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Shekiladze N, Sandesara PB, Tai Z, Maisuradze N, Jaber W, Nicholson W. Technical aspects of entrapped coronary guidewire retrieval using rotational atherectomy device: A case series. Catheter Cardiovasc Interv 2024; 103:89-96. [PMID: 38071427 DOI: 10.1002/ccd.30923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND This article highlights four unique cases where rotational atherectomy (RA Rotapro, Boston Scientific) was used to cut and retrieve an entrapped coronary guidewire with parts extending into the aorta We discuss the technique and step by step approach to the retrieval procedure. CASE SUMMARY Three of four cases described a guide wire entrapment in the right coronary artery (RCA), and one in the left anterior descending artery via retrograde route. In all cases the guide wire was intact within the intracoronary segment. In Case 1, the guide wire (Runthrough; Terumo) was entrapped in an acute marginal branch during chronic total occlusion (CTO) percutaneous coronary intervention. In Case 2, a whisper wire (Abbott) was entrapped during re-wiring of the right posterolateral branch through stent struts, the traction on the wire caused severe malformation of distal and proximal stents requiring second staged procedure to complete revascularization of the RCA CTO. In Case 3, a Runthrough wire was entrapped between two layers of stents and fractured at the proximal point with filaments extending into descending aorta. And in Case 4, a Pilot 200 (Abbott) wire was entrapped retrograde in the subintimal space via saphenous vein graft connection by tying a knot at the distal tip of the wire. In all four cases RA was used to successfully cut and remove the entrapped guide wires. DISCUSSION Rotablation technique appears to be a safe and effective strategy for the management of entrapped coronary guidewire when conventional strategies fail.
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Affiliation(s)
- Nikoloz Shekiladze
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pratik B Sandesara
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zaheed Tai
- Division of Cardiology, Winter Haven Hospital, Winter Haven, Florida, USA
| | - Nodar Maisuradze
- Division of Cardiology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Wissam Jaber
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William Nicholson
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Choi SS, Jung J, Her SH, Kim K, Kim Y, Lee K, Yoo KD, Moon KW, Moon D, Lee SN, Jang WY, Choi IJ, Lee JH, Lee JH, Lee SR, Lee SW, Yun KH, Lee HJ. Comparative Analysis of High-Intensity versus Low-to-Moderate Intensity Statin Therapy in Patients Undergoing Rotational Atherectomy for Calcified Coronary Artery Disease. Life (Basel) 2023; 13:2232. [PMID: 38004373 PMCID: PMC10672288 DOI: 10.3390/life13112232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Moderate-intensity statin therapy, when compared to high-intensity statin therapy in Asian populations, has shown no significant difference in cardiovascular prognosis in small studies. The aim of this study was to compare the prognosis of patients based on statin intensity following rotational atherectomy (RA) during high-complexity percutaneous coronary intervention (PCI). (2) Methods: The ROCK registry, a multicenter retrospective study, included patients who had undergone rotational atherectomy (RA) during percutaneous coronary intervention (PCI) at nine tertiary medical centers in South Korea between January 2010 and October 2019. The patients were divided into high-intensity statin (H-statin) and moderate/low-intensity statin (M/L-statin) therapy groups. The primary endpoint includes outcomes (cardiac death, target vessel myocardial infarction (MI), and target vessel revascularization (TVR)) within an 18-month follow-up period. (3) Results: In this registry, a total of 540 patients with 583 lesions were included. We excluded 39 lesions from the analysis due to the absence of statin usage. The H-statin group had 394 lesions and the M/L-statin group had 150 lesions. There were no significant differences in baseline characteristics, procedural adverse events without heart failure history, triglycerides, or medications between the two groups. The procedural success rate showed a significant difference between the two groups. Multivariate analysis did not show a significant association between M/L-statin therapy and an increased risk of the primary endpoint. In propensity score matching analysis, no significant difference was observed in the primary endpoint either. (4) Conclusions: In high-complex RA PCI, moderate/low-intensity statin therapy is not inferior to high-intensity statin therapy in Korea.
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Affiliation(s)
- Sang-Suk Choi
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (S.-S.C.); (J.J.); (K.K.); (Y.K.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Jin Jung
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (S.-S.C.); (J.J.); (K.K.); (Y.K.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Sung-Ho Her
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (S.-S.C.); (J.J.); (K.K.); (Y.K.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Kyunyeon Kim
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (S.-S.C.); (J.J.); (K.K.); (Y.K.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Youngmin Kim
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (S.-S.C.); (J.J.); (K.K.); (Y.K.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Kyusup Lee
- Department of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 34943, Republic of Korea;
| | - Ki-Dong Yoo
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (S.-S.C.); (J.J.); (K.K.); (Y.K.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Keon-Woong Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (S.-S.C.); (J.J.); (K.K.); (Y.K.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Donggyu Moon
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (S.-S.C.); (J.J.); (K.K.); (Y.K.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Su-Nam Lee
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (S.-S.C.); (J.J.); (K.K.); (Y.K.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Won-Young Jang
- Department of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (S.-S.C.); (J.J.); (K.K.); (Y.K.); (K.-D.Y.); (K.-W.M.); (D.M.); (S.-N.L.); (W.-Y.J.)
| | - Ik-Jun Choi
- Department of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea;
| | - Jae-Hwan Lee
- Department of Cardiology in Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea;
| | - Jang-Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea;
| | - Sang-Rok Lee
- Department of Cardiology, Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Kyeong-Ho Yun
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan 54538, Republic of Korea;
| | - Hyun-Jong Lee
- Department of Internal Medicine, Sejong General Hospital, Bucheon 14754, Republic of Korea
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Ajagbe T, Bello O, Fagbemi O, Ungvari T. Impella-Driven High-Risk Percutaneous Coronary Intervention: A Novel, Single Non-Surgical-Centre Case Report. Cureus 2023; 15:e49128. [PMID: 38125232 PMCID: PMC10732543 DOI: 10.7759/cureus.49128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Complex percutaneous coronary intervention (PCI) procedures have been routinely performed in non-surgical centres in the UK for more than two decades. These procedures follow strict guidelines and recommendations by the British Cardiovascular Intervention Society to ensure a more effective running of PCI programs. Even more so, expected guiding principles necessary for the safe optimisation of complex PCI procedures have also been created. An 81-year-old male was admitted with non-ST-elevation myocardial infarction (NSTEMI) and severely impaired left ventricle ejection fraction (LVEF; 26% according to the cardiac MRI report). Angiogram findings revealed severe multiple-vessel coronary artery disease affecting the following arteries: right coronary artery (RCA), left anterior descending artery (LAD), left circumflex artery (LCx), and intermediate artery (IM). There was also severe disease in the distal left main stem (LMS) bifurcation extending to the ostia of the LAD, LCx, and IM branches. Following a multidisciplinary meeting, the patient underwent Impella-supported high-risk PCI (complex PCI) using the DK crush technique with no peri- and post-procedure complication and a significant LV function improvement (45-49%). This is the first known case of this procedure performed at the Royal Cornwall Hospital in Treliske (RCHT), Truro, Cornwall. This case report highlights that when the decision to choose between coronary artery bypass graft (CABG) and PCI is not straightforward following an individualised risk-stratification scoring system analysis and in the setting of patient comorbidities, a high-risk PCI supported with the Impella device is a suitable alternative with promising short-term and long-term outcomes.
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Affiliation(s)
| | - Olamide Bello
- Haematology, Somerset NHS Foundation Trust, Taunton, GBR
| | - Ona Fagbemi
- General Surgery, University Hospital North Midlands Stoke, Stoke-on-Trent, GBR
| | - Tamas Ungvari
- Cardiology, Royal Cornwall Hospital Treliske, Truro, GBR
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Vachiat A, Ntsekhe M, Hellig F. Hybrid rotablation and drug-eluting balloon strategy. Cardiovasc J Afr 2020; 32:28-32. [PMID: 33179716 DOI: 10.5830/cvja-2020-050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/06/2020] [Indexed: 11/06/2022] Open
Abstract
AIM The aim was to assess the safety and efficacy of rotational atherectomy followed by drug-eluting balloon (DEB) in patients with a high risk of bleeding. METHODS A retrospective review was carried out of hospital records of consecutive patients who underwent the hybrid procedure. RESULTS The average age of the 23 patients was 74 years. Risk factors for bleeding included renal failure (35%), oral anticoagulation use (26%) and peptic ulcer disease (35%). All patients had procedural success. No bleeding was reported over the 24-month follow-up period. Dual antiplatelet therapy was stopped successfully in six patients (26%) at three months. Two patients had confirmed target-lesion failure (restenosis). Two patients died over the study period but the cause of death was not known to be cardiovascular disease related. CONCLUSIONS For patients at high risk of bleeding who require rotablation, the use of a drug-eluting balloon may be a safe, effective alternative.
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Affiliation(s)
- Ahmed Vachiat
- Division of Cardiology, University of Cape Town, Cape Town, South Africa; Wits Donald Gordon Medical Centre, University of the Witwatersrand, Milpark Hospital, Johannesburg, South Africa.
| | - Mpiko Ntsekhe
- Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - Farrel Hellig
- Division of Cardiology, University of Cape Town, Cape Town, South Africa; Sunninghill Hospital, Sunward Park Hospital, Johannesburg, South Africa
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Aznaouridis K, Bonou M, Masoura C, Kapelios C, Tousoulis D, Barbetseas J. Rotatripsy: A Hybrid "Drill and Disrupt" Approach for Treating Heavily Calcified Coronary Lesions. J Invasive Cardiol 2020; 32:E175. [PMID: 32479423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In balloon-uncrossable calcified lesions, rotational atherectomy (RA) is the first-line modality to enable operators to advance balloons and stents over the stenosis. If the lesion is undilatable after RA, a hybrid approach with additional intracoronary lithotripsy (rotatripsy) can be an effective approach that further modifies the calcified plaque and enables stent delivery.
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Affiliation(s)
- Konstantinos Aznaouridis
- 1st Department of Cardiology, Hippokration Hospital, 114 Vas. Sofias Avenue, 11527 Athens, Greece.
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Macaya F, Yeoh J, Hill J, Dworakowski R. Adjunctive Rotational Atherectomy and Intravascular Lithotripsy for Heavily Calcified Left Main Disease Via Radial Access. J Invasive Cardiol 2020; 32:E99. [PMID: 32240100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Coronary angiography demonstrated severe distal left main disease in a patient with heavy concentric calcification extending into the left anterior descending and left circumflex arteries. Rotational atherectomy and lithotripsy were used to debulk plaque so that stenting could be performed.
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Ueki Y, Otsuka T, Hibi K, Räber L. The Value of Intracoronary Imaging and Coronary Physiology When Treating Calcified Lesions. ACTA ACUST UNITED AC 2019; 14:164-168. [PMID: 31867063 PMCID: PMC6918501 DOI: 10.15420/icr.2019.16.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/09/2019] [Indexed: 12/15/2022]
Abstract
Heavily calcified coronary artery lesions hinder the delivery of devices and limit stent expansion, resulting in low procedural success and poor clinical outcomes driven by an increase in restenosis and stent thrombosis. Intracoronary imaging provides a more precise assessment of lesions and is a critical step when deciding whether the lesion needs to be prepared with atherectomy devices. Physiological assessment of lesion significance is an important consideration to avoid unnecessary stenting. This article summarises the current data on the value of intracoronary imaging and functional assessment for coronary calcified lesions and suggests a treatment strategy based on the findings of intracoronary imaging findings.
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Bern University Hospital, University of Bern Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern Bern, Switzerland
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Centre Yokohama, Japan
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern Bern, Switzerland
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Adusumalli S, Gaikwad N, Raffel C, Dautov R. Treatment of rotablation-induced ostial left circumflex perforation by papyrus covered stent and its fenestration to recover the left anterior descending artery during CHIP procedure. Catheter Cardiovasc Interv 2019; 93:E331-E336. [PMID: 30790419 DOI: 10.1002/ccd.28114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/27/2018] [Accepted: 01/20/2019] [Indexed: 11/07/2022]
Abstract
Coronary artery perforation is a rare complication of percutaneous coronary intervention (PCI). Covered stents have been successfully used in these situations. We report a case of ostial left circumflex (LCx) artery perforation during rotablation PCI of left main coronary artery (LMCA) and LCx artery. After failed attempts to balloon tamponade the perforation, a PK Papyrus covered stent was deployed from proximal LCx into LMCA. This resulted in acute exclusion of the left anterior descending (LAD) artery from coronary circulation. Using a dual lumen catheter, a stiff wire was advanced through the side port toward the occluded LAD to fenestrate the membrane of the covered stent. A series of balloons were used to dilate the fenestration in the covered stent to restore a normal flow into the LAD.
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Affiliation(s)
- Srikanth Adusumalli
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, Chermside, Queensland, Australia
| | - Niranjan Gaikwad
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, Chermside, Queensland, Australia
| | - Chris Raffel
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, Chermside, Queensland, Australia
| | - Rustem Dautov
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, Chermside, Queensland, Australia
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Hall R, Jones DA, Muthumala A, Weerackody R, Sohaib A, Monkhouse C. Transient rise in His-lead threshold due to acute myocardial infarction. Pacing Clin Electrophysiol 2019; 42:754-757. [PMID: 30659633 DOI: 10.1111/pace.13612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/19/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Abstract
An 85-year-old male was admitted to our center with a non-ST elevation myocardial infarction. The patient had a dual-chamber pacemaker in situ with an atrial and His lead. A transient increase in His threshold and loss of nonselective capture occurred at the presentation of right coronary artery infarction, peaking during rotational atherectomy therapy causing loss of capture and complete atrioventricular block. A follow-up interrogation, 2 weeks postrevascularization, showed a return to a normal nonselective capture morphology and threshold measurements. Physicians should be aware of this complication in patients with His leads, particularly those with a history of coronary artery disease.
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Affiliation(s)
- Robert Hall
- Barts Heart Centre, West Smithfield, London, England
| | | | | | | | - Afzal Sohaib
- Barts Heart Centre, West Smithfield, London, England
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Dobrzycki S, Reczuch K, Legutko J, Pawłowski T, Grygier M, Ochała A, Wójcik J, Buszman P, Dudek D, Gąsior M, Gil R, Lesiak M, Kukuła K, Witkowski A, Zajdel W, Kralisz P, Wojakowski W, Bartuś S. Rotational atherectomy in everyday clinical practice. Association of Cardiovascular Interventions of the Polish Society of Cardiology (Asocjacja Interwencji Sercowo-Naczyniowych Polskiego Towarzystwa Kardiologicznego - AISN PTK): Expert opinion. Kardiol Pol 2018; 76:1576-1584. [PMID: 30460675 DOI: 10.5603/kp.2018.0225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/05/2018] [Indexed: 11/25/2022]
Abstract
The common use of stents, including antiproliferative drug-eluting stents, has been a major breakthrough in invasive cardiology. Nowadays, a change in the clinical presentation of patients treated with percutaneous coronary intervention (PCI) is observed. The typical clinical characteristics now include advanced age, diabetes, chronic kidney disease, heart failure, and multilevel atherosclerosis. Age, diabetes, and chronic kidney disease are the main predictors of coronary artery calcifications. Severe coronary artery calcifications are the main factor limiting the efficacy of PCI. Successful stent implantation is challenging in the presence of calcifications, because it is difficult to achieve full stent expansion and proper stent apposition. Therefore, it is necessary to adequately prepare the lesion before stent implantation. This document presents the technique of rotational atherectomy (rotablation) as well as indications for and contraindications to the procedure, along with its possible complications and their prevention. Training in rotablation for operators as well as reimbursement policy for the procedure in Poland are also discussed.
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Allali A, Abdelghani M, Mankerious N, Abdel-Wahab M, Richardt G, Toelg R. Feasibility and clinical outcome of rotational atherectomy in patients presenting with an acute coronary syndrome. Catheter Cardiovasc Interv 2018; 93:382-389. [PMID: 30196568 DOI: 10.1002/ccd.27842] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 07/28/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We aimed to investigate the feasibility, safety, and outcome of rotational atherectomy (RA) in the setting of acute coronary syndrome (ACS). BACKGROUND Limited data are available on the use of RA in patients presenting with ACS. METHODS This analysis is from an observational registry, which enrolled all consecutive patients undergoing RA in a tertiary center. Between 2002 and 2015, 433 patients with stable coronary artery disease (SCAD) were treated with RA. Within the same period, 108 patients with ACS (8 STEMI and 100 NSTE-ACS) were treated with RA. Procedural success was similar between the ACS and the SCAD groups (96.6% vs. 96.4%, P = 0.90), and no significant difference was observed in procedural complications (slow-flow: 0.8% vs. 2.8%, P = 0.32; coronary dissection: 6.8% vs. 7.2%, P = 1.00; coronary perforation: 0.8% vs. 1.7%, P = 0.69). In-hospital MACE rates were comparable (3.7% vs. 3.2%, P = 0.77). The risk of MACE within 24 months was higher in ACS patients (39.9% vs. 22.4%, log-rank P = 0.002; HR: 1.39; 95% CI: 1.12-1.73; P = 0.003). Multivariable Cox regression analysis identified left ventricular ejection fraction (HR 0.97; 95% CI: 0.85-0.99; P = 0.001), treatment with a BMS (HR 2.22, 95% CI: 1.15-4.25, P = 0.02) or early generation drug eluting stent (HR 1.99; 95% CI 1.09-3.64; P = 0.03), as well as ACS presentation (HR 1.53; 95% CI: 1.02-2.29; P = 0.04) as predictors of MACE at two years. CONCLUSIONS RA is technically feasible and safe in high risk patients presenting with ACS. However, successful application of RA did not mitigate the higher rate of long term cardiovascular events.
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Affiliation(s)
- Abdelhakim Allali
- Department of cardiology, Heart Center, Segeberger Kliniken, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Mohammad Abdelghani
- Department of cardiology, Heart Center, Segeberger Kliniken, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Nader Mankerious
- Department of cardiology, Heart Center, Segeberger Kliniken, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Department of cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany
| | - Gert Richardt
- Department of cardiology, Heart Center, Segeberger Kliniken, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Ralph Toelg
- Department of cardiology, Heart Center, Segeberger Kliniken, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
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Gorol J, Tajstra M, Hudzik B, Lekston A, Gąsior M. Comparison of outcomes in patients undergoing rotational atherectomy after unsuccessful coronary angioplasty versus elective rotational atherectomy. Postepy Kardiol Interwencyjnej 2018; 14:128-34. [PMID: 30008764 DOI: 10.5114/aic.2018.76403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 02/26/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Revascularization of patients with heavily calcified coronary arteries can be a challenge for interventional cardiologists. The procedural success rate in these patients can be improved by using rotational atherectomy (RA). Aim To compare in-hospital outcomes and those at 12-month follow-up between patients who underwent RA as a bailout procedure secondary to failed conventional angioplasty or as an elective procedure. Material and methods This is a retrospective analysis of 156 consecutive patients hospitalized at a high-volume percutaneous coronary intervention (PCI) center who underwent RA. In 43 (27.6%) patients, RA was performed on an elective basis (group 1). In 113 (72.4%) patients RA was carried out after unsuccessful traditional angioplasty (group 2). Results Patients in group 1 more often had a history of peripheral vascular disease (32.6% vs. 15.9%; p = 0.03). Group 1 was dominated by patients with multivessel disease (62.8% vs. 33.6%; p < 0.001). The left main coronary artery was more often treated in group 1 (25.6% vs. 2.7%; p < 0.001). Success rates in the two groups were similar: 93.0% for group 1 and 91.2% for group 2 (p = 0.71). The rate of in-hospital complications did not significantly differ between the groups. Twelve-month MI, TLR, and TVR rates were similar in both groups. There was no difference in the 12-month survival rate (86.1% vs. 92.0% in group 2; p = 0.27) or MACE (16.3% vs. 15.0%; p = 0.8). Conclusions Rotational atherectomy is associated with high efficacy and a relatively low risk of complications, with no significant differences in outcomes between patients treated with primary and secondary RA procedures.
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Januszek R, Siudak Z, Dziewierz A, Rakowski T, Legutko J, Dudek D, Bartuś S. Bailout rotational atherectomy in patients with myocardial infarction is not associated with an increased periprocedural complication rate or poorer angiographic outcomes in comparison to elective procedures (from the ORPKI Polish National Registry 2015-2016). Postepy Kardiol Interwencyjnej 2018; 14:135-43. [PMID: 30008765 DOI: 10.5114/aic.2018.76404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/19/2018] [Indexed: 01/19/2023] Open
Abstract
Introduction Many years of experience and refinement of existing rotational atherectomy (RA) techniques have resulted in improved clinical outcomes and a tendency to broaden the spectrum of RA usage. Aim To compare the angiographic effectiveness and periprocedural complications in patients with stable angina (SA) and acute myocardial infarction (AMI) treated using RA. Material and methods Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry (ORPKI) on all percutaneous coronary interventions (PCIs) performed in Poland in 2015 and 2016. In total, 975 RA procedures were recorded out of 221,187 PCI procedures. Results We compared angiographic effectiveness and periprocedural complications in 530 patients with SA and 245 with AMI in the RA group of patients, and 60,522 patients with SA and 91,985 with AMI in the non-RA group. The overall rate of periprocedural complications did not differ between SA and AMI patients in the RA group (2.3% vs. 2.0%; p = 0.84), while it was lower in AMI patients from the RA group compared to those from the non-RA group (2.0% vs. 3.0%; p = 0.34). The percentage of patients with angiographic success in the RA group was similar to the non-RA group in SA patients (97.3% vs. 97.1%; p = 0.75), whereas in the AMI group it was significantly higher compared to the non-RA group (96.7% vs. 92.6%; p < 0.001). Conclusions The angiographic effectiveness of PCI with RA in patients with AMI was not worse than in patients with SA.
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Kübler P, Zimoch W, Kosowski M, Tomasiewicz B, Rakotoarison O, Telichowski A, Reczuch K. Novel predictors of outcome after coronary angioplasty with rotational atherectomy. Not only low ejection fraction and clinical parameters matter. Postepy Kardiol Interwencyjnej 2018; 14:42-51. [PMID: 29743903 DOI: 10.5114/aic.2018.74354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/10/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Most established risk factors after rotational atherectomy (RA) of heavily fibro-calcified lesions are associated with patients' general risk and clinical related factors and are not specific for either coronary and culprit lesion anatomy or the RA procedure. Aim To assess novel predictors of poor outcome after percutaneous coronary intervention using RA in an all-comers population. Material and methods A total of 207 consecutive patients after RA were included in a single-center observational study. Primary endpoints were 1-year mortality and 1-year major adverse cardiac events (MACE). Secondary endpoints were angiographic and procedural success and in-hospital complications. Results Procedural complications occurred in 19 (8%) patients. In-hospital mortality was 1%, peri-procedural myocardial infarction (MI) was 9%, and acute stroke occurred in one patient. The 1-year MACE rate was 20% with all-cause mortality 10%, MI 10% and stroke 1%. Multivariable analysis revealed heart failure with left ventricle ejection fraction (LVEF) ≤ 35% (p = 0.02) and uncrossable lesion, as compared to undilatable lesion (p = 0.01), as independent predictors of 1-year mortality and residual SYNTAX score ≤ 8 as an independent predictor of favorable outcome (p = 0.04). Heart failure with LVEF ≤ 35% (p < 0.01) and uncrossable lesion (p = 0.04) were independent predictors of 1-year MACE. Conclusions The presence of a novel factor, uncrossable lesion, as compared to undilatable lesion, is associated with poor outcome, and low residual SYNTAX score ≤ 8 is associated with favorable outcome in 1-year follow-up after the RA procedure and can help in risk stratification of patients undergoing complex coronary intervention with RA.
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Cuenza LR, Jayme AC, Khe Sui JH. Clinical Outcomes of Patients Undergoing Rotational Atherectomy Followed by Drug-eluting Stent Implantation: A Single-center Real-world Experience. Heart Views 2018; 18:115-120. [PMID: 29326773 PMCID: PMC5755191 DOI: 10.4103/1995-705x.221231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Rotational atherectomy (RA) is used to improve procedural success of percutaneous catheter interventions (PCIs) of complex and heavily calcified coronary lesions. We report the clinical experience and outcomes in our institution with the use of RA, followed by drug-eluting stent implantation. Materials and Methods: Data of 81 patients treated with PCI and adjunctive RA were analyzed. Clinical follow-up for the occurrence of major adverse events (MAEs) was obtained in all patients and correlated with significant variables using multivariate Cox proportional hazards analysis. Results: Mean age was 67.9 ± 9.2 years, 61.7% had diabetes, 20.9% had chronic kidney disease, and 48.1% had previous acute coronary syndrome (ACS). Mean SYNTAX score was 29.8 ± 12.2, with a 92.5% angiographic success rate achieved. In-hospital MAEs rate was 7.4% while mortality rate was 8.6%. On median follow-up of 12.2 months, incidence of MAEs of 13.5% with a 75% free incidence from MAEs at 34 months. Multivariate analysis revealed that a history of previous ACS, ejection fraction, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, SYNTAX score, burr to artery ratio, and attainment of angiographic success were significant predictors of MAEs. Conclusion: RA followed by drug-eluting stent implantation is a safe and effective method in improving procedural success as well as short- and long-term outcomes of PCI in our center. A combination of clinical and procedural factors is predictive for the occurrence of MAEs and should be taken into account in the application of this technique.
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Affiliation(s)
| | | | - James Ho Khe Sui
- Department of Invasive Cardiology, Philippine Heart Center, Metro Manila, Philippines
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Januszek R, Siudak Z, Dziewierz A, Dudek D, Bartuś S. Predictors of in-hospital effectiveness and complications of rotational atherectomy (from the ORPKI Polish National Registry 2014-2016). Catheter Cardiovasc Interv 2017; 92:E278-E287. [PMID: 29068164 DOI: 10.1002/ccd.27372] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/25/2017] [Accepted: 09/17/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of the study was to assess trends in the use and periprocedural outcomes of rotational atherectomy (RA) in Poland between January 2014 and December 2016. BACKGROUND In recent years, due to the aging population, RA is becoming more commonly used to treat heavily calcified coronary artery stenoses. METHODS Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry on all percutaneous coronary intervention (PCI) procedures performed in Poland. In total, 1,175 RA procedures were recorded from 317,175 PCI procedures (incidence of 0.37%). RESULTS Patients undergoing RA were older (71.7 ± 9.7 vs. 66.9 ± 10.8, P < 0.00001) and less often males (68.3% vs. 76.4%, P < 0.00001). The complication rate was significantly higher in the RA group (P = 0.0012) with the leading coronary artery perforation (CAP) (P < 0.0001). Complication frequency decreased significantly in the last 3 years and was accompanied by an increase in the percentage of radial access and patients with stable angina. Among several predictors of the use of RA during PCI in multivariate analysis, the strongest one was previous coronary artery by-pass grafting (P < 0.0001), whereas the strongest, predictor of CAP was the RA procedure (P = 0.00004). The increase in RA frequency over the last 3 years may reflect population aging, some fluctuations in indications for RA and reimbursement policies. CONCLUSIONS We observed a substantial increase in the utilization of RA during PCIs performed in Poland; however, it still needs to be increased. Decreased frequency of RA procedures follows change in indications for RA and vascular access. Periprocedural complication rates significantly decreased over the last 3 years.
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Affiliation(s)
- Rafał Januszek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Zbigniew Siudak
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Abstract
Heavily calcified coronary plaques represent a complex lesion subset and a challenge to the interventional cardiologist, as they are often resistant to simple plaque modification with conventional balloon angioplasty. Inadequate plaque modification can lead to stent underdeployment, which itself predisposes to in-stent restenosis and stent thrombosis. Over the years, a number of mechanical devices ranging from modified angioplasty balloons to atherectomy devices have become available in order to tackle such lesions. Here we review these devices concentrating on the evidence behind their use.
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Affiliation(s)
- Mohamed Farag
- a Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Charis Costopoulos
- a Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK.,b Department of Cardiovascular Medicine , University of Cambridge , Cambridge , UK
| | - Diana A Gorog
- c Faculty of Medicine, National Heart and Lung Institute, Imperial College London , London , UK
| | - Abhiram Prasad
- d Department of Cardiology, St George's University Hospitals NHS Trust , London , UK
| | - Manivannan Srinivasan
- a Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
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Showkathali R, Davies JR. Transradial rotablation in a patient with dextrocardia and acute ST-elevation myocardial infarction. Interv Med Appl Sci 2013; 4:221-3. [PMID: 24265880 DOI: 10.1556/imas.4.2012.4.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/17/2012] [Indexed: 11/19/2022] Open
Abstract
An 82-year-old gentleman with situs inversus and dextrocardia was admitted to our unit following thrombolysis for inferior ST-elevation myocardial infarction (STEMI). Due to ongoing ischemic symptoms, he underwent emergency transradial coronary angiography. His culprit right coronary artery (RCA) was heavily calcified with severe stenosis in the mid and distal segments. Therefore, rotational atherectomy was performed for debulking, and four drug eluting stents were deployed in the RCA. To the best of our knowledge, this is the first reported case of successful transradial rotablation percutaneous coronary intervention in acute STEMI in a patient with dextrocardia. We also did not use temporary pacemaker wire insertion (TPW) because of the risk of right ventricular perforation (RV) in inferior STEMI with RV involvement.
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Kosowski M, Zimoch W, Kübler P, Wojtczak M, Telichowski A, Reczuch K. Percutaneous retrieval of a detached rotational atherectomy burr. Postepy Kardiol Interwencyjnej 2013; 9:301-3. [PMID: 24570739 DOI: 10.5114/pwki.2013.37516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 06/05/2013] [Accepted: 08/08/2013] [Indexed: 11/17/2022] Open
Abstract
Rotablation (rotational atherectomy) is an acknowledged method of percutaneous treatment of highly calcified coronary artery lesions that cannot be treated with traditional angioplasty. The complexity of the technique and usage of very specific equipment can contribute to the development of uncommon complications. We present a case of percutaneous retrieval of a damaged rotational atherectomy burr in a 74-year-old male patient.
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