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Abdelaziz A, Elsayed H, Hamdaalah A, Atta K, Mechi A, Kadhim H, Aboutaleb AM, Elaraby A, Ellabban MH, Rzk FM, Eid M, AboElfarh HE, Ibrahim RA, Zawaneh EA, Ezzat M, Abdelaziz M, Hafez AH, Fadel S, Ghaith HS, Suppah M. Safety and feasibility of rotational atherectomy (RA) versus conventional stenting in patients with chronic total occlusion (CTO) lesions: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:4. [PMID: 38166554 PMCID: PMC10763069 DOI: 10.1186/s12872-023-03673-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/13/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND AND AIM Interventional cardiologists face challenges in managing chronic total occlusion (CTO) lesions, with conflicting results when comparing rotational atherectomy (RA) to conventional PCI. This meta-analysis aims to provide a critical evaluation of the safety and feasibility of RA in CTO lesions. METHODS PubMed, Scopus, Web of Science, Ovid, and Cochrane central library until April 2023 were searched for relevant studies. MACE was our primary outcomes, other outcomes were all cause of death, cardiac death, MI, and TVR. Also, we reported angiographic outcomes as technical success, procedural success, and procedural complications in a random effect model. The pooled data was analyzed using odds ratio (OR) with its 95% CI using STATA 17 MP. RESULTS Seven studies comprising 5494 patients with a mean follow-up of 43.1 months were included in this meta-analysis. Our pooled analysis showed that RA was comparable to PCI to decrease the incidence of MACE (OR = 0.98, 95% CI [0.74 to 1.3], p = 0.9). Moreover, there was no significant difference between RA and conventional PCI in terms of other clinical or angiographic outcomes. CONCLUSION Our study showed that RA had comparable clinical and angiographic outcomes as conventional PCI in CTO lesions, which offer interventional cardiologists an expanded perspective when addressing calcified lesions. PROSPERO REGISTRATION CRD42023417362.
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Affiliation(s)
- Ahmed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hanaa Elsayed
- Medical Research group of Egypt (MRGE), Cairo, Egypt.
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | | | - Karim Atta
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Ahmed Mechi
- Internal Medicine Department, Medicine College, University of Kufa, Najaf, Iraq
| | - Hallas Kadhim
- College of Medicine, Al Muthanna university, Samawah, Iraq
| | - Aya Moustafa Aboutaleb
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elaraby
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Hatem Ellabban
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fayed Mohamed Rzk
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mahmoud Eid
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Hadeer Elsaeed AboElfarh
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rahma AbdElfattah Ibrahim
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt
| | - Emad Addin Zawaneh
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of medicine, Jordan university of science and technology, Irbid, Jordan
| | - Mahmoud Ezzat
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman H Hafez
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Shaimaa Fadel
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hazem S Ghaith
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mustafa Suppah
- Department of Cardiovascular Medicine, Mayo Clinic, 13400 E Shea Boulevard, Scottsdale, AZ, 85259, USA
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Allali A, Abdel-Wahab M, Elbasha K, Mankerious N, Traboulsi H, Kastrati A, El-Mawardy M, Hemetsberger R, Sulimov DS, Neumann FJ, Toelg R, Richardt G. Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials. Clin Res Cardiol 2023; 112:1143-1163. [PMID: 35482101 PMCID: PMC10450020 DOI: 10.1007/s00392-022-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE-CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions.
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Affiliation(s)
- Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany.
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Hussein Traboulsi
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | | | - Rayyan Hemetsberger
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Franz-Josef Neumann
- Cardiology Department, Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
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Ayoub M, Corpataux N, Behnes M, Schupp T, Forner J, Akin I, Neumann FJ, Westermann D, Rudolph V, Mashayekhi K. Safety and Efficiency of Rotational Atherectomy in Chronic Total Coronary Occlusion-One-Year Clinical Outcomes of an Observational Registry. J Clin Med 2023; 12:jcm12103510. [PMID: 37240617 DOI: 10.3390/jcm12103510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
The study sought to assess the procedural success of rotational atherectomy (RA) in coronary chronic total occlusion (CTO) and to investigate the in-hospital and one-year outcomes following RA. From 2015 to 2019, patients undergoing percutaneous coronary intervention for CTO (CTO PCI) were retrospectively included into the hospital database. The primary endpoint was procedural success. Secondary endpoints were in-hospital and one-year major adverse cardiovascular and cerebral event (MACCE) rates. During the study period of 5 years, 2.789 patients underwent CTO PCI. Patients treated with RA (n = 193, 6.92%) had a significantly higher procedural success (93.26% vs. 85.10%, p = 0.0002) compared to those treated without RA (n = 2.596, 93.08%). Despite a significantly higher rate of pericardiocentesis (3.11% vs. 0.50%, p = 0.0013) in the RA group, the in-hospital and one-year MACCE rate was similar in both groups (4.15% vs. 2.77%, p = 0.2612; 18.65% vs. 16.72%, p = 0.485). In conclusion, RA is associated with higher procedural success for CTO PCI, but has higher risks for pericardial tamponade than CTO PCI without the need for RA. Nevertheless, in-hospital and one-year MACCE rates did not differ in-between both groups.
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Affiliation(s)
- Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Volker Rudolph
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
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Long-Term Outcomes after Rotational Atherectomy for Calcified Chronic Total Occlusion versus Nonchronic Total Occlusion Coronary Lesions. J Interv Cardiol 2022; 2022:2593189. [PMID: 36636261 PMCID: PMC9810405 DOI: 10.1155/2022/2593189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/28/2021] [Accepted: 12/03/2022] [Indexed: 12/28/2022] Open
Abstract
Background The role of rotational atherectomy (RA) in contemporary percutaneous coronary intervention (PCI) is expanding to include certain chronic total occlusion (CTO) lesions. However, the long-term outcome of RA in CTOs is still unclear. Objective To investigate in-hospital and long-term outcomes after RA for CTO compared to non-CTO calcified lesions. Moreover, this report evaluates the role of the elective RA approach in calcified CTOs. Methods and Results This study enrolled 812 patients (869 lesions; CTO, n = 80 versus non-CTO, n = 789). The mean age of the study population was 73.1 ± 8.6 years, the baseline characteristics were comparable in both groups. Balloon-resistant CTO lesions represented the main indication for RA in CTO patients (61.2%). The mean J-CTO score was 2.42 ± 0.95. The angiographic success rate was lower in CTO patients (88.8% vs 94.9%; p = 0.022). In-hospital major adverse cardiac events (MACE) rate was comparable in both groups (CTO 8.8% vs 7.0% in non-CTO;p = 0.557). At two-year follow-up, a higher target lesion failure (TLF) was observed in CTO group (25.5% vs 15.1%, log rank p = 0.041), driven by higher cardiac mortality while the clinically driven target lesion revascularisation (TLR) was comparable between the study groups. Elective RA for CTO had a shorter procedural time and lower rate of dissection (7.5% vs 25%; p = 0.030) compared to bail-out RA with similar long-term outcomes. Conclusion Compared to non-CTO, RA for CTO can be performed with a high procedural success rate and comparable in-hospital outcomes. Apart from higher cardiac mortality in the CTO group, the long-term outcomes are comparable in both groups. Elective RA is a feasible and beneficial approach to be used in CTO intervention.
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Tsai TC, Lo WJ, Chen WJ, Lai CH, Su CS, Chang WC, Wang CY, Liu TJ, Liang KW, Lee WL, Chen YW. Rotational atherectomy for chronically and totally occluded coronary lesions: A propensity score-matched outcomes study. Front Cardiovasc Med 2022; 9:1061812. [PMID: 36620617 PMCID: PMC9810983 DOI: 10.3389/fcvm.2022.1061812] [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: 10/05/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background Despite advances being made in techniques and devices, certain chronic total occlusion (CTO) lesions remain uncrossable or undilatable. Rotational atherectomy (RA) is usually necessary for such lesions to achieve successful revascularization. Methods Information regarding consecutive patients who underwent coronary RA was retrieved from the catheterization laboratory database. Patients who underwent RA for CTO lesion refractory using other conventional devices were recruited, with propensity score-matched cases serving as controls. Results A total of 411 patients underwent coronary RA in the study period. Most patients had high-risk features (65.7% had acute coronary syndrome (ACS), 14.1% ischemic cardiomyopathy, and 5.1% cardiogenic shock), while only 20.2% of the patients had stable angina. Among them, 44 patients underwent RA for CTO lesions (CTO group), whereas the propensity score matched controls consist of 37 patients (non-CTO group). The baseline characteristics, high-risk features, coronary artery disease (CAD) vessel numbers, left ventricular function and biochemistry profiles of both groups were the same except for more patients with diabetes (67.6% vs. 45.5%, p = 0.046) in the non-CTO group and more 1.25 mm burr uses in the CTO group. There were no significant differences in acute procedural outcomes or incidence of acute contrast-induced nephropathy (CIN), and no patient demanded emergent CABG or died during the procedure. There was no significant difference in major adverse cardiovascular events (MACE), CV MACE or individual components between the two groups in the hospital, at 30, 90, and 180 days or at 1 year. Conclusion In comparison with the propensity risk factor scores-matched controls, there was no difference in procedural complications, acute CIN or clinical outcomes during various stages of RA for CTO lesions. RA for CTO patients was highly efficient and showed safety and outcome profiles similar to those for non-CTO lesions.
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Affiliation(s)
- Tien-Chien Tsai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Jung Lo
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Jhong Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan,Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Cardiovascular Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan,Cardiovascular Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Department of Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chun Chang
- Feng-Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan,Department of Life Sciences, Tunghai University, Taichung, Taiwan
| | - Chi-Yen Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan,Cardiovascular Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan,Cardiovascular Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Department of Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan,Department of Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan,Department of Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan,Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Cardiovascular Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan,*Correspondence: Yu-Wei Chen,
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Wang J, Huang J, Yakubu AS, Wu K, Huang Z, Zhong Z, Liao H, Zhang B. Safety and Feasibility of Rotational Atherectomy for Retrograde Recanalization of Chronically Occluded Coronary Arteries. Front Cardiovasc Med 2022; 9:854757. [PMID: 35783869 PMCID: PMC9247204 DOI: 10.3389/fcvm.2022.854757] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo evaluate the safety and feasibility of rotational atherectomy (RA) in retrograde chronic total occlusion percutaneous coronary intervention (CTO-PCI) by analyzing immediate and long-term outcomes.BackgroundRecent evidence supports the safety and feasibility of RA in CTO-PCI. However, few studies have focused on the use of RA in a retrograde approach to percutaneous revascularization of chronic total occlusion (CTO) lesions and information on long-term outcomes is lacking.MethodsA total of 329 patients who underwent retrograde CTO-PCI, out of 1496 consecutive CTO-PCI patients from April 2017 to July 2020, were retrospectively recruited from the 2nd Cardiology Department of the Guangdong Provincial People's Hospital. 16 patients underwent RA (RA group) whilst 313 did not (non-RA group).ResultsTechnical (87.5% vs. 87.5) and procedural (85.9% vs. 87.5) success rates were similar between both groups. There was no difference concerning major procedural complications between groups (12.5% vs. 19.2%; p > 0.75). No in-hospital MACCEs was recorded in the RA group while there were eight MACCEs in the non-RA group (p > 0.99). In the RA group, 2 cases recorded perforation (1 target vessel perforation case and 1 branch vessel perforation), and 55 cases of vessel perforations/dissections were recorded in non-RA group including 18 target vessel perforations, 2 branch vessel perforations, 35 collateral vessel perforations (one patient died from cardiac tamponade). No difference was found in terms of the perforation rate between the two groups (p > 0.99). Over a mean follow-up period of 26.47 ± 14.46 months, use of RA in retrograde CTO-PCI did not result in an increased mortality rate [hazard ratio (HR) 1.58, 95% confidence interval (CI), 0.31–8.21, p = 0.65], major adverse cardiac and cerebral events (HR 0.99, 95% CI 0.35–2.79, p = 0.99) or overall rehospitalization rate (HR 1.27, 95% CI 0.44–3.67, p = 0.67). Adjusted Kaplan–Meier curves according to Cox regression model suggested several predictors influencing the all-cause mortality, cardiovascular mortality, MACCEs, stroke rate, non-fatal myocardial infarction, target vessel recanalization rate and rehospitalization rate in the comparison.ConclusionsOur study demonstrates that the in-hospital outcomes and long-term follow up events were the same between RA and non-RA retrograde CTO-PCI patients. RA offered an option for skillful operators in difficult cases when the lesion was severely calcified in retrograde CTO-PCI.
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Affiliation(s)
- Jing Wang
- School of Medicine, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Junlin Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Kaize Wu
- Department of Cardiovascular Medicine, Affiliated Nanhai Hospital, Southern Medical University (People's Hospital of Nanhai District), Foshan, China
| | - Zehan Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhian Zhong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongtao Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bin Zhang
- School of Medicine, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Bin Zhang
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Rotational Atherectomy-Assisted Crossing of a Complex Right Coronary Artery Lesion Using the Retrograde Approach. Case Rep Cardiol 2021; 2021:8832213. [PMID: 34484839 PMCID: PMC8416397 DOI: 10.1155/2021/8832213] [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: 06/21/2020] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Chronic total occlusion lesions present a major challenge for the interventional cardiologist. In this case, we report the successful use of rotational atherectomy to facilitate retrograde percutaneous coronary intervention of a complex totally occluded right coronary artery after modification of the proximal cap of the lesion to enable placement of the RotaWire in the vessel architecture.
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Impact of chronic total occlusion lesions on clinical outcomes in patients receiving rotational atherectomy: results from the ROCK registry. Heart Vessels 2021; 36:1617-1625. [PMID: 33837813 DOI: 10.1007/s00380-021-01849-4] [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: 01/22/2021] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to investigate the impact of chronic total occlusion (CTO) on clinical outcomes in patients with calcified coronary lesions receiving rotational atherectomy (RA). This multi-center registry enrolled consecutive patients with calcified coronary artery disease who underwent RA during percutaneous coronary intervention (PCI) from 9 tertiary centers in Korea between January 2010 and October 2019. The primary outcome was target-vessel failure (TVF) which included the composite of cardiac death, target-vessel myocardial infarction (TVMI), and target-vessel revascularization (TVR). A total of 583 lesions were enrolled in this registry and classified as CTO (n = 42 lesions, 7.2%) and non-CTO (n = 541 lesions, 92.8%). The CTO group consisted of younger patients who were more likely to have a history of previous percutaneous coronary intervention or coronary artery bypass graft surgery. The incidence of the primary outcome was 14.1% and 16.7% for the non-CTO group and CTO group, respectively. The primary outcomes observed in the two groups were not significantly different (log-rank p = 0.736). The 18-month clinical outcomes of the CTO group were comparable to those of the non-CTO group in multivariate analysis. About 7% of patients requiring RA have CTO lesions and these patients experience similar clinical outcomes compared with those having non-CTO lesions. Use of RA for CTO lesions was safe despite higher procedural complexity.
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Xenogiannis I, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Mahmud E, Choi JW, Burke MN, Doing AH, Dattilo P, Toma C, Smith AJC, Uretsky B, Krestyaninov O, Khelimskii D, Holper E, Potluri S, Wyman RM, Kandzari DE, Garcia S, Koutouzis M, Tsiafoutis I, Khatri JJ, Jaber W, Samady H, Jefferson BK, Patel T, Moses JW, Lembo NJ, Parikh M, Kirtane AJ, Ali ZA, Doshi D, Tajti P, Rangan BV, Abdullah S, Banerjee S, Brilakis ES. Usefulness of Atherectomy in Chronic Total Occlusion Interventions (from the PROGRESS-CTO Registry). Am J Cardiol 2019; 123:1422-1428. [PMID: 30798947 DOI: 10.1016/j.amjcard.2019.01.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
Abstract
There is limited data on the use of atherectomy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy in a contemporary multicenter CTO PCI registry. Between 2012 and 2018, 3,607 CTO PCIs were performed at 21 participating centers. Atherectomy was used in 117 (3.2%) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Patients in whom atherectomy was used, were older (68 ± 8 vs 64 ± 10 years, p <0.0001) and had higher Japan-chronic total occlusion score (3.0 ± 1.2 vs 2.4 ± 1.3, p <0.0001). CTO PCI cases in which atherectomy was used had similar technical (91% vs 87%, p = 0.240) and procedural (90% vs 85%, p = 0.159) success and in-hospital major adverse cardiac event (4% vs 3%, p = 0.382) rates. However, atherectomy cases were associated with higher rates of donor vessel injury (4% vs 1%, p = 0.031), tamponade requiring pericardiocentesis (2.6% vs 0.4%, p = 0.012) and more often required use of a left ventricular assist device (9% vs 5%, p = 0.031). Atherectomy cases were associated with longer procedural duration (196 [141, 247] vs 119 [76, 180] minutes, p <0.0001), and higher patient air kerma radiation dose (3.6 [2.5, 5.6] vs 2.8 [1.6, 4.7] Gray, p = 0.001). In conclusion, atherectomy is currently performed in approximately 3% of CTO PCI cases and is associated with similar technical and procedural success and overall major adverse cardiac event rates, but higher risk for donor vessel injury and tamponade.
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Affiliation(s)
- Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - Ehtisham Mahmud
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - James W Choi
- Baylor Heart and Vascular Hospital, Dallas, Texas
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Phil Dattilo
- Medical Center of the Rockies, Loveland, Colorado
| | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - A J Conrad Smith
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barry Uretsky
- VA Central Arkansas Healthcare System, Little Rock, Arkansas
| | | | | | | | | | | | | | - Santiago Garcia
- VA Minneapolis Healthcare System and University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia
| | - Habib Samady
- Emory University Hospital Midtown, Atlanta, Georgia
| | | | - Taral Patel
- Tristar Centennial Medical Center, Nashville, Tennesse
| | | | | | | | | | | | | | - Peter Tajti
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Bavana V Rangan
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Shuaib Abdullah
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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Brinkmann C, Eitan A, Schwencke C, Mathey DG, Schofer J. Rotational atherectomy in CTO lesions: too risky? Outcome of rotational atherectomy in CTO lesions compared to non-CTO lesions. EUROINTERVENTION 2018; 14:e1192-e1198. [DOI: 10.4244/eij-d-18-00393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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