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Yoshizaki T, Nakamura T, Horikoshi T, Watanabe Y, Kobayashi T, Saito Y, Obata JE, Sawanobori T, Takano H, Umetani K, Asakawa T, Sato A. Impact of atherothrombotic risk stratification in patients with heavily calcified lesions following rotational atherectomy. J Cardiol 2024; 83:37-43. [PMID: 37524300 DOI: 10.1016/j.jjcc.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Patients who undergo percutaneous coronary intervention (PCI) with rotational atherectomy (RA) are at high risk of adverse clinical outcomes, and there are few clinical risk stratification tools for these patients. METHODS We conducted a study with 196 patients who underwent PCI with RA out of 7391 patients who underwent PCI using a multicenter, prospective cohort registry. Patients were divided into three groups according to the tertiles of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS 2°P): 65 patients in the T1 group (TRS 2°P < 3), 66 patients in the T2 group (TRS 2°P = 3), and 65 patients in the T3 group (TRS 2°P > 3). The primary endpoint was the cumulative 2-year incidence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of cardiac death, acute coronary syndrome, and ischemic stroke. RESULTS Cumulative 2-year MACCE occurred in 41 patients (24 %) during the follow-up period. The cumulative incidence of MACCE was significantly higher in the T3 group than in the T1 group (log-rank test, p = 0.02). Multivariate Cox analyses revealed that the T3 group was associated with an increased risk of MACCE compared to that of the T1 group (adjusted hazard ratio, 2.66; 95 % confidence interval, 1.04-6.77; p = 0.04). The addition of TRS 2°P to conventional risk factors, including male sex, number of diseased vessels, and low-density lipoprotein cholesterol levels, improved the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.39, p = 0.027; IDI 0.072, p < 0.001). CONCLUSIONS Atherothrombotic risk stratification using TRS 2°P was useful in identifying high-risk patients with heavily calcified lesions following RA.
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Affiliation(s)
- Toru Yoshizaki
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan.
| | - Takamitsu Nakamura
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan
| | - Takeo Horikoshi
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan
| | - Yosuke Watanabe
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan
| | - Tsuyoshi Kobayashi
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan
| | - Yukio Saito
- Department of Cardiology, Kofu Municipal Hospital, Kofu, Japan
| | - Jun-Ei Obata
- Department of Cardiology, Fujieda Municipal General Hospital, Fujieda, Japan
| | | | - Hajime Takano
- Department of Cardiology, Kofu Jonan Hospital, Kofu, Japan
| | - Ken Umetani
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Tetsuya Asakawa
- Department of Cardiology, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Akira Sato
- Department of Cardiology, University of Yamanashi, Faculty of Medicine, Chuo, Japan
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Allali A, Abdel-Wahab M, Elbasha K, Mankerious N, Traboulsi H, Kastrati A, El-Mawardy M, Hemetsberger R, Sulimov DS, Neumann FJ, Toelg R, Richardt G. Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials. Clin Res Cardiol 2023; 112:1143-1163. [PMID: 35482101 PMCID: PMC10450020 DOI: 10.1007/s00392-022-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE-CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions.
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Affiliation(s)
- Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany.
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Hussein Traboulsi
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | | | - Rayyan Hemetsberger
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Franz-Josef Neumann
- Cardiology Department, Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
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Dong H, Shan Y, Gong S, Li R, Li Y, Lu X, Sun G. Clinical research of drug-coated balloon after rotational atherectomy for severe coronary artery calcification. BMC Cardiovasc Disord 2023; 23:40. [PMID: 36681814 PMCID: PMC9867860 DOI: 10.1186/s12872-023-03071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Current research results show that drug-coated balloons (DCB) have unique advantages in the treatment of in-stent restenosis, small vessel disease, bifurcation lesions, and de novo lesions, but the data regarding rotational atherectomy (RA) followed by DCB treatment in calcified lesions, especially severe coronary artery calcification (CAC), are limited. METHODS A retrospective study was conducted on 318 individuals with severe CAC who underwent RA-assisted PCI at the First Affiliated Hospital of Zhengzhou University from May 2018 to July 2021. Among them, 57 patients (RA/DCB group) were treated with DCB, and 261 patients (RA/DES group) were treated with drug-eluting stents (DES). The two groups' clinical baseline data, lesion characteristics, intraoperative complications, in-hospital adverse events, and major adverse cardiovascular and cerebrovascular events (MACCE) were compared throughout the follow-up period. RESULTS The baseline clinical data, intraoperative complications, and in-hospital adverse events were not significantly different between the two groups. The anatomical categories in the RA/DES group were more complex and included left main coronary disease, bifurcation disease, and multivessel disease. Although target lesion revascularization (13.79% vs. 7.02%) and MACCE (18.77% vs. 12.28%) occurred more frequently in the RA/DES group than in the RA/DCB group, there was no statistically significant difference (p > 0.05). Multivariate Cox regression analysis showed that bifurcation lesions (HR 2.284, 95% CI 1.063-4.908, p = 0.034), total length of DCB/DES (HR 1.023, 95% CI 1.005-1.047, p = 0.014) and SYNTAX score (HR 1.047, 95% CI 1.013-1.082, p = 0.006) were independent risk factors for MACCE during the follow-up period. CONCLUSION Drug-coated balloon treatment after rotational atherectomy appears safe and effective in selected severe coronary artery calcification.
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Affiliation(s)
- Haozhe Dong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Shenzhen Gong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Ran Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yiming Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xupeng Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Khalid N, Javed H, Shlofmitz E, Chen Y, Dheendsa A, Musallam A, Khan JM, Wermers JP, Case BC, Forrestal BJ, Chezar-Azerrad C, Yerasi C, Rogers T, Hashim H, Ben-Dor I, Bernardo NL, Satler L, Waksman R. Adverse Events and Modes of Failure Related to Rotational Atherectomy System: The Utility of the MAUDE Database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 27:57-62. [PMID: 33071196 DOI: 10.1016/j.carrev.2020.08.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/04/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Coronary artery calcification is a marker of advanced atherosclerosis and a predictor of adverse clinical outcomes. Rotational atherectomy (RA) can effectively modify calcified lesions, optimizing procedural outcomes. We interrogated the most commonly reported adverse events involving rotational atherectomy systems (Rotablator and Rotapro) by analyzing post-marketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database. METHODS/MATERIALS We queried MAUDE from September 1, 2016, through December 31, 2019. After excluding duplicate reports, we included 363 reports for Rotablator and 63 reports for Rotapro in the final analysis. RESULTS Percentages represent the proportion of total submitted MAUDE reports. The most commonly reported complications for Rotablator and Rotapro included dissection (2.7% and 6.3%, respectively) and perforation (4.1% and 19%, respectively). The most commonly reported device-related issues included detachment or structural damage, or both, for Rotablator (39.1%) and entrapment of the device component for Rotapro (47.6%). The most commonly damaged device component was the Rotawire, whereas the most commonly entrapped device component was the Rotaburr for both device configurations. Rotablator and Rotapro device-related complications were most commonly reported for the left anterior descending artery. CONCLUSION An analysis of the MAUDE database demonstrates that in real-world practice, RA devices are associated with important complications. Ongoing surveillance of safety profiles, patient outcomes, and failure modes of RA devices is warranted. Our analysis provides important insights into the mechanisms of failure of RA devices and associated complications but cannot verify causality.
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Affiliation(s)
- Nauman Khalid
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Hasan Javed
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Yuefeng Chen
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Aaphtaab Dheendsa
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Jason P Wermers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Hayder Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Lowell Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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Iwasaki Y, Koike J, Ko T, Funatsu A, Kobayashi T, Ikeda T, Nakamura S. Comparison of drug-eluting stents vs. drug-coated balloon after rotational atherectomy for severely calcified lesions of nonsmall vessels. Heart Vessels 2020; 36:189-199. [PMID: 32857188 DOI: 10.1007/s00380-020-01684-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022]
Abstract
Calcified lesion is a risk factor for adverse events, even in the drug-eluting stent (DES) era. Recently, drug-coated balloon (DCB) has been shown to have favourable results for in-stent restenosis and small vessels, but its results for calcified lesions are unknown. This study aimed to clarify the rotational atherectomy (RA) and DCB results for calcified lesions of nonsmall vessels. A total of 194 consecutive de novo lesions from 165 cases underwent RA for calcified lesions of nonsmall vessels between January 2016 and August 2018 in a single centre. Overall, 8 cases/10 lesions were excluded because of RA followed plain old balloon angioplasty (POBA). Remaining lesions were grouped into the DES (88 cases/104 lesions) and DCB (69 cases/80 lesions) groups and then compared retrospectively. The primary endpoint was post-discharge major adverse cardiovascular events (MACE) at 1 year, and it was defined as cardiac death, noncardiac death, target-vessel-related myocardial infarction, target lesion revascularization (TLR), and major bleeding (BARC ≥ type 3). There was no difference in the clinical follow-up rate between RA + DES (96/104 lesions) and RA + DCB (78/80 lesions). The post-discharge MACE values after 1 year of RA + DES and RA + DCB were 8% and 11% (P = 0.30), respectively, in terms of cardiac death (0% vs. 0%, respectively), noncardiac death (4% vs. 3%, respectively, P = 0.36), target-vessel-related myocardial infarction (0% vs. 0%, respectively), TLR (4% vs. 8%, respectively, P = 0.30), and major bleeding (1% vs. 0%, respectively). For calcified lesions of nonsmall vessels, RA + DCB showed good results as well as RA + DES. RA + DCB is a potential new strategy for these lesions.
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Affiliation(s)
- Yoshihiro Iwasaki
- Cardiovascular Center, Kyoto Katsura Hospital, 1-8,10:17-banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256, Japan.
| | - Jumpei Koike
- Cardiovascular Center, Kyoto Katsura Hospital, 1-8,10:17-banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256, Japan
| | - Toshinori Ko
- Cardiovascular Center, Kyoto Katsura Hospital, 1-8,10:17-banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256, Japan
| | - Atsushi Funatsu
- Cardiovascular Center, Kyoto Katsura Hospital, 1-8,10:17-banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256, Japan
| | - Tomoko Kobayashi
- Cardiovascular Center, Kyoto Katsura Hospital, 1-8,10:17-banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, 9:11-banchi, omorinishi 6 Choume, Ota-ku, Tokyo, 143-8541, Japan
| | - Shigeru Nakamura
- Cardiovascular Center, Kyoto Katsura Hospital, 1-8,10:17-banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256, Japan
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Matsuda Y, Ashikaga T, Sasaoka T, Hatano Y, Umemoto T, Lee T, Yonetsu T, Maejima Y, Sasano T. Comparison of Neointimal Response between Durable-Polymer Everolimus-Eluting Stent and Bioabsorbable-Polymer Everolimus-Eluting Stent for Severely Calcified Lesions Requiring Rotational Atherectomy. Int Heart J 2020; 61:665-672. [PMID: 32684594 DOI: 10.1536/ihj.19-648] [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] [Indexed: 11/18/2022]
Abstract
Clinical outcomes after percutaneous coronary intervention (PCI) for severely calcified lesions remain poor. The purpose of this study was to investigate the neointimal response after everolimus-eluting stents (EES) for severely calcified lesions treated with rotational atherectomy (RA) using optical coherence tomography (OCT).We retrospectively analyzed 34 lesions in which PCI was performed with EES deployment following RA and OCT was performed immediately after PCI and at follow-up (nine months). The EES was either durable-polymer (DP) EES (22 lesions) or bioabsorbable polymer (BP) -EES (12 lesions). Strut coverage and malapposition were evaluated at 1-mm intervals of cross-section (CS) by serial OCT analysis. Malapposed strut was defined as having the distance from luminal border > 100 μm.A total of 11,823 struts immediately after PCI and 11,720 struts at follow-up were analyzed. Immediately after PCI, the strut-level analysis showed no significant differences in the percentage of malapposed struts between the DP-EES group and the BP-EES group. At follow-up, the BP-EES group showed a more prevalent covered strut compared with the DP-EES group (strut-level analysis: 95% versus 97%, P = 0.045; CS-level analysis: 97% versus 100%, P < 0.01; lesion-level analysis: 27% versus 83%, P < 0.01, respectively).In severely calcified lesions requiring RA, the BP-EES group achieved better neointimal coverage than the DP-EES group at nine months. Additional prospective studies are needed.
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Affiliation(s)
- Yuji Matsuda
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital.,Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Taro Sasaoka
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Yu Hatano
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Tomoyuki Umemoto
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University.,Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
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Nagai T, Mizobuchi M, Funatsu A, Kobayashi T, Nakamura S. Acute and mid-term outcomes of drug-coated balloon following rotational atherectomy. Cardiovasc Interv Ther 2019; 35:242-249. [PMID: 31420831 PMCID: PMC7295828 DOI: 10.1007/s12928-019-00611-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/18/2019] [Indexed: 01/28/2023]
Abstract
Rotational atherectomy (RA) is effective for reducing calcified plaque volume as part of percutaneous coronary intervention (PCI). Most lesions are then treated by stenting, but we often observe in-stent restenosis (ISR) due to an under-expanded stent associated with severe calcification, a condition that is particularly challenging to treat. It is unknown if drug-coated balloon (DCB) application following RA can be used as a "stentless" treatment strategy for calcified lesions. The aim of this study is to assess the acute and mid-term efficacy of DCB following RA (RA + DCB) at our institute and to evaluate the overall clinical utility of this stentless strategy for complex calcified lesions. From October 2014 to June 2018, 3644 lesions in 2424 consecutive cases were treated with PCI at our institute. Rotational atherectomy was used for 12.3% of all lesions and 42.3% of these RA-treated lesions were then treated using DCBs (n = 190 RA + DCB-treated lesions, of which 72% were in males). In-hospital major adverse cardiac events included only one case of non-Q-wave myocardial infarction. Average duration of follow-up coronary angiography after initial PCI was 199 ± 61 days. Angiographic restenosis was observed in 17.8% of RA + DCB-treated lesions, with mean late lumen loss of 0.23 ± 0.69 mm, while late lumen enlargement was observed in 39.1% of RA + DCB-treated lesions. At mid-term clinical follow-up, there were no cardiac deaths and target lesion revascularization rate was only 16.4%. Rotational atherectomy followed by DCB demonstrated acceptable acute and mid-term efficacy, suggesting that this stentless strategy may be an effective option for complex calcified lesions with high risk of ISR.
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Affiliation(s)
- Taito Nagai
- Cardiovascular center, Kyoto Katsura hospital, 17 Yamada hirao-cho, Nishikyo-ku, Kyoto, Japan.
| | - Masahiro Mizobuchi
- Cardiovascular center, Kyoto Katsura hospital, 17 Yamada hirao-cho, Nishikyo-ku, Kyoto, Japan
| | - Atsushi Funatsu
- Cardiovascular center, Kyoto Katsura hospital, 17 Yamada hirao-cho, Nishikyo-ku, Kyoto, Japan
| | - Tomoko Kobayashi
- Cardiovascular center, Kyoto Katsura hospital, 17 Yamada hirao-cho, Nishikyo-ku, Kyoto, Japan
| | - Shigeru Nakamura
- Cardiovascular center, Kyoto Katsura hospital, 17 Yamada hirao-cho, Nishikyo-ku, Kyoto, Japan
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Safety and Long-Term Efficacy of Drug-Coated Balloon Angioplasty following Rotational Atherectomy for Severely Calcified Coronary Lesions Compared with New Generation Drug-Eluting Stents. J Interv Cardiol 2019; 2019:9094178. [PMID: 31772551 PMCID: PMC6739772 DOI: 10.1155/2019/9094178] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 02/11/2019] [Indexed: 01/15/2023] Open
Abstract
Objectives This study sought to assess the safety and long-term efficacy of drug-coated balloons (DCB) following aggressive intracoronary image-guided rotational atherectomy (iRA) for severe coronary artery calcification (CAC), and to compare this strategy with new generation drug-eluting stents (nDES) following iRA. Background Ischemic events following the treatment of CAC is still relatively high. Thus, more innovative strategies are required. Methods We evaluated 123 consecutive patients (166 lesions) with de novo CAC undergoing an iRA (burr size; 0.7 of the mean reference diameter by intracoronary imaging) followed by DCB (DCB-iRA; 54 patients, 68 lesions) or nDES (nDES-iRA; 69 patients, 98 lesions). Follow-up angiography was obtained at > 6 months. Results The target vessels (right coronary and circumflex), bifurcation (67.6% versus 47.9%), reference diameter (2.28mm versus 2.49mm), and lesion length (11.89mm versus 18.78mm) were significantly different between the two groups. The median follow-up was 732 days. TLR and TVR in DCB-iRA and nDES-iRA at 3 years were similar: 15.6% versus 16.3% (P=0.99) and 15.6% versus 23.3% (P=0.38). In 41 well-matched lesion pairs after propensity score analysis, the cumulative incidence of TLR and TVR in DCB-iRA and nDES-iRA at 3 years was 12.9% versus 16.3% (P=0.70) and 12.9% versus 26.1% (P=0.17), respectively. On QCA analysis, although the acute gain was smaller in DCB-iRA (0.85 mm versus 1.53 mm, P<0.001), the minimum lumen diameter at follow-up was similar (1.69 mm versus 1.87 mm, P=0.29). The late lumen loss was lower (0.09 mm versus 0.52 mm, P=0.009) in DCB-iRA. Conclusions DCB-iRA is feasible for CAC.
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Hachinohe D, Kashima Y, Kanno D, Kobayashi K, Sugie T, Kaneko U, Tadano Y, Watanabe T, Shitan H, Fujita T. Rotational atherectomy and new-generation drug-eluting stent implantation. Catheter Cardiovasc Interv 2017; 91:1026-1034. [PMID: 29205743 DOI: 10.1002/ccd.27446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical outcomes of rotational atherectomy (RA) followed by new-generation drug-eluting stent (DES) implantation in patients with an extensive amount of calcified and fibrotic plaque. BACKGROUND RA followed by new-generation DES implantation for complex lesions has not been thoroughly evaluated. METHODS A total of 744 consecutive patients (770 lesions) treated with new-generation DES implantation following RA for de novo lesions between January 2013 and November 2015 were retrospectively identified using our institutional database. Clinical outcomes at 12 months were evaluated and the independent predictors of all-cause death and target vessel failure (TVF) were assessed using Cox regression models. RESULTS Target lesion revascularization occurred in 22 lesions (2.9%) and TVF occurred in 51 lesions (6.6%). In a multivariate analysis, hemodialysis, non-ST-segment elevation acute coronary syndrome, low ejection fraction, and HbA1c ≧ 7% were associated with 12-month mortality. Hemodialysis and right coronary artery were identified as independent predictors of TVF (hazard ratio (HR) 4.107, 95% confidence interval (CI) 2.194-7.685, P < .001; HR 2.491, 95% CI 1.023-6.062, P = .044, respectively). CONCLUSIONS A good debulking with RA followed by new-generation DES implantation is recommended for patients with an excessive amount of calcified and fibrotic plaque, as this will likely improve the clinical outcomes.
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Affiliation(s)
- Daisuke Hachinohe
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Yoshifumi Kashima
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Daitaro Kanno
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Ken Kobayashi
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Takuro Sugie
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Umihiko Kaneko
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Yutaka Tadano
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Tomohiko Watanabe
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Hidemasa Shitan
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Tsutomu Fujita
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
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10
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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.
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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
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11
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Rissanen TT, Uskela S, Siljander A, Kärkkäinen JM, Mäntylä P, Mustonen J, Eränen J. Percutaneous Coronary Intervention of Complex Calcified Lesions With Drug-Coated Balloon After Rotational Atherectomy. J Interv Cardiol 2017; 30:139-146. [PMID: 28116778 DOI: 10.1111/joic.12366] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES We investigated the safety and efficacy of PCI using drug-coated balloon (DCB) after rotational atherectomy (rotablation) in a retrospective single center study in patients with calcified de novo coronary lesions. The majority of patients had an increased risk for bleeding. BACKGROUND DCB has been effective in the treatment of in-stent restenosis, small vessels, and bifurcations. DCB enables short one month dual antiplatelet treatment. No published data exist on the use of DCB after rotablation. METHODS 82 PCIs were performed in 65 patients (mean age 72 ± 10 years) using rotablation followed by DCB treatment. The median follow-up time was 17 months. 82% of the patients had at least one risk factor for bleeding such as oral anticoagulation. 32% had an acute coronary syndrome. Median duration of dual antiplatelet treatment was 1 month. RESULTS MACE (the composite of cardiovascular death, ischemia-driven target-lesion revascularization [TLR] or non-fatal myocardial infarction) occurred in 14% and 20% of the patients at 12 and 24 months, respectively. The rate of ischemia-driven TLR was 1.5% at 12 months and 3.0% at 24 months. No acute closure of the treated vessel occurred. Bailout stenting was needed in 10% of the PCIs. The incidence of significant bleeding was 9% at 12 months. CONCLUSIONS This is the first study to show that PCI using DCB after preparation of calcified lesions with rotablation is safe and effective. This novel strategy may be considered especially in patients with a bleeding risk such as those using an oral anticoagulant.
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Affiliation(s)
| | - Sanna Uskela
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| | | | | | - Pirjo Mäntylä
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| | - Juha Mustonen
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| | - Jaakko Eränen
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
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12
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Allali A, Abdel-Wahab M, Sulimov DS, Jose J, Geist V, Kassner G, Richardt G, Toelg R. Comparison of Bailout and Planned Rotational Atherectomy for Heavily Calcified Coronary Lesions: A Single-Center Experience. J Interv Cardiol 2016; 30:124-133. [DOI: 10.1111/joic.12361] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Abdelhakim Allali
- 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
| | - Dmitriy S. Sulimov
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
| | - John Jose
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
| | - Volker Geist
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
| | - Guido Kassner
- 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
| | - Ralph Toelg
- Heart Center; Segeberger Kliniken GmbH; Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg; Bad Segeberg Germany
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13
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Sakakura K, Taniguchi Y, Matsumoto M, Wada H, Momomura SI, Fujita H. How Should We Perform Rotational Atherectomy to an Angulated Calcified Lesion? Int Heart J 2016; 57:376-9. [PMID: 27170474 DOI: 10.1536/ihj.15-421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rotational atherectomy to an angulated calcified lesion is always challenging. The risk of catastrophic complications such as a burr becoming stuck or vessel perforation is greater when the calcified lesion is angulated. We describe the case of an 83-year-old female suffering from unstable angina. Diagnostic coronary angiography revealed an angulated calcified lesion in the proximal segment of the right coronary artery. We performed rotational atherectomy to the lesion, but intentionally did not advance the rotational atherectomy burr beyond the top of the angulation. We controlled the rotational atherectomy burr and stopped it just before the top of the angulation to avoid complications. Following rotational atherectomy, balloon dilatation with a non-compliant balloon was performed, and drug-eluting stents were successfully deployed. In this manuscript, we provide a review of the literature on this topic, and discuss how rotational atherectomy to an angulated calcified lesion should be performed.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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14
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Généreux P, Bettinger N, Redfors B, Lee AC, Kim CY, Lee MS, Shlofmitz RA, Moses JW, Stone GW, Chambers JW. Two-year outcomes after treatment of severely calcified coronary lesions with the orbital atherectomy system and the impact of stent types: Insight from the ORBIT II trial. Catheter Cardiovasc Interv 2016; 88:369-77. [DOI: 10.1002/ccd.26554] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/21/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Philippe Généreux
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
- Hôpital Du Sacré-Coeur De Montréal; Université De Montréal; Montréal Québec Canada
| | - Nicolas Bettinger
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Björn Redfors
- Cardiovascular Research Foundation; New York New York
- Sahlgrenska University Hospital; Gothenburg Sweden
| | - Arthur C. Lee
- The Cardiac & Vascular Institute; Gainesville Florida
| | | | | | | | - Jeffrey W. Moses
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Gregg W. Stone
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Jeff W. Chambers
- Mercy Hospital; Metropolitan Heart and Vascular Institute; Minneapolis Minnesota
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