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Shiraishi J, Mabuchi T, Kajihara T, Ukawa R, Nishimura T, Ohkura T, Taminishi S, Tsuji Y, Saburi M, Takigami M, Tsubakimoto Y, Inoue K, Ishibashi K. Modest dilation using rotational atherectomy and drug-coated balloon for native coronary proximal lesion with patent internal thoracic artery graft. J Cardiol Cases 2024; 30:196-200. [PMID: 39697690 PMCID: PMC11651034 DOI: 10.1016/j.jccase.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 12/20/2024] Open
Abstract
Intervention to proximal lesions should be avoided in graft-protected native coronary arteries in general, because there might be a risk for bypass-graft failure. An 81-year-old man with coronary artery bypass grafting surgery due to 3-vessel disease 17 years previously complained of worsening angina. Coronary angiography (CAG) revealed a diseased saphenous vein graft (SVG) and a probable functional occlusion in the mid left anterior descending coronary artery (LAD) concomitant with calcified severe stenosis in the left main (LM)-proximal LAD, and patent right internal thoracic artery (RITA)-LAD graft. After the first percutaneous coronary intervention (PCI) against the SVG lesion, we performed second PCI against the LM-proximal LAD lesions to release angina symptom and prevent LM occlusion. After rotational atherectomy (RA) with 1.5/1.75 mm burrs and balloon dilations, we detected a slight antegrade flow to distal LAD. To preclude possibility of graft failure in the RITA, we did not add further large-balloon dilations and stent implantations, and finally dilated with 3.0-mm drug-coated balloons (DCBs), leading to angina-free condition. Six-month follow-up CAG revealed no further vessel narrowing in both target vessels without RITA-graft failure. Stent-less PCI using relatively small-sized RA/DCB might be feasible for native proximal calcified lesions with patent bypass graft. Learning objectives •Full expansion of native proximal lesions should be avoided in internal thoracic artery (ITA) - protected coronary arteries in general, because it might provoke ITA-graft failure due to flow competition.•Stent-less modest dilation using relatively small-sized rotational atherectomy burr and drug-coated balloon might be a revascularization therapy of choice for native proximal calcified lesion with patent ITA bypass graft.
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Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Takashi Mabuchi
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Takashi Kajihara
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Rikuya Ukawa
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Tetsuro Nishimura
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Takashi Ohkura
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Shunta Taminishi
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Yumika Tsuji
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Makoto Saburi
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Masao Takigami
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | | | - Keiji Inoue
- Department of Second Laboratory Medicine, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kazuya Ishibashi
- Department of Cardiology, Kyoto Saiseikai Hospital, Nagaokakyo, Japan
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Lee T, Ashikaga T, Nozato T, Nagata Y, Kaneko M, Miyazaki R, Misawa T, Taomoto Y, Okata S, Nagase M, Horie T, Terui M, Kachi D, Odanaka Y, Matsuda K, Naito M, Koido A, Yonetsu T, Sasano T. Predictors of target lesion failure after percutaneous coronary intervention with a drug-coated balloon for de novo lesions. EUROINTERVENTION 2024; 20:e818-e825. [PMID: 38949242 PMCID: PMC11200664 DOI: 10.4244/eij-d-23-01006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/18/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND There are limited data about determinant factors of target lesion failure (TLF) in lesions after percutaneous coronary intervention (PCI) using a drug-coated balloon (DCB) for de novo coronary artery lesions, including optical coherence tomography (OCT) findings. AIMS The present study aims to investigate the associated factors of TLF in de novo coronary artery lesions with DCB treatment. METHODS We retrospectively enrolled 328 de novo coronary artery lesions in 328 patients who had undergone PCI with a DCB. All lesions had been treated without a stent, and both pre- and post-PCI OCT had been carried out. Patients were divided into two groups, with or without TLF, which was defined as a composite of culprit lesion-related cardiac death, myocardial infarction, and target lesion revascularisation, and the associated factors of TLF were assessed. RESULTS At the median follow-up period of 460 days, TLF events occurred in 31 patients (9.5%) and were associated with patients requiring haemodialysis (HD; 29.0% vs 10.8%), with a severely calcified lesion (median maximum calcium arc 215° vs 104°), and with the absence of OCT medial dissection (16.1% vs 60.9%) as opposed to those without TLF events. In Cox multivariable logistic regression analysis, HD (hazard ratio [HR]: 2.26, 95% confidence interval [CI]: 1.00-5.11; p=0.049), maximum calcium arc (per 90°, HR: 1.34, 95% CI: 1.05-1.72; p=0.02), and the absence of post-PCI medial dissection on OCT (HR: 8.24, 95% CI: 3.15-21.6; p<0.001) were independently associated with TLF. CONCLUSIONS In de novo coronary artery lesions that received DCB treatment, factors associated with TLF were being on HD, the presence of a severely calcified lesion, and the absence of post-PCI medial dissection.
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Affiliation(s)
- Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Toru Misawa
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yuta Taomoto
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tomoki Horie
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Mao Terui
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Daigo Kachi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yuki Odanaka
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Kazuki Matsuda
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Michihito Naito
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Ayaka Koido
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Sakakura K, Jinnouchi H, Taniguchi Y, Yamamoto K, Fujita H. Lifetime management of severely calcified coronary lesions: the treatment algorithm focused on the shape of calcification. Cardiovasc Interv Ther 2023; 38:375-380. [PMID: 37542662 DOI: 10.1007/s12928-023-00950-x] [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: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
The concept of lifetime management has not been discussed in the field of percutaneous coronary intervention (PCI), because the durability of drug-eluting stent (DES) is considered to be long enough for most patients. Furthermore, even if in-stent restenosis occurs, the treatment for in-stent restenosis is simple in most cases. On the other hand, the long-term clinical outcomes after DES implantation are worse in severely calcified coronary lesions than in non-calcified lesions. Moreover, the treatment for in-stent calcified restenosis or restenosis due to stent underexpansion is not simple. The concept of lifetime management of severely calcified lesions may be necessary like that of aortic stenosis. Recently, several algorithms have been published in PCI to severely calcified lesions, partly because of the emergence of IVL. These algorithms focus on the selection of cracking and debulking devices for the preparation of stenting. However, the optimal stent expansion does not guarantee the long-term patency, when the target lesion includes calcified nodules. Stent restenosis due to calcified nodules is difficult to manage. In this review article, we propose the algorithm for severely calcified lesions focused on the shape of calcification. We do not need to hesitate stenting when multiple cracks on circumferential calcification are observed by intravascular imaging devices. However, DCB may be an option as final device in some situations, when lifetime management of severely calcified lesions is considered.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
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Shan Y, Lu W, Han Z, Pan S, Li X, Wang X, Pan L, Wang X, Zheng X, Li R, Zhou Y, Qin P, Shi Q, Zhou S, Zhang W, Guo S, Qiu J, Zhang P, Qin X, Sun G, Qin Z, Huang Z, Qiu C. Long-term outcomes of drug-coated balloon treatment of calcified coronary artery lesions: a multicenter, retrospective, propensity matching study. Front Cardiovasc Med 2023; 10:1122290. [PMID: 37388642 PMCID: PMC10303933 DOI: 10.3389/fcvm.2023.1122290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/26/2023] [Indexed: 07/01/2023] Open
Abstract
Background Coronary artery calcification (CAC) is associated with high rates of restenosis and adverse clinical events after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Objectives The aim of this study was to evaluate the long-term clinical outcomes of drug-coated balloon (DCB)-only treatment for de novo lesions with and without CAC. Methods Patients with de novo coronary disease treated with the DCB-only strategy were retrospectively enrolled from three centers and categorized into a CAC group and a non-CAC group. The primary endpoint was the target lesion failure (TLF) rate during the 3-year follow-up. Secondary endpoints included the occurrence of major adverse cardiac events (MACEs), target lesion revascularization (TLR), cardiac death, myocardial infarction (MI) and any revascularization. Propensity score matching (PSM) was conducted to assemble a cohort of patients with similar baseline characteristics. Results A total of 1,263 patients with 1,392 lesions were included, and 243 patients were included in each group after PSM. Compared with the non-CAC group, the incidence rates of TLF (9.52% vs. 4.94%, odds ratio [OR]: 2.080; 95% confidence interval [CI]: 1.083-3.998, P = 0.034) and TLR (7.41% vs. 2.88%, OR: 2.642; 95% CI: 1.206-5.787, P = 0.020) in the CAC group were higher. The incidence rates of MACE (12.35% vs. 7.82%, OR: 1.665; 95% CI: 0.951-2.916, P = 0.079), cardiac death (2.06% vs. 2.06%, OR: 0.995; 95% CI: 0.288-3.436, P = 0.993), MI (1.23% vs. 0.82%, OR: 2.505; 95% CI: 0.261-8.689, P = 0.652) and any revascularization (12.76% vs. 9.67%, OR: 1.256; 95% CI: 0.747-2.111, P = 0.738) were similar between groups. Conclusions CAC increased the incidence of TLF and TLR without a substantial increase in the risk of MACE, cardiac death, MI, or any revascularization in patients treated with DCB-only angioplasty during the 3-year follow-up.
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Affiliation(s)
- Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjie Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanying Han
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Xiangbing Li
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Xi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Pan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xule Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaolin Zheng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ran Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanjun Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Qin
- Department of Geriatric Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiangwei Shi
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wencai Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sen Guo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peisheng Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofei Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongsheng Qin
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Zhenwen Huang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunguang Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Mitsui K, Lee T, Miyazaki R, Hara N, Nagamine S, Nakamura T, Terui M, Okata S, Nagase M, Nitta G, Watanabe K, Kaneko M, Nagata Y, Nozato T, Ashikaga T. Drug-coated balloon strategy following orbital atherectomy for calcified coronary artery compared with drug-eluting stent: One-year outcomes and optical coherence tomography assessment. Catheter Cardiovasc Interv 2023. [PMID: 37210618 DOI: 10.1002/ccd.30689] [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: 01/20/2023] [Accepted: 04/30/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) for calcified coronary artery remains challenging in the drug-eluting stent (DES) era. While recent studies reported the efficacy of orbital atherectomy (OA) combined with DES for calcified lesion, the effectiveness of drug-coated balloon (DCB) following OA has not been fully elucidated. METHODS Between June 2018 and June 2021, 135 patients who received PCI for calcified de novo coronary lesions with OA were enrolled and divided into two groups; OA followed by DCB (n = 43) if the target lesion achieved acceptable preparation, or second- or third-generation DESs (n = 92) if the target lesion showed suboptimal preparation between June 2018 and June 2021. All patients underwent PCI with optical coherence tomography (OCT) imaging. The primary endpoint was 1-year major adverse cardiac event (MACE), that was a composite of cardiac death, nonfatal myocardial infarction, or target lesion revascularization. RESULTS Mean age was 73 years and 82% was male. In OCT analysis, maximum calcium plaque was thicker (median: 1050 µm [interquartile range (IQR): 945-1175 µm] vs. 960 µm [808-1100 µm], p = 0.017), calcification arc tended to larger (median: 265° [IQR: 209-360°] vs. 222° [162-305°], p = 0.058) in patients with DCB than in DES, and the postprocedure minimum lumen area was smaller in DCB compared with minimum stent area in DES (median: 3.83 mm2 [IQR: 3.30-4.52 mm2 ] vs. 4.86 mm2 [4.05-5.82 mm2 ], p < 0.001). However, 1 year MACE free rate was not significantly different between 2 groups (90.3% in DCB vs. 96.6% in DES, log-rank p = 0.136). In the subgroup analysis of 14 patients who underwent follow-up OCT imaging, late lumen area loss was lower in patients with DCB than DES, despite lower lesion expansion rate in DCB than DES. CONCLUSIONS In calcified coronary artery disease, DCB alone strategy (if acceptable lesion preparation was performed with OA) was feasible compared with DES following OA with respect to 1-year clinical outcomes. Our finding indicated using DCB with OA might be reduce late lumen area loss for severe calcified lesion.
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Affiliation(s)
- Kentaro Mitsui
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Sho Nagamine
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Tomofumi Nakamura
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Mao Terui
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Giichi Nitta
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Keita Watanabe
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo, Japan
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Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023. Cardiovasc Interv Ther 2023; 38:141-162. [PMID: 36642762 PMCID: PMC10020250 DOI: 10.1007/s12928-022-00906-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Abstract
The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidences regarding rotational atherectomy (RA) in 2020. Because the revascularization strategy to severely calcified lesions is the hottest topic in contemporary percutaneous coronary intervention (PCI), many evidences related to RA have been published since 2020. Latest advancements have been incorporated in this updated expert consensus document.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Interventional Cardiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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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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8
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Zheng B, Yi T, Wu Q, Bai F, Li J. Drug-Coated Balloon Treatment for Possible Sequelae of Kawasaki Disease Evaluated by Multi-Modalities. Int Heart J 2022; 63:773-776. [PMID: 35831142 DOI: 10.1536/ihj.21-593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The most devastating sequela of Kawasaki disease (KD) is coronary artery complications that may lead to myocardial infarction and cardiac mortality. Percutaneous coronary intervention (PCI) and bypass grafting are recommended for KD patients with inducible myocardial ischemia and amendable coronary anatomy. However, there are few reports about coronary revascularization with drug-eluting balloons among KD patients, especially at an early age. We present a case report of multi-modality guidance of PCI with a drug-coated balloon (DCB) for a young patient with acute coronary syndrome and a history of KD. Post-procedural optical coherence tomography, angiography-derived fractional flow reserve, and 12-month coronary artery magnetic resonance showed favorable outcomes. The present case indicated that DCB therapy with intravascular imaging and physiologic assessment guidance may be an alternative strategy to treat severe coronary artery stenosis in selected patients with KD.
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Affiliation(s)
- Bo Zheng
- Peking University First Hospital
| | - Tieci Yi
- Peking University First Hospital
| | - Qiang Wu
- Lanzhou University Second Hospital
| | - Feng Bai
- Lanzhou University Second Hospital
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9
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Kitabata H. Vascular response following drug-eluting stent implantation in calcified coronary lesions: 2 major clinical questions emerged. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 41:61-62. [PMID: 35624013 DOI: 10.1016/j.carrev.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, 811 Kimiidera, Wakayama 641-8509, Japan.
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10
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Emori H, Shiono Y, Terada K, Higashioka D, Takahata M, Fujita S, Wada T, Ota S, Satogami K, Kashiwagi M, Kuroi A, Yamano T, Tanimoto T, Tanaka A. Effect of Atherectomy on Lesion Preparation in Heavily Calcified Coronary Artery Disease. Circ Rep 2022; 4:205-214. [PMID: 35600718 PMCID: PMC9072102 DOI: 10.1253/circrep.cr-22-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Percutaneous coronary intervention (PCI) of heavily calcified lesions remains challenging. This study examined whether calcified lesion preparation is better with an ablation-based than balloon-based technique. Methods and Results: Results of lesion preparations with and without atherectomy devices were compared in 121 patients undergoing optical coherence tomography (OCT)-guided PCI of heavily calcified lesions. Lesion preparation was performed with the ablation-based technique in 59 patients (atherectomy group) and with the balloon-based technique in 62 patients (balloon group). Lower grades of angiographic coronary dissections (National Heart, Lung, and Blood Institute [NHLBI] classification) occurred in the atherectomy than balloon group (atherectomy group: none, 33%; NHLBI A, 59%; B, 8%; C, 0%; D, 0%; balloon group: none, 1%; NHLBI A, 24%; B, 58%; C, 15%; D, 2%). On OCT, a large dissection was less common (49% vs. 90%; P<0.001) and calcium fractures were more frequent (75% vs. 18%; P<0.001) in the atherectomy than balloon group. In multivariable analyses, the ablation-based technique was associated with a lower grade of angiographic coronary dissection (adjusted odds ratio [aOR] 0.04; 95% confidence interval [CI] 0.01-0.12; P<0.001), a lower incidence of OCT-detected large dissection (aOR 0.09; 95% CI 0.03-0.30; P<0.001), and a higher incidence of OCT-detected calcium fracture (aOR 18.19; 95% CI 6.45-58.96; P<0.001). Conclusions: The ablation-based technique outperformed the balloon-based technique in the lesion preparation of heavily calcified lesions.
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Affiliation(s)
- Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Kosei Terada
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Daisuke Higashioka
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Suwako Fujita
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Keisuke Satogami
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
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11
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Niizeki T, Iwayama T, Kumagai Y, Tsuchikane E. A Case Report: Directional coronary atherectomy supported with optical coherence tomography is useful for the slit lesion. J Cardiol Cases 2022; 25:91-94. [PMID: 35079306 PMCID: PMC8766346 DOI: 10.1016/j.jccase.2021.07.002] [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: 05/28/2021] [Revised: 06/22/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Directional coronary atherectomy (DCA) was revived in Japan in 2014. DCA is a special procedure to remove the atherosclerotic plaque of coronary artery during percutaneous coronary intervention. We present the case of a 91-year-old woman with symptoms of angina. Coronary angiography revealed significant stenosis with a slit lesion of the proximal left anterior descending artery. Because she had a high risk of bleeding, we did not want to implant a stent to prevent bleeding events. Then, we performed optical coherence tomography (OCT) and intravascular ultrasound to evaluate the morphology of the slit lesion in more detail. OCT showed clearly that the direction of the flap was counterclockwise and the edge of the flap was located in the epicardium. Since we could understand the localization of plaque distribution fully by OCT examination, we successfully removed the flap by DCA based on information from OCT. After that, we performed balloon dilatation with a 3.0-mm drug-coated balloon and finished without implanting the stent successfully. Her symptoms completely disappeared and postoperative course was good. DCA supported with OCT might be one of the options in high bleeding risk patients, suggesting a potential stent-less therapeutic option. <Learning objective: There may be hesitation about implantation of stents in patients with high risk of bleeding, such as the elderly. Stent-less percutaneous coronary intervention using directional coronary atherectomy followed by drug-coated balloon under optical coherence tomography (OCT) guidance may be the one of the option for patients with a high risk of bleeding, because OCT can more clearly show the feature of the lesion and the effect of treatment compared to intravascular ultrasound.>
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Affiliation(s)
- Takeshi Niizeki
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
- Corresponding author: Takeshi Niizeki, MD, FJCC, Department of Cardiology, Okitama Public General Hospital. Ooaza Nishi Ohtuka 2000, Kawanishi Town, Yamagata Prefecture, Japan, 992-0601, Tel: +81-238-46-5000, Fax: +81-238-46-5711
| | - Tadateru Iwayama
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Yu Kumagai
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
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12
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Shiraishi J, Ito F, Yoshimura J, Kirii Y, Kataoka E, Ozawa T, Ito D, Kojima A, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Sawada T. Stentless Interventional Procedure Using Rotational Atherectomy and Drug-Coated Balloon for Noncalcified De Novo Lesions. CJC Open 2021; 3:714-722. [PMID: 34169250 PMCID: PMC8209394 DOI: 10.1016/j.cjco.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Several recent reports have shown that a stentless interventional procedure using rotational atherectomy followed by drug-coated balloon (DCB) treatment (RA/DCB) is a potent revascularization therapy for calcified de novo lesions even in the new-generation drug-eluting stent era; however, the role of the RA/DCB procedure for noncalcified de novo lesions remains unclear. Methods A total of 47 consecutive patients (53 lesions) who underwent RA/DCB for coronary de novo lesions were enrolled. According to the presence or absence of severe calcification at target lesions on fluoroscopy, the 47 patients were divided into the noncalcified cases (n = 12) and the calcified cases (n = 35), and the 53 lesions were divided into the noncalcified lesions (n = 14) and the calcified lesions (n = 39). Results The noncalcified cases tended to have a higher frequency of bleeding risk and had a significantly lower prevalence of dual antiplatelet therapy compared with the calcified cases. The main lesion-specific factors for the RA/DCB procedure among the noncalcified lesions were presence of left circumflex coronary artery ostial lesion. The final burr size, DCB diameter used, and angiographic success rate did not significantly differ between the 2 groups. The noncalcified lesions had a larger reference diameter and a shorter lesion length than the calcified lesions, whereas acute gain and late lumen loss did not differ between the 2 groups. Nine-month clinical outcomes were comparable between the 2 groups. Conclusions Under drug-eluting stent-unsuitable clinical or lesion conditions, acute and midterm outcomes of RA/DCB for noncalcified de novo lesions might be comparable with those for calcified de novo lesions.
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Affiliation(s)
- Jun Shiraishi
- Corresponding author: Dr Jun Shiraishi, Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan. Tel.: +81-75-561-1121; fax: +81-75-561-6308.
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13
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Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics. Cardiovasc Interv Ther 2020; 36:1-18. [PMID: 33079355 PMCID: PMC7829233 DOI: 10.1007/s12928-020-00715-w] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/15/2020] [Indexed: 12/12/2022]
Abstract
Rotational atherectomy (RA) has been widely used for percutaneous coronary intervention (PCI) to severely calcified lesions. As compared to other countries, RA in Japan has uniquely developed with the aid of greater usage of intravascular imaging devices such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). IVUS has been used to understand the guidewire bias and to decide appropriate burr sizes during RA, whereas OCT can also provide the thickness of calcification. Owing to such abundant experiences, Japanese RA operators modified RA techniques and reported unique evidences regarding RA. The Task Force on Rotational Atherectomy of the J apanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document to summarize the contemporary techniques and evidences regarding RA.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Interventional Cardiology, Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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14
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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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15
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Scheller B. Editorial: Rotational Atherectomy Followed by Drug-Coated Balloons in Calcified Coronary De Novo Lesions – An Alternative to Stent Implantation? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:654-656. [DOI: 10.1016/j.carrev.2020.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/26/2020] [Indexed: 11/15/2022]
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