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Her AY, Shin ES. Drug-Coated Balloon Treatment for De Novo Coronary Lesions: Current Status and Future Perspectives. Korean Circ J 2024; 54:54.e70. [PMID: 38956941 DOI: 10.4070/kcj.2024.0148] [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: 05/11/2024] [Accepted: 05/22/2024] [Indexed: 07/04/2024] Open
Abstract
The outstanding development in contemporary medicine, highlighted by percutaneous coronary intervention (PCI), was achieved through the adoption of drug-eluting stents (DESs). Although DES is the established therapy for patients undergoing PCI for de novo coronary artery disease (CAD), their drawbacks include restenosis, stent thrombosis, and the requirement for dual antiplatelet therapy (DAPT) with an uncertain duration regarding its optimality. Drug-coated balloon (DCB) treatment leaves nothing behind on the vessel wall, providing the benefit of avoiding stent thrombosis and not necessitating obligatory extended DAPT. After optimizing coronary blood flow, DCB treatment delivers an anti-proliferative drug directly coated on a balloon. Although more evidence is needed for the application of DCB treatment in de novo coronary lesions, recent studies suggest the safety and effectiveness of DCB treatment for diverse conditions including small and large vessel diseases, complex lesions like bifurcation lesions or diffuse or multivessel diseases, chronic total occlusion lesions, acute myocardial infarctions, patients at high risk of bleeding, and beyond. Consequently, we will review the current therapeutic choices for managing de novo CAD using DCB and assess the evidence supporting their concurrent application. Additionally, it aims to discuss future important perspectives.
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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Rivero-Santana B, Jurado-Roman A, Galeote G, Jimenez-Valero S, Gonzalvez A, Tebar D, Moreno R. Drug-Eluting Balloons in Calcified Coronary Lesions: A Meta-Analysis of Clinical and Angiographic Outcomes. J Clin Med 2024; 13:2779. [PMID: 38792321 PMCID: PMC11122257 DOI: 10.3390/jcm13102779] [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: 03/10/2024] [Revised: 04/16/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The usefulness of drug-eluting balloons (DEBs) has not been fully elucidated in calcified coronary lesions (CCLs). This meta-analysis aimed to evaluate the efficacy of DEBs compared to a drug-eluting stent (DES) in this setting. Methods: PubMed, EMBASE and Cochrane were searched through December 2023. The primary endpoint was 12 months major adverse cardiac events (MACE). Secondary endpoints included clinical outcomes and angiographic results after PCI and at a 12-month follow-up. Results: Five studies and a total of 1141 patients with 1176 coronary lesions were included. Overall, the DEB was comparable to DES in MACE (RR = 0.86, 95% CI: 0.62-1.19, p = 0.36), cardiac death (RR = 0.59, 95% CI: 0.23-1.53, p = 0.28), myocardial infarction (RR = 0.89, 95% CI: 0.25-3.24, p = 0.87) and target lesion revascularization (RR = 1.1, 95% CI: 0.68-1.77, p = 0.70). Although the DEB was associated with worse acute angiographic outcomes (acute gain; MD = -0.65, 95% CI: -0.73, -0.56 and minimal lumen diameter; MD = -0.75, 95% CI: -0.89, -0.61), it showed better results at 12 months follow-up (late lumen loss; MD = -0.34, 95% CI: -0.62, -0.07). Conclusions: This meta-analysis showed that the DEB strategy is comparable to DES in the treatment of CCLs in terms of clinical outcomes. Although the DEB strategy had inferior acute angiographic results, it may offer better angiographic results at follow-up.
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Affiliation(s)
- Borja Rivero-Santana
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
- Hospital La Paz Institute for Health Research (IdiPAZ), 28040 Madrid, Spain
| | - Alfonso Jurado-Roman
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
- Hospital La Paz Institute for Health Research (IdiPAZ), 28040 Madrid, Spain
| | - Guillermo Galeote
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
- Hospital La Paz Institute for Health Research (IdiPAZ), 28040 Madrid, Spain
| | - Santiago Jimenez-Valero
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
- Hospital La Paz Institute for Health Research (IdiPAZ), 28040 Madrid, Spain
| | - Ariana Gonzalvez
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
| | - Daniel Tebar
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
| | - Raul Moreno
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
- Hospital La Paz Institute for Health Research (IdiPAZ), 28040 Madrid, Spain
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Bai X, Shen C, Zhang W, Yu T, Jiang J. Efficacy and risks of drug-coated balloon treatment for coronary artery disease: A meta-analysis. Heliyon 2023; 9:e22224. [PMID: 38053896 PMCID: PMC10694162 DOI: 10.1016/j.heliyon.2023.e22224] [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: 07/03/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Introduction Coronary artery disease (CAD) often leads to myocardial ischemia and impaired cardiac function, significantly impacting the well-being and quality of life (QOL) of individuals. The use of drug-coated balloon (DCB) treatment has become a widespread approach in CAD management. However, currently, there is limited evidence available for the meta-analysis of DCB treatment in CAD. Materials and methods A systematic search was conducted across databases including PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database, covering data from the inception of each database up to April 2023. Randomized controlled trials (RCTs) regarding DCB treatment were meticulously chosen based on independent assessment of eligibility and scope by three researchers. Literature screening and data extraction were independently performed by two researchers, while methodological quality of the enrolled studies was assessed using the risk of bias (ROB) tool developed by the Cochrane Collaboration. Meta-analysis was conducted using RevMan 5.3. Results Following the screening process, seven studies were included. Four studies demonstrated an odds ratio (OR) of 0.66 for target lesion revascularization (TLR), five reported an OR of 0.41 for postoperative myocardial infarction (MI), four indicated a mean difference (MD) of 6.03 in the degree of stenosis (DOS), five exhibited an MD of 0.13 for late lumen loss (LLL), five reported an OR of 0.33 for cardiac death, and two presented an OR of 1.01 for binary restenosis (BR). Conclusion DCB demonstrated a comparable efficacy to drug-eluting stents (DES) in treating CAD, with relatively lower associated risks.
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Affiliation(s)
- Xinghua Bai
- Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang Province, China
- Department of Cardiovascular Medicine, First People's Hospital, Linping District, Hangzhou 311100, Zhejiang Province, China
| | - Chaofeng Shen
- Department of Cardiovascular Medicine, First People's Hospital, Linping District, Hangzhou 311100, Zhejiang Province, China
| | - Weizong Zhang
- Department of Cardiovascular Medicine, First People's Hospital, Linping District, Hangzhou 311100, Zhejiang Province, China
| | - Tao Yu
- Department of Cardiovascular Medicine, First People's Hospital, Linping District, Hangzhou 311100, Zhejiang Province, China
| | - Jun Jiang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Zhejiang University, Shangcheng District, Hangzhou 310009, Zhejiang Province, China
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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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8
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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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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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Incidence and prognostic impact of the calcified nodule in coronary artery disease patients with end-stage renal disease on dialysis. Heart Vessels 2022; 37:1662-1668. [PMID: 35499643 DOI: 10.1007/s00380-022-02076-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/08/2022] [Indexed: 01/15/2023]
Abstract
Coronary artery calcification is frequently observed in coronary artery disease (CAD) patients with end-stage renal disease (ESRD). Calcified nodule (CN) is recognized as one of the vulnerable plaque characteristics responsible for acute coronary syndrome (ACS). Although CN is a cause of ACS in only 10%, its prevalence may be higher in elderly patients and/or ESRD. The aim of this study is to investigate incidence, clinical characteristics, and prognostic impact of CN in CAD patients with ESRD on dialysis. A total of 51 vessels from 49 CAD patients with ESRD on dialysis were enrolled in this study. CN was defined as a high-backscattering mass protruding into the lumen with a strong signal attenuation and an irregular surface by optical coherence tomography. Incidence, clinical characteristics and prognosis of patients with CN were studied. Major adverse cardiac events (MACE) were defined as a composite of all-cause death, non-fatal myocardial infarction, target vessel revascularization (TVR) and stroke. CNs were observed in 30 vessels from 29 patients (59.2%). Duration of dialysis was significantly longer in CN group than in non-CN group (P = 0.03). Overall, all-cause death, cardiac death, TVR and MACE occurred in 7 (14.3%), 3 (6.1%), 11 (22.4%) and 16 (32.7%) patients during follow-up (median 826 days), respectively. Kaplan-Meier survival analysis revealed that MACE-free survival was significantly lower in patients with CN compared with those without CN (Log-rank, P = 0.036).In conclusion, CN was observed in about 60% of the CAD patients with ESRD and was associated with duration of dialysis and worse prognosis.
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12
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Samia AM, Adams GL. Changes to Drug-Coated Balloon Reimbursement Affect Peripheral Arterial Disease Patient Care: A Single-Center Experience. Cureus 2022; 14:e23514. [PMID: 35495006 PMCID: PMC9040687 DOI: 10.7759/cureus.23514] [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] [Accepted: 03/26/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Balloon angioplasty (BA) and stenting have long been the mainstays of endovascular therapy in peripheral arterial disease (PAD). However, the rise of drug-coated balloons (DCBs) has revolutionized care in recent years, with multiple clinical trials showing superiority over BA in maintaining primary patency and freedom from target lesion revascularization (TLR). With the recent drop of the add-on payment for DCBs, a barrier for their use and consequently reduced therapy adoption in PAD might arise. We assessed if this affected physicians' behavior and hospital administration towards stocking and using DCBs. Methods: This single-center, retrospective study evaluated DCB utilization in 2017 versus 2018. Data were collected in two groups: 1) July 1, 2017, to December 31, 2017 - with pass-through code (PTC) - prior medical billing reimbursement - and 2) January 1, 2018, to June 30, 2018 - without PTC - markedly reduced reimbursement. Patients treated for superficial femoral artery (SFA) or popliteal artery (POP) disease were included. The study aimed to determine changes in DCB utilization between the years with and without PTC, and we investigated the treatments that have replaced DCBs. Additionally, we aimed to collect data on readmissions and procedure costs compared to national data. Results: From July through December 2017, 350 DCBs were used in 209 patients (1.675 DCBs per patient), while from January through June 2018, 256 DCBs were used in 180 patients (1.422 DCBs per patient) - a 15.07% reduction in DCBs per patient. The detailed numbers of DCB-treated patients were presented as fractions of total interventions in the groups with and without PTC. Conclusion: The findings of this study show a statistically significant reduction in DCB usage following PTC withdrawal. There are several ethical implications to these findings, primarily highlighting patient beneficence and justice. Moving forward, it will be important to determine if this shift in treatment is owed to other treatment strategies such as BA, BA and atherectomy, BA and bare-metal stents (BMS), or BA and drug-eluting-stents (DES). The next steps should also include determining procedure costs and comparing readmission rates.
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13
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Iwai S, Watanabe M, Okamura A, Kyodo A, Nogi K, Kamon D, Hashimoto Y, Ueda T, Soeda T, Okura H, Saito Y. Prognostic Impact of Calcified Plaque Morphology After Drug Eluting Stent Implantation - An Optical Coherence Tomography Study. Circ J 2021; 85:2019-2028. [PMID: 34039823 DOI: 10.1253/circj.cj-20-1233] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) has the potential to characterize the detailed morphology of calcified coronary plaques. This study examined the prognostic impact of calcified plaque morphology in patients with coronary artery calcification (CAC) who underwent newer-generation drug-eluting stent (DES) implantation.Methods and Results:In all, 251 patients with moderate to severe CAC who underwent OCT-guided DES implantation were reviewed retrospectively and divided into 3 groups according to OCT findings of the target lesion: 25 patients (10.0%) with calcified nodules (CN), 69 patients (27.5%) with calcified protrusion (CP) without CN, and 157 patients (62.5%) with superficial calcific sheet (SC) without CN and CP. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). Kaplan-Meier survival analysis revealed that, among the 3 groups, the rates of MACE-free survival (log-rank test, P=0.0117), myocardial infarction (log-rank test, P=0.0103), and TLR (log-rank test, P=0.0455) were significantly worse in patients with CN. Multivariate Cox proportional hazards analysis demonstrated that CN was an independent predictor of MACE (hazard ratio 4.41; 95% confidence interval 1.63-10.8; P=0.0047). CONCLUSIONS Target lesion CN was associated with higher cardiac event rates in patients who underwent newer-generation DES implantation for lesions with moderate to severe CAC.
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Affiliation(s)
- Saki Iwai
- Department of Cardiovascular Medicine, Nara Medical University
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
| | - Akihiko Okamura
- Department of Cardiovascular Medicine, Nara Medical University
| | - Atsushi Kyodo
- Department of Cardiovascular Medicine, Nara Medical University
| | - Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
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14
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Miyazaki R, Lee T, Nagamine S, Nagata Y, Nozato T, Ashikaga T. Optical coherence tomography findings on intima healing reaction using drug-coated balloon after orbital atherectomy for a heavily calcified coronary artery lesion. Cardiovasc Interv Ther 2021; 37:566-568. [PMID: 34535886 DOI: 10.1007/s12928-021-00810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Japan.
| | - Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Japan
| | - Sho Nagamine
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Japan
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15
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Shockwave intravascular lithotripsy and drug-coated balloon angioplasty in calcified coronary arteries: preliminary experience in two cases. J Geriatr Cardiol 2021; 18:689-691. [PMID: 34527034 PMCID: PMC8390929 DOI: 10.11909/j.issn.1671-5411.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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Ito R, Ishii H, Oshima S, Nakayama T, Sakakibara T, Kakuno M, Murohara T. Outcomes after drug-coated balloon interventions for de novo coronary lesions in the patients on chronic hemodialysis. Heart Vessels 2021; 36:1646-1652. [PMID: 33895872 DOI: 10.1007/s00380-021-01858-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
The impact of drug-coated balloon (DCB) on hemodialysis (HD) patients with coronary lesions remains unclear. This study aimed to compare outcomes after DCB treatment between HD and non-HD patients with de novo coronary lesions. A total of 235 consecutive patients who electively underwent DCB treatment for de novo coronary lesions were included (HD group: n = 100; non-HD group: n = 135). Angiographic follow-up was performed 6 months after the procedure. Patients were clinically followed up for 2 years. The incidence rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE) were investigated. Diabetes and a history of coronary bypass grafting were more frequent in the HD group than in the non-HD group (69.0% vs. 50.7%, p = 0.007, and 24.0% vs 9.1%, p = 0.013, respectively). The reference diameter and pre-procedural diameter stenosis were greater in the HD group than in the non-HD group (2.49 mm vs. 2.24 mm, p = 0.007, and 65.9% vs. 59.6%, p = 0.015, respectively). Calcification was observed in 65.5% of all lesions, and rotational atherectomy was performed in 30.2% patients. The average diameter of the DCB was 2.51 mm (2.57 mm, HD group vs. 2.47 mm, non-HD group, p = 0.14). Although post-procedural diameter stenosis was similar between the groups, late lumen loss on follow-up angiography was larger in HD patients than in non-HD patients (0.27 mm vs. - 0.03 mm, p = 0.0009). The 2-year rates of freedom from TLR and MACE were lower in HD patients than in non-HD patients [79.3% vs. 91.7%, hazard ratio (HR) 2.76, 95% confidence interval (CI) 1.23-6.77, p = 0.014; and 61.6% vs. 89.4%, HR 4.60, 95% CI 2.30-10.2, p < 0.001, respectively]. In conclusion, the rates of TLR and MACE after DCB treatment were higher in HD patients than in non-HD patients.
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Affiliation(s)
- Ryuta Ito
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan.
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoru Oshima
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Takuya Nakayama
- Department of Cardiovascular Surgery, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Takashi Sakakibara
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Motohiko Kakuno
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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17
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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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18
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Efficacy of Low-Pressure Inflation of Oversized Drug-Coated Balloon for Coronary Artery Disease. J Interv Cardiol 2020; 2020:6615988. [PMID: 33447166 PMCID: PMC7781681 DOI: 10.1155/2020/6615988] [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: 11/12/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives This study sought to assess the efficacy of oversized drug-coated balloon (DCB) inflation at low pressure for the prevention of acute dissections and late restenosis. Background The major limitation of DCB coronary angioplasty is the occurrence of severe dissection after inflation of DCB. Methods Between 2014 and 2018, 273 consecutive patients were retrospectively studied. 191 lesions (154 patients) treated by oversized DCB inflation at low pressure (<4 atm, 2.4 ± 1.2 atm, DCB/artery ratio 1.14 ± 0.22; LP group) were compared with 135 lesions (119 patients) treated by the standard DCB technique (7.1 ± 2.2 atm, DCB/artery ratio 1.03 ± 0.16; SP group). Results Although the lesions in the LP group were more complex than those in the SP group (smaller reference diameter (2.38 mm vs. 2.57 mm, P=0.011), longer lesions (11.7 mm vs. 10.5 mm, P=0.10), and more frequent use of rotational atherectomy (45.0% vs. 28.1%, P=0.003), there was no significant difference in the NHLBI type of dissections between the two groups (11.5%, 12.0%, 5.2% vs. 12.6%, 12.6%, 2.2% in type A, B, and C, P=0.61), and no bailout stenting was required. In 125 well-matched lesion pairs after propensity score analysis, the cumulative incidence of target lesion revascularization at 3 years was 4.5% vs. 7.0%, respectively (P=0.60). Late lumen loss (−0.00 mm vs. −0.01 mm, P=0.94) and restenosis rates (7.4% vs. 7.1%, P=1.0) were similar in both of the groups. Conclusion The application of oversized DCB at low pressure is effective and feasible for preventing late restenosis comparative to the standard technique of DCB.
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19
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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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20
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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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21
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Onishi T, Onishi Y, Kobayashi I, Sato Y. Late lumen enlargement after drug-coated balloon angioplasty for de novo coronary artery disease. Cardiovasc Interv Ther 2020; 36:311-318. [PMID: 32647991 DOI: 10.1007/s12928-020-00690-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022]
Abstract
We aimed to identify predictors of late lumen enlargement (LLE) after drug-coated balloon (DCB) angioplasty for de novo coronary lesions. LLE, which is defined as an increase in the luminal diameter of the vessel from the immediate postprocedural measurement to follow-up measurements, is frequently observed after DCB angioplasty for de novo coronary artery disease. No predictors of LLE are known. This retrospective observational study analyzed 196 de novo coronary lesions in 182 patients who underwent both DCB angioplasty and follow-up angiography. Of the 196 lesions, 109 (56%) developed LLE during a mean follow-up period of 7.2 ± 2.5 months. As defined by American College of Cardiology (ACC)/American Heart Association (AHA) lesion types, lesions with LLE were significantly less severe than lesions without LLE (types A, B1, B2 and C 15%, 35%, 38% and 13% vs. 7%, 24%, 45% and 24%, respectively; p = 0.036), although no significant differences in clinical or other lesion background characteristics were observed between the groups. Among type C lesions, chronic total occlusion (CTO) was more frequently observed in lesions with LLE than in lesions without LLE (79% vs 43%, p = 0.036). Lesion severity predicts LLE after DCB angioplasty for de novo coronary artery disease. Among type C lesions, CTO is expected in lesions showing LLE, and preparations should therefore be made prior to DCB application. Further research is needed.
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Affiliation(s)
- Takayuki Onishi
- Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, Japan.
| | - Yuko Onishi
- Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, Japan
| | - Isshi Kobayashi
- Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, Japan
| | - Yasuhiro Sato
- Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, Japan
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