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Ghazzal A, Martinsen BJ, Sendil S, Torres CA, Croix GS, Sethi P, Cipriano R, Kirtane AJ, Leon MB, Beohar N. Orbital atherectomy safety and efficacy: A comparative analysis of ostial versus non-ostial calcified coronary lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:52-57. [PMID: 37482450 DOI: 10.1016/j.carrev.2023.07.013] [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: 05/24/2023] [Revised: 06/26/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The safety and efficacy of coronary orbital atherectomy (OA) for treatment of ostial lesions are not yet fully established. We sought to evaluate (OA) treatment of severely calcified ostial and non-ostial lesions. METHODS A retrospective analysis of subjects treated with OA for severely calcified ostial and non-ostial lesions, at the Mount Sinai Medical Center, Miami Beach, Florida (MSMCMB) from January 2014 to September 2020, was completed. Study baseline characteristics, lesion and vessel characteristics, procedural outcomes, and in-hospital major adverse cardiovascular events (MACE) were analyzed and compared. RESULTS A total of 609 patients that underwent PCI with OA were identified. The majority of patients (81.9 %) had non-ostial lesions, while 16.6 % had ostial lesions (of which 2.8 % classified as aorto-ostial) and 1.5 % had unknown lesion anatomy. The mean age of the overall cohort was 74.0 ± 9.3 years, and 63.5 % were male. All patients received drug-eluting stent (DES) placement, and the overall freedom from MACE was 98.5 %, with no significant difference observed between the ostial and non-ostial groups. The freedom from cardiac death and MI was also similar between the two groups. There were low rates of bleeding complications and severe angiographic complications, and no persistent slow flow/no reflow was reported. CONCLUSIONS This study demonstrated no significant differences in in-hospital MACE outcomes between patients with ostial versus non-ostial lesions, indicating that OA is a safe and effective treatment option for both lesion types, including those classified as aorto-ostial.
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Affiliation(s)
- Amre Ghazzal
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Brad J Martinsen
- Scientific Affairs, Cardiovascular Systems Inc, St. Paul, MN, USA
| | - Selin Sendil
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christian A Torres
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Garly Saint Croix
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Prince Sethi
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ralph Cipriano
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, NY, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, NY, USA
| | - Nirat Beohar
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
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Lobo TN, Ajluni S, Mogalapalli A, Kumar S, Hammad T, Abo-Salem E. Coronary Orbital Atherectomy Through Newly Deployed Left Main Coronary Stent. Cureus 2023; 15:e42821. [PMID: 37664326 PMCID: PMC10471353 DOI: 10.7759/cureus.42821] [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: 07/13/2023] [Indexed: 09/05/2023] Open
Abstract
Percutaneous coronary intervention (PCI) in complex, calcified coronary lesions can be assisted with orbital atherectomy (OA). OA is generally avoided when there are lesions amendable to OA distal to a newly deployed stent due to the risk of device-stent interaction, burr entrapment, and stent avulsion. We present a case documenting the successful passage of an OA system through a recently deployed left main stent to prepare a chronically occluded left anterior descending for PCI.
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Affiliation(s)
- Tabitha N Lobo
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Steven Ajluni
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Akhil Mogalapalli
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Sundeep Kumar
- Department of Cardiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Tarek Hammad
- Department of Cardiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Elsayed Abo-Salem
- Department of Cardiology, Saint Louis University Hospital, St. Louis, USA
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3
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Chambers JW, Martinsen BJ, Sturm RC, Mandair D, Valle JA, Waldo SW, Guzzetta F, Armstrong EJ. Orbital atherectomy of calcified coronary ostial lesions. Catheter Cardiovasc Interv 2022; 100:553-559. [PMID: 35989487 DOI: 10.1002/ccd.30369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the feasibility and safety of coronary orbital atherectomy (OA) for the treatment of calcified ostial lesions. BACKGROUND Percutaneous coronary intervention (PCI) is increasingly being completed in complex patients and lesions. OA is effective for severely calcified coronary lesions; however, there is a dearth of evidence on the use of OA in ostial lesions, especially with long-term outcome data. METHODS Data were obtained from a retrospective analysis of patients who underwent OA of heavily calcified ostial lesions followed by stent implantation from December 2010 to June 2019 at two high-volume PCI centers. Kaplan-Meier analysis was utilized to assess the primary endpoints of 30-day, 1-year, and 2-year freedom-from (FF) major adverse cardiac events (MACE: death, myocardial infarction, or target vessel revascularization), stroke, and stent thrombosis (ST). RESULTS A total of 56 patients underwent OA to treat heavily calcified ostial coronary lesions. The mean age was 72 years with a high prevalence of diabetes (55%) and heart failure (36%), requiring hemodynamic support (14%). There was high FF angiographic complications (93%), and at 30-day, 1-year, and 2-year, a high FF-MACE (96%, 91%, and 88%), stroke (98%, 96%, and 96%), and ST (100%), respectively. CONCLUSIONS This study represents the largest real-world experience of coronary OA use in heavily calcified ostial lesions with long-term outcomes over 2 years. The main finding in this retrospective analysis is that, despite the complex patients and lesions included in this analysis, OA appears to be a feasible and safe treatment option for calcified coronary ostial lesions.
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Affiliation(s)
- Jeffrey W Chambers
- Metropolitan Heart and Vascular Institute, Mercy Hospital, Minneapolis, Minnesota, USA.,Clinical & Medical Affairs, Cardiovascular Systems Inc., St. Paul, Minnesota, USA
| | - Brad J Martinsen
- Clinical & Medical Affairs, Cardiovascular Systems Inc., St. Paul, Minnesota, USA
| | - Robert C Sturm
- Denver VA Medical Center, University of Colorado, Denver, Colorado, USA
| | - Divneet Mandair
- Denver VA Medical Center, University of Colorado, Denver, Colorado, USA
| | - Javier A Valle
- Denver VA Medical Center, University of Colorado, Denver, Colorado, USA
| | - Stephen W Waldo
- Denver VA Medical Center, University of Colorado, Denver, Colorado, USA
| | - Francesca Guzzetta
- Metropolitan Heart and Vascular Institute, Mercy Hospital, Minneapolis, Minnesota, USA
| | - Ehrin J Armstrong
- Denver VA Medical Center, University of Colorado, Denver, Colorado, USA.,Adventist Health and Vascular Institute, Adventist Health, St. Helena, California, USA
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Beohar N, Stone GW, Martinsen BJ, Parise H, Vinardell JM, Heimowitz T, Koelbl C, Leon MB, Kirtane AJ. Coronary orbital atherectomy treatment of Hispanic and Latino patients: A real-world comparative analysis. Catheter Cardiovasc Interv 2022; 99:1752-1757. [PMID: 35312163 PMCID: PMC9540752 DOI: 10.1002/ccd.30158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 11/09/2022]
Abstract
Objectives To assess coronary orbital atherectomy (OA) use in Hispanic or Latino (HL) patients compared to non‐HL patients. Background HL patients are at greater risk of cardiovascular disease mortality compared with Whites with similar coronary artery calcium (CAC) scores. The safety and efficacy of coronary atherectomy in the HL patient population is unknown due to the under‐representation of minorities in clinical trial research. Methods A retrospective analysis of consecutive patients undergoing coronary OA treatment of severely calcified lesions at the Mount Sinai Medical Center, Miami Beach, Florida (MSMCMB) was completed. From January 2014 to September 2020, a total of 609 patients from MSMCMB who underwent percutaneous coronary intervention with OA were identified in the electronic health records. Results Of those identified, 350 (57.5%) had an ethnicity classification of HL. The overall mean age was 74 years and there was a high prevalence of diabetes in the HL group compared to the non‐HL group (49.7% vs. 34.7%; p = 0.0003). Severe angiographic complications were uncommon and in‐hospital freedom from major adverse cardiac events (MACE), a composite of cardiac death, MI, and stroke (ischemic or hemorrhagic cerebrovascular accidents), was 98.5% overall, with no significant difference between the HL and non‐HL groups, despite the higher prevalence of diabetes in the HL group. Conclusions This study represents the largest real‐world experience of OA use in HL versus non‐HL patients. The main finding in this retrospective analysis is that OA can be performed safely and effectively in a high‐risk population of HL patients.
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Affiliation(s)
- Nirat Beohar
- Division of Cardiology at the Mount Sinai Medical Center, Columbia University, Miami Beach, Florida, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brad J Martinsen
- Clinical Scientific Affairs, Cardiovascular Systems, Inc., St. Paul, Minnesota, USA
| | - Helen Parise
- Cardiovascular Medicine, Yale University Medical Center, New Haven, Connecticut, USA
| | - Juan M Vinardell
- Division of Cardiology at the Mount Sinai Medical Center, Columbia University, Miami Beach, Florida, USA
| | - Todd Heimowitz
- Division of Cardiology at the Mount Sinai Medical Center, Columbia University, Miami Beach, Florida, USA
| | - Christian Koelbl
- Division of Cardiology at the Mount Sinai Medical Center, Columbia University, Miami Beach, Florida, USA
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
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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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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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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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Sorini Dini C, Nardi G, Ristalli F, Mattesini A, Hamiti B, Di Mario C. Contemporary Approach to Heavily Calcified Coronary Lesions. ACTA ACUST UNITED AC 2019; 14:154-163. [PMID: 31867062 PMCID: PMC6918474 DOI: 10.15420/icr.2019.19.r1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022]
Abstract
Percutaneous treatment of heavily calcified coronary lesions still represents a challenge for interventional cardiology, with higher risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. Good characterisation of calcium distribution with multimodal imaging is important to improve the successful treatment of these lesions. The use of traditional or new dedicated devices for the treatment of calcified lesions allows better lesion preparation; therefore, it is important that we know the different mechanisms and technical features of these devices.
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Affiliation(s)
- Carlotta Sorini Dini
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy.,Cardiology Division, Spedali Riuniti Livorno, Italy
| | - Giulia Nardi
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Francesca Ristalli
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Brunilda Hamiti
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
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