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Vizzari G, Caminiti R, Ielasi A, Vetta G, Parlavecchio A, Mazzone P, Sacchetta G, Magnocavallo M, Della Rocca DG, Siviglia M, Versace AG, Contarini M, Micari A. Contrast-enhanced excimer laser stepwise approach during PCI for resistant coronary lesions. Catheter Cardiovasc Interv 2024; 104:220-226. [PMID: 38959377 DOI: 10.1002/ccd.31141] [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: 09/10/2023] [Revised: 01/06/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The treatment of resistant coronary lesions (RCL) is a great challenge for interventional cardiologists. The excimer laser coronary atherectomy (ELCA) is a plaque modification tool based on a main mechanism of photomechanical effect leading to mechanical disruption of the plaque. Contrast dye injection during laser delivery has demonstrated to enhance its power. AIM To evaluate the effectiveness and safety of the contrast-enhanced ELCA by a stepwise approach in the treatment of RCLs. METHODS We retrospectively examined consecutive patients undergoing contrast-enhanced ELCA-assisted PCI between 2018 and 2021 at two Italian sites. RCLs were defined as novo or in-stent undilatable/uncrossable with conventional balloons (SC/NC balloon). The primary endpoint was ELCA technical success defined as the laser catheter crossing the entire length of the target lesion established by angiographic evidence of the catheter tip in the artery distal to the stenosis. RESULTS We enrolled 114 patients who underwent contrast-enhanced ELCA-assisted PCI: 58% of the patients had acute coronary syndrome while the left anterior descending artery was the target vessel in 42.1% of cases. The target lesion was most commonly in-stent (56.2%). The 0.9 mm ELCA catheter tip was employed in 89.5% of cases. The most used frequency/fluency profile was 70/70 (39.5%). The use of contrast-enhanced ELCA was associated with high technical, procedural, and clinical success rates (97.4%, 93.7%, and 90.1%, respectively). CONCLUSIONS The contrast-enhanced ELCA seems to be a safe and effective treatment option for the management of both de novo and in-stent-resistant coronary lesions.
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Affiliation(s)
- Giampiero Vizzari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Alfonso Ielasi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Parlavecchio
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Paolo Mazzone
- Cardiology Unit, Ospedale"Umberto I", Siracusa, Italy
| | | | - Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Massimo Siviglia
- Interventional Cardiology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Antonio Giovanni Versace
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | | | - Antonio Micari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
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Power DA, Hemetsberger R, Farhan S, Abdel-Wahab M, Yasumura K, Kini A, Sharma SK. Calcified coronary lesions: Imaging, prognosis, preparation and treatment state of the art review. Prog Cardiovasc Dis 2024:S0033-0620(24)00095-1. [PMID: 38925256 DOI: 10.1016/j.pcad.2024.06.007] [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: 06/23/2024] [Accepted: 06/23/2024] [Indexed: 06/28/2024]
Abstract
Calcific coronary artery stenosis is a complex disease associated with adverse outcomes and suboptimal percutaneous treatment. Calcium plaque modification has emerged as a key strategy to tackle the issues that accompany calcific stenosis - namely reduced device deliverability, unpredictable lesion characteristics, and difficult dilatation. Atherectomy has traditionally been the treatment modality of choice for heavily calcified coronary stenoses. Contemporary technologies have emerged to aid with planning, preparation, and treatment of calcified coronary stenosis in an attempt to improve procedural success and long-term outcomes. In this State Of The Art Review, we synthesize the body of data surrounding the diagnosis, imaging, and treatment of calcific coronary disease, with a focus on i) intravascular imaging, ii) calcific lesion preparation, iii) treatment modalities including atherectomy, and iv) updated treatment algorithms for the management of calcified coronary stenosis.
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Affiliation(s)
- David A Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Rayyan Hemetsberger
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, Austria
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Keisuke Yasumura
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America.
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Wang Q, Ma W, Zhang D, Zhang W, An J, Dou K, Li P, Jiang J, He Y, Tong Q, Zhang X, Pang W, Qiu C, Yang Q, Hu X, Zhong L, Cheng X, Peng X, Kan J, Zhang J, Zhang B, Li Y. Effectiveness and Safety of a Novel Intravascular Lithotripsy System for Severe Coronary Calcification: The CALCI-CRACK Trial. Can J Cardiol 2024:S0828-282X(24)00333-7. [PMID: 38670457 DOI: 10.1016/j.cjca.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Intravascular lithotripsy is effective and safe for managing coronary calcification; however, available devices are limited, and complex lesions have been excluded in previous studies. This study aimed to investigate the effectiveness and safety of a novel intravascular lithotripsy system for severe calcification in a population with complex lesions. METHODS CALCI-CRACK (treatment of severe calcified coronary lesions with a novel intracoronary shock wave lithotripsy system) (ChiCTR2100052058) was a prospective, single-arm, multicentre study. The primary end point was the procedural success rate. Major safety end points included major adverse cardiovascular events (MACE) and target lesion failure (TLF) at 30 days and 6 months, and severe angiographic complications. Calcification morphology was assessed in the optical coherence tomography (OCT) subgroup. RESULTS In total, 242 patients from 15 high-volume Chinese centres were enrolled, including 26.45% of patients with true bifurcation lesions, 3.31% with severely tortuous vessels, and 2.48% with chronic total occlusion, respectively. The procedural success rate was 95.04% (95% confidence interval 91.50%-97.41%), exceeding the prespecified performance goal of 83.4% (P < 0.001). The 30-day and 6-month MACE rates were 4.13% and 4.55%, respectively. TLF rates at those time points were 1.24% and 1.65%, respectively. Severe angiographic complications occurred in 0.42% of patients. In the OCT subgroup (n = 93), 93.55% of calcified lesions were fractured, and minimal lumen area increased from 1.55 ± 0.55 mm2 to 4.91 ± 1.22 mm2 after stent implantation, with acute gain rate of 245 ± 102%. CONCLUSIONS The novel intravascular lithotripsy system is effective and safe for managing severely calcified coronary lesions in a cohort that included true bifurcation lesions, severely tortuous vessels, and chronic total occlusion. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR), number ChiCTR2100052058.
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Affiliation(s)
- Qiuhe Wang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Wenshuai Ma
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Dongwei Zhang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Wei Zhang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jian An
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, China
| | - Kefei Dou
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Li
- Department of Cardiology, First People's Hospital of Yulin, Yulin, China
| | - Jun Jiang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Tong
- Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China
| | - Xiaoyong Zhang
- Department of Cardiology, Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan City People's Hospital, Qingyuan, China
| | - Wenyue Pang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunguang Qiu
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xinqun Hu
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Lin Zhong
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Xiang Cheng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Peng
- Department of Cardiology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Kan
- Department of Cardiology, Nanjing First Hospital of Nanjing Medical University, Nanjing, China
| | - Junjie Zhang
- Department of Cardiology, Nanjing First Hospital of Nanjing Medical University, Nanjing, China
| | - Bin Zhang
- Department of Cardiology, Guangdong People's Hospital, Guangzhou, China
| | - Yan Li
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China.
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Faisal S, Barbour M, Seibel EJ, Aliseda A. Hemodynamics of Saline Flushing in Endoscopic Imaging of Partially Occluded Coronary Arteries. Cardiovasc Eng Technol 2024; 15:211-223. [PMID: 38191806 DOI: 10.1007/s13239-023-00708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Intravascular endoscopy can aid in the diagnosis of coronary atherosclerosis by providing direct color images of coronary plaques. The procedure requires a blood-free optical path between the catheter and plaque, and achieving clearance safely remains an engineering challenge. In this study, we investigate the hemodynamics of saline flushing in partially occluded coronary arteries to advance the development of intravascular forward-imaging catheters that do not require balloon occlusion. METHODS In-vitro experiments and CFD simulations are used to quantify the influence of plaque size, catheter stand-off distance, saline injection flowrate, and injection orientation on the time required to achieve blood clearance. RESULTS Experiments and simulation of saline injection from a dual-lumen catheter demonstrated that flushing times increase both as injection flow rate (Reynolds number) decreases and as the catheter moves distally away from the plaque. CFD simulations demonstrated that successful flushing was achieved regardless of lumen axial orientation in a 95% occluded artery. Flushing time was also found to increase as plaque size decreases for a set injection flowrate, and a lower limit for injection flowrate was found to exist for each plaques size, below which clearance was not achieved. For the three occlusion sizes investigated (90, 95, 97% by area), successful occlusion was achieved in less than 1.2 s. Investigation of the pressure fields developed during injection, highlight that rapid clearance can be achieved while keeping the arterial overpressure to < 1 mmHg. CONCLUSIONS A dual lumen saline injection catheter was shown to produce clearance safely and effectively in models of partially occluded coronary arteries. Clearance was achieved across a range of engineering and clinical parameters without the use of a balloon occlusion, providing development guideposts for a fluid injection system in forward-imaging coronary endoscopes.
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Affiliation(s)
- Syed Faisal
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
| | - Michael Barbour
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA.
| | - Eric J Seibel
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
| | - Alberto Aliseda
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
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Riley RF, Patel MP, Abbott JD, Bangalore S, Brilakis ES, Croce KJ, Doshi D, Kaul P, Kearney KE, Kerrigan JL, McEntegart M, Maehara A, Rymer JA, Sutton NR, Shah B. SCAI Expert Consensus Statement on the Management of Calcified Coronary Lesions. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101259. [PMID: 39132214 PMCID: PMC11307856 DOI: 10.1016/j.jscai.2023.101259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
The prevalence of calcification in obstructive coronary artery disease is on the rise. Percutaneous coronary intervention of these calcified lesions is associated with increased short-term and long-term risks. To optimize percutaneous coronary intervention results, there is an expanding array of treatment modalities geared toward calcium modification prior to stent implantation. The Society for Cardiovascular Angiography and Interventions, herein, puts forth an expert consensus document regarding methods to identify types of calcified coronary lesions, a central algorithm to help guide use of the various calcium modification strategies, tips for when using each treatment modality, and a look at future studies and trials for treating this challenging lesion subset.
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Affiliation(s)
| | | | - J. Dawn Abbott
- Lifespan Cardiovascular Institute, Providence, Rhode Island
| | | | | | | | - Darshan Doshi
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Margaret McEntegart
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Akiko Maehara
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Cardiovascular Research Foundation, New York, New York
| | | | - Nadia R. Sutton
- Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University, Nashville, Tennessee
| | - Binita Shah
- NYU Grossman School of Medicine, New York, New York
- VA New York Harbor Healthcare System, New York, New York
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Sheikh AS, Connolly DL, Abdul F, Varma C, Sharma V. Intravascular lithotripsy for severe coronary calcification: a systematic review. Minerva Cardiol Angiol 2023; 71:643-652. [PMID: 34713678 DOI: 10.23736/s2724-5683.21.05776-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Coronary artery calcification remains a challenge in percutaneous coronary interventions, due to the higher risk of suboptimal result with subsequent poor clinical outcomes. Intravascular lithotripsy is a novel way of treating severe coronary calcification as it has the ability to modify calcium both circumferentially as well as transmurally, facilitating stent expansion and apposition. We conducted a systematic overview of the published literature on intravascular lithotripsy (IVL) assessing the efficacy and feasibility of IVL in treating severe coronary calcification. EVIDENCE ACQUISITION Of the retrieved publications, 62 met our inclusion criteria and were included. A total of 1389 patients (1414 lesions) with significant coronary calcification or under-expanded stents underwent IVL. EVIDENCE SYNTHESIS The mean age was 72.03 years (74.7% male). There was a significant improvement in acute and sustained vessel patency, with mean minimal lumen diameter of 2.78±0.46 mm, resulting in acute gain of 1.72±0.51 mm. The acute procedural success rate was 78.2 to 100% with in-hospital complication rate of 5.6 to 7.0%. The majority of the studies reported 30-day MACE, which was between 2.2 to 7.8%. CONCLUSIONS The recent studies have highlighted that the use of IVL with adjuvant intracoronary imaging has revolutionized the way of treating heavily calcified, non-dilatable coronary lesions and is likely to succeed the conventional ways of treating these complex lesions. We need further studies to gauge the long-term efficacy and safety of IVL against techniques currently available for calcium modification including conventional balloons, cutting or scoring balloons, rotational atherectomy and laser atherectomy.
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Affiliation(s)
- Azeem S Sheikh
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK -
| | - Derek L Connolly
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Fairoz Abdul
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Chetan Varma
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Vinoda Sharma
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Barbato E, Gallinoro E, Abdel-Wahab M, Andreini D, Carrié D, Di Mario C, Dudek D, Escaned J, Fajadet J, Guagliumi G, Hill J, McEntegart M, Mashayekhi K, Mezilis N, Onuma Y, Reczuch K, Shlofmitz R, Stefanini G, Tarantini G, Toth GG, Vaquerizo B, Wijns W, Ribichini FL. Management strategies for heavily calcified coronary stenoses: an EAPCI clinical consensus statement in collaboration with the EURO4C-PCR group. Eur Heart J 2023; 44:4340-4356. [PMID: 37208199 DOI: 10.1093/eurheartj/ehad342] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely calcified coronary artery disease has grown substantially. This has been prompted on one side by the clinical demand for the continuous increase in life expectancy, the sustained expansion of the primary PCI networks worldwide, and the routine performance of revascularization procedures in elderly patients; on the other side, the availability of new and dedicated technologies such as orbital atherectomy and intravascular lithotripsy, as well as the optimization of the rotational atherectomy system, has increased operators' confidence in attempting more challenging PCI. This current EAPCI clinical consensus statement prepared in collaboration with the EURO4C-PCR group describes the comprehensive management of patients with heavily calcified coronary stenoses, starting with how to use non-invasive and invasive imaging to assess calcium burden and inform procedural planning. Objective and practical guidance is provided on the selection of the optimal interventional tool and technique based on the specific calcium morphology and anatomic location. Finally, the specific clinical implications of treating these patients are considered, including the prevention and management of complications and the importance of adequate training and education.
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Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa n. 1035, Rome, 00189, Italy
| | - Emanuele Gallinoro
- Division of University Cardiology, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Division of University Cardiology, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Didier Carrié
- Service de Cardiologie B, CHU Rangueil, Université Paul Sabatier, Toulouse, France
| | - Carlo Di Mario
- Interventional Structural Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | | | | | - Jonathan Hill
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, MediClin Heart Institute Lahr/Baden, Lahr & Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Yoshinobu Onuma
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, Toyoake, Japan
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Krzyszstof Reczuch
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Giulio Stefanini
- Humanitas Clinical and Research Hospital IRCCS & Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gabor G Toth
- University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Beatriz Vaquerizo
- Unidad de Cardiología Intervencionista, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory, Corrib Core Laboratory and Curam, National University of Ireland, Galway, Ireland
| | - Flavio L Ribichini
- Cardiovascular Section of the Department of Medicine, University of Verona, Verona, Italy
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Petousis S, Skalidis E, Zacharis E, Kochiadakis G, Hamilos M. The Role of Intracoronary Imaging for the Management of Calcified Lesions. J Clin Med 2023; 12:4622. [PMID: 37510737 PMCID: PMC10380390 DOI: 10.3390/jcm12144622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
Interventional cardiologists in everyday practice are often confronted with calcified coronary lesions indicated for percutaneous transluminal coronary angioplasty (PTCA). PTCA of calcified lesions is associated with diverse technical challenges resulting in suboptimal coronary stenting and adverse long-term clinical outcomes. Angiography itself offers limited information regarding coronary calcification, and the adjuvant use of intracoronary imaging such as intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT) can guide the treatment of calcified coronary lesions, optimizing the different stages of the procedure. This review offers a description of why, when, and how to use intracoronary imaging for PTCA of calcified coronary lesions in order to obtain the most favorable results. We used the PubMed and Google Scholar databases to search for relevant articles. Keywords were calcified coronary lesions, intracoronary imaging, IVUS, OCT, coronary calcium modification techniques, PTCA, and artificial intelligence in intracoronary imaging. A total of 192 articles were identified. Ninety-one were excluded because of repetitive or non-important information.
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Affiliation(s)
- Stylianos Petousis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - Emmanouil Skalidis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - Evangelos Zacharis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - George Kochiadakis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - Michalis Hamilos
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
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9
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Pinilla-Echeverri N, Bossard M, Hillani A, Chavarria JA, Cioffi GM, Dutra G, Guerrero F, Madanchi M, Attinger A, Kossmann E, Sibbald M, Cuculi F, Sheth T. Treatment of Calcified Lesions Using a Dedicated Super-High Pressure Balloon: Multicenter Optical Coherence Tomography Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:49-58. [PMID: 36907698 DOI: 10.1016/j.carrev.2023.02.020] [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: 01/16/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Calcified lesions often lead to difficulty achieving optimal stent expansion. OPN non-compliant (NC) is a twin layer balloon with high rated burst pressure that may modify calcium effectively. METHODS Retrospective, multicenter registry in patients undergoing optical coherence tomography (OCT) guided intervention with OPN NC. Superficial calcification with > 180o arc and > 0.5 mm thickness, and/or nodular calcification with > 90o arc were included. OCT was performed in all cases before and after OPN NC, and after intervention. Primary efficacy endpoints were frequency of expansion (EXP) ≥80 % of the mean reference lumen area and mean final EXP by OCT, and secondary endpoints were calcium fractures (CF), and EXP ≥90 %. RESULTS 50 cases were included; 25 (50 %) superficial, and 25 (50 %) nodular. Calcium score of 4 in 42 (84 %) cases and 3 in 8 (16 %). OPN NC was used alone, or after other devices if further modification was needed, NC in 27 (54 %), cutting in 29 (58 %), scoring in 1 (2 %), IVL in 2 (4 %); or if non-crossable lesion, rotablation in 5 (10 %) cases. EXP ≥80 % was achieved in 40 (80 %) cases with mean final EXP post intervention of 85.7 % ± 8.9. CF were documented in 49 (98 %) cases; multiple in 37 (74 %). There were 1 flow limiting dissection requiring stent deployment and 3 non-cardiovascular related deaths in 6 months follow-up. No records of perforation, no-reflow or other major adverse events. CONCLUSION Among patients with heavy calcified lesions undergoing OCT guided intervention with OPN NC, acceptable expansion was achieved in most cases without procedure related complications.
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Affiliation(s)
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzern, Switzerland; Luzerner Kantonsspital, Luzern, Switzerland
| | - Ali Hillani
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jorge A Chavarria
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
| | - Giacomo M Cioffi
- Cardiology Division, Heart Center, Luzern, Switzerland; Luzerner Kantonsspital, Luzern, Switzerland
| | - Gustavo Dutra
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
| | - Fernando Guerrero
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
| | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzern, Switzerland; Luzerner Kantonsspital, Luzern, Switzerland
| | - Adrian Attinger
- Cardiology Division, Heart Center, Luzern, Switzerland; Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Matthew Sibbald
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzern, Switzerland; Luzerner Kantonsspital, Luzern, Switzerland
| | - Tej Sheth
- McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
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10
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Nakano T, Ikenaga H, Takeda A, Morita Y, Higashihara T, Watanabe N, Sada Y, Nakano Y. Relationship Between Attenuated Plaque Identified by Intravascular Ultrasound and Thrombus Formation After Excimer Laser Coronary Angioplasty. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 49:15-21. [PMID: 36599747 DOI: 10.1016/j.carrev.2022.12.010] [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: 11/22/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Excimer laser coronary angioplasty (ELCA) has been reported to be a safe and effective atherectomy device in percutaneous coronary intervention (PCI). However, thrombotic complications after ELCA have been occasionally observed. In this study, we evaluated the impact of attenuated plaque on thrombus formation and transient no-reflow after ELCA. METHODS This study enrolled 58 lesions in 56 patients who underwent PCI with ELCA. It was a retrospective observational study at a single center. All lesions were imaged by intravascular ultrasound (IVUS) before and immediately after ELCA. On the plaque with ultrasound attenuation, attenuation angle per millimeter and attenuation length were measured. ELCA-induced thrombus was detected by IVUS, and transient no-reflow after ELCA was recorded. RESULTS Thrombus was detected in 14 lesions (30 %), and transient no-reflow occurred in 3 lesions (5 %). Lesions with thrombus had a higher mean attenuation angle (median [interquartile range] 142° [112°-152°] vs. 64° [0°-115°]; p = 0.001), maximum attenuation angle (209° [174°-262°] vs. 86° [0°-173°]; p < 0.001), and longer attenuation length (12 mm [8 mm-17 mm] vs. 2 mm [0 mm-5 mm]; p < 0.001). Lesions with thrombus leading to transient no-reflow had a longer lipid length and a significantly higher troponin I level after PCI. CONCLUSIONS IVUS-identified attenuated plaque was strongly correlated with ELCA-induced thrombus. Furthermore, attenuation length may predict transient no-reflow.
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Affiliation(s)
- Takayuki Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Atsushi Takeda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuichi Morita
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tasuku Higashihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshiharu Sada
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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11
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Karacsonyi J, Kostantinis S, Simsek B, Rempakos A, Allana SS, Alaswad K, Krestyaninov O, Khatri J, Poommipanit P, Jaffer FA, Choi J, Patel M, Gorgulu S, Koutouzis M, Tsiafoutis I, Sheikh AM, ElGuindy A, Elbarouni B, Patel T, Jefferson B, Wollmuth JR, Yeh R, Karmpaliotis D, Kirtane AJ, McEntegart MB, Masoumi A, Davies R, Rangan BV, Mastrodemos OC, Doshi D, Sandoval Y, Basir MB, Megaly MS, Ungi I, Abi Rafeh N, Goktekin O, Brilakis ES. Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention. J Pers Med 2023; 13:515. [PMID: 36983697 PMCID: PMC10051461 DOI: 10.3390/jpm13030515] [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: 02/06/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.
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Affiliation(s)
- Judit Karacsonyi
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Athanasios Rempakos
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Salman S. Allana
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Oleg Krestyaninov
- Meshalkin Novosibirsk Research Institute, Novosibirsk 630055, Russia
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Paul Poommipanit
- Cardiology, Case Western Reserve University, University Hospitals, Cleveland, OH 44610, USA
| | - Farouc A. Jaffer
- Department of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James Choi
- Department of Cardiology, Baylor Heart and Vascular Hospital, Dallas, TX 75226, USA
| | - Mitul Patel
- Cardiovascular Institute, University of California San Diego, VA San Diego Healthcare System, La Jolla, CA 92037, USA
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University School of Medicine, Istanbul 34295, Turkey
| | - Michalis Koutouzis
- First Cardiology Department Athens, Red Cross Hospital of Athens, Athens 11526, Greece
| | - Ioannis Tsiafoutis
- First Cardiology Department Athens, Red Cross Hospital of Athens, Athens 11526, Greece
| | - Abdul M. Sheikh
- Interventional Cardiology Department, Wellstar Health System, Marietta, GA 30141, USA
| | - Ahmed ElGuindy
- Aswan Heart Centre, Department of Cardiology, Magdi Yacoub Foundation, Aswan 4271185, Egypt
| | - Basem Elbarouni
- Department of Internal Medicine, St. Boniface General Hospital, Winnipeg, MB R2H 2A6, Canada
| | - Taral Patel
- Interventional Cardiology, Tristar Centennial Medical Center, Nashville, TN 37203, USA
| | - Brian Jefferson
- Interventional Cardiology, Tristar Centennial Medical Center, Nashville, TN 37203, USA
| | - Jason R. Wollmuth
- Interventional Cardiology, Providence Heart institute, Portland, OR 97213, USA
| | - Robert Yeh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Dimitrios Karmpaliotis
- Interventional Cardiology, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ 07960, USA
| | - Ajay J. Kirtane
- Division of Cardiology, Columbia University, New York, NY 10032, USA
| | | | - Amirali Masoumi
- Interventional Cardiology, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ 07960, USA
| | - Rhian Davies
- Interventional Cardiology, WellSpan York Hospital, York, PA 17403, USA
| | - Bavana V. Rangan
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Olga C. Mastrodemos
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Darshan Doshi
- Department of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Yader Sandoval
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Mir B. Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Michael S. Megaly
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Imre Ungi
- Division of Invasive Cardiology, Department of Internal Medicine and Cardiology Center, University of Szeged, 6725 Szeged, Hungary
| | - Nidal Abi Rafeh
- Cardiology, North Oaks Health System, Hammond, LA 70403, USA
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul 34676, Turkey
| | - Emmanouil S. Brilakis
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
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12
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Contemporary Management of Severely Calcified Coronary Lesions. J Pers Med 2022; 12:jpm12101638. [PMID: 36294777 PMCID: PMC9605395 DOI: 10.3390/jpm12101638] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Coronary artery calcification is increasingly prevalent in our patient population. It significantly limits the procedural success of percutaneous coronary intervention and is associated with a higher risk of adverse cardiovascular events both in the short-term and long-term. There are several modalities for modifying calcified plaque, such as balloon angioplasty (including specialty balloons), coronary atheroablative therapy (rotational, orbital, and laser atherectomy), and intravascular lithotripsy. We discuss each modality’s relative advantages and disadvantages and the data supporting their use. This review also highlights the importance of intravascular imaging to characterize coronary calcification and presents an algorithm to tailor the calcium modification therapy based on specific coronary lesion characteristics.
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13
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Shlofmitz RA, Galougahi KK, Jeremias A, Shlofmitz E, Thomas SV, Ali ZA. Calcium Modification in Percutaneous Coronary Interventions. Interv Cardiol Clin 2022; 11:373-381. [PMID: 36243483 DOI: 10.1016/j.iccl.2022.06.001] [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] [Indexed: 06/16/2023]
Abstract
Moderate-severe calcification increases procedural complications and impairs long-term prognosis post-PCI. Intravascular imaging (particularly optical coherence tomography [OCT]) is useful in guiding the treatment of calcified lesions. Weighted sum of calcium length, arc, and thickness on OCT can predict adequate stent expansion, identifying when atherectomy is required. With intravascular imaging guidance, various techniques alone or in combination may be used in an algorithmic fashion to modify calcified lesions. Calcium fracture by balloon angioplasty, cutting/scoring balloons, intravascular lithotripsy (IVL), atherectomy devices, or Excimer laser improves stent expansion. Intravascular imaging is essential in the treatment of in-stent restenosis when luminal and/or abluminal peri-strut calcium is present.
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Affiliation(s)
- Richard A Shlofmitz
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA.
| | - Keyvan Karimi Galougahi
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Allen Jeremias
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Evan Shlofmitz
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Susan V Thomas
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Ziad A Ali
- Staint Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
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14
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Torp Kristensen A, Jakobsen JC, Olsen NT. Percutaneous coronary intervention in calcified stenoses: a protocol for a systematic review with meta-analysis, trial sequential analysis and network meta-analysis. BMJ Open 2022; 12:e063884. [PMID: 36691161 PMCID: PMC10439345 DOI: 10.1136/bmjopen-2022-063884] [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: 04/14/2022] [Accepted: 08/10/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Severely calcified coronary stenoses are difficult to treat with percutaneous coronary interventions. The presence of severe calcifications complicates lesion preparation, advancement of stents and achievement of full stent expansion. Intervention in these lesions is associated with an increased risk of complications and procedural failure compared with treatment of less calcified lesions. Due to the high burden of comorbidity, patients with severely calcified lesions are often excluded from interventional trials, and there is little evidence on how to treat these patients. METHODS AND ANALYSIS We will conduct a systematic review of randomised trials enrolling patients with calcified coronary artery disease undergoing percutaneous coronary intervention. We will investigate any percutaneous treatment option including any lesion preparation, stenting or postdilatation technique. We will search The Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature, Science Citation Index Expanded, and Excerpta Medica database for studies from inception to 31 October 2022. The coprimary outcome is all-cause mortality and serious adverse events. If appropriate, we will conduct meta-analysis, trial sequential analysis and network meta-analysis. ETHICS AND DISSEMINATION No ethics approval is required for this study. The results will be published in a peer-reviewed journal in this field. PROSPERO REGISTRATION NUMBER CRD42021226034.
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Affiliation(s)
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Interventional Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
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15
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Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Karmpaliotis D, Masoumi A, Jaffer FA, Doshi D, Khatri J, Poommipanit P, Gorgulu S, Abi Rafeh N, Goktekin O, Krestyaninov O, Davies R, ElGuindy A, Jefferson BK, Patel TN, Patel M, Chandwaney RH, Mastrodemos OC, Rangan BV, Brilakis ES. Prevalence and outcomes of balloon undilatable chronic total occlusions: Insights from the PROGRESS-CTO. Int J Cardiol 2022; 362:42-46. [PMID: 35483480 DOI: 10.1016/j.ijcard.2022.04.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The prevalence, treatment, and outcomes of balloon undilatable lesions encountered in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study. METHODS We examined the clinical characteristics and procedural outcomes of balloon undilatable lesions in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436). RESULTS Of 6535 CTO PCIs performed between 2012 and 2022, 558 (8.5%) lesions were balloon undilatable. In this subset, patients were older (mean age 67 ± 10 vs. 64 ± 10, p < 0.001) and had higher prevalence of comorbidities: diabetes mellitus (54% vs. 40%, p < 0.001), prior PCI (71% vs. 59%, p < 0.001), prior myocardial infarction (52% vs. 45%, p = 0.003), and prior coronary artery bypass graft surgery (44% vs. 25%, p < 0.001). The CTO lesion length was estimated to be 34 ± 23 mm, mean J-CTO score was 2.9 ± 1.1 and mean PROGRESS-CTO score was 1.4 ± 1.0. A cutting balloon was used in 27%, a scoring balloon in 15%, laser in 14%, rotational atherectomy in 28%, orbital atherectomy in 10%, intravascular lithotripsy in 1% and other modalities/approaches in 5%. Balloon undilatable lesions had lower technical success (90.9% vs. 93.8%, p = 0.007) and higher incidence of major adverse cardiovascular events (MACE) (composite of in-hospital death, acute myocardial infarction, stroke, re-PCI, emergency CABG, and pericardiocentesis) (5.0% versus 1.3%, p < 0.001). CONCLUSION Approximately 1 in 12 CTO (8.5%) lesions are balloon undilatable. Treatment of balloon undilatable lesions is associated with lower technical success and higher in-hospital MACE.
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Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | | | | | - Amirali Masoumi
- Gagnon Cardiovascular Institute Morristown Medical Center, NJ, USA
| | - Farouc A Jaffer
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Darshan Doshi
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Sevket Gorgulu
- Department of Cardiology, Acibadem Kocaeli Hospital, Kocaeli, Turkey
| | | | | | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | | | | | | | | | - Mitul Patel
- UCSD Medical Center, Division of Cardiovascular Medicine, La Jolla, CA, USA
| | | | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
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16
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Delgado-Arana JR, Rumoroso JR, Regueiro A, Martín-Moreiras J, Miñana G, Mohandes M, Pan M, Salinas P, Caballero-Borrego J, Fernández-Díaz JA, Jurado-Román A, Lacunza J, Vaquerizo B, Rivero F, Abellán-Huerta J, Rondán J, Gómez Menchero A, Santos-Martínez S, Subinas A, Arévalos V, Diego Nieto A, Sanchis J, Rojas S, Ojeda S, Gonzalo N, López-Pérez M, Goicolea J, Sádaba M, Gómez-Salvador I, Sabaté M, Núñez García JC, Amat-Santos IJ. Plaque modification in calcified chronic total occlusions: the PLACCTON study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:213-222. [PMID: 34301507 DOI: 10.1016/j.rec.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. METHODS Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. RESULTS Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). CONCLUSIONS Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits.
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Affiliation(s)
- José R Delgado-Arana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José R Rumoroso
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Javier Martín-Moreiras
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Gema Miñana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Mohsen Mohandes
- Departamento de Cardiología, Hospital Joan XXIII, Tarragona, Spain
| | - Manuel Pan
- Departamento de Cardiología, Hospital Reina Sofia, Instituto Maimónides de investigación biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Pablo Salinas
- Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Alfonso Jurado-Román
- Departamento de Cardiología, Hospital La Paz, Madrid, Spain; Departamento de Cardiología, Hospital de Ciudad Real, Ciudad Real, Spain
| | - Javier Lacunza
- Departamento de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Fernando Rivero
- Departamento de Cardiología, Hospital de La Princesa, Madrid, Spain
| | | | - Juan Rondán
- Departamento de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | | | - Sandra Santos-Martínez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Asier Subinas
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Víctor Arévalos
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alejandro Diego Nieto
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Sergio Rojas
- Departamento de Cardiología, Hospital Joan XXIII, Tarragona, Spain
| | - Soledad Ojeda
- Departamento de Cardiología, Hospital Reina Sofia, Instituto Maimónides de investigación biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Nieves Gonzalo
- Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Javier Goicolea
- Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Mario Sádaba
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Itziar Gómez-Salvador
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Manel Sabaté
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jean Carlos Núñez García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
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17
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Delgado-Arana JR, Rumoroso JR, Regueiro A, Martín-Moreiras J, Miñana G, Mohandes M, Pan M, Salinas P, Caballero-Borrego J, Fernández-Díaz JA, Jurado-Román A, Lacunza J, Vaquerizo B, Rivero F, Abellán-Huerta J, Rondán J, Gómez Menchero A, Santos-Martínez S, Subinas A, Arévalos V, Diego Nieto A, Sanchis J, Rojas S, Ojeda S, Gonzalo N, López-Pérez M, Goicolea J, Sádaba M, Gómez-Salvador I, Sabaté M, Núñez García JC, Amat-Santos IJ. Dispositivos de modificación de placa en oclusiones coronarias crónicas totales: estudio PLACCTON. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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18
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Moroni F, Azzalini L. The calcium pandemic and use of plaque modification devices in chronic total occlusion percutaneous coronary intervention. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:196-199. [PMID: 34716124 DOI: 10.1016/j.rec.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Francesco Moroni
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States; Università Vita-Salute San Raffaele, Milan, Italy
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States.
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19
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Moroni F, Azzalini L. La pandemia del calcio y el uso de dispositivos modificadores de placa en el tratamiento percutáneo de la oclusión coronaria crónica. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Exciter laser coronary atherectomy (ELCA) can be a powerful weapon in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Zaidan M, Alkhalil M, Alaswad K. Calcium Modification Therapies in Contemporary Percutaneous Coronary Intervention. Curr Cardiol Rev 2022; 18:e281221199533. [PMID: 34963434 PMCID: PMC9241119 DOI: 10.2174/1573403x18666211228095457] [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: 12/31/2020] [Revised: 07/02/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022] Open
Abstract
Coronary Artery Calcification (CAC) has been known to be associated with worse Percutaneous Coronary Intervention (PCI) short- and long-term outcomes. Nowadays, with the increased prevalence of the risk factors leading to CAC in the population and also more PCI procedures done in older patients and with the growing number of higher-risk cases of Chronic Total Occlusion (CTO) PCI and PCI after Coronary Artery Bypass Grafting (CABG), severe cases of CAC are now encountered on a daily basis in the catheterization lab and remain a big challenge to the interventional community, making it crucial to identify cases of severe CAC and plan a CAC PCI modification strategy upfront. Improved CAC detection with intravascular imaging helped identify more of these severe CAC cases and predict response to therapy and stent expansion based on CAC distribution in the vessel. Multiple available therapies for CAC modification have evolved over the years. Familiarity with the specifics and special considerations and limitations of each of these tools are essential in the choice and application of these therapies when used in severe CAC treatment. In this review, we discuss CAC pathophysiology, modes of detection, and different available therapies for CAC modification.
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Affiliation(s)
- Mohammad Zaidan
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Mohammad Alkhalil
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK.,Department of Cardiology, Vascular Biology, Newcastle University, Newcastle- upon-Tyne, UK
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
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22
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Bardooli FK, Hussain T, Amin H, Shivappa S, Noor HA. Case Series and Brief Review Report: Excimer Laser Coronary Atherectomy, Facilitating Daily Complex Interventional Challenges. Heart Views 2021; 22:206-211. [PMID: 34760053 PMCID: PMC8574092 DOI: 10.4103/heartviews.heartviews_213_20] [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: 12/03/2020] [Accepted: 08/29/2021] [Indexed: 11/29/2022] Open
Abstract
The excimer laser has revolutionary impact on lesion preparation and chronic total occlusion outcomes. Furthermore, this technology has made huge progression in modern percutaneous intervention, especially in ones labeled as noncrossable lesions. This device has the advantage of crossing lesions that 0.14 wire pass through. The mechanism through which excimer laser coronary atherectomy (ELCA) works are photochemical, photothermal, and photomechanical. In this review cases article, we discuss the uses of ELCA in daily catheterization laboratory alone and with other plaque modification tools. We touch on acute coronary syndrome uses of ELCA, no-balloon crossing lesion, and intervening on deformed stents.
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Affiliation(s)
| | - Tajammul Hussain
- Mohammed Bin Khalifa Bin Cardiac Center, Awali, Kingdom of Bahrain
| | - Haitham Amin
- Mohammed Bin Khalifa Bin Cardiac Center, Awali, Kingdom of Bahrain
| | | | - Husam A Noor
- Mohammed Bin Khalifa Bin Cardiac Center, Awali, Kingdom of Bahrain
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23
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Cosgrove C, Mahadevan K, Spratt JC, McEntegart M. The Impact of Calcium on Chronic Total Occlusion Management. Interv Cardiol 2021; 16:e30. [PMID: 34754332 PMCID: PMC8559150 DOI: 10.15420/icr.2021.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022] Open
Abstract
Coronary artery calcification is prevalent in chronic total occlusions (CTO), particularly in those of longer duration and post-coronary artery bypass. The presence of calcium predicts lower procedural success rates and a higher risk of complications of CTO percutaneous coronary intervention. Adjunctive imaging, including pre-procedural computed tomography and intracoronary imaging, are useful to understand the distribution and morphology of the calcium. Specialised guidewires and microcatheters, as well as penetration, subintimal entry and luminal re-entry techniques, are required to cross calcific CTOs. The use of both atherectomy devices and balloon-based calcium modification tools has been reported during CTO percutaneous coronary intervention, although they are limited by concerns regarding safety and efficacy in the subintimal space.
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Affiliation(s)
- Claudia Cosgrove
- St George's University Hospitals NHS Foundation Trust London, UK
| | | | - James C Spratt
- St George's University Hospitals NHS Foundation Trust London, UK
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24
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Faisal S, Seibel EJ, Aliseda A. Optimization Study of the Hemodynamics of Saline Flushing in Endoscopic Imaging of Chronic Total Occlusions (CTOs). Cardiovasc Eng Technol 2021; 12:541-555. [PMID: 34131832 DOI: 10.1007/s13239-021-00550-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE In this study, in vitro experiments and computational fluid dynamic (CFD) simulations are used to expand the understand of the physics of saline flushing of a blocked artery to enable optical imaging. This process involves saline injection, mixing with blood, and advection of the mixture away from the region of interest to provide a clear optical path for imaging. METHODS CFD simulations are used as a rapid turn-around tool for the evolutionary design process of an endovascular catheter that combines imaging forward-viewing element with saline flushing lumens. RESULTS A novel design and control technique is developed that provides the method to regulate the pressure in a blocked artery during saline flushing, so only small deviations from physiological pressure values are exerted on the damaged artery wall at any time, minimizing risk of rupture. In vitro experiments demonstrate the optical clearing process in phantoms simulating chronic total occlusions (CTOs) in coronary arteries with an opaque blood surrogate being removed by saline flushing. With the CFD compared by the experiments, parametric analyses of artery diameter and curvature, and flushing lumen diameter size were conducted to understand their impact on flushing times and pressures. Different plaque morphologies were studied to explore the feasibility of saline flushing in different CTO conditions. CONCLUSIONS A new catheter design is demonstrated to safely and effectively produce saline flushing, leading to a clear optical imaging field, and an improved technique is outlined that overcomes some practical challenges and limitations commonly encountered in angioscopy.
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Affiliation(s)
- Syed Faisal
- Mechanical Engineering Department, University of Washington, Seattle, USA
| | - Eric J Seibel
- Mechanical Engineering Department, University of Washington, Seattle, USA
| | - Alberto Aliseda
- Mechanical Engineering Department, University of Washington, Seattle, USA.
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25
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Patel NJ, Okamoto N, Murphy J, Vengrenyuk Y, Sharma SK, Kini AS. Management of calcified coronary artery bifurcation lesions. Catheter Cardiovasc Interv 2021; 97:1407-1416. [PMID: 32776696 DOI: 10.1002/ccd.29148] [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: 05/15/2020] [Accepted: 07/03/2020] [Indexed: 11/09/2022]
Abstract
Calcified coronary artery bifurcation lesions (CBL) remain a challenge for the interventional cardiologist. Evidence regarding treatment of CBL is minimal. Optimal plaque modification is the most important step prior to stent deployment. Provisional stenting is the preferred strategy for most bifurcation lesions. However, two-stent strategy should be considered for BL with compromised large SB (>2.5 mm) supplying a large territory, >70% SB stenosis and lesions more than 5 mm long. In this contemporary review article, we present a simplified approach to treating CBL and demonstrate the approach to specific case examples using our newly developed mobile application, BifurcAID.
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Affiliation(s)
- Nileshkumar J Patel
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Naotaka Okamoto
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Jonathan Murphy
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Yuliya Vengrenyuk
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York
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26
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Protty MB, Gallagher S, Farooq V, Sharp ASP, Egred M, O'Kane P, Kinnaird T. Combined use of rotational and excimer lASER coronary atherectomy (RASER) during complex coronary angioplasty-An analysis of cases (2006-2016) from the British Cardiovascular Intervention Society database. Catheter Cardiovasc Interv 2021; 97:E911-E918. [PMID: 33201601 DOI: 10.1002/ccd.29377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Combining rotational (RA) and excimer laser coronary atherectomy (ELCA)-RASER atherectomy-is technique utilized in the percutaneous management of calcific coronary disease. The evidence base examining its safety and utility is sparse and limited to small case-series. This study examines the patterns and outcomes of RASER atherectomy use in the largest cohort to date. METHODS Using the British Cardiac Intervention Society database, data were analyzed on all PCI procedures in the UK between 2006 and 2016. Descriptive statistics and multivariate logistic regressions were used to examine baseline, procedural, and outcome associations with RASER. RESULTS We identified 153 (0.02%) RASER atherectomy cases out of 686,358 PCI procedures. Baseline covariates associated with RASER use were age, BMI, diabetes, stable coronary disease, and previous CABG. Procedural co-variates associated with RASER were CTO-PCI, the use of more/longer stents, intravascular imaging, cutting balloons, and microcatheters. Adjusted rates of in-hospital major adverse cardiac/cerebrovascular events (MACCE) were not significantly different with RASER. However, there were higher odds of arterial complications (OR 3.23, 95% CI: 1.58-6.61), slow flow (OR 3.50, 95% CI: 1.29-9.55), and shock induction (OR 9.66, 95% CI: 3.44-27.06). CONCLUSIONS RASER atherectomy use in complex PCI is associated with higher risk baseline and procedural characteristics. Although increased rates of shock induction, slow flow, and arterial complications were observed, RASER does not increase the likelihood of in-hospital MACCE, major bleeding, or death.
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Affiliation(s)
- Majd B Protty
- Department of Cardiology, University Hospital of Wales, Cardiff, UK.,Systems Immunity University Research Institute, Cardiff University, Cardiff, UK
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Vasim Farooq
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Andrew S P Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, UK.,University of Exeter, Exeter, UK
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Peter O'Kane
- Department of Cardiology, Bournemouth Hospital, Bournemouth, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK.,Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, UK
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27
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Karacsonyi J, Alaswad K, Choi JW, Vemmou E, Nikolakopoulos I, Poommipanit P, Rafeh NA, ElGuindy A, Ungi I, Egred M, Brilakis ES. Laser for balloon uncrossable and undilatable chronic total occlusion interventions. Int J Cardiol 2021; 336:33-37. [PMID: 34022321 DOI: 10.1016/j.ijcard.2021.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is limited information on use of laser in complex percutaneous coronary interventions (PCI). We examined the impact of laser on the outcomes of balloon uncrossable and balloon undilatable chronic total occlusion (CTO) PCI. METHODS We reviewed baseline clinical and angiographic characteristics and procedural outcomes of 4845 CTO PCIs performed between 2012 and 2020 at 32 centers. RESULTS Of the 4845 CTO lesions, 752 (15.5%) were balloon uncrossable (523 cases) or balloon undilatable (356 cases) and were included in this analysis. Mean patient age was 66.9 ± 10 years and 83% were men. Laser was used in 20.3% of the lesions. Compared with cases in which laser was not used, laser was more commonly used in longer length occlusions (33 [21, 50] vs. 25 [15, 40] mm, p = 0.0004) and in-stent restenotic lesions (41% vs. 20%, p < 0.0001). Laser use was associated with higher technical (91.5% vs. 83.1%, p = 0.010) and procedural (88.9% vs. 81.6%, p = 0.033) success rates and similar incidence of major adverse cardiac events (3.92% vs. 3.51%, p = 0.805). Laser use was associated with longer procedural (169 [109, 231] vs. 130 [87, 199], p < 0.0001) and fluoroscopy time (64 [40, 94] vs. 50 [31, 81], p = 0.003). CONCLUSIONS In a contemporary, multicenter registry balloon uncrossable and balloon undilatable lesions represented 15.5% of all CTO PCIs. Laser was used in approximately one-fifth of these cases and was associated with high technical and procedural success and similar major complication rates.
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Affiliation(s)
- Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - James W Choi
- Baylor Heart and Vascular Hospital, Dallas, TX, USA
| | - Evangelia Vemmou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | | | - Ahmed ElGuindy
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Imre Ungi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Mohaned Egred
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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28
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Ye Y, Zhao X, Du J, Zeng Y. Efficacy and safety of balloon-assisted microdissection with Sapphire® II 1.0-mm balloon in balloon-uncrossable chronic total occlusion lesions. J Int Med Res 2021; 48:300060520965822. [PMID: 33103520 PMCID: PMC7645396 DOI: 10.1177/0300060520965822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Earlier studies have shown that the balloon-assisted microdissection (BAM) technique is feasible using a 1.2- to 1.5-mm small balloon in balloon-uncrossable chronic total occlusion (CTO) lesions. This study was performed to assess the efficacy and safety of the BAM technique with a Sapphire® II 1.0-mm balloon. Methods In this retrospective study, patients undergoing percutaneous coronary intervention for CTO were consecutively screened for balloon-uncrossable CTO lesions using BAM with the Sapphire® II 1.0-mm balloon. The patients’ clinical and angiographic characteristics and procedural outcomes were collected for analyses. Results Twenty-four balloon-uncrossable CTO lesions were identified. Most of the CTO lesions were located in the right coronary artery, followed by the left anterior descending artery and left circumflex artery. The mean Japanese Multicenter CTO Registry (J-CTO) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) scores were 1.96 and 1.38, respectively. The total technical success rates were 91.6% (22/24) and 75.00% (18/24) for the lesions that were successfully treated with BAM. No patients developed major complications with the exception of one patient who developed a femoral hematoma. Conclusion BAM with the Sapphire® II 1.0-mm balloon may be an effective and safe technique for balloon-uncrossable CTO lesions.
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Affiliation(s)
- Yicong Ye
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Xiliang Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Jianjun Du
- Department of Cardiology, Tongliao Hospital, Neimengu, China
| | - Yong Zeng
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
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29
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Jawad-Ul-Qamar M, Sharma H, Vetrugno V, Sandhu K, Ludman PF, Doshi SN, Townend JN, Osheiba M, Zaphiriou A, Khan SQ. Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital. Open Heart 2021; 8:openhrt-2020-001522. [PMID: 33863837 PMCID: PMC8055138 DOI: 10.1136/openhrt-2020-001522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background Excimer laser coronary atherectomy (ELCA) can be used as an adjunctive percutaneous coronary intervention treatment for challenging, heavily calcified lesions. Although previous studies have documented high rates of complication and restenosis, these predate the introduction of the smaller 0.9 mm laser catheter. As the coronary complexity has increased, there has been a renewed interest in the ELCA. This study investigates the indications, procedural characteristics, complications and outcomes of ELCA in a contemporary coronary interventional practice. Methods This single-centre study retrospectively analysed 50 patients treated with ELCA between January 2013 and January 2019. Results Patients had a mean age of 67.9±11.4 years with a male predominance (65.3%). 25 (50%) cases were performed in patients with stable angina. Failure to deliver the smallest available balloon/microcatheter was the most frequent indication in 32 (64%) cases for ELCA use. 30 (60%) of the procedures were performed via radial access. The 0.9 mm X-80 catheter was used in 41 (82%) of cases, delivering on average 9000±3929 pulses. ELCA-related complications included 2 coronary dissections and 1 perforation, all of which were covered with stents. No major complications could be directly attributed to the use of ELCA. There was one death and one case of stent thrombosis within 30 days of the procedure. Conclusion ELCA can be performed safely via the radial approach with a 0.9 mm catheter with a high success rate by suitably trained operators. The low procedure-related complications with contemporary techniques make this a very useful tool for complex coronary interventions, especially for difficult to dilate lesions and chronic total occlusion vessels.
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Affiliation(s)
- Muhammad Jawad-Ul-Qamar
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Harish Sharma
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Vincenzo Vetrugno
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Cardiology Division, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Kully Sandhu
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Peter F Ludman
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sagar N Doshi
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Jonathan N Townend
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mohammed Osheiba
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Alex Zaphiriou
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sohail Q Khan
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK .,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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30
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Karimi Galougahi K, Shlofmitz E, Jeremias A, Gogia S, Kirtane AJ, Hill JM, Karmpaliotis D, Mintz GS, Maehara A, Stone GW, Shlofmitz RA, Ali ZA. Therapeutic Approach to Calcified Coronary Lesions: Disruptive Technologies. Curr Cardiol Rep 2021; 23:33. [PMID: 33666772 DOI: 10.1007/s11886-021-01458-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW Moderate or severe calcification is present in approximately one third of coronary lesions in patients with stable ischemic heart disease and acute coronary syndromes and portends unfavorable procedural results and long-term outcomes. In this review, we provide an overview on the state-of-the-art in evaluation and treatment of calcified coronary lesions. RECENT FINDINGS Intravascular imaging (intravascular ultrasound or optical coherence tomography) can guide percutaneous coronary intervention of severely calcified lesions. New technologies such as orbital atherectomy and intravascular lithotripsy have significantly expanded the range of available techniques to effectively modify coronary calcium and facilitate stent expansion. Calcium fracture improves lesion compliance and is essential to optimize stent implantation. Intravascular imaging allows for detailed assessment of patterns and severity of coronary calcium that are integrated into scoring systems to predict stent expansion, identifying which lesions require atherectomy for lesion modification. Guided by intravascular imaging, older technologies such as rotational atherectomy and excimer laser can be incorporated with newer technologies such as orbital atherectomy and intravascular lithotripsy into an algorithmic approach for the safe and effective treatment of patients with heavily calcified coronary lesions.
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Affiliation(s)
- Keyvan Karimi Galougahi
- Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia.,Heart Research Institute, Sydney, Australia
| | - Evan Shlofmitz
- St. Francis Hospital - The Heart Center, Roslyn, NY, USA
| | - Allen Jeremias
- St. Francis Hospital - The Heart Center, Roslyn, NY, USA.,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Shawnbir Gogia
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Dimitri Karmpaliotis
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ziad A Ali
- St. Francis Hospital - The Heart Center, Roslyn, NY, USA. .,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA. .,Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA. .,Columbia University Irving Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.
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31
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Fan LM, Tong D, Mintz GS, Mamas MA, Javed A. Breaking the deadlock of calcified coronary artery lesions: A contemporary review. Catheter Cardiovasc Interv 2021; 97:108-120. [PMID: 32865328 DOI: 10.1002/ccd.29221] [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] [Received: 04/14/2020] [Accepted: 08/02/2020] [Indexed: 01/01/2023]
Abstract
Percutaneous coronary intervention (PCI) of severely calcified lesions is known to result in lower procedural success rates, higher complication rates, and worse long-term clinical outcomes compared to noncalcified lesions. Adequate lesion preparation through calcium modification is crucial in ensuring procedural success and reducing adverse cardiovascular outcomes. There are numerous calcium modification devices currently available whose usefulness depends on the nature of the calcific disease and its anatomical distribution. It can be challenging for the interventionists to decide which device is best suited for their patient. There is also emerging evidence for intravascular imaging in guiding selection of calcium modification devices using parameters such as calcium distribution and depth that directly impact on procedural success and clinical outcomes. In this review we aim to discuss the pathophysiology of coronary calcification, evaluate strategies and technologies of calcium modification and propose an A-M-A-S-A algorithm in managing calcified coronary lesions.
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Affiliation(s)
- Lampson M Fan
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - David Tong
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Gary S Mintz
- Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Mamas A Mamas
- Department of Cardiology, University hospital of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ahmed Javed
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
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Ojeda S, Azzalini L, Suárez de Lezo J, Johal GS, González R, Barman N, Hidalgo F, Bellera N, Dangas G, Jurado‐Román A, Kini A, Romero M, Moreno R, Garcia del Blanco B, Mehran R, Sharma SK, Pan M. Excimer laser coronary atherectomy for uncrossable coronary lesions. A multicenter registry. Catheter Cardiovasc Interv 2020; 98:1241-1249. [DOI: 10.1002/ccd.29392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/27/2020] [Accepted: 11/08/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Soledad Ojeda
- Division of Interventional Cardiology, Reina Sofia Hospital University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC) Córdoba Spain
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center Virginia Commonwealth University Richmond Virginia USA
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York USA
| | - Javier Suárez de Lezo
- Division of Interventional Cardiology, Reina Sofia Hospital University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC) Córdoba Spain
| | - Gurpreet S. Johal
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York USA
| | - Rafael González
- Division of Interventional Cardiology, Reina Sofia Hospital University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC) Córdoba Spain
| | - Nitin Barman
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York USA
| | - Francisco Hidalgo
- Division of Interventional Cardiology, Reina Sofia Hospital University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC) Córdoba Spain
| | - Neus Bellera
- Division of Interventional Cardiology Hospital Universitario Vall d'Hebron, Centro de Investigación Biomédica en Red, CIBER CV Barcelona Spain
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York USA
| | - Alfonso Jurado‐Román
- Division of Interventional Cardiology Hospital La Paz, IDIPAZ, CIBER‐CV Madrid Spain
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York USA
| | - Miguel Romero
- Division of Interventional Cardiology, Reina Sofia Hospital University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC) Córdoba Spain
| | - Raúl Moreno
- Division of Interventional Cardiology Hospital La Paz, IDIPAZ, CIBER‐CV Madrid Spain
| | - Bruno Garcia del Blanco
- Division of Interventional Cardiology Hospital Universitario Vall d'Hebron, Centro de Investigación Biomédica en Red, CIBER CV Barcelona Spain
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York USA
| | - Samin K. Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York USA
| | - Manuel Pan
- Division of Interventional Cardiology, Reina Sofia Hospital University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC) Córdoba Spain
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Tsutsui RS, Sammour Y, Kalra A, Reed G, Krishnaswamy A, Ellis S, Nair R, Khatri J, Kapadia S, Puri R. Excimer Laser Atherectomy in Percutaneous Coronary Intervention: A Contemporary Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 25:75-85. [PMID: 33158754 DOI: 10.1016/j.carrev.2020.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
Excimer laser coronary atherectomy (ELCA) during percutaneous coronary intervention (PCI) has been in use for more than twenty years. While early experiences were not favorable over balloon angioplasty alone, with improvement in operator technique, patient selection and technology, ELCA has established its own niche in contemporary PCI as a safe and effective atherectomy strategy. With growing experience in complex coronary interventions worldwide, ELCA has become one of the essential atherectomy tools offering unique advantages over other atherectomy devices. In the modern era, ELCA is commonly used for patients with in-stent restenosis, stent under expansion, balloon uncrossable lesions and chronic total occlusions. Technical success rates are reported to be >80% in most situations while procedural complication rates such as vessel dissection and perforation among others are reported to average 9% over the past 25 years with improvement over time. In this review, we provide a comprehensive systematic review of the ELCA system, its practical use, indications, and procedural techniques in the contemporary PCI era.
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Affiliation(s)
- Rayji S Tsutsui
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America; Division of Cardiology, Straub Medical Center, Hawaii Pacific Health, Honolulu, HI, United States of America
| | - Yasser Sammour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Stephen Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Ravi Nair
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America.
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Elrayes MM, Xenogiannis I, Nikolakopoulos I, Vemmou E, Wollmuth J, Abi Rafeh N, Karmpaliotis D, Gasparini GL, Burke MN, Brilakis ES. An algorithmic approach to balloon‐uncrossable coronary lesions. Catheter Cardiovasc Interv 2020; 97:E817-E825. [DOI: 10.1002/ccd.29215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Mahmoud M. Elrayes
- Department of Cardiology Specialized Medical Hospital, Mansoura University Mansoura Egypt
| | - Iosif Xenogiannis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota
| | - Evangelia Vemmou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota
| | | | - Nidal Abi Rafeh
- St. George Hospital University Medical Center Beirut Lebanon
| | | | | | - Martin Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis Minnesota
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De Maria GL, Scarsini R, Banning AP. Management of Calcific Coronary Artery Lesions: Is it Time to Change Our Interventional Therapeutic Approach? JACC Cardiovasc Interv 2020; 12:1465-1478. [PMID: 31395217 DOI: 10.1016/j.jcin.2019.03.038] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 01/07/2023]
Abstract
Patients with obstructive coronary lesions with a high calcium content (LHCC) have an exaggerated clinical risk, because the presence of calcification is associated with more extensive coronary atheroma and higher burden of comorbidities. Treatment of LHCC using percutaneous techniques is complex because of an increased risk of incomplete lesion preparation with suboptimal stent deployment and higher rates of acute and chronic stent failure. Rotational atherectomy has been the predominant technology for treatment of high-grade LHCC, but novel devices/technologies have entered clinical practice. It seems likely that combining enhanced intravascular imaging, which allows definition of the patterns of calcification with these new technologies, will herald a change in procedural algorithms for treatment of LHCC. This review provides an overview about LHCC with special focus on existing and emergent technologies. We also provide a proposed procedural algorithm to facilitate optimal use of technology according to specific features of LHCC and coronary anatomy.
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Affiliation(s)
| | - Roberto Scarsini
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom.
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Treatment of In-Stent Restenosis Using Excimer Laser Coronary Atherectomy and Bioresorbable Vascular Scaffold Guided by Optical Coherence Tomography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 22:44-49. [PMID: 32448779 DOI: 10.1016/j.carrev.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022]
Abstract
The rate of in-stent restenosis (ISR) has become increasingly prevalent with the exponential growth in stent implantation due to an aging population and a higher life expectancy, in addition to the high rates of obesity and diabetes. In this prospective, single operator, all-comer study, we sought to analyze the performance of ELCA followed by bioresorbable vascular scaffold (BVS) placement in patients undergoing percutaneous coronary intervention (PCI) for ISR. A total of 13 patients had ISR treated with a combination of ELCA and BVS, with 9 patients having matched OCT pre, post ELCA and post BVS. Mean age was 65 ± 11.22 and 83% of the patients were male. Hypertension and dyslipidemia were present in 100% of the patients and smoking and diabetes in 50%. After the procedure, we did not detect residual stenosis over 10% in any patient, resulting in a technical success of 100%. No patients had MACE during their hospital stay or within the next six months, resulting in a procedure success of 100%. The mean lumen area increased 0.35 mm2 from pre procedure to post ELCA and 3.58 mm2 from post ELCA to post BVS. The final difference, from pre procedure to post BVS, was a 3.93 mm2 lumen area gain. The mean lumen diameter increased 0.11 mm from baseline to ELCA, 0.95 mm from post laser to BVS implantation and 1.06 mm from pre procedure to post BVS. The NIH area reduced 0.48 mm2 from pre to post ELCA, 1.13mm2 from post ELCA to BVS implantation and 1.61 mm2 from baseline to post BVS implantation. We conclude that ELCA is a safe and feasible debulking method to approach ISR, with high rates of post-procedural BVS success, within six months follow-up.
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37
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Mohandes M, Rojas S, Moreno C, Fernández F, Fuertes M, Guarinos J. Excimer Laser in Percutaneous Coronary Intervention of Device Uncrossable Chronic Total and Functional Occlusions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:657-660. [DOI: 10.1016/j.carrev.2019.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
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Pradhan A, Bhandari M, Snigdha B. Lasers for the treatment of coronary artery disease: An update. HEART INDIA 2020. [DOI: 10.4103/heartindia.heartindia_35_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sorini Dini C, Nardi G, Ristalli F, Mattesini A, Hamiti B, Di Mario C. Contemporary Approach to Heavily Calcified Coronary Lesions. Interv Cardiol 2019; 14:154-163. [PMID: 31867062 PMCID: PMC6918474 DOI: 10.15420/icr.2019.19.r1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022] Open
Abstract
Percutaneous treatment of heavily calcified coronary lesions still represents a challenge for interventional cardiology, with higher risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. Good characterisation of calcium distribution with multimodal imaging is important to improve the successful treatment of these lesions. The use of traditional or new dedicated devices for the treatment of calcified lesions allows better lesion preparation; therefore, it is important that we know the different mechanisms and technical features of these devices.
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Affiliation(s)
- Carlotta Sorini Dini
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
- Cardiology Division, Spedali RiunitiLivorno, Italy
| | - Giulia Nardi
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Francesca Ristalli
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Brunilda Hamiti
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University HospitalFlorence, Italy
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Uemura Y, Takemoto K, Koyasu M, Ishikawa S, Ishii H, Murohara T, Watarai M. Clinical outcomes of rotational atherectomy in severely calcified in-stent restenosis: a single-center, retrospective study. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:313-323. [PMID: 31239599 PMCID: PMC6556452 DOI: 10.18999/nagjms.81.2.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Neointimal calcification after stent implantation has been reported as one of the forms of neoatherosclerosis. There are a few patients with in-stent restenosis (ISR) and an undilatable calcified neointima who require rotational atherectomy to achieve sufficient acute gain in lumen diameter. However, the clinical outcomes of rotational atherectomy for undilatable calcified ISR have not been fully elucidated. Therefore, we investigated the safety and efficacy of rotational atherectomy for treating calcified ISR. This retrospective study included 17 patients (20 lesions) who had undergone percutaneous coronary intervention including rotational atherectomy to treat ISR with severely calcified neointima. Kaplan-Meier analysis was used to analyze the data. The mean age of the enrolled patients was 67±18 years, and 71% were men. The patients had highly atherogenic characteristics: 65% had diabetes mellitus and 53% were receiving hemodialysis. Procedural success was obtained in 19 (95%) patients, and the acute gain in lumen diameter was acceptable (1.7±0.6 mm). However, during a median follow-up of 571 days, the incidences of major adverse cardiac and cerebrovascular events per patient and clinical-driven target lesion revascularizations per lesion were relatively high. There were no differences in clinical outcomes according to the baseline characteristics, type of restenotic stents, and therapeutic strategy. In conclusion, clinical outcomes of rotational atherectomy for severely calcified ISR were unfavorable despite a high success rate and acceptable acute gain in lumen diameter.
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Affiliation(s)
- Yusuke Uemura
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Kenji Takemoto
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Masayoshi Koyasu
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Shinji Ishikawa
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Watarai
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
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Dallan LAP, Pereira GTR, Alaiti MA, Zimin V, Vergara-Martel A, Zago EI, Pizzato PE, Bezerra HG. Laser Imaging: Unraveling Laser Atherectomy Mechanisms of Action with Optical Coherence Tomography. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9508-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Shen H, Du Y, Zhou YJ. Contemporary management of complex higher-risk and indicated patients: perspectives from China. Chin Med J (Engl) 2019; 132:1387-1389. [PMID: 31205094 PMCID: PMC6629338 DOI: 10.1097/cm9.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hua Shen
- Department of Cardiology, 12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
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Kassimis G, Raina T, Kontogiannis N, Patri G, Abramik J, Zaphiriou A, Banning AP. How Should We Treat Heavily Calcified Coronary Artery Disease in Contemporary Practice? From Atherectomy to Intravascular Lithotripsy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1172-1183. [PMID: 30711477 DOI: 10.1016/j.carrev.2019.01.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022]
Abstract
Heavily calcified and densely fibrotic coronary lesions continue to represent a challenge for percutaneous coronary intervention (PCI), as they are difficult to dilate, and it is difficult to deliver and implant drug-eluting stents (DES) properly. Poor stent deployment is associated with high rates of periprocedural complications and suboptimal long-term clinical outcomes. Thanks to the introduction of several adjunctive PCI tools, like cutting and scoring balloons, atherectomy devices, and to the novel intravascular lithotripsy technology, the treatment of such lesions has become increasingly feasible, predictable and safe. A step-wise progression of strategies is described for coronary plaque modification, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. We highlight these techniques in the setting of clinical examples how best to apply them through better patient and lesion selection, with the main objective of optimising DES delivery and implantation, and subsequent improved outcomes.
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Affiliation(s)
- George Kassimis
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom; Second Department of Cardiology, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Tushar Raina
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom
| | - Nestoras Kontogiannis
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom
| | - Gopendu Patri
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom
| | - Joanna Abramik
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom
| | - Alex Zaphiriou
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Adrian P Banning
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom
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Abstract
PURPOSE OF REVIEW To summarize novel techniques and developments in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). RECENT FINDINGS Using an algorithmic, step-by-step approach can help overcome several complex CTO lesions subsets, such as proximal cap ambiguity, ostial location, in-stent occlusion, bifurcations, balloon uncrossable and undilatable lesions. Similarly, an algorithmic approach can help prevent and optimally treat CTO PCI-related complication, such as perforation, radiation, and contrast-induced nephropathy. Continual update and reassessment of each operator's algorithm for performing CTO PCI can lead to improved outcomes.
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45
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Meraj PM, Shlofmitz E, Kaplan B, Jauhar R, Doshi R. Clinical outcomes of atherectomy prior to percutaneous coronary intervention: A comparison of outcomes following rotational versus orbital atherectomy (COAP-PCI study). J Interv Cardiol 2018; 31:478-485. [DOI: 10.1111/joic.12511] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/22/2018] [Accepted: 03/14/2018] [Indexed: 01/11/2023] Open
Affiliation(s)
- Perwaiz M. Meraj
- Department of Cardiology; Northwell Health; Hofstra Northwell Health School of Medicine; Manhasset New York
| | - Evan Shlofmitz
- Department of Cardiology; Northwell Health; Hofstra Northwell Health School of Medicine; Manhasset New York
| | - Barry Kaplan
- Department of Cardiology; Northwell Health; Hofstra Northwell Health School of Medicine; Manhasset New York
| | - Rajiv Jauhar
- Department of Cardiology; Northwell Health; Hofstra Northwell Health School of Medicine; Manhasset New York
| | - Rajkumar Doshi
- Department of Cardiology; Northwell Health; Hofstra Northwell Health School of Medicine; Manhasset New York
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Synetos A, Toutouzas K, Latsios G, Papanikolaou A, Peskesis G, Sianos G, Tousoulis D. Proximal anchoring distal trapping technique in a chronic total occlusion unable to cross. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:887-889. [PMID: 29631951 DOI: 10.1016/j.carrev.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Andreas Synetos
- First Department of Cardiology, Athens Medical School, Athens, Greece.
| | | | - George Latsios
- First Department of Cardiology, Athens Medical School, Athens, Greece
| | | | - George Peskesis
- First Department of Cardiology, Athens Medical School, Athens, Greece
| | - George Sianos
- Cardiology Department, Papageorgiou General Hospital, Thessaloniki, Greece
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47
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Felekos I, Karamasis GV, Pavlidis AN. When everything else fails: High-pressure balloon for undilatable lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:306-313. [DOI: 10.1016/j.carrev.2017.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
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48
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Tajti P, Karmpaliotis D, Alaswad K, Toma C, Choi JW, Jaffer FA, Doing AH, Patel M, Mahmud E, Uretsky B, Karatasakis A, Karacsonyi J, Danek BA, Rangan BV, Banerjee S, Ungi I, Brilakis ES. Prevalence, Presentation and Treatment of 'Balloon Undilatable' Chronic Total Occlusions: Insights from a Multicenter US Registry. Catheter Cardiovasc Interv 2018; 91:657-666. [PMID: 29359452 DOI: 10.1002/ccd.27510] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/08/2017] [Accepted: 01/03/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence, treatment and outcomes of balloon undilatable chronic total occlusions (CTOs) have received limited study. METHODS We examined the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable CTOs in a contemporary multicenter US registry. RESULTS Between 2012 and 2017 data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients in whom guidewire crossing was successful: 52 of 425 CTOs were balloon undilatable (12%). Mean patient age was 65 ± 10 years and most patients were men (84%). Patients with balloon undilatable CTOs were more likely to be diabetic (67 vs. 41%, P < 0.001) and have heart failure (44 vs. 28%, P = 0.027). Balloon undilatable CTOs were longer (40 mm [interquartile range, IQR 20-50] vs. 30 [IQR 15-40], P = 0.016), more likely to have moderate/severe calcification (87 vs. 54%, P < 0.001), and had higher J-CTO score (3.2 ± 1.1 vs. 2.5 ± 1.3, P < 0.001) and PROGRESS-CTO complications score (3.9 ± 1.7 vs. 3.1 ± 2.0, P < 0.005). They were associated with lower technical and procedural success (92 vs. 98%, P = 0.024; and 88 vs. 96%, P = 0.034, respectively) and higher risk for in-hospital major adverse events (8 vs. 2%, P = 0.008) due to higher perforation rates. The most frequent treatments for balloon undilatable CTOs were high pressure balloon inflations (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%). CONCLUSIONS Balloon undilatable CTOs are common and are associated with lower success and higher complication rates.
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Affiliation(s)
- 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.,VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James W Choi
- Baylor Heart and Vascular Hospital, Dallas, Texas
| | | | | | - 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
| | - Barry Uretsky
- VA Central Arkansas Healthcare System, Little Rock, Arkansas
| | - Aris Karatasakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Judit Karacsonyi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.,VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Barbara A Danek
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bavana V Rangan
- 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
| | - Imre Ungi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.,VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
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Koutouzis M, Avdikos G, Nikitas G, Zografos T, Tsiafoutis I, Agelaki M, Lazaris E. “Ping-pong” technique for treating a balloon uncrossable chronic total occlusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:117-119. [DOI: 10.1016/j.carrev.2017.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/02/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
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Bhatt H, Janzer S, George JC. Utility of adjunctive modalities in Coronary chronic total occlusion intervention. Indian Heart J 2017; 69:375-381. [PMID: 28648437 PMCID: PMC5485396 DOI: 10.1016/j.ihj.2017.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/07/2017] [Accepted: 02/13/2017] [Indexed: 12/03/2022] Open
Abstract
Coronary chronic total occlusion (CTO) intervention remains one of the most challenging domains in interventional cardiology. Due to the technical challenges involved and potential procedural complications, CTO percutaneous coronary intervention (PCI) attempt and success rates remain less than standard PCI. However, the use of several adjunctive tools such as intravascular ultrasound, optical coherence tomography, rotational atherectomy, orbital atherectomy, excimer laser coronary atherectomy and percutaneous left ventricular assist device may contribute to improved CTO PCI success rates or provide better hemodynamic assessment of CTO lesion (i.e., using fractional flow reserve). In this review we present the current literature describing the utility and efficacy of these adjunctive modalities in CTO intervention.
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Affiliation(s)
- Hemal Bhatt
- Division of Cardiovascular Disease, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA 19141, USA.
| | - Sean Janzer
- Division of Cardiovascular Disease, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Jon C George
- Division of Cardiovascular Disease, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA 19141, USA.
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