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Okamoto N, Egami Y, Nohara H, Kawanami S, Sugae H, Kawamura A, Ukita K, Matsuhiro Y, Nakamura H, Yasumoto K, Tsuda M, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. Direct Comparison of Rotational vs Orbital Atherectomy for Calcified Lesions Guided by Optical Coherence Tomography. JACC Cardiovasc Interv 2023; 16:2125-2136. [PMID: 37704299 DOI: 10.1016/j.jcin.2023.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND There are several retrospective studies comparing rotational atherectomy (RA) and orbital atherectomy (OA), but all percutaneous coronary interventions (PCIs) in those studies were not performed under intracoronary imaging guidance. OBJECTIVES This study sought to compare the efficacy and safety of optical coherence tomography (OCT)-guided PCI with RA vs OA. METHODS The DIRO (To directly compare RA and OA for calcified lesions, a prospective randomized trial) trial was conducted. We enrolled patients with de novo calcified lesions (arc >180°) assessed by OCT or angiographically moderate or severe calcifications if the OCT catheter could not cross the lesion before any intervention. Eligible patients were randomly 1:1 allocated to lesion preparation with RA vs OA. Stent expansion was defined as the minimum stent area divided by the distal reference area multiplied by 100. Tissue modification was assessed using preatherectomy and postatherectomy OCT images. Procedural outcomes including periprocedural myocardial infarctions were evaluated. Furthermore, clinical events and vascular healing evaluated by OCT at 8 months postprocedure were assessed. RESULTS The stent expansion was significantly greater in the RA group vs the OA group (99.5% vs 90.6%; P = 0.02). The maximum atherectomy area was significantly larger in the RA group than in the OA group (1.34 [IQR: 1.02-1.89] mm2 vs 0.83 [IQR: 0.59-1.11] mm2; P = 0.004). The procedural outcomes and clinical events at 8 months did not differ between the groups. The vascular healing was sufficient in both groups. CONCLUSIONS The prospective randomized DIRO trial revealed that RA could produce a more favorable tissue modification, which may lead to a larger stent expansion than OA in heavily calcified lesions.
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Affiliation(s)
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Hiroaki Nohara
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | | | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan.
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
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2
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Manasrah N, Zghouzi M, Naughton R, Patel D, Osman H, Abdelrahman AK, Halboni A, Deschamps R, Sattar Y, Alraies MC. Outcomes of Orbital Atherectomy for the Treatment of Severely Calcified Coronary Artery Lesions. Cureus 2023; 15:e37651. [PMID: 37200667 PMCID: PMC10188128 DOI: 10.7759/cureus.37651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/20/2023] Open
Abstract
Background Orbital atherectomy (OA) is used to prepare severely calcified coronary artery lesions before percutaneous coronary intervention (PCI). Intravascular ultrasound (IVUS) is used to determine the plaque volume and degree of stenosis within the arterial vessel. This study evaluated the safety and efficacy of OA for treating severely calcified coronary lesions and determined if IVUS impacted these outcomes. Methods We retrospectively collected data from a single center of patients with severe coronary artery calcification who underwent OA. The data on baseline characteristics and procedural and clinical outcomes were collected and analyzed. Results A total of 374 patients underwent OA. The mean age was 69 ± 12.7; 53.6% were Black, and 38% were female. Hypertension was present in 96% of the patients, followed by hyperlipidemia in 79.4%, diabetes mellitus in 53.7%, and chronic kidney disease (CKD) in 22.7%. More patients had presented with a non-ST-elevation myocardial infarction (NSTEMI) compared to ST-elevation myocardial infarction (STEMI) at 36.3% versus 4.3%, respectively. The radial artery was used in 35.4% of the cases, and the left anterior descending artery (LAD) was the most commonly treated vessel with OA at 61%, followed by the right coronary artery (RCA) at 30.7%. IVUS was utilized in 63.4% of cases. The most common complication of the procedure was perforation and dissection at an equal proportion of 1.3% among all patients. The no-reflow rate was 0.5%, and 0.5% developed post-procedural myocardial infarction (MI). The average length of stay was 4.7 days, while a marginal proportion, at 10.5%, had same-day discharge with no recorded complications. Conclusion In this analysis of patients with severely calcified coronary lesions, OA had low rates of major adverse cardiovascular events (MACE) and was considered a safe and effective treatment for complex coronary lesions.
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Affiliation(s)
- Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | | | - Ryan Naughton
- Internal Medicine, Wayne State University, Detroit, USA
| | - Dhruvil Patel
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Heba Osman
- Internal Medicine/Pediatrics, Wayne State University-Detroit Medical Center, Detroit, USA
| | - Ahmad K Abdelrahman
- Internal Medicine, Wayne State University-Detroit Medical Center, Detroit, USA
| | - Adnan Halboni
- Internal Medicine, Wayne State University-Detroit Medical Center, Detroit, USA
| | - Raegan Deschamps
- Cardiology, Wayne State University-Detroit Medical Center, Detroit, USA
| | - Yasar Sattar
- Cardiology, West Virginia University, Morgantown, USA
| | - M Chadi Alraies
- Cardiology, Wayne State University-Detroit Medical Center, Detroit, USA
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3
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Acheampong A, Monsegu J. [Why and how do I use the orbitalatherectomy ?]. Ann Cardiol Angeiol (Paris) 2021; 70:432-434. [PMID: 34742467 DOI: 10.1016/j.ancard.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/02/2021] [Indexed: 06/13/2023]
Abstract
Severe coronary artery calcification, too often underestimated, increases the complexity of percutaneous coronary interventions. Atherectomy is one of preferred approach for the preparation of calcified lesions before stent placement. Orbital atherectomy (OA) is a new method that has proven to be safe and effective in the preparation of calcium plaques (ORBIT I and ORBIT II studies). The OA is made up of a crown mounted with diamonds that abrades the endoluminal calcium plaque by centrifugal force and creates pulsatile forces on the wall that fractures the deep calcified plaques in the media. The OA Diamondback 360 ™ consists of a tableside electric powered motor handle connected to a drive shaft mounted with an eccentric crown. The OA specific 0.012" coronary guidewire made of Nitinol (ViperWire ™) has 3 qualities; the torquability, the ease of navigation and the support. Compared to rotational atherectomy, AO is associated with a lower rate of MACE at 1 year, with less revascularization of the target vessel and reduced fluoroscopy time but at the cost of an increased rate of coronary dissection and perforation. AO is a new, quite attractive, safe and effective tool to consider in the preparation of calcified coronary lesions.
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Affiliation(s)
- Angela Acheampong
- Institut Cardio Vasculaire, GroupeHospitalierMutualiste de Grenoble, 8 rue du DrCalmette 38000Grenoble, France.
| | - Jacques Monsegu
- Institut Cardio Vasculaire, GroupeHospitalierMutualiste de Grenoble, 8 rue du DrCalmette 38000Grenoble, France.
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4
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Khan AA, Murtaza G, Khalid MF, White CJ, Mamas MA, Mukherjee D, Jneid H, Shanmugasundaram M, Nagarajarao HS, Paul TK. Outcomes of rotational atherectomy versus orbital atherectomy for the treatment of heavily calcified coronary stenosis: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2021; 98:884-892. [PMID: 33325587 DOI: 10.1002/ccd.29430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/29/2020] [Accepted: 11/29/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The optimal approach to deal with severe coronary artery calcification (CAC) during percutaneous coronary intervention (PCI) remains ill-defined. METHODS We conducted an electronic database search of all published studies comparing Orbital versus Rotational Atherectomy in patients undergoing PCI. RESULTS Eight observational studies were included in the analysis. Overall, there were no significant differences in Major-adverse-cardiac-events/MACE (OR: 0.81, CI: 0.63-1.05, p = .11), myocardial-infarction/MI (OR: 0.75, CI: 0.56-1.00, p = .05), all-cause mortality (OR: 0.82, CI: 0.25-2.64, p = .73) or Target-vessel-revascularization/TVR (OR: 0.72, CI: 0.38-1.36, p = .31). However, OA was associated with lower long-term MACE (1-year), (OR: 0.66, CI: 0.44-0.99, p = .04), long-term TVR (OR: 0.40, CI: 0.18-0.89, p = .03), and short-term MI (in-hospital and 30-day) (OR: 0.64, CI: 0.44-0.94, p = .02). OA was associated with more coronary artery dissections (OR: 2.61, CI: 1.38-4.92, p = .003) and device-related coronary perforations (OR: 2.79, CI: 1.08-7.19, p = .03). There were no differences in cardiac tamponade (OR: 1.78, CI: 0.37-8.69, p = .47). OA was noted to have significantly lower fluoroscopy time (MD: -3.96 min, CI: -7.67, -0.25; p = .04) compared to RA. No significant difference was noted in terms of contrast volume between the two groups (OR: -4.35 ml, CI: -14.52, 23.22; p = .65). CONCLUSION Although there was no difference in overall MACE, MI, all-cause mortality and TVR, OA was associated with lower long-term MACE and short-term MI. OA is associated with lower fluoroscopy time but higher rates of coronary artery dissection and coronary perforation.
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Affiliation(s)
- Abdul Ahad Khan
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Ghulam Murtaza
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Muhammad Faisal Khalid
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Christopher J White
- Department of Cardiovascular Diseases, The Ochsner Clinical School, University of Queensland, Brisbane, Queensland, Australia.,The John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK.,Department of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University, Lubbock, Texas, USA
| | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Harsha S Nagarajarao
- Division of Cardiology, Department of Internal Medicine, Texas Tech University, Lubbock, Texas, USA
| | - Timir K Paul
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, Tennessee, USA
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5
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Rozenbaum Z, Takahashi T, Kobayashi Y, Bliagos D, Menegus M, Colombo A, Latib A. Contemporary technologies to modify calcified plaque in coronary artery disease. Prog Cardiovasc Dis 2021; 69:18-26. [PMID: 34252411 DOI: 10.1016/j.pcad.2021.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
With aging society, one of the more challenging obstacles in percutaneous coronary interventions are calcified coronary lesions. Calcified lesions may impede stent delivery, limit balloon and stent expansion, cause uneven drug distribution, and hinder wire advancement. Even in the setting of acceptable procedural success, vessel calcification is independently associated with increased target lesion revascularization rates at follow-up and lower survival rates. In order to effectively manage such lesions, dedicated technologies have been developed. Atherectomy aims at excising tissue and debulking plaques, as well as compressing and reshaping the atheroma, generally referred to as lesion preparation that enables further balloon and/or stent expansion in contemporary clinical practice. In the current review, we will discuss the available methods for atherectomy, including rotational, orbital, and excimer laser coronary atherectomy, as well as intravascular lithotripsy. In addition, we will review the role of imaging in calcified lesions.
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Affiliation(s)
- Zach Rozenbaum
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Tatsunori Takahashi
- Jacobi Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Yuhei Kobayashi
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Dimitrios Bliagos
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Mark Menegus
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States.
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6
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Doshi R, Thakkar S, Patel K, Majmundar M, Shlofmitz E, Kumar A, Gupta N, Adalja D, Patel HP, Jauhar R, Meraj P. Short term outcomes of rotational atherectomy versus orbital atherectomy in patients undergoing complex percutaneous coronary intervention: a systematic review and meta-analysis. SCAND CARDIOVASC J 2021; 55:129-137. [PMID: 33461347 DOI: 10.1080/14017431.2021.1875139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Coronary artery calcification (CAC) is one of the paramount hurdles for percutaneous coronary intervention (PCI) since it impedes stent delivery and complete expansion. This study intended to evaluate the short-term clinical and procedural outcomes comparing rotational atherectomy (RA) and orbital atherectomy (OA) in patients with heavily calcified coronary lesions undergoing PCI. Design: This systematic review and meta-analysis included all head-to-head published comparisons of coronary RA versus OA. Procedural endpoints and post-procedural clinical outcomes (30 days/in-hospital), were compared. RevMan 5.3 software was used for data analysis. Results: Seven retrospective observational investigations with a total of 4623 patients, including 3203 patients in the RA group and 1420 patients in the OA group, were incorporated. Compared with OA, the RA group was associated with a higher incidence of myocardial infarction at short-term follow-up (OR: 1.56, 95% CI: 1.07-2.29, p = .02, I2 = 0%). No difference was noted among other short-term post-procedural clinical outcomes including all-cause mortality, target vessel revascularization, or major adverse cardiac events. Among procedural complications, RA was associated with reduced coronary artery dissection and arterial perforation. Increased fluoroscopy time was observed in the RA cohort as compared with OA (MD: 4.78, 95% CI: 2.25-7.30, p = .0002, I2 = 80%). Conclusion: RA was associated with fewer vascular complications, but at a cost of higher incidence of myocardial infarction and higher fluoroscopy time compared with OA, at short term follow-up. OA is a safe and effective alternative for the management of CAC.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Samarthkumar Thakkar
- Department of Internal Medicine, Rochester Regional Hospital, Rochester, NY, USA
| | - Krunalkumar Patel
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA, USA
| | - Monil Majmundar
- Department of Internal Medicine, Metropolitan Hospital Center, New York Medical College, New York, NY, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | - Ashish Kumar
- Department of Critical Care, St John's Medical College Hospital, Bangalore, India
| | - Neelesh Gupta
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, India
| | - Harsh P Patel
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Rajiv Jauhar
- Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA
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7
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Barrett C, Warsavage T, Kovach C, McGuinn E, Plomondon ME, Armstrong EJ, Waldo SW. Comparison of rotational and orbital atherectomy for the treatment of calcific coronary lesions: Insights from the
VA
clinical assessment reporting and tracking (
CART
) program. Catheter Cardiovasc Interv 2020; 97:E219-E226. [DOI: 10.1002/ccd.28971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Christopher Barrett
- Division of Cardiology, Department of Medicine University of Colorado Aurora Colorado USA
| | - Theodore Warsavage
- Department of Medicine VA Eastern Colorado Health Care System Aurora Colorado USA
| | - Christopher Kovach
- Division of Cardiology, Department of Medicine University of Colorado Aurora Colorado USA
| | - Erin McGuinn
- Division of Cardiology, Department of Medicine University of Colorado Aurora Colorado USA
| | - Mary E. Plomondon
- Department of Medicine VA Eastern Colorado Health Care System Aurora Colorado USA
| | - Ehrin J. Armstrong
- Division of Cardiology, Department of Medicine University of Colorado Aurora Colorado USA
| | - Stephen W. Waldo
- Department of Medicine VA Eastern Colorado Health Care System Aurora Colorado USA
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8
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Sawant AC, Panchal H, Radadiya D, Pomakov A, Tse G, Liu T, Sridhara S, Rodriguez J, Prakash MPH, Kanwar N, Kumar A, Banerjee K, Wiesner P, Pershad A. Comparison of Rotational with Orbital Atherectomy During Percutaneous Coronary Intervention for Coronary Artery Calcification: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:501-507. [PMID: 31377129 DOI: 10.1016/j.carrev.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/29/2019] [Accepted: 07/17/2019] [Indexed: 01/13/2023]
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9
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Shlofmitz E, Jeremias A, Shlofmitz R, Ali ZA. Lesion Preparation with Orbital Atherectomy. ACTA ACUST UNITED AC 2019; 14:169-173. [PMID: 31867064 PMCID: PMC6918479 DOI: 10.15420/icr.2019.20.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/01/2019] [Indexed: 01/15/2023]
Abstract
Despite significant improvements in stent design, severe coronary calcification continues to impede adequate stent expansion and is associated with worse clinical outcomes. Angiography is limited in its ability to detect and comprehensively characterise calcified plaque. Intravascular imaging provides information on lesion morphology guiding appropriate treatment strategies. Orbital atherectomy allows for lesion preparation of severely calcified plaque prior to stent implantation. Utilising a unique mechanism of action incorporating centrifugal forces, a standard 1.25 mm eccentrically mounted and diamond-coated burr orbits bi-directionally to ablate calcified plaque. Lesion preparation with orbital atherectomy allows for modification of calcified plaque to facilitate stent expansion.
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Affiliation(s)
| | - Allen Jeremias
- St Francis Hospital, Roslyn New York NY, US.,Cardiovascular Research Foundation New York NY, US
| | | | - Ziad A Ali
- St Francis Hospital, Roslyn New York NY, US.,Cardiovascular Research Foundation New York NY, US.,Columbia University Medical Center New York, NY, US
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10
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OCT-Guided Treatment of Calcified Coronary Artery Disease: Breaking the Barrier to Stent Expansion. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9509-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Abstract
Successful percutaneous coronary intervention (PCI) can be challenging in the presence of heavily calcified lesions. Severely calcified lesions are associated with worse clinical outcomes. Recognition of calcification is important before stenting to ensure adequate stent expansion can be attained. Orbital atherectomy is a safe and effective method to ablate calcified plaque. Lesion preparation through plaque modification with orbital atherectomy before stent implantation can help to optimize the results of PCI in these complex lesions.
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Affiliation(s)
- Evan Shlofmitz
- MedStar Washington Hospital Center, 110 Irving Street, Suite 4B1, Washington, DC 20010, USA
| | - Richard Shlofmitz
- St. Francis Hospital- The Heart Center, 100 Port Washington Boulevard, Suite 105, Roslyn, NY 11576, USA
| | - Michael S Lee
- UCLA Medical Center, 100 Medical Plaza Suite 630, Los Angeles, CA 90095, USA.
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12
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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.
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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
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