrotic or ostially-located lesions, which were prepared using scoring balloons, in addition to SC/NC balloons and other plaque modification strategies. The final treatment consisted in either stent or DCB usage. The primary endpoint was the rate of clinically-driven target lesion revascularization. Secondary endpoints entailed the procedural success and the individual rates of major adverse cardiac events (MACE) at 12 months. RESULTS Most of the patients had left main (LM) or ostial lesions, 65% of them being moderate/severely calcified, with further debulking strategies being required in 15 (19.2%) patients (rotational atherectomy, 3.8% or coronary intravascular lithotripsy, 15.3%). A high-rate of DCB usage was reported. Angiographic and procedural success was obtained in 77 and 76 patients, respectively. We encountered one vessel perforation, which was sealed with a covered stent, without consequence. During follo- up, we observed only 6 MACE, 6 target lesion revascularizations (TLR) and 2 cardiovascular deaths. CONCLUSIONS Among patients with high complexity and calcific lesions, an optimal lesion preparation using a dedicated scoring balloon was associated with low clinical events at mid-term follow-up and may be considered to improve immediate procedural success rate.
Collapse
Affiliation(s)
| | | | - Bernardo Cortese
- San Carlo Clinic, Paderno Dugnano, Milan, Italy - .,Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| |
Collapse
|
11
|
Bamford P, Collins N, Boyle A. A State-of-the-Art Review: The Percutaneous Treatment of Highly Calcified Lesions. Heart Lung Circ 2022; 31:1573-1584. [PMID: 36150953 DOI: 10.1016/j.hlc.2022.08.009] [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: 12/27/2021] [Revised: 04/28/2022] [Accepted: 08/04/2022] [Indexed: 12/27/2022]
Abstract
Coronary artery calcification is prevalent in coronary heart disease with its progression being predictive of future adverse cardiac events. Its presence is considered to be a marker of interventional procedural complexity. Several adjunctive percutaneous coronary intervention tools, such as modifying balloons, atherectomy devices and intravascular lithotripsy, now exist to successfully treat calcified lesions. In this state-of-the-art review, a step-wise progression of strategies is described to modify coronary plaque, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. Technology has advanced greatly over the past few decades and we discuss how future technologies might shape percutaneous intervention.
Collapse
Affiliation(s)
- Paul Bamford
- Cardiology Department, John Hunter Hospital, Newcastle, NSW, Australia; Cardiology Department, University of Newcastle, Newcastle, NSW, Australia.
| | - Nicholas Collins
- Cardiology Department, John Hunter Hospital, Newcastle, NSW, Australia; Cardiology Department, University of Newcastle, Newcastle, NSW, Australia
| | - Andrew Boyle
- Cardiology Department, John Hunter Hospital, Newcastle, NSW, Australia; Cardiology Department, University of Newcastle, Newcastle, NSW, Australia
| |
Collapse
|
12
|
Kalzifizierte Stenosen richtig behandeln. Herz 2022; 47:503-512. [DOI: 10.1007/s00059-022-05144-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
|
13
|
Doost A, Rankin J, Sapontis J, Ko B, Lo S, Jaltotage B, Dwivedi G, Wood D, Byrne J, Sathananthan J, Ihdayhid AR. Contemporary Evidence-Based Diagnosis and Management of Severe Coronary Artery Calcification. Heart Lung Circ 2022; 31:766-778. [PMID: 35227609 DOI: 10.1016/j.hlc.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 02/03/2023]
Abstract
Percutaneous treatment of heavily calcified coronary lesions remains a challenge for interventional cardiologists with increased risk of incomplete lesion preparation, suboptimal stent deployment, procedural complications, and a higher rate of acute and late stent failure. Adequate lesion preparation through calcium modification is crucial in optimising procedural outcomes. Several calcium modification devices and techniques exist, with rotational atherectomy the predominant treatment for severely calcified lesions. Novel technologies such as intravascular lithotripsy are now available and show promise as a less technical and highly effective approach for calcium modification. Emerging evidence also emphasises the value of detailed characterisation of calcification severity and distribution especially with intracoronary imaging for appropriate device selection and individualised treatment strategy. This review aims to provide an overview of the non-invasive and invasive evaluation of coronary calcification, discuss calcium modification techniques and propose an algorithm for the management of calcified coronary lesions.
Collapse
Affiliation(s)
- Ata Doost
- Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia; King's College Hospital, London, UK
| | - James Rankin
- Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - James Sapontis
- Monash Heart, Monash Medical Centre, Melbourne, Vic, Australia
| | - Brian Ko
- Monash Heart, Monash Medical Centre, Melbourne, Vic, Australia
| | - Sidney Lo
- Liverpool Hospital, Sydney, NSW, Australia
| | - Biyanka Jaltotage
- Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - Girish Dwivedi
- Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - David Wood
- Centre for Cardiovascular Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | | | | | - Abdul Rahman Ihdayhid
- Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia.
| |
Collapse
|
14
|
Mattesini A, Demola P, Parikh SA, Secco GG, Pighi M, Di Mario C. Material Selection. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
15
|
Bulluck H, McEntegart M. Contemporary tools and devices for coronary calcium modification. JRSM Cardiovasc Dis 2022; 11:20480040221089760. [PMID: 35401972 PMCID: PMC8990704 DOI: 10.1177/20480040221089760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022] Open
Abstract
With the aging population, up to a third of patients referred for percutaneous
coronary intervention (PCI) have moderate or severe calcified lesions assessed
by coronary angiography. The presence of coronary calcium is associated with
difficult device delivery, sub-optimal stent deployment, and prolonged
procedures, with more complications. Furthermore, it is known that sub-optimal
stent expansion is associated with poor clinical outcomes. In this manuscript we
describe how to quantify the severity of coronary calcium, review the
armamentarium of contemporary devices available for calcium modification, and
provide a systematic approach to device selection, assessment of successful
calcium modification, and stent optimization.
Collapse
Affiliation(s)
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Kinoshita Y, Iwasaki K, Suzuki T. Verification of the differences of scoring effect in current scoring balloons. Cardiovasc Interv Ther 2021; 37:513-518. [PMID: 34432207 DOI: 10.1007/s12928-021-00807-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022]
Abstract
The characteristics of each scoring balloon seem to be different because material or configuration of scoring element in each device is unique. The aim of this study is to clarify the difference of scoring effect among 3 different scoring devices. We prepared 3 different scoring devices [Wolverine™ Cutting Balloon™ (CB), ScoreFlex™ NC (SF), NSE Alpha™ (NSE), n = 5 respectively. Balloon diameter is 3 mm and 2 types of silicone tubes with different elasticity [140 kPa (tube S) and 576 kPa (tube H), respectively. Inner diameter is 3 mm]. We dilated each balloon in each silicone tube with nominal pressure (NP) and 20 atmosphere (HP) and took a picture using a micro CT. We measured penetration depth of all scoring elements into silicone tube wall and calculated their percentage using the following formula; penetration depth/original scoring element height × 100. We also observed the deformation of scoring element during balloon inflation in each device. Scoring element of CB cut deeper into both tubes significantly than SF and NSE at both pressure (40.5% vs 25.1% and 16.8% at NP and 86.1% vs 33.5% and 29.1% at HP in tube S, p < 0.01, respectively, 62.6% vs 33.5% and 17.0% at NP and 93.3% vs 45.1% and 36.5% at HP in tube H, p < 0.01, respectively). Although no deformation of scoring element was recognized in CB, some deformations were observed in 50% of NSE and 40% of SF (p = 0.0377). Scoring balloon with sharp and firmly fixed scoring elements like CB may show definite scoring effect.
Collapse
Affiliation(s)
- Yoshihisa Kinoshita
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobutori, Oyamacho, Toyohashi, Aichi, 441-8530, Japan.
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Takahiko Suzuki
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobutori, Oyamacho, Toyohashi, Aichi, 441-8530, Japan
| |
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
Iwańczyk S, Włodarczak A, Hiczkiewicz J, Faron W, Grygier M, Furtan Ł, Łanocha M, Jastrzębski A, Siniawski A, Lesiak M. Feasibility of intravascular lithotripsy for calcific coronary lesions: A multi-institutional experience. Catheter Cardiovasc Interv 2021; 98:E540-E547. [PMID: 34051136 DOI: 10.1002/ccd.29792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/25/2021] [Accepted: 05/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We sought to determine the safety and performance of intravascular lithotripsy in the treatment of severe calcified atherosclerotic lesions. BACKGROUND The modification of severe calcified atherosclerotic lesions with noncompliant or specialty balloons, as well as orbital or rotational atherectomy has limitations and may be ineffective, increasing the risk of periprocedural complications and worsening long-term results. Intravascular lithotripsy has recently been shown to be a safe and feasible alternative to the above methods. METHODS All consecutive patients treated with Shockwave Medical Intravascular Lithotripsy (S-IVL) between May 2019 and June 2020 were included in current analysis. Device safety and efficacy were the critical endpoints of the study. The primary safety endpoint was 30-day major adverse cardiac events (MACE). In turn, device and clinical success were the primary performance endpoints. RESULTS In total, 46 patients undergoing percutaneous coronary intervention were treated with S-IVL before stent deployment (65% male; age, 71 ± 7 years). Device success was achieved in 45 (97.8%) patients with reduction of diameter stenosis from 80% to 5.2% with an acute gain of 2.5 mm. Clinical success was demonstrated in 95.6% of cases. During the 30-day follow-up, one sudden death was recorded, regarded as probable subacute stent thrombosis. During 6-month follow up one target lesion and target vessel revascularizations occurred. The rate of MACE after 6 month was 6.2%. CONCLUSIONS S-IVL appears to be a safe and effective treatment modality in coronary calcium modification to optimize stent expansion. In selected cases this device obviates the need for more complex lesion preparation strategies such as atherectomy.
Collapse
Affiliation(s)
- Sylwia Iwańczyk
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Jarosław Hiczkiewicz
- Department of Cardiology, Multidisciplinary District's Hospital, University of Zielona Góra, Nowa Sol, Poland
| | - Wojciech Faron
- Department of Cardiology, Multidisciplinary District's Hospital, University of Zielona Góra, Nowa Sol, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Łukasz Furtan
- Department of Cardiology, Copper Health Center, Lubin, Poland
| | | | | | - Andrzej Siniawski
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| |
Collapse
|
20
|
Inomata Y, Hanaoka Y, Koyama JI, Suzuki Y, Fujii Y, Ogiwara T, Horiuchi T. Endovascular Revascularization with a Scoring Balloon for Carotid In-Stent Restenosis : Case Report and Literature Review. Clin Neuroradiol 2021; 31:1199-1204. [PMID: 33929560 DOI: 10.1007/s00062-021-01016-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/04/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Yuki Inomata
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| | - Yota Suzuki
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| |
Collapse
|
21
|
Affiliation(s)
- Emanuele Barbato
- Cardiovascular Research Center, OLV Hospital, Aalst, Belgium .,Department of Advanced Biomedical Sciences, Universita degli Studi di Napoli Federico II, Napoli, Italy
| |
Collapse
|
22
|
Hong XL, Li Y, Zhou BQ, Fu GS, Zhang WB. Comparison of rotational atherectomy and modified balloons prior to drug-eluting stent implantation for the treatment of heavily calcified coronary lesions. Medicine (Baltimore) 2021; 100:e25323. [PMID: 33761735 PMCID: PMC9281966 DOI: 10.1097/md.0000000000025323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/01/2021] [Indexed: 02/05/2023] Open
Abstract
The optimal strategy for lesion preparation in heavily calcified coronary lesions (HCCL) prior to drug-eluting stent (DES) implantation remains debatable. This study sought to compare the performance of rotational atherectomy (RA) and modified balloon (MB)-based strategy in patients with HCCL receiving current-generation DES.This retrospective study comprised 564 consecutive patients who underwent RA (n = 229) or MB (n = 335) for HCCL at our hospital and were treated with DES. Baseline clinical and angiographic data was obtained from our database. Patients were clinically monitored for the occurrence of any adverse events during the hospitalization. One-year follow-up was conducted by either telephone contact or outpatient visits. 1:1 propensity score matching (PSM) was performed to balance the baseline covariates. After PSM, the clinical outcomes between the 2 groups were compared.After PSM, except more target lesion in right coronary artery existing in the RA group (P = .008), no significant statistical differences were shown in regard of the other angiographic and procedural characteristics of the 2 groups. Strategy success rates were all 100% in both groups. In the unadjusted Cox proportional hazard analysis, participants with RA had a significantly lower risk of target lesion revascularization (TLR) (hazard ratio, HR 0.275, 95% confidence intervals, CI 0.119-0.635, P = .003) and major adverse cardiac event (MACE) (HR 0.488, 95% 0.277-0.859, P = .013). After adjusting for potential confounding variables, RA was significantly associated with TLR (HR 0.32, 95% 0.12-0.853, P = .023), but no longer significantly associated with MACE (HR 0.674, 95% 0.329-1.381, P = .282).In patients with HCCL, lesion preparation with RA was safe and could improve strategy success rate. There was lower rate of TLR with RA, however, no significant difference was found in the MACE rate at 1-year follow-up between RA and MB-based strategy.
Collapse
Affiliation(s)
- Xu-Lin Hong
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Ya Li
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Bin-Quan Zhou
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Guo-Sheng Fu
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Wen-Bin Zhang
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
| |
Collapse
|
23
|
Shah M, Najam O, Bhindi R, De Silva K. Calcium Modification Techniques in Complex Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2021; 14:e009870. [PMID: 33441017 DOI: 10.1161/circinterventions.120.009870] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Percutaneous coronary intervention is the most common mode of revascularization and is increasingly undertaken in high-risk subsets, including the elderly. The presence of coronary artery calcification is increasingly observed and significantly limits technical success. The mechanisms for this are multi-factorial, including increased arterial wall stiffness and impaired delivery of devices, leading to suboptimal stent delivery, deployment, and expansion which are harbingers for increased risk of in-stent restenosis and stent thrombosis. Although conventional balloon pretreatment techniques aim to mitigate this risk by modifying the lesion before stent placement, many lesions remain resistant to conventional strategies, due to the severity of calcification. There have been several substantial technological advancements in calcium modification methods in recent years, which have allowed improved procedural success with low periprocedural complication rates. This review will summarize the current adjunctive modification technologies that can be employed to improve technical outcomes in percutaneous coronary intervention in calcific disease and the evidence supporting these tools.
Collapse
Affiliation(s)
- Mohammed Shah
- University College London, United Kingdom (M.S., O.N.)
| | - Osman Najam
- University College London, United Kingdom (M.S., O.N.)
| | | | - Kalpa De Silva
- St. Thomas' Hospital, Guy's & St. Thomas' NHS Foundation Trust, King's College London, United Kingdom (K.D.S.)
| |
Collapse
|
24
|
Fan LM, Tong D, Mintz GS, Mamas MA, Javed A. Breaking the deadlock of calcified coronary artery lesions: A contemporary review. Catheter Cardiovasc Interv 2021; 97:108-120. [PMID: 32865328 DOI: 10.1002/ccd.29221] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/02/2020] [Indexed: 01/01/2023]
Abstract
Percutaneous coronary intervention (PCI) of severely calcified lesions is known to result in lower procedural success rates, higher complication rates, and worse long-term clinical outcomes compared to noncalcified lesions. Adequate lesion preparation through calcium modification is crucial in ensuring procedural success and reducing adverse cardiovascular outcomes. There are numerous calcium modification devices currently available whose usefulness depends on the nature of the calcific disease and its anatomical distribution. It can be challenging for the interventionists to decide which device is best suited for their patient. There is also emerging evidence for intravascular imaging in guiding selection of calcium modification devices using parameters such as calcium distribution and depth that directly impact on procedural success and clinical outcomes. In this review we aim to discuss the pathophysiology of coronary calcification, evaluate strategies and technologies of calcium modification and propose an A-M-A-S-A algorithm in managing calcified coronary lesions.
Collapse
Affiliation(s)
- Lampson M Fan
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - David Tong
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Gary S Mintz
- Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Mamas A Mamas
- Department of Cardiology, University hospital of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ahmed Javed
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
| |
Collapse
|
25
|
Gedela M, Li S, Desai C, Stys T, Stys A. Triple-Guidewire Technique for Treating Stent Underexpansion in Severely Calcified Coronary Artery Lesions. Tex Heart Inst J 2020; 47:155-159. [PMID: 32603468 DOI: 10.14503/thij-18-6622] [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] [Indexed: 11/23/2022]
Abstract
Stent underexpansion, a potential complication of percutaneous coronary intervention in severely calcified and stenotic coronary arteries, may result in in-stent thrombosis and restenosis. Different balloon-based and atheroablative techniques have been proposed to reduce the risk of these complications. We describe a simple triple-guidewire technique that we used to treat stent underexpansion in 2 elderly men.
Collapse
Affiliation(s)
- Maheedhar Gedela
- Sanford Cardiovascular Institute, Sanford Heart Hospital, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota 57105
| | - Shenjing Li
- Sanford Cardiovascular Institute, Sanford Heart Hospital, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota 57105
| | - Chirag Desai
- Sanford Cardiovascular Institute, Sanford Heart Hospital, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota 57105
| | - Tomasz Stys
- Sanford Cardiovascular Institute, Sanford Heart Hospital, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota 57105
| | - Adam Stys
- Sanford Cardiovascular Institute, Sanford Heart Hospital, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota 57105
| |
Collapse
|
26
|
Cuculi F, Bossard M, Zasada W, Moccetti F, Voskuil M, Wolfrum M, Malinowski KP, Toggweiler S, Kobza R. Performing percutaneous coronary interventions with predilatation using non-compliant balloons at high-pressure versus conventional semi-compliant balloons: insights from two randomised studies using optical coherence tomography. Open Heart 2020; 7:e001204. [PMID: 32076567 PMCID: PMC6999685 DOI: 10.1136/openhrt-2019-001204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 12/30/2022] Open
Abstract
Introduction Stent underexpansion is a predictor of in-stent-restenosis and stent thrombosis. Semi-compliant balloons (SCBs) are generally used for lesion preparation. It remains unknown whether routine predilatation using non-compliant balloons (NCBs) improves stent expansion in ordinary coronary lesions. Methods The PREdilatation by high-pressure NC balloon catheter for better vessel preparation and Optimal lesion preparation with non-compliant balloons for the implantation of bioresorbable vascular scaffolds studies randomised patients presenting with stable coronary artery disease or non-ST-elevation myocardial infarction requiring stent implantation to lesion preparation using NCBs versus SCBs. Stent expansion index (SEI-minimal luminal area/mean luminal area on optical coherence tomography) and periprocedural complications were compared. Results We enrolled 104 patients: 53 patients (54 lesions) vs 51 patients (56 lesions) to the NCB and SCB groups, respectively. Predilatation pressure was higher in the NCB group (24±7 atmospheres (atm) vs 14±3 atm, p<0.0001). Postdilatation using NCBs was performed in 41 (76%) lesions vs 46 (82%) lesions pretreated with NCBs versus SCBs (p=0.57). Similar pressures were used for postdilatation with NCB in both groups (23±8 atm vs 23±9 atm, p=0.65). SEI after stent implantation was 0.88±0.13 in the NCB vs 0.85±0.14 in the SCB group (p=0.18). After postdilatation, SEI increased to 0.94±0.13 in the NCB group vs 0.88±0.13 in the SCB group (p=0.02). No relevant complications occurred. Conclusions In simple coronary lesions, predilatation/postdilatation with NCBs at high pressures appears to result in better scaffold and stent expansion. Using SCBs only for predilatation might lead to inadequate stent expansion and postdilatation with NCBs might only partially correct this. Predilatation and postdilatation using NCBs at high pressure is safe. Trial registration number ClinicalTrials.gov no. NCT03518645.
Collapse
Affiliation(s)
- Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Wojciech Zasada
- Krakow Cardiovascular Research Institute (KCRI), Krakow, Poland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Michiel Voskuil
- Department of Cardiology, UMC Utrecht, Utrecht, The Netherlands
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Krzysztof Piotr Malinowski
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| |
Collapse
|
27
|
Sorini Dini C, Nardi G, Ristalli F, Mattesini A, Hamiti B, Di Mario C. Contemporary Approach to Heavily Calcified Coronary Lesions. Interv Cardiol 2019; 14:154-163. [PMID: 31867062 PMCID: PMC6918474 DOI: 10.15420/icr.2019.19.r1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022] Open
Abstract
Percutaneous treatment of heavily calcified coronary lesions still represents a challenge for interventional cardiology, with higher risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. Good characterisation of calcium distribution with multimodal imaging is important to improve the successful treatment of these lesions. The use of traditional or new dedicated devices for the treatment of calcified lesions allows better lesion preparation; therefore, it is important that we know the different mechanisms and technical features of these devices.
Collapse
Affiliation(s)
- Carlotta Sorini Dini
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
- Cardiology Division, Spedali RiunitiLivorno, Italy
| | - Giulia Nardi
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Francesca Ristalli
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Brunilda Hamiti
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| |
Collapse
|
28
|
Terzian Z, Demian H, Karrillon GJ, Aubry P. [Fenestration of a spontaneous coronary hematoma with life-threatening dissection: A case of recurrent and multivessel spontaneous coronary artery dissections in a young female]. Ann Cardiol Angeiol (Paris) 2019; 68:382-388. [PMID: 31542199 DOI: 10.1016/j.ancard.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
The fenestration of a coronary artery hematoma is a therapeutic option in case of a life-threatening spontaneous coronary artery dissection, if the conservative treatment is not feasible. Here we present the case of a 34-year-old woman who presented three spontaneous coronary artery dissections, on three different arteries, over a period of twenty-one months. The diagnosis was confirmed by endovascular imaging. During an acute coronary syndrome, emergent percutaneous coronary intervention of the left anterior descending artery was performed, successfully, by a fenestration of the hematoma, using an AngioSculpt® scoring balloon.
Collapse
Affiliation(s)
- Z Terzian
- Département de cardiologie, centre hospitalo-universitaire Xavier-Bichat, 46, rue Henri-Huchard, 75018 Paris, France.
| | - H Demian
- Service de cardiologie, centre hospitalier de Gonesse, 2, boulevard du 19-Mars-1962, 95500 Gonesse, France
| | - G J Karrillon
- Service de cardiologie, entre hospitalier Simone-Veil, 14, rue de Saint-Prix, 95600 Eaubonne, France
| | - P Aubry
- Département de cardiologie, centre hospitalo-universitaire Xavier-Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Service de cardiologie, centre hospitalier de Gonesse, 2, boulevard du 19-Mars-1962, 95500 Gonesse, France
| |
Collapse
|
29
|
Stavroulakis K, Argyriou A, Watts M, Varghese JJ, Estes BA, Torsello G, Bisdas T, Huasen B. How to deal with calcium in the superficial femoral artery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:572-581. [PMID: 31241269 DOI: 10.23736/s0021-9509.19.11038-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite the continuous evolution of endovascular therapy, severe calcification remains a major issue for the minimally invasive treatment of superficial femoral artery (SFA) disease. The presence of calcium might negatively affect both the crossing of peripheral lesions and outcomes of all available treatment modalities and is therefore associated with unfavorable acute and long-term results. This manuscript summarizes the challenges raised from severe calcified atherosclerotic lesions and presents the outcomes of the various endovascular modalities in the treatment of calcified SFA disease.
Collapse
Affiliation(s)
| | - Angeliki Argyriou
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany
| | - Mike Watts
- Vascular Institute of Atlantic Medical Imaging, Brick, Galloway, and Cape May Court House, NJ, USA
| | - Joji J Varghese
- Department of Interventional Cardiology, Hendrick Medical Center, Abilene, TX, USA
| | - Bailey A Estes
- Department of Interventional Cardiology, Hendrick Medical Center, Abilene, TX, USA
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital GmbH, Münster, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, Athens Medical Center, Athens, Greece
| | - Bella Huasen
- Department of Interventional Radiology, Royal Preston LTHTR, Manchester, UK
| |
Collapse
|
30
|
Allen DW, Kaul P. Atherectomy and Specialty Balloons in Percutaneous Coronary Intervention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:13. [PMID: 30830449 DOI: 10.1007/s11936-019-0717-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Interventional cardiologists are increasingly being called upon to perform complex revascularization in patients who are deemed not to be candidates for surgical revascularization and, until recently, many of these patients would have only been offered medical management. Further, changing demographics have resulted in an increasingly elderly and frail population with diabetes and chronic kidney disease being referred for revascularization. Owing to the increasing prevalence of coronary artery calcification and the importance of achieving complete revascularization, advanced tools and techniques are required to safely revascularize this patient population. RECENT FINDINGS Coronary artery calcification is a marker for increased periprocedural complications and worse long-term outcomes in percutaneous intervention. Its presence may mandate advanced revascularization strategies to facilitate safe revascularization. Several studies have highlighted the importance of intracoronary imaging and there have been iterative changes and new devices that have been developed that can facilitate revascularization in the setting of significant coronary artery calcification. Successful coronary revascularization is increasingly dependent on the rational use of intraavascular imaging, specialized balloons and atherectomy to overcome complex coronary artery disease and calcification. A rational strategy for the safe use of advanced techniques and tools is presented here.
Collapse
Affiliation(s)
- David W Allen
- Department of Medicine, Section of Cardiology Max Rady College of Medicine, University of Manitoba, Y3543 Bergen Cardiac Care Centre St. Boniface Hospital Winnipeg, Manitoba, R2H 2A6, Canada.
| | - Prashant Kaul
- Cardiac Catheterization Laboratory, Piedmont Heart Institute, 95 Collier Road, Suite 2065, Atlanta, Georgia, 30309, USA
| |
Collapse
|
31
|
Calcium-Binding Nanoparticles for Vascular Disease. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2019. [DOI: 10.1007/s40883-018-0083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
32
|
Chin DD, Chowdhuri S, Chung EJ. Calcium-binding nanoparticles for vascular disease. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2019; 5:74-85. [PMID: 31106257 PMCID: PMC6516760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cardiovascular disease (CVD) including atherosclerosis is the leading cause of death worldwide. As CVDs and atherosclerosis develop, plaques begin to form in the blood vessels and become calcified. Calcification within the vasculature and atherosclerotic plaques have been correlated with rupture and consequently, acute myocardial infarction. However, current imaging methods to identify vascular calcification have limitations in determining plaque composition and structure. Nanoparticles can overcome these limitations due to their versatility and ability to incorporate a wide range of targeting and contrast agents. In this review, we summarize the current understanding of calcification in atherosclerosis, their role in instigating plaque instability, and clinical methodologies to detect and analyze vascular calcification. In addition, we highlight the potential of calcium-targeting ligands and nanoparticles to create novel calcium-detecting tools.
Collapse
Affiliation(s)
- Deborah D. Chin
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Sampreeti Chowdhuri
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Eun Ji Chung
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
- Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, CA, USA
- Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
33
|
Abstract
The occurrence of in-stent restenosis (ISR) still remains a daunting challenge in the current era, despite advancements in coronary intervention technology. The authors explore the underlying pathophysiology and mechanisms behind ISR, and describe how the use of different diagnostic tools helps to best elucidate these. They propose a simplistic algorithm to manage ISR, including a focus on how treatment strategies should be selected and a description of the contemporary technologies available. This article aims to provide a comprehensive outline of ISR that can be translated into evidence-based routine clinical practice, with the aim of providing the best outcomes for patients.
Collapse
Affiliation(s)
- Nikhil Pal
- Dorset Heart Centre, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Bournemouth, UK
| | - Jehangir Din
- Dorset Heart Centre, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Bournemouth, UK
| | - Peter O'Kane
- Dorset Heart Centre, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Bournemouth, UK
| |
Collapse
|
34
|
Plaque modification using a cutting balloon is more effective for stenting of heavily calcified lesion than other scoring balloons. Cardiovasc Interv Ther 2019; 34:325-334. [DOI: 10.1007/s12928-019-00578-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/08/2019] [Indexed: 11/29/2022]
|
35
|
Onuma Y, Katagiri Y, Burzotta F, Holm NR, Amabile N, Okamura T, Mintz GS, Darremont O, Lassen JF, Lefèvre T, Louvard Y, Stankovic G, Serruys PW. Joint consensus on the use of OCT in coronary bifurcation lesions by the European and Japanese bifurcation clubs. EUROINTERVENTION 2019; 14:e1568-e1577. [DOI: 10.4244/eij-d-18-00391] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
36
|
Kassimis G, Raina T, Kontogiannis N, Patri G, Abramik J, Zaphiriou A, Banning AP. How Should We Treat Heavily Calcified Coronary Artery Disease in Contemporary Practice? From Atherectomy to Intravascular Lithotripsy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1172-1183. [PMID: 30711477 DOI: 10.1016/j.carrev.2019.01.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022]
Abstract
Heavily calcified and densely fibrotic coronary lesions continue to represent a challenge for percutaneous coronary intervention (PCI), as they are difficult to dilate, and it is difficult to deliver and implant drug-eluting stents (DES) properly. Poor stent deployment is associated with high rates of periprocedural complications and suboptimal long-term clinical outcomes. Thanks to the introduction of several adjunctive PCI tools, like cutting and scoring balloons, atherectomy devices, and to the novel intravascular lithotripsy technology, the treatment of such lesions has become increasingly feasible, predictable and safe. A step-wise progression of strategies is described for coronary plaque modification, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. We highlight these techniques in the setting of clinical examples how best to apply them through better patient and lesion selection, with the main objective of optimising DES delivery and implantation, and subsequent improved outcomes.
Collapse
Affiliation(s)
- George Kassimis
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom; Second Department of Cardiology, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Tushar Raina
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom
| | - Nestoras Kontogiannis
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom
| | - Gopendu Patri
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom
| | - Joanna Abramik
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom
| | - Alex Zaphiriou
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Adrian P Banning
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom
| |
Collapse
|
37
|
Blessing E, Lugenbiel I, Holden A. The evidence to support the use of focal force balloon technology to improve outcomes in the treatment of lower extremity arterial occlusive disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 60:14-20. [PMID: 30350932 DOI: 10.23736/s0021-9509.18.10766-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite recent advances in endovascular therapy of lower extremity atherosclerotic disease, mainly driven through drug eluting balloon angioplasty, treatment of complex lesions remains challenging. Drug-eluting balloons work less well in heavily calcified lesions and in particular long lesions often require bail-out stenting. Lesion preparation, as a stand-alone treatment or before delivering antiproliferative therapy or scaffolding, has gained increased recognition in recent years. Focal force or other specialty balloons are designed to prepare complex lesions to improve acute technical success and, ideally, long term patency of the vessel. There are numerous dedicated balloons on the market that use different modes of action to prepare the lesions. The current review focuses on mechanistic insights and the evidence behind those specialty balloons.
Collapse
Affiliation(s)
- Erwin Blessing
- SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany -
| | - Ira Lugenbiel
- University Hospital of Heidelberg, Heidelberg, Germany
| | | |
Collapse
|
38
|
Sugawara Y, Ueda T, Soeda T, Watanabe M, Okura H, Saito Y. Plaque modification of severely calcified coronary lesions by scoring balloon angioplasty using Lacrosse non-slip element: insights from an optical coherence tomography evaluation. Cardiovasc Interv Ther 2018; 34:242-248. [DOI: 10.1007/s12928-018-0553-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/14/2018] [Indexed: 10/28/2022]
|
39
|
Abdel-Wahab M, Toelg R, Byrne RA, Geist V, El-Mawardy M, Allali A, Rheude T, Robinson DR, Abdelghani M, Sulimov DS, Kastrati A, Richardt G. High-Speed Rotational Atherectomy Versus Modified Balloons Prior to Drug-Eluting Stent Implantation in Severely Calcified Coronary Lesions. Circ Cardiovasc Interv 2018; 11:e007415. [DOI: 10.1161/circinterventions.118.007415] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
- Department of Cardiology, Heart Center Leipzig, Leipzig University Hospital, Germany (M.A.-W., D.S.S.)
| | - Ralph Toelg
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Robert A. Byrne
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (R.A.B., T.R., A.K.)
- German Center for Cardiovascular Research, partner site Munich Heart Alliance, Germany (R.A.B., A.K.)
| | - Volker Geist
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Mohamed El-Mawardy
- Department of Cardiology, Vivantes Wenckebach Hospital, Berlin, Germany (M.E.-M.)
| | - Abdelhakim Allali
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Tobias Rheude
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (R.A.B., T.R., A.K.)
| | - Derek R. Robinson
- Department of Mathematics, University of Sussex, Brighton, United Kingdom (D.R.R.)
| | - Mohammad Abdelghani
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Dmitriy S. Sulimov
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
- Department of Cardiology, Heart Center Leipzig, Leipzig University Hospital, Germany (M.A.-W., D.S.S.)
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (R.A.B., T.R., A.K.)
- German Center for Cardiovascular Research, partner site Munich Heart Alliance, Germany (R.A.B., A.K.)
| | - Gert Richardt
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| |
Collapse
|
40
|
Hachinohe D, Mitomo S, Candilio L, Latib A. A Practical Approach to Assessing Stent Results with IVUS or OCT. Methodist Debakey Cardiovasc J 2018; 14:32-41. [PMID: 29623170 DOI: 10.14797/mdcj-14-1-32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Coronary angiography is routinely used to assess the extent and severity of coronary artery disease and for decision-making during percutaneous coronary interventions (PCI). However, it is sometimes inadequate for deciding a strategy and defining optimal stenting outcomes. In this review, we present a comprehensive and practical approach to PCI using intravascular ultrasound or optical coherence tomography to optimize stent deployment and assess procedural complications after stent implantation.
Collapse
Affiliation(s)
- Daisuke Hachinohe
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY
| | - Satoru Mitomo
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY
| | - Luciano Candilio
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY.,cHAMMERSMITH HOSPITAL, IMPERIAL COLLEGE LONDON, UNITED KINGDOM
| | - Azeem Latib
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY
| |
Collapse
|
41
|
Koifman E, Garcia-Garcia HM, Kuku KO, Kajita AH, Buchanan KD, Steinvil A, Rogers T, Bernardo NL, Lager R, Gallino RA, Ben-Dor I, Pichard AD, Torguson R, Gai J, Satler LF, Waksman R. Comparison of the Efficacy and Safety of Orbital and Rotational Atherectomy in Calcified Narrowings in Patients Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2018; 121:934-939. [PMID: 29452688 DOI: 10.1016/j.amjcard.2017.12.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/18/2017] [Accepted: 12/29/2017] [Indexed: 01/15/2023]
Abstract
We aimed to compare the safety and efficacy of rotational atherectomy (RA) and orbital atherectomy (OA) during percutaneous coronary intervention in an all-comer population with severely calcified lesions. We included all patients who underwent percutaneous coronary intervention with OA or RA in our institution from October 2013 until October 2016. Comparison of baseline and procedural characteristics, along with acute complication rates and postprocedural cardiac enzyme elevation, was performed. There were 191 RA and 57 OA patients. Other than creatinine clearance, which was lower in patients with OA (p = 0.01), there were no differences in baseline characteristics. OA was more frequent in left anterior descending artery lesions (p = 0.02), whereas RA was more common in right coronary artery lesions (p = 0.01). Intracoronary imaging rates were above 60% in both groups. There was a higher rate of coronary dissections with OA compared with RA (p = 0.003), but there was no difference in periprocedural events. Maximal troponin levels were similar in both groups. Residual stenosis measured by intravascular ultrasound in 29 patients revealed no significant differences between OA and RA (p = 0.58). In conclusion, RA and OA have similar safety and efficacy profiles in treating patients with calcified coronary lesions, and intracoronary imaging is highly beneficial in identifying coronary injury after atherectomy procedures.
Collapse
|
42
|
Sato R, Sato T, Shirasawa Y, Kondo C, Tadakoshi M, Fukuda M, Ohte N, Morozumi K. A case series of favorable vessel dilatation using a nitinol scoring element-equipped helical balloon catheter (AngioSculpt®). J Vasc Access 2018; 20:93-96. [PMID: 29544387 DOI: 10.1177/1129729818757978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Although percutaneous transluminal angioplasty is an effective therapy against vascular access failure in hemodialysis patients, recurrent stenosis imposes enormous burden for hemodialysis patients. A nitinol scoring element-equipped helical balloon catheter (AngioSculpt®) has been altered the landscape for treating several vascular diseases. It is not, however, fully elucidated whether AngioSculpt for advanced vascular access stenosis, difficult to expand by conventional balloons, successfully provides bailout angioplasty. Here, we report our cases whose intradialytic venous pressure significantly improved after percutaneous transluminal angioplasty without any serious adverse complications using AngioSculpt. PATIENTS AND METHODS Among patients undergoing hemodialysis in Masuko Memorial Hospital, 16 cases with resistant and recurrent vascular access stenosis underwent AngioSculpt (diameter 6 mm, total length 4 cm) angioplasty. We simultaneously measured the average venous pressures during hemodialysis before and after percutaneous transluminal angioplasty. RESULTS The average outflow vessel stenosis rate was 73.0 ± 11.3% before AngioSculpt intervention. Fully enlarged vessels were observed by expanding vessels at maximum pressure of 14 atm in all cases without any complications including vascular ruptures. Their intradialytic venous pressures decreased from 181.8 ± 39.2 mmHg to 150.5 ± 39.3 mmHg ( p < 0.0001). CONCLUSION AngioSculpt may provide a promising option for treating hemodialysis patients with severely advanced vascular access stenosis, who would otherwise need repeated vascular access surgeries and/or conventional percutaneous transluminal angioplasties.
Collapse
Affiliation(s)
- Ryo Sato
- 1 Division of Nephrology, Masuko Memorial Hospital, Nagoya, Japan
| | - Tetsuhiko Sato
- 2 Division of Diabetes and Endocrinology, Masuko Memorial Hospital, Nagoya, Japan
| | - Yuichi Shirasawa
- 1 Division of Nephrology, Masuko Memorial Hospital, Nagoya, Japan
| | - Chika Kondo
- 1 Division of Nephrology, Masuko Memorial Hospital, Nagoya, Japan
| | - Masao Tadakoshi
- 3 Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Michio Fukuda
- 4 Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Medical School, Nagoya, Japan
| | - Nobuyuki Ohte
- 4 Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Medical School, Nagoya, Japan
| | - Kunio Morozumi
- 1 Division of Nephrology, Masuko Memorial Hospital, Nagoya, Japan
| |
Collapse
|
43
|
Allali A, Holy EW, Sulimov DS, Toelg R, Richardt G, Abdel-Wahab M. Long-Term Clinical Outcome of Early Generation Versus New-Generation Drug-Eluting Stents in 481 Patients Undergoing Rotational Atherectomy: A Retrospective Analysis. Cardiol Ther 2017; 7:89-99. [PMID: 29164408 PMCID: PMC5986666 DOI: 10.1007/s40119-017-0101-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION New-generation drug-eluting stents (NG-DES) are superior to early generation DES (EG-DES) in the majority of lesion and patient subsets, but comparative data in patients with severely calcified coronary lesions are lacking. This study aims to compare clinical outcomes of EG-DES and NG-DES in patients undergoing rotational atherectomy (RA) in calcified lesions. METHODS Data of 268 patients (288 lesions) treated with EG-DES and 213 patients (225 lesions) receiving NG-DES after RA were retrospectively analyzed from a single-center registry. All major adverse cardiac events (MACE) were assessed at 2 years. RESULTS Compared to the EG-DES group, patients with NG-DES more commonly had diabetes mellitus (31.9% vs. 40.9%; p = 0.04), left main lesions (7.6% vs. 17.3%; p < 0.001) and chronic total occlusions (3.5% vs. 8.5%; p = 0.016), and had a higher total stent length (30.5, IQR 20-40 mm, vs. 38, IQR 22-53 mm, p < 0.001). The Kaplan-Meier estimated rate of cardiovascular events at 2 years showed a lower incidence of death (13.5% vs. 8.2%, log-rank p = 0.13; adjusted HR after Cox regression analysis 0.49; 95% CI 0.26-0.92; p = 0.03) and a lower MACE rate (31.1% vs. 21.1%, log-rank p = 0.04; adjusted HR 0.65; 95% CI 0.42-0.98; p = 0.04) in the NG-DES group. CONCLUSIONS Although RA is performed in more complex patients and lesions in the NG-DES era, use of NG-DES is associated with lower rates of death and MACE at 2 years as compared to EG-DES.
Collapse
Affiliation(s)
- Abdelhakim Allali
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany.
| | - Erik W Holy
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Dmitry S Sulimov
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| |
Collapse
|
44
|
Barbato E, Shlofmitz E, Milkas A, Shlofmitz R, Azzalini L, Colombo A. State of the art: evolving concepts in the treatment of heavily calcified and undilatable coronary stenoses – from debulking to plaque modification, a 40-year-long journey. EUROINTERVENTION 2017; 13:696-705. [DOI: 10.4244/eij-d-17-00473] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
45
|
Schmidt T, Hansen S, Meincke F, Frerker C, Kuck KH, Bergmann MW. Safety and efficacy of lesion preparation with the AngioSculpt Scoring Balloon in left main interventions: the ALSTER Left Main registry. EUROINTERVENTION 2016; 11:1346-54. [PMID: 25990742 DOI: 10.4244/eijy15m05_04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Left main interventions require optimal initial results for good clinical outcome. Lesion preparation with the AngioSculpt Scoring Balloon (ASB) combined with the provisional T-stenting technique, if proven safe, might lead to better lumen gain and better clinical outcome. The aim of this registry was to investigate the safety and efficacy of the ASB as an option for lesion preparation in unprotected left main interventions (ULMI). METHODS AND RESULTS Out of the all-comers unprotected left main registry (ULMI ALSTER), 47 patients with elective ULMI fulfilled the inclusion criteria for this study. The endpoints were acute lumen gain and 12-month MACCE. The drop-out rate was 4%. The provisional T-stenting technique was used in 97% of distal ULMI. The interventions were grouped according to use of ASB with an in-house, historical no-ASB patient control group. Lumen gain was 1.63±0.12 mm in the ASB group (n=34) and 1.35±0.12 mm in the no-ASB group (n=8, p=0.26), respectively. The use of the ASB was safe. Intravascular ultrasound (IVUS) data for 21 patients showed numerically greater lumen area gain of 3.14±0.33 mm2 in the ASB group compared to 2.33±0.88 mm2 with the conventional technique. TLR/TVR was 6.6% overall. Twelve-month MACCE was 12.5% (4/32) for ASB and 15.4% (2/13) in the historical control group. CONCLUSIONS Adding ASB lesion preparation to the standard provisional T-stenting technique for ULMI is feasible and safe. Low TLR and TVR rates were observed. Lesion preparation led to a numerically larger lumen gain; the data allow valid power statistics to show this approach as leading to improved outcome in a possible randomised trial.
Collapse
Affiliation(s)
- Tobias Schmidt
- Division of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | | | | | | | | |
Collapse
|
46
|
Butman SM. In early returns scoring scores big. Catheter Cardiovasc Interv 2016; 88:60-1. [PMID: 27400636 DOI: 10.1002/ccd.26642] [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: 05/31/2016] [Accepted: 06/04/2016] [Indexed: 11/09/2022]
Abstract
A scoring or cutting balloon is always useful in preventing slippage during therapy of in-stent restenosis. A drug-coated scoring balloon for in-stent restenosis may be an alternative to a drug-coated balloon Definitive comparison trials are needed and likely to help define their exact role in patients with in-stent restenosis.
Collapse
|
47
|
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.
Collapse
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
| |
Collapse
|
48
|
Shimamura K, Guagliumi G. Optical Coherence Tomography for Online Guidance of Complex Coronary Interventions. Circ J 2016; 80:2063-72. [PMID: 27616595 DOI: 10.1253/circj.cj-16-0846] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Giulio Guagliumi
- Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII
| |
Collapse
|
49
|
Scheller B, Fontaine T, Mangner N, Hoffmann S, Bonaventura K, Clever YP, Chamie D, Costa R, Gershony G, Kelsch B, Kutschera M, Généreux P, Cremers B, Böhm M, Speck U, Abizaid A. A novel drug-coated scoring balloon for the treatment of coronary in-stent restenosis: Results from the multi-center randomized controlled PATENT-C first in human trial. Catheter Cardiovasc Interv 2015; 88:51-9. [DOI: 10.1002/ccd.26216] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/13/2015] [Accepted: 08/09/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Bruno Scheller
- Universitätsklinikum des Saarlandes; Homburg Saar Germany
| | | | | | | | | | | | - Daniel Chamie
- Instituto Dante Pazzanese De Cardiologia; Sao Paulo Brazil
| | - Ribamar Costa
- Instituto Dante Pazzanese De Cardiologia; Sao Paulo Brazil
| | - Gary Gershony
- John Muir Cardiovascular Institute; Concord California
| | | | | | - Philippe Généreux
- Columbia University and Cardiovascular Research Foundation; New York New York
| | - Bodo Cremers
- Universitätsklinikum des Saarlandes; Homburg Saar Germany
| | - Michael Böhm
- Universitätsklinikum des Saarlandes; Homburg Saar Germany
| | - Ulrich Speck
- Experimentelle Radiologie; Charite Berlin Germany
| | | |
Collapse
|
50
|
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]
|