1
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Allali A, Abdel-Wahab M, Elbasha K, Mankerious N, Traboulsi H, Kastrati A, El-Mawardy M, Hemetsberger R, Sulimov DS, Neumann FJ, Toelg R, Richardt G. Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials. Clin Res Cardiol 2023; 112:1143-1163. [PMID: 35482101 PMCID: PMC10450020 DOI: 10.1007/s00392-022-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE-CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions.
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Affiliation(s)
- Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany.
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Hussein Traboulsi
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | | | - Rayyan Hemetsberger
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Franz-Josef Neumann
- Cardiology Department, Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
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2
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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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3
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Tehrani DM, Seto AH. Management of Coronary Complications. Interv Cardiol Clin 2022; 11:445-453. [PMID: 36243489 DOI: 10.1016/j.iccl.2022.06.002] [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
Coronary complications are increasingly rare but remain fatal if not managed promptly and effectively. We review the incidence, management, and prevention of the most serious coronary complications including acute vessel closure from dissection, no-reflow, thrombosis, and air embolism as well as mechanical complications including perforation, stent dislodgment, and atherectomy burr entrapment.
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Affiliation(s)
- David M Tehrani
- University of California Los Angeles, 650 Charles East Young Drive South, A20237 CHS, Los Angeles, CA 90095, USA.
| | - Arnold H Seto
- Long Beach Veterans Administration Medical Center, 5901 East 7th Street 111C, Long Beach, CA 90822, USA
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4
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Sharma N, Asrress KN, O'Kane P, Pyo RT, Redwood SR. Laser, Rotational, Orbital Coronary Atherectomy, and Coronary Intravascular Lithoplasty. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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5
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Sanz‐Sánchez J, Mashayekhi K, Agostoni P, Egred M, Avran A, Kalyanasundaram A, Garbo R, Colombo A, Regazzoli D, Reimers B, Brilakis ES, Gasparini GL. Device entrapment during percutaneous coronary intervention. Catheter Cardiovasc Interv 2022; 99:1766-1777. [PMID: 35312151 PMCID: PMC9544850 DOI: 10.1002/ccd.30160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/20/2022] [Accepted: 03/05/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Device entrapment is a life-threatening complication during percutaneous coronary intervention (PCI). However, the success for its management is predominantly based on operator experience with limited available guidance in the published literature. METHODS A systematic review was performed on December 2021; we searched PubMed for articles on device entrapment during PCI. In addition, backward snowballing (i.e., review of references from identified articles and pertinent reviews) was employed. RESULTS A total of 4209 articles were retrieved, of which 150 studies were included in the synthesis of the data. A methodical algorithmic approach to prevention and management of device entrapment can help to optimize outcomes. The recommended sequence of steps are as follows: (a) pulling, (b) trapping, (c) snaring, (d) plaque modification, (e) telescoping, and (f) surgery. CONCLUSIONS In-depth knowledge of the techniques and necessary tools can help optimize the likelihood of successful equipment retrieval and minimization of complications.
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Affiliation(s)
- Jorge Sanz‐Sánchez
- Interventional cardiology UnitHospital Universitari i Politecnic La FeValenciaSpain
- Centro de Investigación Biomedica en Red (CIBERCV)–MadridMadridSpain
| | - Kambis Mashayekhi
- Division of CardiologyUniversity Heart Center Freiburg‐Bad KrozingenBad KrozingenGermany
| | | | - Mohaned Egred
- Department of CardiologyFreeman HospitalNewcastle upon TyneUK
- Division of Cardiology, School of MedicineUniversity of SunderlandSunderlandUK
- Division of Cardiology, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alexandre Avran
- Department of Interventional CardiologyClinique PasteurEssey‐lès‐NancyFrance
| | - Arun Kalyanasundaram
- Interventional Cardiology Unit, Division of CardiologyPromed HospitalChennaiIndia
| | - Roberto Garbo
- Department of Interventional CardiologyMaria Pia HospitalTorinoItaly
| | - Antonio Colombo
- Interventional Cardiology UnitIRCCS Humanitas Clinical and Research CenterMilanItaly
| | - Damiano Regazzoli
- Interventional Cardiology UnitIRCCS Humanitas Clinical and Research CenterMilanItaly
| | - Bernhard Reimers
- Interventional Cardiology UnitIRCCS Humanitas Clinical and Research CenterMilanItaly
| | | | - Gabriele L. Gasparini
- Interventional Cardiology UnitIRCCS Humanitas Clinical and Research CenterMilanItaly
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6
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McDonald CP, Hui DS. Commentary: Cath lab 911. JTCVS Tech 2021; 7:159-160. [PMID: 34318235 PMCID: PMC8312115 DOI: 10.1016/j.xjtc.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Connor P. McDonald
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Dawn S. Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
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7
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Kassimis G, Ziakas A, Didagelos M, Theodoropoulos KC, Hadjimiltiades S. How Should I Get Prepared for and Treat Rota Burr Entrapment in a Focally Underexpanded and Restenosed Stent: A Case Report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:197-200. [PMID: 34031007 DOI: 10.1016/j.carrev.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Although high-speed rotational atherectomy has been successfully used in selected cases of stent underexpansion secondary to heavy peri-stent calcification, a higher risk of burr entrapment demands extreme caution and surgical back-up on site. The main cause of this complication is the lack of diamond dust on the back end of the burr, which prevents backward ablation of tissues when retracted. To date, only few reports of successful burr retrieval using percutaneous bailout techniques have been published. We report a case of burr entrapment within a previously implanted left circumflex artery stent which was successfully recaptured using the dual catheter technique; following the retrieval the patient underwent routine percutaneous coronary intervention.
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Affiliation(s)
- George Kassimis
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Antonios Ziakas
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos C Theodoropoulos
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Hadjimiltiades
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
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8
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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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9
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Waterford SD, Suleman UJ, Sharma S, Filsoufi F. Surgical removal of rotational atherectomy device. JTCVS Tech 2021; 7:153-156. [PMID: 34318233 PMCID: PMC8311989 DOI: 10.1016/j.xjtc.2021.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Stephen D Waterford
- Division of Cardiac Surgery, Department of Surgery, SUNY Upstate Medical University, Syracuse, NY
| | - Umer J Suleman
- Division of Cardiology, Department of Medicine, Mount Sinai Hospital, New York, NY
| | - Samin Sharma
- Division of Cardiology, Department of Medicine, Mount Sinai Hospital, New York, NY
| | - Farzan Filsoufi
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY
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10
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Karacsonyi J, Vemmou E, Nikolakopoulos ID, Ungi I, Rangan BV, Brilakis ES. Complications of chronic total occlusion percutaneous coronary intervention. Neth Heart J 2021; 29:60-67. [PMID: 33111194 PMCID: PMC7782769 DOI: 10.1007/s12471-020-01502-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 01/29/2023] Open
Abstract
Chronic total occlusion percutaneous coronary interventions can be highly complex and are associated with an increased risk of complications, such as perforation, acute vessel closure (which can lead to rapid haemodynamic compromise if it involves the donor vessel), and equipment loss or entrapment. Awareness of the potential complications and meticulous attention to equipment position and patient monitoring can help minimise the risk of complications and allow prompt treatment should they occur.
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Affiliation(s)
- J Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital, Minneapolis, MN, USA
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - E Vemmou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - I D Nikolakopoulos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - I Ungi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - B V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - E S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital, Minneapolis, MN, USA.
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11
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Tehrani S, Achan V, Rathore S. Percutaneous Retrieval of an Entrapped Rotational Atherectomy Burr Using Novel Technique of Controlled Traction and Counter Traction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28S:132-135. [PMID: 33191146 DOI: 10.1016/j.carrev.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
Burr entrapment is a rare but serious complication during rotational atherectomy (RA). The Japanese have termed this the Kokeshi phenomenon named after a wooden doll found in northern Japan consisted of a simple trunk but a large head akin to the Rotablator (Mechery et al., 2016; Kaneda et al., 2000). The reason underlying this complication is the lack of diamond dust on the back end of the burr (Lin et al., 2013). The burr is olive-shaped and has diamond coating at its distal surface for antegrade ablation. The proximal part is smooth without diamonds, which prevents backward ablation of tissues when retracted (Lin et al., 2013; Dahdouh et al., 2013). Rota entrapment usually needs surgical management with coronary artery bypass grafting (CABG) surgery. To date, only few cases of successful non-traumatic retrieval using nonsurgical bailout techniques have been published (Grise et al., 2002). We report a case of burr entrapment within the left anterior descending (LAD) artery which was successfully retrieved by combination of multiple maneuvers and the patient underwent routine PCI following the retrieval.
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Affiliation(s)
- Shana Tehrani
- Frimley Health NHS Foundation Trust, Camberley, Surrey GU16 7UJ, United Kingdom.
| | - Vinod Achan
- Frimley Health NHS Foundation Trust, Camberley, Surrey GU16 7UJ, United Kingdom
| | - Sudhir Rathore
- Frimley Health NHS Foundation Trust, Camberley, Surrey GU16 7UJ, United Kingdom
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12
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Kirov H, Tkebuchava S, Faerber G, Diab M, Sandhaus T, Doenst T. Lost in circulation. J Card Surg 2020; 35:1885-1890. [PMID: 32643849 DOI: 10.1111/jocs.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Device complications in complex percutaneous coronary interventions are rare but potentially deadly. Surgical removal is often required. However, an evaluation of surgical therapy beyond case reports is practically not existent. METHODS We prospectively followed all cases of retained guide wires and/or other devices referred to us for surgical removal between 2015 and 2019 and retrospectively searched our database for such cases between 2010 and 2014. RESULTS From 2015 on, eight cases were referred for surgical removal from six different cardiology departments. In the 5 years before, there was not a single case. Six patients were operated emergently. Patients were 60.5 ± 5.42 years old, overweight (body mass index 30.1 ± 3.77) and except for one case (left ventricular-assist device) showed preserved ejection fraction (EF) (mean EF 57 ± 18.01). The retained devices were mostly located in the right coronary artery (50%), followed by the circumflex artery (37.5%) and diagonal branch (12.5%). The devices were remnants of guide wires (n = 4), balloon catheters (n = 3), and in one case a rotablator. Full sternotomy was performed in six patients and two received a left-sided minithoracotomy (n = 2). The operations were performed on-pump in five (62.5%) and off-pump in three patients. Complete extraction of the foreign bodies was possible in all patients. Two patients died; one in unrelated multiorgan failure and one due to retained-device-related right heart failure. The other patients survived and had uneventful postoperative courses. CONCLUSIONS Retained foreign bodies from cardiac interventions can be completely removed surgically using individualized approaches. There appears to be a trend toward a rising incidence of such interventional complications.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Sophio Tkebuchava
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Tim Sandhaus
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
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13
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Giannini F, Candilio L, Mitomo S, Ruparelia N, Chieffo A, Baldetti L, Ponticelli F, Latib A, Colombo A. A Practical Approach to the Management of Complications During Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 11:1797-1810. [PMID: 30236352 DOI: 10.1016/j.jcin.2018.05.052] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/07/2018] [Accepted: 05/29/2018] [Indexed: 12/13/2022]
Abstract
Percutaneous coronary intervention relieves symptoms in patients with chronic ischemic heart disease resistant to optimal medical therapy and alters the natural history of acute coronary syndromes. However, adverse procedural outcomes may occur during the intervention. Knowledge of possible complications and their timely management are essential for the practicing cardiologist and can be life-saving for the patient. In this review, the authors summarize potential complications of percutaneous coronary intervention focusing on their practical management.
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Affiliation(s)
- Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Luciano Candilio
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Cardiovascular Department, Hammersmith Hospital, Imperial College, London, United Kingdom
| | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Neil Ruparelia
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Baldetti
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ponticelli
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
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14
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Gupta T, Weinreich M, Greenberg M, Colombo A, Latib A. Rotational Atherectomy: A Contemporary Appraisal. ACTA ACUST UNITED AC 2019; 14:182-189. [PMID: 31867066 PMCID: PMC6918488 DOI: 10.15420/icr.2019.17.r1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
Rotational atherectomy (RA) is an atheroablative technology that enables percutaneous coronary intervention for complex, calcified coronary lesions. RA works on the principle of 'differential cutting' and preferentially ablates hard, inelastic, calcified plaque. The objective of RA use has evolved from plaque debulking to plaque modification to enable balloon angioplasty and optimal stent expansion. The clinical experience over the past 30 years has informed the current best practices for RA with use of smaller burr sizes, short ablation runs a 'pecking' motion, and avoidance of sudden decelerations. This has led to significant improvements in procedural safety and a reduced rate of associated complications. This article reviews the principles, clinical indications, contemporary evidence, technical considerations and complications associated with the use of RA.
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Affiliation(s)
- Tanush Gupta
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US.,Department of Cardiology, Columbia University Medical Center New York, NY, US
| | - Michael Weinreich
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US
| | - Mark Greenberg
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Cotignola Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US.,Division of Cardiology, Department of Medicine, University of Cape Town Cape Town, South Africa
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15
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Sharma SK, Tomey MI, Teirstein PS, Kini AS, Reitman AB, Lee AC, Généreux P, Chambers JW, Grines CL, Himmelstein SI, Thompson CA, Meredith IT, Bhave A, Moses JW. North American Expert Review of Rotational Atherectomy. Circ Cardiovasc Interv 2019; 12:e007448. [DOI: 10.1161/circinterventions.118.007448] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Samin K. Sharma
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., M.I.T., A.S.K.)
| | - Matthew I. Tomey
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., M.I.T., A.S.K.)
| | - Paul S. Teirstein
- Scripps Prebys Cardiovascular Institute, Scripps Health, La Jolla, CA (P.S.T.)
| | - Annapoorna S. Kini
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., M.I.T., A.S.K.)
| | | | - Arthur C. Lee
- The Cardiac and Vascular Institute, Gainesville, FL (A.C.L.)
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | | | - Cindy L. Grines
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (C.L.G.)
| | | | - Craig A. Thompson
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine (C.A.T.)
| | | | - Aparna Bhave
- Boston Scientific Corporation, Natick, NA (A.B.)
| | - Jeffrey W. Moses
- Center for Interventional Vascular Therapies, Columbia University Medical Center, New York, NY (J.W.M.)
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Brinkmann C, Eitan A, Schwencke C, Mathey DG, Schofer J. Rotational atherectomy in CTO lesions: too risky? Outcome of rotational atherectomy in CTO lesions compared to non-CTO lesions. EUROINTERVENTION 2018; 14:e1192-e1198. [DOI: 10.4244/eij-d-18-00393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hirai T, Rosenberg J, Nathan S, Blair JEA. Broken arrow: Successful retrieval of a dislodged coronary orbital atherectomy microtip. Catheter Cardiovasc Interv 2018; 92:511-514. [DOI: 10.1002/ccd.27674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 04/19/2018] [Accepted: 05/09/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Taishi Hirai
- Department of Medicine; Section of Cardiology, University of Chicago Medical Center; Chicago Illinois
| | - Jonathan Rosenberg
- Department of Medicine; Section of Cardiology, University of Chicago Medical Center; Chicago Illinois
| | - Sandeep Nathan
- Department of Medicine; Section of Cardiology, University of Chicago Medical Center; Chicago Illinois
| | - John E. A. Blair
- Department of Medicine; Section of Cardiology, University of Chicago Medical Center; Chicago Illinois
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18
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Mahmoud AA, Mahmoud AN, Elgendy AY, Anderson RD. Current Status of Coronary Atherectomy. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Morales-Victorino N, Rojas-Chavez M, Osnaya-Martinez JC, Alvarado-Montes de Oca M, Garcia-Garcia F, Alcantara-Melendez MA. STEMI under-expanded stent, stuck Rotablator burr and successful retrieval by using a mini STAR technique. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:16-19. [PMID: 29929843 DOI: 10.1016/j.carrev.2018.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/27/2018] [Indexed: 11/29/2022]
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20
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Lee MS, Gordin JS, Stone GW, Sharma SK, Saito S, Mahmud E, Chambers J, Généreux P, Shlofmitz R. Orbital and rotational atherectomy during percutaneous coronary intervention for coronary artery calcification. Catheter Cardiovasc Interv 2017; 92:61-67. [PMID: 29045041 DOI: 10.1002/ccd.27339] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/24/2017] [Indexed: 11/09/2022]
Abstract
Severe coronary artery calcification (CAC) increases the complexity of percutaneous coronary intervention (PCI) by inhibiting optimal stent expansion, leading to an increased risk of death, myocardial infarction, repeat revascularization, and stent thrombosis. Coronary atherectomy modifies and debulks calcified plaque to facilitate PCI. Although there is no clear consensus, and further studies are needed, the decision to perform atherectomy should be based upon the presence of fluoroscopic CAC or with the use of intravascular imaging. The management of CAC in the modern era relies on rotational and orbital atherectomy to prepare the lesion to facilitate stent delivery and optimal expansion. While the two technologies differ in equipment, technique, and mechanism of action, the available literature suggests similar efficacy and safety of the two systems, although head-to-head comparisons are limited. While rotational and orbital atherectomy have been shown to have excellent procedural success in terms of facilitating stent delivery, no system has been shown to reduce long-term major adverse cardiovascular events, although the definitive trial for orbital atherectomy has not been completed. Additional trials are needed to find the population who would derive the most benefit of atherectomy and to compare the two systems in a prospective manner.
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Affiliation(s)
- Michael S Lee
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan S Gordin
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | | | | | | | - Jeff Chambers
- Metropolitan Heart and Vascular Institute, Mercy Hospital, Roslyn, New York
| | - Philippe Généreux
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
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21
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Rotational atherectomy in the subadventitial space to allow safe and successful chronic total occlusion recanalization: Pushing the limit further. Catheter Cardiovasc Interv 2017; 91:47-52. [DOI: 10.1002/ccd.27035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/16/2017] [Accepted: 02/25/2017] [Indexed: 12/19/2022]
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22
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Successful removal of entrapped Burr with sheathless guiding during stent rotablation. Anatol J Cardiol 2017; 17:156-157. [PMID: 28209930 PMCID: PMC5336757 DOI: 10.14744/anatoljcardiol.2017.7519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Iannaccone M, Piazza F, Boccuzzi G, D’Ascenzo F, Latib A, Pennacchi M, Rossi ML, Ugo F, Meliga E, Kawamoto H, Moretti C, Ielasi A, Garbo R, Frangieh A, Hildick-Smith D, Templin C, Colombo A, Sardella G. ROTational AThErectomy in acute coronary syndrome: early and midterm outcomes from a multicentre registry. EUROINTERVENTION 2016; 12:1457-1464. [DOI: 10.4244/eij-d-15-00485] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Asrress KN, O'Kane P, Pyo R, Redwood SR. Laser, Rotational, and Orbital Coronary Atherectomy. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kaleab N. Asrress
- Department of Cardiology; St Thomas’ Hospital, and King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital; London UK
| | - Peter O'Kane
- Dorset Heart Centre; Royal Bournemouth Hospital; Bournemouth UK
| | - Robert Pyo
- Montefiore Medical Center; Albert Einstein College of Medicine; New York NY USA
| | - Simon R. Redwood
- Department of Cardiology; St Thomas’ Hospital, and King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital; London UK
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Édes IF, Ruzsa Z, Szabó G, Lux Á, Gellér L, Molnár L, Nowotta F, Hajas Á, Szilveszter B, Becker D, Merkely B. Rotational atherectomy of undilatable coronary stents: stentablation, a clinical perspective and recommendation. EUROINTERVENTION 2016; 12:e632-5. [PMID: 27497363 DOI: 10.4244/eijv12i5a103] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Our aim was to examine procedural viability and midterm outcomes following the use of rotational atherectomy (RA) on malapposed, crippled, otherwise non-salvageable metallic stents (i.e., stentablation [SA]), and convey important procedural pointers for practitioners encountering such situations. METHODS AND RESULTS Data on twelve SA subjects were analysed. The primary endpoint was procedural success: effective ablation of the malapposed stent and successful implantation of a new device. Major adverse cardiac events (MACE) and all-cause death at six months following the index procedure were examined as a secondary endpoint. All twelve patients underwent successful SA and novel stent implantation, with sufficient salvage of coronary anatomy (residual stenosis <30%). At six-month follow-up, however, MACE amounted to 50% and all-cause mortality to 25% in the inspected subjects. CONCLUSIONS We found that, although feasible as an acute salvage option, SA distinctively increases post-procedural midterm MACE and mortality rates. This places emphasis on the importance of avoiding eventual SA situations, underlining the importance of ample lesion preparation prior to stent implantation.
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Affiliation(s)
- István F Édes
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
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26
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Sakakura K, Funayama H, Taniguchi Y, Tsurumaki Y, Yamamoto K, Matsumoto M, Wada H, Momomura SI, Fujita H. The incidence of slow flow after rotational atherectomy of calcified coronary arteries: A randomized study of low speed versus high speed. Catheter Cardiovasc Interv 2016; 89:832-840. [PMID: 27453426 DOI: 10.1002/ccd.26698] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this randomized trial was to compare the incidence of slow flow between low-speed and high-speed rotational atherectomy (RA) of calcified coronary lesions. BACKGROUND Preclinical studies suggest that slow flow is less frequently observed with low-speed than high-speed RA because of less platelet aggregation with low-speed RA. METHODS This was a prospective, randomized, single center study. A total of 100 patients with calcified coronary lesions were enrolled and randomly assigned in a 1:1 ratio to low-speed (140,000 rpm) or high-speed (190,000 rpm) RA. The primary endpoint was the occurrence of slow flow following RA. Slow flow was defined as slow or absent distal runoff (Thrombolysis in Myocardial Infarction [TIMI] flow grade ≤ 2). RESULTS The incidence of slow flow in the low-speed group (24%) was the same as that in the high-speed group (24%) (P = 1.00; odds ratio, 1.00; 95% confidence interval, 0.40-2.50). The frequencies of TIMI 3, TIMI 2, TIMI 1, and TIMI 0 flow grades were similar between the low-speed (TIMI 3, 76%; TIMI 2, 14%; TIMI 1, 8%; TIMI 0, 2%) and high-speed (TIMI 3, 76%; TIMI 2, 14%; TIMI 1, 10%; TIMI 0, 0%) groups (P = 0.77 for trend). The incidence of periprocedural myocardial infarction was the same between the low-speed (6%) and high-speed (6%) groups (P = 1.00). CONCLUSIONS This randomized trial did not show a reduction in the incidence of slow flow following low-speed RA as compared with high-speed RA (UMIN ID: UMIN000015702). © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, Japan, 330-8503
| | - Hiroshi Funayama
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, Japan, 330-8503
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, Japan, 330-8503
| | - Yoshimasa Tsurumaki
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, Japan, 330-8503
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, Japan, 330-8503
| | - Mitsunari Matsumoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, Japan, 330-8503
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, Japan, 330-8503
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, Japan, 330-8503
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, Japan, 330-8503
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Sakakura K, Taniguchi Y, Matsumoto M, Wada H, Momomura SI, Fujita H. How Should We Perform Rotational Atherectomy to an Angulated Calcified Lesion? Int Heart J 2016; 57:376-9. [PMID: 27170474 DOI: 10.1536/ihj.15-421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rotational atherectomy to an angulated calcified lesion is always challenging. The risk of catastrophic complications such as a burr becoming stuck or vessel perforation is greater when the calcified lesion is angulated. We describe the case of an 83-year-old female suffering from unstable angina. Diagnostic coronary angiography revealed an angulated calcified lesion in the proximal segment of the right coronary artery. We performed rotational atherectomy to the lesion, but intentionally did not advance the rotational atherectomy burr beyond the top of the angulation. We controlled the rotational atherectomy burr and stopped it just before the top of the angulation to avoid complications. Following rotational atherectomy, balloon dilatation with a non-compliant balloon was performed, and drug-eluting stents were successfully deployed. In this manuscript, we provide a review of the literature on this topic, and discuss how rotational atherectomy to an angulated calcified lesion should be performed.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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28
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Isogai T, Yasunaga H, Matsui H, Tanaka H, Fushimi K. Relationship between hospital volume and major cardiac complications of rotational atherectomy: A nationwide retrospective cohort study in Japan. J Cardiol 2016; 67:442-8. [DOI: 10.1016/j.jjcc.2015.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/30/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
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Miyazaki T, Latib A, Ruparelia N, Kawamoto H, Sato K, Figini F, Colombo A. The use of a scoring balloon for optimal lesion preparation prior to bioresorbable scaffold implantation: a comparison with conventional balloon predilatation. EUROINTERVENTION 2016; 11:e1580-8. [DOI: 10.4244/eijv11i14a308] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mechery A, Jordan PJ, Doshi SN, Khan SQ. Retrieval of a stuck Rotablator burr ("Kokeshi phenomenon") and successful percutaneous coronary intervention. J Cardiol Cases 2015; 13:90-92. [PMID: 30546615 DOI: 10.1016/j.jccase.2015.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/06/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 74-year-old man having angioplasty following admission with a troponin positive acute coronary syndrome. Due to heavy coronary artery calcification, rotablation was used. The procedure was complicated by a stuck burr ("Kokeshi phenomenon"). We employed a novel method to safely remove the burr and complete the procedure. <Learning objective: Various methods have been described for the retrieval of an entrapped Rotablator burr; we show in this case that deep engagement of guiding catheter and manual traction is a safe and effective method for retrieval.>.
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Affiliation(s)
- Anthony Mechery
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Paul J Jordan
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Sagar N Doshi
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Sohail Q Khan
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
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Tanaka Y, Saito S. Successful retrieval of a firmly stuck rotablator burr by using a modified STAR technique. Catheter Cardiovasc Interv 2015; 87:749-56. [PMID: 26651133 DOI: 10.1002/ccd.26342] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 08/15/2015] [Accepted: 11/08/2015] [Indexed: 11/08/2022]
Abstract
Rotablator burr entrapment occurring during rotational atherectomy is a rare but serious complication that can lead to coronary occlusion and require emergency cardiac surgery. Although several bailout techniques for stuck burrs have been proposed, no definitive methods for removal have been established. We report here a difficult case of a stuck rotablator burr, in which various techniques failed to retrieve the burr. It was ultimately removed using the subintimal tracking and reentry (STAR) technique with a 3-g tapered tip hydrophilic wire. This modified STAR technique, which was originally developed for percutaneous coronary intervention for chronic total occlusion, may be useful as a bailout technique in patients with a firmly stuck rotablator burr that cannot be removed by using standard procedures.
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Affiliation(s)
- Yutaka Tanaka
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan
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33
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Édes IF, Ruzsa Z, Szabó G, Nardai S, Becker D, Benke K, Szilveszter B, Merkely B. Clinical predictors of mortality following rotational atherectomy and stent implantation in high-risk patients: A single center experience. Catheter Cardiovasc Interv 2015; 86:634-41. [PMID: 26032270 PMCID: PMC5033034 DOI: 10.1002/ccd.25945] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/26/2015] [Accepted: 03/14/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Our aim was to assess the procedural success and determine the clinical predictors of postprocedure mortality, following rotational atherectomy (RA) and stenting in high-risk patients. BACKGROUND RA is mainly used to facilitate stenting in complex lesions. Outcomes involving RA and stenting have been investigated, yet high-risk patients have not been adequately described. METHODS Data of 218 consecutive patients who underwent RA were evaluated in a prospective register. Primary endpoints were the angiographic success and long-term mortality. Secondary endpoints were procedural success, consumption of the angioplasty equipment, and periprocedural major adverse cardiac events. The impact of the relevant angiographic and clinical characteristics on long-term mortality was analyzed using uni- and multivariate Cox regression analysis. RESULTS Mean age of the patients was 70 ± 8.2 years, diabetes was present in 44%, and chronic renal failure in 29%. Prior myocardial infarction and three-vessel disease amounted to 42.2% and 32.6%, respectively. Altogether, 52.8% of patients underwent RA after a failed, non-RA intervention attempt, and 30.7% of cases presented as acute coronary syndromes. Angiographic success was 100%, and all patients received stents after RA. Periprocedural major adverse cardiac events occurred in five (2.3%) patients. Postprocedural death was investigated, with a mean follow-up of 36 months. Mortality amounted to 37.2%. Multivariate analysis revealed that left ventricular ejection fraction < 50%, glomerular filtration rate < 60 ml/min, cardiogenic shock, and diabetes were the only independent mortality predictors. CONCLUSIONS We have found that RA and stenting is feasible and viable in an elderly high-risk population, with exceptional procedural success and acceptable long-term results.
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Affiliation(s)
- István F. Édes
- Semmelweis University Heart and Vascular CenterVárosmajor street 681122BudapestHungary
| | - Zoltán Ruzsa
- Semmelweis University Heart and Vascular CenterVárosmajor street 681122BudapestHungary
| | - György Szabó
- György Gottsegen National Institute of CardiologyHaller steet 291096BudapestHungary
| | - Sándor Nardai
- Semmelweis University Heart and Vascular CenterVárosmajor street 681122BudapestHungary
| | - Dávid Becker
- Semmelweis University Heart and Vascular CenterVárosmajor street 681122BudapestHungary
| | - Kálmán Benke
- Semmelweis University Heart and Vascular CenterVárosmajor street 681122BudapestHungary
| | - Bálint Szilveszter
- Semmelweis University Heart and Vascular CenterVárosmajor street 681122BudapestHungary
| | - Béla Merkely
- Semmelweis University Heart and Vascular CenterVárosmajor street 681122BudapestHungary
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Barbato E, Carrié D, Dardas P, Fajadet J, Gaul G, Haude M, Khashaba A, Koch K, Meyer-Gessner M, Palazuelos J, Reczuch K, Ribichini FL, Sharma S, Sipötz J, Sjögren I, Suetsch G, Szabó G, Valdés-Chávarri M, Vaquerizo B, Wijns W, Windecker S, de Belder A, Colombo A, Di Mario C, Latib A, Hamm C, Latib A, Hamm C. European expert consensus on rotational atherectomy. EUROINTERVENTION 2015; 11:30-6. [DOI: 10.4244/eijv11i1a6] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kanazawa T, Kadota K, Mitsudo K. Successful rescue of stuck rotablator burr entrapment using a Kiwami straight catheter. Catheter Cardiovasc Interv 2015; 86:942-5. [PMID: 25712486 DOI: 10.1002/ccd.25903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/22/2015] [Indexed: 11/07/2022]
Abstract
Rotational atherectomy is an indispensable modality for percutaneous coronary intervention of severely calcified lesions. An entrapped rotablator burr is a rare but life-threatening complication because retrieval is difficult. Although emergent surgical removal is a reliable option for this complication, it is invasive. There are various methods to retrieve an entrapped burr by bailout endovascular approaches. We present two cases of successful rescue of stuck rotablator burr entrapment using a Kiwami straight catheter (4 Fr, Heartrail II, Terumo, Tokyo, Japan).
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Affiliation(s)
- Takenori Kanazawa
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazuaki Mitsudo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
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Locca D, Eeckhout E, Noc M, Sianos G, Shin DH, Hong MK. How should I treat an undeployed stent stuck in the proximal LAD? Going for another round... EUROINTERVENTION 2014; 10:528-30. [PMID: 25138192 DOI: 10.4244/eijv10i4a91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Didier Locca
- Cardiology Division, University Hospital CHUV, Lausanne, Switzerland
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Tomey MI, Kini AS, Sharma SK. Current Status of Rotational Atherectomy. JACC Cardiovasc Interv 2014; 7:345-53. [DOI: 10.1016/j.jcin.2013.12.196] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 12/05/2013] [Accepted: 12/19/2013] [Indexed: 01/06/2023]
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Sato K, Latib A, Costopoulos C, Panoulas VF, Naganuma T, Miyazaki T, Colombo A. A case of Kawasaki's disease with extensive calcifications needing rotational atherectomy with a 2.5mm burr. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:248-51. [PMID: 24565607 DOI: 10.1016/j.carrev.2014.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/28/2013] [Accepted: 01/07/2014] [Indexed: 11/17/2022]
Abstract
This case report demonstrates a unique strategy requiring a 2.5 mm burr to treat in-stent restenosis of an originally underexpanded stent, implanted in a heavily calcified lesion within a giant aneurysm by Kawasaki disease. Despite our procedural success, it should be emphasized that stent implantation in undilatable lesions should be avoided. When an angiographically calcified lesion within an ectatic segment is observed in a patient with Kawasaki disease, it is recommended that the operator evaluates in detail the severity and location of calcification using intravascular ultrasound imaging and pays meticulous attention to lesion preparation.
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Affiliation(s)
- Kastsumasa Sato
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Charis Costopoulos
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | | | - Toru Naganuma
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Tadashi Miyazaki
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
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DAHDOUH ZIAD, ABDEL-MASSIH TONY, ROULE VINCENT, SARKIS ANTOINE, GROLLIER GILLES. Rotational Atherectomy as Endovascular Haute Couture: A Road Map of Tools and Techniques for the Interventional Management of Burr Entrapment. J Interv Cardiol 2013; 26:586-95. [DOI: 10.1111/joic.12075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- ZIAD DAHDOUH
- Department of Interventional Cardiology; University Hospital of Caen; Caen France
| | - TONY ABDEL-MASSIH
- Department of Cardiology; Hotel-Dieu de France Hospital; Achrafieh Beirut Lebanon
| | - VINCENT ROULE
- Department of Interventional Cardiology; University Hospital of Caen; Caen France
| | - ANTOINE SARKIS
- Department of Cardiology; Hotel-Dieu de France Hospital; Achrafieh Beirut Lebanon
| | - GILLES GROLLIER
- Department of Interventional Cardiology; University Hospital of Caen; Caen France
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