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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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Hu B, Xiao C, Wang Z, Jia D, Yang S, Jia S, Zhai G, Han H, Xu X, Shi D, Zhou Y. Relationship between Metabolic Syndrome and Clinical Outcome in Patients Treated with Drug-Eluting Stenting after Rotational Atherectomy for Complex Calcified Coronary Lesions. J Clin Med 2022; 11:jcm11144192. [PMID: 35887955 PMCID: PMC9322199 DOI: 10.3390/jcm11144192] [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: 06/13/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background and aims: although an association between metabolic syndrome (MS) and cardiovascular disease risk has been documented, the relationship in patients with complex calcified coronary lesions undergoing rotational atherectomy (RA) and drug-eluting stent(DES) insertion remains controversial. Here, the influence of MS on outcomes was assessed. Methods and results: we retrospectively included 398 patients who underwent RA and DES insertion for complex calcified coronary lesions in our institution between June 2015 and January 2019. The modified Adult Treatment Plan III was used to diagnose MS. The endpoint was major adverse cardiovascular events (MACEs), comprising mortality from all causes, myocardial infarction, and target vessel revascularization (TVR). In all, 173 (43.5%) patients had MS. MS was significantly associated with MACE over the 28.32 ± 6.79-month follow-up period (HR 1.783, 95% CI from 1.122 to 2.833) even after adjustment for other possible confounders. Conclusion: MS was frequently observed in patients treated with RA with DES insertion for complex calcified coronary lesions. MS independently predicted MACE in these patients.
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Affiliation(s)
- Bin Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Changbo Xiao
- Department of Cardiovascular Surgery, Henan Chest Hospital, Zhengzhou 450001, China;
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Dean Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Shiwei Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Shuo Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Guangyao Zhai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Xiaohan Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
- Correspondence: ; Tel.: +86-10-64456489; Fax: +86-10-64456461
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Comparison of Invasive Coronary Angiography Versus Computed Tomography Angiography to Assess Mehran Classification of In-Stent Restenosis in Bifurcation Percutaneous Coronary Intervention. Am J Cardiol 2022; 172:11-17. [PMID: 35351284 DOI: 10.1016/j.amjcard.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/21/2022]
Abstract
The Mehran classification is used to determine the presence of in-stent restenosis (ISR) and characterization of its subtypes in invasive coronary angiography (ICA). The utility of computed tomography angiography (CTA) for the assessment of Mehran classification is unknown. We aimed to compare the agreement and reproducibility of Mehran classification between ICA and CTA and evaluate the sensitivity and specificity of both imaging methods. Consecutive patients who had ISR on ICA preceded with CTA before intervention were enrolled in our study. Modified Mehran's classification was employed by CTA and ICA to classify ISR into 4 subtypes: focal (type I [A, B, C]), intra-stent (type II [A, B, C]), proliferative (type III [A, B, C]), and total occlusion (type IV). Agreement between ISR classification and main vessel lesion length, reference vessel diameter, and bifurcation angles were compared. A total of 405 patients with 431 bifurcation percutaneous coronary interventions with ISR were included in this investigation. The total agreement between CTA and ICA for assessment of Mehran class was poor (kappa = 0.168). Proliferative ISR (25% vs 10%, p = 0.012) and total occlusions (24% vs 5%, p <0.001) were reclassified more often between ICA and CTA, respectively. CTA assessment of lesion length was significantly longer than that of ICA measurements in all subtypes of ISR (32.15 ± 5.23 vs 27.41 ± 3.63, p = 0.004). Receiver operating characteristic curve expressed CTA to be more sensitive and specific than ICA in diagnosing ISR. In conclusion, Mehran classification was significantly affected by imaging modality, and CTA results were more reproducible than ICA. Therefore, CTA evaluation of ISR may facilitate treatment options and generate a sound plan before the procedure.
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