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Lyu JJ, Liu Y, Gurm HS, Shih A, Zheng Y. Electroplating a miniature diamond wheel for grinding of the calcified plaque inside arteries. Med Eng Phys 2023; 113:103969. [PMID: 36966003 DOI: 10.1016/j.medengphy.2023.103969] [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: 11/15/2022] [Revised: 02/17/2023] [Accepted: 03/12/2023] [Indexed: 03/16/2023]
Abstract
A miniature grinding wheel (0.85 mm diameter) was fabricated by nickel (Ni)-diamond electroplating on a thin (0.65 mm outer diameter) flexible hollow stainless steel drive shaft to remove the calcified plaque in coronary and peripheral arteries by atherectomy procedure. To coat electrically nonconductive diamond grits, the drive shaft was submerged in a pile of diamond grit during Ni electroplating. The electroplating current density and temperature were investigated for better surface finishing and Faraday efficiency. The electroplating time to obtain the designed coating thickness was modeled based on Faraday's law of electrolysis and the geometry of drive shaft, wheel, and diamond grit. To validate the miniature wheel performance in atherectomy, grinding experiments were conducted on an atherectomy cardiovascular simulator with a calcified plaque surrogate. The wheel motion, material removal rate, and wheel surface wear were studied via high-speed camera imaging and laser confocal microscopy. The grinding wheel with 80,000 rpm rotational speed had an orbital speed of 14,300 rpm around the 1.5 mm diameter plaque surrogate lumen. After grinding for 120 s, the plaque surrogate inner diameter was enlarged to 3.03 mm, and no wear or loss of diamond abrasive was observed on the grinding wheel. This study demonstrated that the proposed electroplating process for fabricating miniature grinding wheels could effectively remove the calcified plaque surrogate. This research could lead to a more effective and safer atherectomy device with sub-mm miniature diamond wheels to treat lesions deep in coronary and peripheral arteries.
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Affiliation(s)
| | - Yao Liu
- Shanxi Key Laboratory of Advanced Manufacturing Technology, North University of China, Taiyuan, Shanxi 030051, China
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Albert Shih
- Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yihao Zheng
- Mechanical & Materials Engineering, Worcester Polytechnic Institute, Worcester, MA 01609, USA.
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2
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First United States experience with Rota-Shock: A case series. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:209-213. [PMID: 34507912 DOI: 10.1016/j.carrev.2021.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/08/2021] [Accepted: 08/31/2021] [Indexed: 11/20/2022]
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Abstract
Nanotherapies based on micelles, liposomes, polymersomes, nanocapsules, magnetic nanoparticles, and noble metal nanoparticles have been at the forefront of drug delivery in the past few decades. Some of these nanopharmaceuticals have been commercially applied to treat a wide range of diseases, from dry eye syndrome to cancer. However, the majority involve particles that are passive, meaning that they do not change shape, and they lack motility; the static features can limit their therapeutic efficacy. In this review, we take a critical look at an emerging field that seeks to utilize active matter for therapeutics. In this context, active matter can be broadly referred to as micro or nanosized constructs that energetically react with their environment or external fields and translate, rotate, vibrate or change shape. Essentially, the recent literature suggests that such particles could significantly augment present-day drug delivery, by enhancing transport and increasing permeability across anatomical barriers by transporting drugs within solid tumor microenvironments or disrupting cardiovascular plaque. We discuss examples of such particles and link the transport and permeability properties of active matter to potential therapeutic applications in the context of two major diseases, namely cancer and heart disease. We also discuss potential challenges, opportunities, and translational hurdles.
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Affiliation(s)
- Arijit Ghosh
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Weinan Xu
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Neha Gupta
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - David H. Gracias
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
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Sawant AC, Panchal H, Radadiya D, Pomakov A, Tse G, Liu T, Sridhara S, Rodriguez J, Prakash MPH, Kanwar N, Kumar A, Banerjee K, Wiesner P, Pershad A. Comparison of Rotational with Orbital Atherectomy During Percutaneous Coronary Intervention for Coronary Artery Calcification: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:501-507. [PMID: 31377129 DOI: 10.1016/j.carrev.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/29/2019] [Accepted: 07/17/2019] [Indexed: 01/13/2023]
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Saab F, Martinsen BJ, Wrede D, Behrens A, Adams GL, Mustapha J. Orbital atherectomy for calcified femoropopliteal lesions: a current review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:212-220. [PMID: 30698373 DOI: 10.23736/s0021-9509.19.10879-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The orbital atherectomy system is a novel form of atherectomy that uses orbital sanding and pulsatile forces, an effective method of treatment for peripheral atherosclerotic lesions with varying levels of occlusion. Although the devices only has a general indication from the FDA to treat atherosclerotic lesions, they are effective in treating all kinds of lesions, and can therefore mitigate effects of all severities of peripheral artery disease. This approach to endovascular therapy involves the use of differential sanding to preferentially ablate fibrous, fibrofatty and calcified lesions, while deflecting healthy intima away from the crown. The eccentrically mounted crown design allows the device to employ rhythmic pulsating forces that penetrate the medial layer, and cause cracking in the lesions in order to facilitate easier balloon inflation and intravascular drug elution. The combination of vessel modification and lumen enlargement through sanding can effectively restore blood flow to the extremities, and can eliminate risk of critical limb ischemia, as well as subsequent amputation. Extensive lab testing and clinical trials have confirmed the high success rates and low major adverse events associated with this form of treatment. The device is economically viable as well, since its cost is offset by the lower frequency of adjunctive therapy sessions when compared to other devices. Considering the results outlined in this manuscript, the Diamondback 360° is an effective form of atherectomy therapy for peripheral artery disease. In-depth understanding of the operation preparation, procedure, and best imaging techniques can help to optimize outcomes.
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Affiliation(s)
- Fadi Saab
- Advanced Cardiac and Vascular Amputation Prevention Centers, Michigan State University, School of Medicine, Grand Rapids, MI, USA -
| | - Brad J Martinsen
- Scientific Affairs, Clinical, Cardiovascular Systems Inc., St. Paul, MN, USA
| | - Dylan Wrede
- Scientific Affairs, Clinical, Cardiovascular Systems Inc., St. Paul, MN, USA
| | - Ann Behrens
- Scientific Affairs, Clinical, Cardiovascular Systems Inc., St. Paul, MN, USA
| | - George L Adams
- North Carolina Heart and Vascular, Rex Hospital, UNC School of Medicine, Raleigh, NC, USA
| | - Jihad Mustapha
- Advanced Cardiac and Vascular Amputation Prevention Centers, Michigan State University, School of Medicine, Grand Rapids, MI, USA
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Desai R, Mirza O, Martinsen BJ, Kumar G. Plaque modification of severely calcified coronary lesions via orbital atherectomy: Single-center observations from a complex Veterans Affairs cohort. Health Sci Rep 2018; 1:e99. [PMID: 30623053 PMCID: PMC6295613 DOI: 10.1002/hsr2.99] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Orbital atherectomy (OA) is a known alternative to other atherectomy devices. However, some complex patient demographics (eg, left ventricular ejection fraction <25%) were excluded from the first-in-human trial (ORBIT I) and the pivotal FDA device approval trial (ORBIT II) which evaluated the safety and efficacy of OA in severely calcified de novo coronary lesions. This single-operator cohort study aimed to examine the impact of OA on a real-world complex Veterans Affairs patient subset. METHODS Retrospective analysis was completed on 40 consecutive patients with severely calcified coronary lesions who underwent OA prior to drug-eluting stent placement at the Atlanta Veterans Affairs Medical Center from January 2015 to June 2017. RESULTS Orbital atherectomy plus drug-eluting stent placement was successful in all 40 cases. Chocolate focal force balloon angioplasty was the most commonly used post-atherectomy balloon (N = 34, 85%). Few complications were observed, including one case (2.5%) of perforation and one case (2.5%) of no-reflow. Neither acute stent thrombosis nor emergent coronary artery bypass grafting was observed. The intravascular ultrasound (IVUS)-determined median [IQR] pre-procedure minimum lumen area and post-procedure minimum stent area (MSA) were 2.8 [2.2, 3.0] mm2 and 8.7 [7.7, 10.0] mm2, respectively (P < 0.0001, Mann-Whitney test). Major adverse cardiovascular events, including all-cause mortality, at 30 days and at a median [IQR] follow-up of 197.5 [35.5, 461.3] days, was 5% and 10%, respectively. During that period, one target vessel revascularization (2.5%) was observed. CONCLUSIONS This study indicates that OA is a useful tool in performing high-risk percutaneous coronary intervention effectively in VA patients with severely calcified coronary lesions. OA plaque modification in combination with a high utilization rate of IVUS and Chocolate focal force angioplasty facilitates stent delivery and optimal stent expansion, resulting in a large MSA.
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Affiliation(s)
- Rupak Desai
- Division of CardiologyEmory University and Atlanta Veterans Affairs Medical CenterAtlantaGAUSA
| | - Omer Mirza
- Division of CardiologyEmory University and Atlanta Veterans Affairs Medical CenterAtlantaGAUSA
| | - Brad J. Martinsen
- Department of Clinical and Scientific Affairs, Cardiovascular Systems, Inc.St. PaulMNUSA
| | - Gautam Kumar
- Division of CardiologyEmory University and Atlanta Veterans Affairs Medical CenterAtlantaGAUSA
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Mahmoud AA, Mahmoud AN, Elgendy AY, Anderson RD. Current Status of Coronary Atherectomy. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zheng Y, Liu Y, Pitre JJ, Bull JL, Gurm HS, Shih AJ. Computational Fluid Dynamics Modeling of the Burr Orbital Motion in Rotational Atherectomy with Particle Image Velocimetry Validation. Ann Biomed Eng 2018; 46:567-578. [PMID: 29368259 DOI: 10.1007/s10439-018-1984-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/13/2018] [Indexed: 12/19/2022]
Abstract
Rotational atherectomy (RA) uses a high-speed rotating burr introduced via a catheter through the artery to remove hardened atherosclerotic plaque. Current clinical RA technique lacks consensus on burr size and rotational speed. The rotating burr orbits inside the artery due to the fluid force of the blood. Different from a common RA technique of upsizing burrs for larger luminal gain, a small burr can orbit to treat a large lumen. A 3D computational fluid dynamics (CFD) model was developed to simulate the burr motion and study the fluid flow and force in RA. A particle image velocimetry experiment was conducted to measure and validate the flow field including the radial and axial velocities and a pair of counter-rotating vortices near the burr equator in CFD. The hydraulic force on the burr and the contact force between the burr and the arterial wall were estimated by CFD. The contact force can be reduced by using smaller burr and lower rotational speed. Utilizing the small burr orbital motion has the potential to be an improved RA technique.
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Affiliation(s)
- Yihao Zheng
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward, Ann Arbor, MI, 48109, USA.
| | - Yang Liu
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward, Ann Arbor, MI, 48109, USA
| | - John J Pitre
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Joseph L Bull
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Hitinder S Gurm
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward, Ann Arbor, MI, 48109, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Lee MS, Gordin JS, Stone GW, Sharma SK, Saito S, Mahmud E, Chambers J, Généreux P, Shlofmitz R. Orbital and rotational atherectomy during percutaneous coronary intervention for coronary artery calcification. Catheter Cardiovasc Interv 2017; 92:61-67. [PMID: 29045041 DOI: 10.1002/ccd.27339] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/24/2017] [Indexed: 11/09/2022]
Abstract
Severe coronary artery calcification (CAC) increases the complexity of percutaneous coronary intervention (PCI) by inhibiting optimal stent expansion, leading to an increased risk of death, myocardial infarction, repeat revascularization, and stent thrombosis. Coronary atherectomy modifies and debulks calcified plaque to facilitate PCI. Although there is no clear consensus, and further studies are needed, the decision to perform atherectomy should be based upon the presence of fluoroscopic CAC or with the use of intravascular imaging. The management of CAC in the modern era relies on rotational and orbital atherectomy to prepare the lesion to facilitate stent delivery and optimal expansion. While the two technologies differ in equipment, technique, and mechanism of action, the available literature suggests similar efficacy and safety of the two systems, although head-to-head comparisons are limited. While rotational and orbital atherectomy have been shown to have excellent procedural success in terms of facilitating stent delivery, no system has been shown to reduce long-term major adverse cardiovascular events, although the definitive trial for orbital atherectomy has not been completed. Additional trials are needed to find the population who would derive the most benefit of atherectomy and to compare the two systems in a prospective manner.
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Affiliation(s)
- Michael S Lee
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan S Gordin
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | | | | | | | - Jeff Chambers
- Metropolitan Heart and Vascular Institute, Mercy Hospital, Roslyn, New York
| | - Philippe Généreux
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
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Shlofmitz E, Martinsen BJ, Lee M, Rao SV, Généreux P, Higgins J, Chambers JW, Kirtane AJ, Brilakis ES, Kandzari DE, Sharma SK, Shlofmitz R. Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices. Expert Rev Med Devices 2017; 14:867-879. [DOI: 10.1080/17434440.2017.1384695] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Evan Shlofmitz
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Brad J. Martinsen
- Department of Clinical and Scientific Affairs, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Michael Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Sunil V. Rao
- Duke Clinical Research Institute, Durham, NC, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY, USA
- Morristown Medical Center, Morristown, NJ, USA
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Joe Higgins
- Department of Engineering, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Jeffrey W. Chambers
- Metropolitan Heart and Vascular Institute, Mercy Hospital, Minneapolis, MN, USA
| | - Ajay J. Kirtane
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Samin K. Sharma
- Division of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital-The Heart Center, Roslyn, NY, USA
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Lee MS, Park KW, Shlofmitz E, Shlofmitz RA. Comparison of Rotational Atherectomy Versus Orbital Atherectomy for the Treatment of Heavily Calcified Coronary Plaques. Am J Cardiol 2017; 119:1320-1323. [PMID: 28258729 DOI: 10.1016/j.amjcard.2017.01.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/19/2022]
Abstract
We evaluated the outcomes of patients with severe coronary artery calcification (CAC) who underwent rotational atherectomy (RA) and orbital atherectomy (OA). Severe CAC increases the complexity of percutaneous coronary intervention (PCI) because of the difficulty in optimizing stent expansion, leading to worse clinical outcomes. Both devices are effective treatment strategies for severe CAC. No comparisons have been performed to evaluate the clinical outcomes after RA and OA. The outcomes of 67 patients with severe CAC who underwent RA from July 2012 to June 2015 and 60 patients who underwent OA from February 2014 to September 2016 were evaluated. The primary end point was the rate of 30-day major adverse cardiac and cerebrovascular events, comprising cardiac death, myocardial infarction, target vessel revascularization, and stroke. The primary end point was similar in the RA and OA groups (6% vs 6%, p >0.9), as were the individual end points of death (0% vs 2%, p = 0.8), myocardial infarction (6% vs 4%, p = 0.7), target vessel revascularization (0% vs 0%, p >0.9), and stroke (0% vs 0%, p >9). Procedural success was achieved in all patients. Angiographic complications were uncommon in both groups. No patient had stent thrombosis. In conclusion, both RA and OA are safe and effective for the treatment of severe CAC as they provided similar clinical outcomes at short-term follow-up.
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Affiliation(s)
- Michael S Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, California.
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Evan Shlofmitz
- Department of Cardiology, Northwell Health, Manhasset, New York
| | - Richard A Shlofmitz
- Cardiology Department, St. Francis Hospital-The Heart Center, Roslyn, New York
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