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Galougahi KK, Shin D, Dakroub A, Sakai K, Singh M, Malik S, Maehara A, Matsumura M, Mintz G, Spratt JC, Khalique O, Shlofmitz E, Jeremias A, Shlofmitz R, Ali ZA. Distinct Challenges of Eruptive and Non-Eruptive Calcified Nodules in Percutaneous Coronary Intervention. Curr Cardiol Rep 2024; 26:757-765. [PMID: 38809401 DOI: 10.1007/s11886-024-02075-w] [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] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW To provide a summary of prevalence, pathogenesis, and treatment of coronary calcified nodules (CNs). RECENT FINDINGS CNs are most frequently detected at the sites of hinge motion of severely calcified lesions such as in the middle segment of right coronary artery and left main coronary bifurcation. On histopathology, CNs exhibit two distinctive morphologies: eruptive and non-eruptive. Eruptive CNs, which have a disrupted fibrous cap with adherent thrombi, are biologically active. Non-eruptive CNs, which have an intact fibrous cap without thrombi, are biologically inactive, representing either healed eruptive CNs or protrusion of calcium due to plaque progression. Recent studies using optical coherence tomography (OCT) have shown a difference in the mechanism of stent failure in the two subtypes, demonstrating early reappearance of eruptive CNs in the stent (at ~ 6 months) as a unique mechanism of stent failure that does not seem to be preventable by simply achieving adequate stent expansion. The cause of CN reappearance in stent is not known and could be due to acute or subacute intrusion or continued growth of the CN. Whether modification of CN is needed, the most effective calcium modification modality and effectiveness of stent implantation in eruptive CNs has not been elucidated. In this review, we discuss pathogenesis of CNs and how intravascular imaging can help diagnose and manage patients with CNs. We also discuss medical and transcatheter therapies beyond conventional stent implantation for effective treatment of eruptive CNs that warrant testing in prospective studies.
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Affiliation(s)
- Keyvan Karimi Galougahi
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Doosup Shin
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Ali Dakroub
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Koshiro Sakai
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Mandeep Singh
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Sarah Malik
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
- Division of Cardiology, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Gary Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - James C Spratt
- Department of Cardiology, St George's, University of London, London, UK
| | - Omar Khalique
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Evan Shlofmitz
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Richard Shlofmitz
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Ziad A Ali
- Department of Cardiology, St Francis Hospital & Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA.
- Cardiovascular Research Foundation, New York, NY, USA.
- New York Institute of Technology, Old Westbury, NY, USA.
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Narui S, Yamamoto MH, Mori H, Amemiya K, Okabe T, Koyanagi Y, Ito Y, Gibo Y, Okura T, Fujioka T, Ishigaki S, Usumoto S, Kimura T, Shimazu S, Saito J, Oyama Y, Igawa W, Ono M, Isomura N, Ochiai M. Mechanism of Stent Failure in Patients With Eruptive Calcified Nodule Treated With Rotational Atherectomy. Can J Cardiol 2024:S0828-282X(24)00440-9. [PMID: 38880396 DOI: 10.1016/j.cjca.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) for lesions with eruptive calcified nodules (CNs) is associated with worse outcomes compared with that for other calcified lesions. We aimed to clarify the relationship between eruptive CNs at index PCI, optical coherence tomography (OCT) findings at the 8-month follow-up, and clinical outcomes using serial OCT. METHODS This retrospective observational study used data from a prospective, single-centre registry. We conducted consecutive PCI for calcified lesions requiring rotational atherectomy (RA) with OCT guidance. We categorized 51 patients (54 lesions) into those with (16 patients [16 lesions]) and without eruptive CNs (35 patients [38 lesions]). RESULTS Post-PCI, stent expansion was comparable between the 2 groups, and CN-like protrusion was found in 75% of lesions with eruptive CNs. Follow-up OCT at 8 months revealed in-stent CNs in 54% of treated eruptive CN lesions, whereas lesions without eruptive CNs lacked in-stent CNs. Multivariate linear regression analysis demonstrated that eruptive CN was associated with maximum neointimal tissue (NIT) thickness (regression coefficient 0.303; 95% confidence interval, 0.057-0.549; P = 0.02). Consequently, patients with eruptive CNs exhibited a higher clinically driven target lesion revascularization (TLR) rate than did those without at 1 year (31.3% vs 2.9%, P = 0.009) and 5 years (43.8% vs 11.4%, P = 0.02). TLR primarily occurred in lesions with maximum eruptive CN arc angles > 180°. CONCLUSIONS Following RA treatment with acceptable stent expansion, eruptive CNs before PCI correlated with greater NIT formation with in-stent CNs, resulting in a higher TLR rate, particularly in lesions with maximum eruptive CN arc angles exceeding 180°.
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Affiliation(s)
- Shuro Narui
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Myong Hwa Yamamoto
- Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan.
| | - Hiroyoshi Mori
- Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Kisaki Amemiya
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshitaka Okabe
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yui Koyanagi
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yuki Ito
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yuma Gibo
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Takeshi Okura
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Tatsuki Fujioka
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Shigehiro Ishigaki
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Soichiro Usumoto
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Taro Kimura
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Suguru Shimazu
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Jumpei Saito
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yuji Oyama
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Wataru Igawa
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Morio Ono
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Naoei Isomura
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Masahiko Ochiai
- Division of Cardiology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
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Shin D, Karimi Galougahi K, Spratt JC, Maehara A, Collet C, Barbato E, Ribichini FL, Gonzalo N, Sakai K, Mintz GS, Stone GW, Shlofmitz E, Shlofmitz RA, Jeremias A, Ali ZA. Calcified Nodule in Percutaneous Coronary Intervention: Therapeutic Challenges. JACC Cardiovasc Interv 2024; 17:1187-1199. [PMID: 38811101 DOI: 10.1016/j.jcin.2024.03.032] [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: 08/22/2023] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 05/31/2024]
Abstract
Calcified nodules (CNs) are among the most challenging lesions to treat in contemporary percutaneous coronary intervention. CNs may be divided into 2 subtypes, eruptive and noneruptive, which have distinct histopathological and prognostic features. An eruptive CN is a biologically active lesion with a disrupted fibrous cap and possibly adherent thrombus, whereas a noneruptive CN has an intact fibrous cap and no adherent thrombus. The use of intravascular imaging may allow differentiation between the 2 subtypes, thus potentially guiding treatment strategy. Compared with noneruptive CNs, eruptive CNs are more likely to be deformable, resulting in better stent expansion, but are paradoxically associated with worse clinical outcomes, in part because of their frequent initial presentation as an acute coronary syndrome and subsequent reprotrusion of the CN into the vessel lumen through the stent struts. Pending the results of ongoing studies, a tailored therapeutic approach based on the distinct features of the different CNs may be of value.
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Affiliation(s)
- Doosup Shin
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | | | - James C Spratt
- St. George's, University of London, London, United Kingdom
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Nieves Gonzalo
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Koshiro Sakai
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Evan Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Richard A Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Ziad A Ali
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; New York Institute of Technology, Old Westbury, New York, USA.
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Mori H, Sekimoto T, Arai T, Sakai R, Sato S, Tezuka T, Omura A, Shinke T, Suzuki H. Mechanisms of Very Late Stent Thrombosis in Japanese Patients as Assessed by Optical Coherence Tomography. Can J Cardiol 2024; 40:696-704. [PMID: 38043704 DOI: 10.1016/j.cjca.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Although very late stent thrombosis (VLST) remains an important concern, the underlying etiology and clinical characteristics are not fully elucidated in Japanese patients who undergo intravascular imaging-guided percutaneous coronary intervention (PCI) regularly. METHODS We identified 50 VLST lesions (bare-metal stent [BMS] [n = 16], first-generation drug-eluting stent [DES] [n = 14] and newer-generation DES [n = 20]) in patients managed in our institutes. The underlying mechanism of VLST was assessed by optical coherence tomography (OCT), and the major etiology of each lesion was determined. The aim of this study was to explore the mechanisms of VLST of BMSs and DESs in Japanese patients. RESULTS The median duration since stent implantation was 10 years (range: 1-20). The most frequent etiology of VLST was neoatherosclerotic rupture (44%), followed by neointimal erosion (24%). Edge disease (10%) and evagination (10%) were similarly observed. Malapposition (8%) was deemed to be acquired late by looking at intravascular imaging from the index procedure. Uncovered struts (2%) and in-stent calcified nodule (2%) were the least frequent etiologies. Regardless of etiology, signs of neoatherosclerosis were present in most lesions (82%). Most patients received single (68%) or dual (8%) antiplatelet therapy or oral anticoagulation alone (4%), whereas a considerable proportion of patients discontinued medication (20%). Regarding the treatment strategy, drug-coated balloon was the most frequent strategy (56%), followed by implantation of newer DESs (34%). CONCLUSIONS Various mechanisms have been identified in Japanese patients with VLST. In these patients, biological responses seemed to be more relevant than the index procedure-related factors.
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Affiliation(s)
- Hiroyoshi Mori
- Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.
| | - Teruo Sekimoto
- Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Taito Arai
- Showa University Hospital, Shinagawa, Tokyo, Japan
| | - Rikuo Sakai
- Showa University Hospital, Shinagawa, Tokyo, Japan
| | - Shunya Sato
- Showa University Hospital, Shinagawa, Tokyo, Japan
| | - Takahiro Tezuka
- Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Ayumi Omura
- Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | | | - Hiroshi Suzuki
- Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Dawood M, Elwany M, Abdelgawad H, Sanhoury M, Zaki M, Elsharkawy E, Nawar M. Coronary calcifications, the Achilles heel in coronary interventions. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:1-17. [PMID: 38616941 PMCID: PMC11008515 DOI: 10.5114/aic.2024.136415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/04/2023] [Indexed: 04/16/2024] Open
Abstract
Percutaneous coronary intervention in severely calcified coronaries has been associated with higher rates of procedural complications, including myocardial infarction and death in addition to increased frequency of coronary revascularization on an intermediate and long-term basis. The SYNTAX score, which is designed to assess the complexity of coronary artery disease and aids in choosing a revascularization method, allocates two points per lesion when there is heavy calcification present on fluoroscopy. With the advent of novel multimodality imaging technologies, the detection and evaluation of coronary calcifications improved significantly over the last decade. Several tools are now available for modifying calcified lesions including different types of dedicated balloons and atherectomy devices, which may create some degree of confusion regarding the suitable application of each instrument. The aim of this review is to cover this vital topic from different aspects. First, we tried to provide an overview on the pathophysiology and types of coronary calcification and its risk factors. Then, we outlined the available imaging modalities for the evaluation of calcified coronary lesions, highlighting the points of strength and weakness of each of them. A comprehensive discussion of calcium-modifying techniques was elaborated, summarizing their mechanism of action, pros and cons, and possible complications. Finally, an integrated algorithm was proposed for the best management of calcified coronary lesions.
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Affiliation(s)
- Moustafa Dawood
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Moustafa Elwany
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hoda Abdelgawad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- King’s College Hospital NHS Trust, London, UK
| | | | - Moataz Zaki
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Eman Elsharkawy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Moustafa Nawar
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Jinnouchi H, Sakakura K, Taniguchi Y, Yamamoto K, Hatori M, Tsukui T, Kasahara T, Watanabe Y, Seguchi M, Fujita H. Clinical Impact of In-Stent Calcification in Coronary Arteries: Optical Coherence Tomography Study. Am J Cardiol 2024; 214:115-124. [PMID: 38232806 DOI: 10.1016/j.amjcard.2023.12.060] [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: 11/16/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
In-stent restenosis with neoatherosclerosis has been known as the predictor of target lesion revascularization (TLR) after percutaneous coronary intervention. However, the impact of in-stent calcification (ISC) alone on clinical outcomes remains unknown since neoatherosclerosis by optical coherence tomography includes in-stent lipid and calcification. We aimed to assess the effect of ISC on clinical outcomes and clinical differences among different types of ISC. We included 126 lesions that underwent optical coherence tomography-guided percutaneous coronary intervention and divided those into the ISC group (n = 38) and the non-ISC group (n = 88) according to the presence of ISC. The cumulative incidence of clinically driven TLR (CD-TLR) was compared between the ISC and non-ISC groups. The impact of in-stent calcified nodule and nodular calcification on CD-TLR was evaluated using the Cox hazard model. The incidence of CD-TLR was significantly higher in the ISC group than in the non-ISC group (p = 0.004). In the multivariate Cox hazard model, ISC was significantly associated with CD-TLR (hazard ratio [HR] 3.58, 95% confidence interval [CI] 1.33 to 9.65, p = 0.01). In-stent calcified nodule/nodular calcification and in-stent nodular calcification alone were also the factors significantly associated with CD-TLR (HR 3.34, 95%CI 1.15 to 9.65, p = 0.03 and HR 5.21, 95%CI 1.82 to 14.91, p = 0.002, respectively). ISC without in-stent calcified nodule/nodular calcification, which was defined as in-stent smooth calcification, was not associated with CD-TLR. In conclusion, ISC was associated with a higher rate of CD-TLR. The types of calcifications that led to a high rate of CD-TLR were in-stent calcified nodule/nodular calcification and in-stent nodular calcification alone but not in-stent smooth calcification. In-stent calcified nodule and nodular calcification should be paid more attention.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masashi Hatori
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taku Kasahara
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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7
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Taniguchi Y, Sakakura K, Jinnouchi H, Tsukui T, Fujita H. Rotational atherectomy to left circumflex ostial lesions: tips and tricks. Cardiovasc Interv Ther 2023; 38:367-374. [PMID: 37300802 DOI: 10.1007/s12928-023-00941-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
Serious complications including vessel perforation may occur during rotational atherectomy (RA) to left circumflex (LCX) ostial lesions. In fact, if perforation occurs around LCX ostium, bailout procedures including deployment of covered stents may cause fatal ischemia in the territory of left anterior descending artery, which results in broad anterior acute myocardial infarction and subsequent death. In this review article, we described tips and tricks for RA to LCX ostial lesions. First, we should cautiously decide the indication for RA to LCX ostial lesions, because there are several reasons to avoid RA to LCX ostial lesions. Before procedures, we should estimate the difficulty of RA to LCX ostial lesions, which is mainly determined by the combination of the bifurcation angle and the severity of stenosis. Thus, the combination of the large bifurcation angle and the tight stenosis makes RA to LCX ostial lesions most difficult. Appropriate position of guide catheter and RotaWire is a key to successful RA to LCX ostial lesions. Differential cutting is an essential concept for RA to LCX ostial lesions. However, since there is no guarantee that differential cutting always works, small burr (≤ 1.5 mm) would be a safe choice as initial burr for RA to LCX ostial lesions.
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Affiliation(s)
- Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, Saitama, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, Saitama, 330-8503, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, Saitama, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, Saitama, 330-8503, Japan
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8
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Sakakura K, Jinnouchi H, Taniguchi Y, Yamamoto K, Fujita H. Lifetime management of severely calcified coronary lesions: the treatment algorithm focused on the shape of calcification. Cardiovasc Interv Ther 2023; 38:375-380. [PMID: 37542662 DOI: 10.1007/s12928-023-00950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
The concept of lifetime management has not been discussed in the field of percutaneous coronary intervention (PCI), because the durability of drug-eluting stent (DES) is considered to be long enough for most patients. Furthermore, even if in-stent restenosis occurs, the treatment for in-stent restenosis is simple in most cases. On the other hand, the long-term clinical outcomes after DES implantation are worse in severely calcified coronary lesions than in non-calcified lesions. Moreover, the treatment for in-stent calcified restenosis or restenosis due to stent underexpansion is not simple. The concept of lifetime management of severely calcified lesions may be necessary like that of aortic stenosis. Recently, several algorithms have been published in PCI to severely calcified lesions, partly because of the emergence of IVL. These algorithms focus on the selection of cracking and debulking devices for the preparation of stenting. However, the optimal stent expansion does not guarantee the long-term patency, when the target lesion includes calcified nodules. Stent restenosis due to calcified nodules is difficult to manage. In this review article, we propose the algorithm for severely calcified lesions focused on the shape of calcification. We do not need to hesitate stenting when multiple cracks on circumferential calcification are observed by intravascular imaging devices. However, DCB may be an option as final device in some situations, when lifetime management of severely calcified lesions is considered.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
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9
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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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Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023. Cardiovasc Interv Ther 2023; 38:141-162. [PMID: 36642762 PMCID: PMC10020250 DOI: 10.1007/s12928-022-00906-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Abstract
The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidences regarding rotational atherectomy (RA) in 2020. Because the revascularization strategy to severely calcified lesions is the hottest topic in contemporary percutaneous coronary intervention (PCI), many evidences related to RA have been published since 2020. Latest advancements have been incorporated in this updated expert consensus document.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Interventional Cardiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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