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Shammas NW, Yates T, Sastry A, Ricotta J, Beasley R, Swee W, Torey JT, Shammas GA, Jones-Miller S, Corbet M. Prospective, Multi-center, Single-Arm Study of the Auryon Laser System for Treatment of Below-the-Knee Arteries in Patients With Chronic Limb-Threatening Ischemia: 30-Day Results of the Auryon BTK. Am J Cardiol 2024; 219:1-8. [PMID: 38458581 DOI: 10.1016/j.amjcard.2024.03.008] [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: 01/25/2024] [Revised: 02/15/2024] [Accepted: 03/03/2024] [Indexed: 03/10/2024]
Abstract
The 355 nm Auryon laser (AngioDynamics, Inc., Latham, New York) has been shown to be effective and safe in treating various morphology lesions in the femoropopliteal arteries. There are limited data on the Auryon laser in treating below-the-knee (BTK) arteries in patients with chronic limb-threatening ischemia. We present the 30-day efficacy and safety findings from the ongoing Auryon BTK study. Patients with chronic limb-threatening ischemia were prospectively enrolled in the Auryon BTK study between March 2022 and February 2023 in 4 US centers after obtaining written informed consent. The primary safety end point included major adverse limb events + postoperative death at 30 days, defined as a composite of all-cause death, major amputation, and target vessel revascularization. Demographic, procedural, angiographic, and outcome data were collected. A total of 60 patients (61 lesions) were treated. The mean age was 74.6 ± 10.3 years, with 65.0% men, 58.3% with diabetes, 43.3% Rutherford Becker (RB) IV, and 56.7% RB V. Of the 61 lesions, 59% had severe calcification, 31.1% were chronic total occlusions, and 90.2% were de novo disease. The baseline diameter stenosis was 80.2 ± 16.4%, after laser 57.4 ± 21.7%, and after final treatment 24.0 ± 23.1% (p <0.0050). The primary performance end point showed a procedure success rate of 37 of 68 (63.8%). Bailout stenting occurred in 1 of 61 lesions (1.6%). The RB category was 100% RB IV or higher at baseline versus 35.3% at 30 days. At 30 days, there was no target vessel revascularization and the patency was 88.9% (Peak Systolic Velocity Ratio (PSVR) ≤2.4). In conclusion, the Auryon laser is safe and relatively effective in treating BTK lesions with minimal complications.
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Affiliation(s)
| | - Timothy Yates
- Palm Vascular Centers of Florida, Ft. Lauderdale, Florida
| | | | | | - Robert Beasley
- Palm Vascular Centers of Florida, Ft. Lauderdale, Florida
| | - Warren Swee
- Palm Vascular Centers of Florida, Ft. Lauderdale, Florida
| | - James T Torey
- St. John Hospital and Medical Center, Detroit, Michigan
| | - Gail A Shammas
- Midwest Cardiovascular Research Foundation, Davenport, Iowa
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Emori H, Shiono Y, Kuriyama N, Honda Y, Kadooka K, Kudo T, Ogata K, Kimura T, Nishihira K, Tanaka A, Shibata Y. Impact of Periprocedural Myocardial Injury on Long-Term Outcomes After Percutaneous Coronary Intervention Requiring Atherectomy. Am J Cardiol 2024; 222:S0002-9149(24)00318-7. [PMID: 38677665 DOI: 10.1016/j.amjcard.2024.04.035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/20/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
The prognostic implications of cardiac troponin elevation after percutaneous coronary intervention (PCI) with atherectomy have not been established. The aim of this study was to investigate the incidence of periprocedural myocardial injury (PMI) and its association with cardiovascular events in patients with severely calcified lesions who underwent PCI with atherectomy. The study analyzed 346 patients (377 lesions) who underwent PCI with atherectomy between January 2018 and December 2021. Peak post-PCI high-sensitivity cardiac troponin (hs-cTn) was measured. The primary outcome was target lesion failure (TLF), a composite of cardiovascular death, target vessel myocardial infarction, and clinically driven target lesion revascularization. A lesion-based analysis was conducted to assess the association of PMI with TLF up to 5 years after PCI. Increase of hs-cTn was seen with 362 lesions (96%), and significant PMI, defined as hs-cTn increase ≥70 × upper reference limit, was seen with 83 lesions (22%). Significant PMI was associated with a significantly greater risk of TLF (adjusted hazard ratio 1.93, 95% confidence interval 1.12 to 3.30, p = 0.017), primarily driven by an increased risk of cardiovascular death (adjusted hazard ratio 5.29, 95% confidence interval 1.46 to 19.16, p = 0.011). In conclusion, hs-cTn increase was frequently observed in patients who underwent PCI with atherectomy, and significant PMI was associated with an increased risk of TLF and cardiovascular death.
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Affiliation(s)
- Hiroki Emori
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan.
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Nehiro Kuriyama
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yasuhiro Honda
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Kosuke Kadooka
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Takeaki Kudo
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Kenji Ogata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Toshiyuki Kimura
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Kensaku Nishihira
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
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Khan MR, Koshy AN, Tanner R, Farhan S, Vinayak M, Farooq A, Sartori S, Feng Y, Spirito A, Arora A, Dhulipala V, Kapur V, Suleman J, Sharma R, Mehran R, Kini A, Sharma SK. Real-World Comparison of Clopidogrel With Ticagrelor and Prasugrel in Patients With Chronic Coronary Disease Who Underwent Atherectomy. Am J Cardiol 2024; 217:1-4. [PMID: 38401658 DOI: 10.1016/j.amjcard.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/09/2024] [Accepted: 02/04/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Mahin R Khan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anoop N Koshy
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard Tanner
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Manish Vinayak
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ali Farooq
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yihan Feng
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ayush Arora
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vishal Dhulipala
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vishal Kapur
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Javed Suleman
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raman Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Ayyad M, Ayasa LA, Shbaita S, Qozat A, Tessarek J. Nonspecific Presentation of an Infected Aorto-Iliac Artery Stent Following Endovascular Revision and Stent Insertion. Vasc Endovascular Surg 2024; 58:436-442. [PMID: 37975794 PMCID: PMC10996291 DOI: 10.1177/15385744231217366] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Over the last few decades, the use of covered stent grafts became increasingly popular; as it plays a pivotal role in the management of various atherosclerotic diseases that are rising in both incidence and prevalence. Subsequently, vascular stent infections, although rare, are becoming a well-recognized complication with possibly devastating consequences, owing to the difficulties associated with its diagnosis and treatment. This has prompted significant interest in the condition regarding its pathophysiology, modifiable and non-modifiable risk factors, diagnostic and therapeutic approaches, and the possible implementation of prophylactic measures. We herein present a case of a patient with an infected aortoiliac stent 4 weeks after endovascular revision with atherectomy and additional stent insertion. The patient initially developed nonspecific symptoms and later developed a life-threatening hemorrhage, which was urgently controlled using a percutaneously inserted covered stent at the infected site. Definitive treatment using extraanatomical bypass implantation and an explantation of the infected stents was performed with excellent clinical response.
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Affiliation(s)
- Mohammed Ayyad
- Faculty of Medicine, Al Quds University, Jerusalem, Palestine
| | - Laith A. Ayasa
- Faculty of Medicine, Al Quds University, Jerusalem, Palestine
| | - Sara Shbaita
- Faculty of Medicine, An Najah National University Nablus, Palestine
| | - Ahmad Qozat
- Vascular Surgery Department, Bonifatius Hospital, Lingen, Germany
| | - Jörg Tessarek
- Vascular Surgery Department, Bonifatius Hospital, Lingen, Germany
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Nugteren MJ, Welling RHA, Bakker OJ, Ünlü Ç, Hazenberg CEVB. Vessel Preparation in Infrapopliteal Arterial Disease: A Systematic Review and Meta-Analysis. J Endovasc Ther 2024; 31:191-202. [PMID: 36062761 PMCID: PMC10938478 DOI: 10.1177/15266028221120752] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Infrapopliteal lesions are generally complex to treat due to small vessel diameter, long lesion length, multilevel disease, and severe calcification. Therefore, different vessel preparation devices have been developed to contribute to better peri- and postprocedural outcomes. This systematic review aims to compare different vessel preparation techniques prior to plain old balloon angioplasty (POBA) or drug-coated balloon (DCB) angioplasty with POBA or DCB alone in infrapopliteal arterial disease. METHODS Medline, EMBASE, and Cochrane databases were searched for studies published between 2000 and 2022 assessing the value of adjunctive vessel preparation in infrapopliteal arterial disease. The primary outcomes were 12-month primary patency and limb salvage. RESULTS A total of 1685 patients with 1913 lesions were included in 11 POBA studies. Methodological quality was assessed as poor to moderate in these studies. Only 2 studies with 144 patients assessed vessel preparation in conjunction with DCB angioplasty. These randomized trials were assessed as high quality and found no significant benefit of adjunctive atherectomy to DCB angioplasty. The pooled Kaplan-Meier estimates of 12-month primary patency and limb salvage in the POBA studies were 67.8% and 80.9% for POBA, 62.1% and 86.4% for scoring balloons, 67.9% and 79.6% for mechanical atherectomy (MA), and 79.7% and 82.6% for laser atherectomy, respectively. Within the pooled data only scoring balloons and MA demonstrated significantly improved 12-month limb salvage compared to POBA. CONCLUSIONS Different forms of adjunctive vessel preparation demonstrate similar 12-month outcomes compared to POBA and DCB angioplasty alone in infrapopliteal disease, with the exception of improved 12-month limb salvage in scoring balloons and MA. However, since the included studies were heterogeneous and assessed as poor to moderate methodological quality, selection bias may have played an important role. Main conclusion is that this systematic review found no additional value of standard use of vessel preparation. CLINICAL IMPACT Infrapopliteal arterial disease is associated with chronic limb-threatening ischemia (CLTI) and generally complex to treat due to small vessel diameter, long lesion length, multilevel disease and severe calcification. A wide range of vessel preparation devices have been developed to contribute to improved peri- and postprocedural outcomes in these complex lesions. This systematic review aims to compare different vessel preparation techniques prior to plain old balloon angioplasty (POBA) or drug coated balloon (DCB) angioplasty with POBA or DCB angioplasty alone in infrapopliteal arterial disease. Different forms of adjunctive vessel preparation demonstrate similar 12-month outcomes compared to POBA and DCB angioplasty alone in infrapopliteal disease, with the exception of improved 12-month limb salvage in scoring balloons and mechanical atherectomy (MA). However, since the included studies were heterogeneous and assessed as poor to moderate methodological quality, selection bias may have played an important role. Main conclusion is that this systematic review found no additional value of standard use of vessel preparation.
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Affiliation(s)
- Michael J. Nugteren
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rutger H. A. Welling
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Olaf J. Bakker
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
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Koppara T, Dregely I, Nekolla SG, Nährig J, Langwieser N, Bradaric C, Ganter C, Laugwitz KL, Schwaiger M, Ibrahim T. Simultaneous 18-FDG PET and MR imaging in lower extremity arterial disease. Front Cardiovasc Med 2024; 11:1352696. [PMID: 38404725 PMCID: PMC10884315 DOI: 10.3389/fcvm.2024.1352696] [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] [Received: 12/08/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background Simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) is a novel hybrid imaging method integrating the advances of morphological tissue characterization of MRI with the pathophysiological insights of PET applications. Aim This study evaluated the use of simultaneous 18-FDG PET/MR imaging for characterizing atherosclerotic lesions in lower extremity arterial disease (LEAD). Methods Eight patients with symptomatic stenoses of the superficial femoral artery (SFA) under simultaneous acquisition of 18-FDG PET and contrast-enhanced MRI using an integrated whole-body PET/MRI scanner. Invasive plaque characterization of the SFA was performed by intravascular imaging using optical coherence tomography. Histological analysis of plaque specimens was performed after directional atherectomy. Results MRI showed contrast enhancement at the site of arterial stenosis, as assessed on T2-w and T1-w images, compared to a control area of the contralateral SFA (0.38 ± 0.15 cm vs. 0.23 ± 0.11 cm; 1.77 ± 0.19 vs. 1.57 ± 0.15; p-value <0.05). On PET imaging, uptake of 18F-FDG (target-to-background ratio TBR > 1) at the level of symptomatic stenosis was observed in all but one patient. Contrast medium-induced MR signal enhancement was detected in all plaques, whereas FDG uptake in PET imaging was increased in lesions with active fibroatheroma and reduced in fibrocalcified lesions. Conclusion In this multimodal imaging study, we report the feasibility and challenges of simultaneous PET/MR imaging of LEAD, which might offer new perspectives for risk estimation.
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Affiliation(s)
- Tobias Koppara
- Department of Internal Medicine I, Cardiology and Angiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research)—Partner Site Munich Heart Alliance, Munich, Germany
| | - Isabel Dregely
- Department of Nuclear Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stephan G. Nekolla
- DZHK (German Center for Cardiovascular Research)—Partner Site Munich Heart Alliance, Munich, Germany
- Department of Nuclear Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Jörg Nährig
- Institute of Pathology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Nicolas Langwieser
- Department of Internal Medicine I, Cardiology and Angiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christian Bradaric
- Department of Internal Medicine I, Cardiology and Angiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Carl Ganter
- Institute of Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, Cardiology and Angiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research)—Partner Site Munich Heart Alliance, Munich, Germany
| | - Markus Schwaiger
- DZHK (German Center for Cardiovascular Research)—Partner Site Munich Heart Alliance, Munich, Germany
- Department of Nuclear Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Tareq Ibrahim
- Department of Internal Medicine I, Cardiology and Angiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
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Savage MP, Fischman DL, Mamas MA. Between a Rock and a Hard Place: Technological Progress in Treating Calcified Coronary Lesions. JACC Cardiovasc Interv 2024:S1936-8798(24)00015-3. [PMID: 38385927 DOI: 10.1016/j.jcin.2023.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 12/31/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Michael P Savage
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
| | - David L Fischman
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mamas A Mamas
- Keele University, Stoke-on-Trent, Staffordshire, United Kingdom
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Gumus F, Arslanturk O. Usage of rotational atherectomy and drug-coated balloon angioplasty for isolated popliteal artery lesions: two-year results of a retrospective study. Acta Chir Belg 2024:1-7. [PMID: 38294176 DOI: 10.1080/00015458.2024.2313266] [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: 05/25/2023] [Accepted: 01/28/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES In this study, perioperative properties and early and mid-term clinical outcomes of endovascular revascularization with a combined usage of rotational atherectomy (RA) and drug-coated balloon angioplasty (DCB) angioplasty for isolated popliteal artery lesion were reported. METHODS A total of 28 patients with isolated popliteal artery stenosis who underwent combined RA and DCB angioplasty between December 2018 and September 2022 were analyzed retrospectively. Temren atherectomy system (Invamed, Ankara, Turkey) and Extender paclitaxel-coated drug-coated balloon catheter (Invamed, Ankara, Turkey) were used in all cases. The main outcome was primary patency; secondary outcomes were technical success, freedom from amputation, and mortality. RESULTS The mean age of patients was 64.2 ± 9.1 years and the majority of the patients were male (n = 20; 71.4%). Types of the lesions were total occlusion in 24 limbs and critical stenosis in 4 limbs. The mean total occlusion length was 65.2 ± 14.2 mm. Flow-limiting dissection was seen in lesions of 2 patients (7.1%) and treated with prolonged balloon dilatation without bail-out stenting requirement. Technical success defined as an adequate vascular lumen (less than 30% stenosis) was achieved in 26 (92.8%) with a mean follow-up of 17.2 ± 8.2 months. The mean primary patency rates at 12 months and 24 months were 92.3% ± 3.2 and 81.2% ± 3.2, respectively. Complications included 1 distal embolization following RA, 2 flow-limiting dissections, and 3 puncture site hematomas. CONCLUSIONS Endovascular procedures using combined RA and DCB angioplasty seem to be effective alternative treatment modalities for the treatment of popliteal artery lesions with high rates of primary patency and freedom from TLR.
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Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Memorial Hospital, Ankara, Turkey
| | - Oguz Arslanturk
- Department of Cardiovascular Surgery, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
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9
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Effoe VS, Mewissen MW, Bajwa TK, Khitha J, Kostopoulos L, Ammar KA, Nfor TK. Effects of atherectomy on major adverse limb events for femoropopliteal interventions: Vascular Quality Initiative registry. Catheter Cardiovasc Interv 2024; 103:106-114. [PMID: 37983656 DOI: 10.1002/ccd.30912] [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: 05/23/2023] [Revised: 10/19/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Atherectomy use in treatment of femoropopliteal disease has significantly increased despite scant evidence of benefit to long-term clinical outcomes. AIMS We investigated the clinical benefits of atherectomy over standard treatment for femoropopliteal interventions. METHODS Using data from the Society of Vascular Surgery's Vascular Quality Initiative (VQI) registry, we identified patients who underwent isolated femoropopliteal interventions for occlusive disease. We compared 13,423 patients treated with atherectomy with 47,371 receiving standard treatment; both groups were allowed definitive treatment with a drug-coated balloon or stenting. The primary endpoint was major adverse limb events (MALEs), which is a composite of target vessel re-occlusion, ipsilateral major amputation, and target vessel revascularization. RESULTS Mean age was 69 ± 11 years, and patients were followed for a median of 30 months. Overall rates of complications were slightly higher in the atherectomy group than the standard treatment group (6.2% vs. 5.9%, p < 0.0001). In multivariable analysis, after adjusting for demographic and clinical covariates, atherectomy use was associated with a 13% reduction in risk of MALEs (adjusted odds ratio [aOR]: 0.87; 95% confidence interval [CI]: 0.77-0.98). Rates of major and minor amputations were significantly lower in the atherectomy group (3.2% vs. 4.6% and 3.3% vs. 4.3%, respectively, both p < 0.001), primarily driven by a significantly decreased risk of major amputations (aOR 0.69; 95% CI: 0.52-0.91). There were no differences in 30-day mortality, primary patency, and target vessel revascularization between the atherectomy and standard treatment groups. CONCLUSIONS In adults undergoing femoropopliteal interventions, the use of atherectomy was associated with a reduction in MALEs compared with standard treatment.
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Affiliation(s)
- Valery S Effoe
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Mark W Mewissen
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Tanvir K Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Jayant Khitha
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Louie Kostopoulos
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Khawaja A Ammar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Tonga K Nfor
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
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10
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Pan D, Guo J, Su Z, Meng W, Wang J, Guo J, Gu Y. Efficacy and Safety of Atherectomy Combined With Balloon Angioplasty vs Balloon Angioplasty Alone in Patients With Femoro-Popliteal Lesions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Endovasc Ther 2023:15266028231215354. [PMID: 38049942 DOI: 10.1177/15266028231215354] [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] [Indexed: 12/06/2023]
Abstract
BACKGROUND Balloon angioplasty (BA), including drug-coated balloons (DCBs) and percutaneous transluminal angioplasty (PTA), has traditionally been used to treat femoral-popliteal lesions. However, in recent years, atherectomy (ATH) has been proposed as a complementary approach. To assess the effectiveness of ATH compared with BA alone in patients with femoral-popliteal artery lesions, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We included RCTs that focused on patients with femoral-popliteal artery lesions and reported data on the use of ATH and BA therapy. Two reviewers conducted a literature search, refined the data, and assessed the risk of bias. RESULTS We included a total of 6 RCTs involving 399 patients with femoral-popliteal artery lesions. The use of ATH in combination with BA appeared to improve the patency rate at 12 months (odds ratio [OR]=2.04, 95% confidence interval [CI]=1.14-3.62). In addition, ATH with BA was associated with lower major amputation rates (MD=2.01, 95% CI=0.06-0.77, p=0.02) and a decreased likelihood of bailout stenting (OR=0.07, 95% CI=0.02-0.25, p=0.001). However, there were no statistically significant differences between the groups in terms of target lesion revascularization (TLR) at 12 months, major adverse cardiovascular events (MACEs), and distal embolization events. In addition, we performed subgroup analysis for different ATH devices and BA types. CONCLUSIONS Based on this meta-analysis, it can be concluded that the use of ATH in combination with BA is a safe and effective method for treating femoral-popliteal artery lesions. In addition, the patency rate at 1 year is superior to treatment with BA alone. Atherectomy also reduces the likelihood of amputation and bailout stenting. Clinicians should consider these findings when designing future RCTs and developing clinical practice guidelines. CLINICAL IMPACT This meta-analysis summarises a number of existing studies to advance understanding of the atherectomy devices and to reveal its potential. This new technique, when compared with drug coated balloon, shows the possibility of obtaining better clinical outcomes in femoro-popliteal lesions than drug-coated balloon alone, such as higher 12-month primary patency rates as shown in some studies. Currently, it is important to consider the appropriate technology applicable for individualised treatment. atherectomy devices seem to provide clinicians with additional options in clinical practice and to benefit patients in the future. This requires more high quality studies to explore the role and benefits of atherectomy devices in femoro-popliteal lesions.
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Affiliation(s)
- Dikang Pan
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Julong Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhixiang Su
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenzhuo Meng
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingyu Wang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Simonte G, Fino G, Casali F, Parlani G, Lenti M, Isernia G. Effectiveness of the Rotarex Excisional Atherectomy System in Both Subacute and Chronic Aortoiliac Endograft Thrombosis: An Innovative Option for the Modern Endovascular Surgeon Toolkit. J Endovasc Ther 2023; 30:957-963. [PMID: 35735194 DOI: 10.1177/15266028221105177] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a successful revascularization case using the Rotarex™S atherothrombectomy system in a recent iliac limb thrombosis, and chronic hypogastric stent obstruction after previous aortoiliac aneurysm endovascular repair (EVAR). CASE REPORT A 72-year-old patient was treated for recent right iliac limb thrombosis and left iliac branch chronic hypogastric stent occlusion, 5 years after EVAR. A total endovascular approach, using both upper extremity and femoral vascular access, was settled with 2 Rotarex™S (6Fr and 10Fr) devices. The Rotarex™S catheters removed most of the intraluminal material, allowing additional endografts and bare metal stents to be deployed to support a new healthy lumen surface. CONCLUSION The total endovascular approach provided by the Rotarex™S device appears to be safe and effective in treating aortoiliac endografts occlusions, both in subacute and chronic phases. Larger studies could highlight differences and eventual advantages compared with more traditional solutions.
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Affiliation(s)
- Gioele Simonte
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
- Unit of Vascular Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Gianluigi Fino
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Francesco Casali
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Gianbattista Parlani
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Massimo Lenti
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Giacomo Isernia
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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12
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Komiyama H, Abe T, Ando T, Ishikawa M, Tanaka S, Ishihara S, Inoue Y, Jujo K, Hamatani T, Matsukage T. Analyzing drilling noise in rotational atherectomy: Improving safety and effectiveness through visualization and anomaly detection using autoencoder-A preclinical study. Health Sci Rep 2023; 6:e1739. [PMID: 38033711 PMCID: PMC10684982 DOI: 10.1002/hsr2.1739] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Background and Aims As the population of aging societies continues to grow, the prevalence of complex coronary artery diseases, including calcification, is expected to increase. Rotational atherectomy (RA) is an essential technique for treating calcified lesions. This study aimed to assess the usefulness of the drilling noise produced during rotablation as a parameter for evaluating the safety and effectiveness of the procedure. Methods A human body model mimicking calcified stenotic coronary lesions was constructed using plastic resin, and burrs of sizes 1.25 and 1.5 mm were utilized. To identify the noise source during rotablation, we activated the ROTAPRO™ rotablator at a rotational speed of 180,000 rpm, recording the noise near the burr (inside the mock model) and advancer (outside). In addition to regular operation, we simulated two major complications: burr entrapment and guidewire transection. The drilling noise recorded in Waveform Audio File Format files was converted into spectrograms for analysis and an autoencoder analyzed the image data for anomalies. Results The drilling noise from both inside and outside the mock model was predominantly within the 3000 Hz frequency domain. During standard operation, intermittent noise within this range was observed. However, during simulated complications, there were noticeable changes: a drop to 2000 Hz during burr entrapment and a distinct squealing noise during guidewire transection. The autoencoder effectively reduced the spectrogram data into a two-dimensional representation suitable for anomaly detection in potential clinical applications. Conclusion By analyzing drilling noise, the evaluation of procedural safety and efficacy during RA can be enhanced.
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Affiliation(s)
- Hidenori Komiyama
- Department of Cardiology, Saitama Medical CenterSaitama Medical UniversityKawagoeshiJapan
| | - Takuro Abe
- Department of Cardiology, Saitama Medical CenterSaitama Medical UniversityKawagoeshiJapan
| | - Toshiyuki Ando
- Department of Cardiology, Saitama Medical CenterSaitama Medical UniversityKawagoeshiJapan
| | - Masahiro Ishikawa
- Department of Cardiology, Saitama Medical CenterSaitama Medical UniversityKawagoeshiJapan
| | - Shinji Tanaka
- Department of Cardiology, Saitama Medical CenterSaitama Medical UniversityKawagoeshiJapan
| | - Shiro Ishihara
- Department of Cardiology, Saitama Medical CenterSaitama Medical UniversityKawagoeshiJapan
| | - Yoshiro Inoue
- Department of Cardiology, Saitama Medical CenterSaitama Medical UniversityKawagoeshiJapan
| | - Kentaro Jujo
- Department of Cardiology, Saitama Medical CenterSaitama Medical UniversityKawagoeshiJapan
| | | | - Takashi Matsukage
- Department of Cardiology, Saitama Medical CenterSaitama Medical UniversityKawagoeshiJapan
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13
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Wu H, Zheng D, Zhou L, Wang Q, Wang T, Liang S. A Systematic Review and Meta-analysis of Atherectomy Plus Balloon Angioplasty Versus Balloon Angioplasty Alone for Infrapopliteal Arterial Disease. J Endovasc Ther 2023:15266028231209236. [PMID: 37933456 DOI: 10.1177/15266028231209236] [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] [Indexed: 11/08/2023]
Abstract
OBJECTIVE The article aimed to compare the efficiency and safety of atherectomy plus balloon angioplasty (BA) with BA alone for the treatment of infrapopliteal arterial disease. METHODS According to the inclusion and exclusion criteria, PubMed, Embase, and Cochrane Library database were searched for studies comparing atherectomy plus angioplasty and angioplasty alone in treating infrapopliteal artery lesions until November 2022. The endpoints included technical success, primary patency, clinically-driven target lesion revascularization (CD-TLR), periprocedural complications, distal embolization, target limb major amputation, and all-cause mortality. RESULTS Ten studies met the requirements of our meta-analysis, including 7723 patients in the atherectomy plus BA group and 2299 patients in the BA alone group. The meta-analysis showed that atherectomy plus BA was associated with reduced CD-TLR (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.34, 0.78, p=0.002) and target limb major amputation (OR: 0.43, 95% CI: 0.19, 1.01, p=0.05) at 12-month follow-up. No statistically significant difference was found in technical success, primary patency, periprocedural complications, distal embolization, or all-cause mortality. Subgroup analysis found a higher rate of primary patency at 6 and 12 months (6 months: OR: 2.26, 95% CI: 1.11, 4.60, p=0.02; 12 months: OR: 2.38, 95% CI: 1.16, 4.86, p=0.02), and lower rates of CD-TLR (OR: 0.45, 95% CI: 0.25, 0.82, p=0.009) and target limb major amputation (OR: 0.43, 95% CI: 0.19, 1.01, p=0.05) at 12 months in patients treated with atherectomy plus drug-coated balloon (DCB) but not in patients treated with atherectomy plus plain old balloon angioplasty (POBA). CONCLUSIONS This meta-analysis suggests that compared with BA alone, atherectomy plus BA may reduce the need for CD-TLR and the incidence of target limb major amputation at 12-month follow-up in the treatment of infrapopliteal artery occlusive lesions, even though there are no significant advantages in technical success, primary patency, periprocedural complications, distal embolization, or all-cause mortality. To go further, atherectomy plus DCB shows significant benefits in primary patency, CD-TLR, and target limb major amputation rate but atherectomy plus POBA does not'. However, due to the limitations of this article, more randomized controlled trials (RCTs) are needed to confirm these conclusions. CLINICAL IMPACT According to our research, atherectomy combined with BA has the advantages of higher primary patency rate, lower CD-TLR and target limb significant amputation rate in treating infrapopliteal artery occlusive lesions, which may replace the current mainstream surgical method ---BA alone. For the clinician, although the surgery may take longer, it will significantly improve the prognosis and quality of life of patients and hold considerable significance for the management of patients with infrapopliteal arterial disease. Based on the characteristics of infrapopliteal artery disease, this study explored the feasibility of atherectomy combined with BA for infrapopliteal artery disease. Moreover, we found that atherectomy combined with DCB had better clinical efficacy, which should be the innovation of this study.
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Affiliation(s)
- Haichao Wu
- Department of Vascular Surgery, Taizhou Municipal Hospital, Taizhou University, Taizhou, China
| | - Dandan Zheng
- Faculty of Nursing, Mahidol University, Nakhon Pathom, Thailand
- Health Science Center, Yangtze University, Jingzhou, China
| | - Long Zhou
- Department of Vascular Surgery, Taizhou Municipal Hospital, Taizhou University, Taizhou, China
| | - Qiang Wang
- Department of Vascular Surgery, Taizhou Municipal Hospital, Taizhou University, Taizhou, China
| | - Tao Wang
- Department of Vascular Surgery, Taizhou Municipal Hospital, Taizhou University, Taizhou, China
| | - Siyuan Liang
- Department of Vascular Surgery, Taizhou Municipal Hospital, Taizhou University, Taizhou, China
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14
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Jamil Y, Nanna MG, Chaar CIO, Mena-Hurtado C, Attaran RR. Comparative Analysis of Mortality and Amputation Rates in Patients Undergoing Atherectomy for Infra-Popliteal Peripheral Arterial Disease: Insight From the VQI. J Endovasc Ther 2023:15266028231208895. [PMID: 37919968 DOI: 10.1177/15266028231208895] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Infra-popliteal peripheral arterial disease (IPPAD) poses challenges due to high restenosis and occlusion rates. The BASIL-2 trial demonstrated the superiority of endovascular treatment compared with surgical bypass in patients with IPPAD. However, the association between different endovascular modalities and clinical outcomes has not been conclusive. HYPOTHESIS Combining plain old balloon angioplasty (POBA) with atherectomy is associated with improved clinical outcomes compared with POBA alone. METHODS Patients who underwent POBA vs POBA+atherectomy for IPPAD from the Vascular Quality Initiative database were identified. To mitigate potential selection bias, we employed propensity score matching (PSM) to balance the distribution of confounding variables for mortality identified on multivariable logistic regression. Subsequently, we compared patient characteristics and long-term outcomes between the 2 treatment groups. RESULTS Among patients who underwent endovascular intervention for IPPAD, 19 979 individuals (80.8%) were treated with POBA alone, while 4747 (19.2%) were treated with both POBA+atherectomy after PSM. Propensity score matching ensured minimal differences in baseline characteristics, such as indication for lower extremity revascularization (LER) and history of LER. After PSM, patients receiving POBA+atherectomy experienced higher rates of technical success and lower perioperative complications, such as renal complications and hematoma, compared with POBA alone. During long-term follow-up, patients who underwent atherectomy had lower rates of major amputation and major adverse limb events (MALE) but slightly lower freedom from reintervention. Nonetheless, there were no differences in mortality. CONCLUSION Combining POBA with atherectomy appears to be a safe approach in patients with IPPAD, with lower rates of long-term amputation and MALE at the cost of a higher risk of reintervention. CLINICAL IMPACT The use of adjunctive atherectomy is associated with improved long-term outcomes in patients with infra-popliteal disease.
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Affiliation(s)
- Yasser Jamil
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Michael G Nanna
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Robert Ramak Attaran
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
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15
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Budak AB, Altınay L, Günertem OE, Sağlam MS, Külahçıoğlu E, Tümer NB, Yağız BK, Terzioğlu SG, Saba T, Özışık K, Günaydın S. Evaluation of endovascular treatment of chronic limb-threatening ischemia for patients in the PLAN gray zone. J Int Med Res 2023; 51:3000605231211768. [PMID: 38000011 PMCID: PMC10676071 DOI: 10.1177/03000605231211768] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/17/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE To compare the results of endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients categorized under the gray and yellow zones of the patient risk, limb severity, and anatomic pattern (PLAN) concept over a 2-year follow-up period. METHODS Patients who underwent endovascular therapy for peripheral artery disease and presented with CLTI from February 2017 to February 2019 were retrospectively reviewed. The patients were grouped into yellow and gray zones based on the PLAN concept. Preoperative and postoperative walking distances, Rutherford classes, and postoperative target vessel patency rates were recorded and compared between the groups. Follow-up evaluations were performed at 1, 6, 12, and 24 months post-procedure. RESULTS Of the 387 patients evaluated, the yellow and gray groups comprised 88 patients each. The overall patency rates were similar between the groups (84 (95.45%) vs. 81 (92.05%), respectively). The occlusion-/stenosis-free survival times, amputation-free survival time, and mean survival time were not significantly different. However, the gray group had a significantly higher number of atherectomy interventions (74 vs. 59) and crosser devices used (62 vs. 42). CONCLUSION Endovascular therapy is an effective treatment option for patients in the gray zone of the PLAN color coding system.
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Affiliation(s)
- Ali Baran Budak
- Department of Cardiovascular Surgery, Ulus Liv Hospital, Beşiktaş-İstanbul, Türkiye
| | - Levent Altınay
- Department of Cardiovascular Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Türkiye
| | - Orhan Eren Günertem
- Department of Cardiovascular Surgery, Batıkent Medical Park Hospital, Batıkent, Türkiye
| | - Muhammet Sefa Sağlam
- Department of Cardiovascular Surgery, Niğde Training and Research Hospital, Niğde, Türkiye
| | - Emre Külahçıoğlu
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye
| | - Naim Boran Tümer
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye
| | | | | | - Tonguç Saba
- Department of Cardiovascular Surgery, Baskent University Hospital Alanya, Alanya-Antalya, Türkiye
| | - Kanat Özışık
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye
| | - Serdar Günaydın
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye
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16
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Shabbir A, Wang L, Jeronimo A, Travieso A, Mejía-Rentería H, Gonzalo N, Salinas P, Escaned J. Ultra-Low Contrast Multivessel Orbital Atherectomy-Assisted PCI in a Patient With Severe Peripheral Vascular Disease. JACC Cardiovasc Interv 2023; 16:2564-2568. [PMID: 37879811 DOI: 10.1016/j.jcin.2023.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/29/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Asad Shabbir
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Lin Wang
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Adrian Jeronimo
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Travieso
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Hernán Mejía-Rentería
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo Salinas
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Escaned
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain.
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17
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Dafaalla M, Rashid M, Moledina S, Kinnaird T, Ludman P, Curzen N, Zaman S, Nolan J, Mamas MA. Characteristics and Outcomes of Patients Who Underwent Coronary Atherectomy in Centers With and Without On-Site Cardiac Surgery. Am J Cardiol 2023; 204:242-248. [PMID: 37556893 DOI: 10.1016/j.amjcard.2023.07.073] [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: 01/27/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/11/2023]
Abstract
We aimed to describe the clinical characteristics and outcomes of patients who underwent atherectomy at the time of percutaneous coronary intervention in centers with on-site surgical centers (SCs) versus nonsurgical centers (NSCs). Patients treated with coronary atherectomy between January 1, 2006, to December 31, 2019, from the British Cardiovascular Society Intervention (BCIS) registry were included. Primary outcomes were in-hospital all-cause mortality and major adverse cardiovascular and cerebrovascular events. A total of 20,833 patients were treated with coronary atherectomy, of which 7,983 (38%) were performed at NSC. The proportion of coronary atherectomies performed in NSC increased from 12.5% in 2006 to 42% in 2019. Compared with patients treated at SC, patients treated in NSC were older (mean age 75.1 ± SD years vs 74.2 ± SD, p <0.001), but had comparable prevalence of hypertension (NSC 73.9% vs SC 72.8%, p = 0.085), diabetes mellitus (NSC 32.2% vs SC 31.6%, p = 0.43) and renal disease (NSC 6.0% vs SC 6.0%, p = 0.99). Intracoronary imaging was used more often in NSC than SC (22.3% vs 19.4%, p <0.001). After adjustment, the odds of in-hospital mortality (odds ratios [OR] 0.76, 95% confidence intervals [CI] 0.50 to 1.16), major adverse cardiovascular and cerebrovascular events (OR 0.80, 95% CI 0.53 to 1.21), emergency coronary artery bypass graft (OR 0.49, 95% CI 0.15 to 1.57), major bleeding (OR 0.67, 95% CI 0.36 to 1.24) and coronary perforation (OR 1.07, 95% CI 0.97 to 1.43) in NSC were comparable with SC. In conclusion, coronary atherectomy in hospitals with off-site surgical cover has become more frequent, with no association with poorer outcomes, compared with hospitals with on-site surgical cover.
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Affiliation(s)
- Mohamed Dafaalla
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Tim Kinnaird
- University Hospital of Wales, Cardiff, United Kingdom
| | - Peter Ludman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Trust and Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Australia
| | - James Nolan
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
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18
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Affiliation(s)
- Neel M. Butala
- Rocky Mountain Regional VA Medical Center, Aurora, CO
- University of Colorado School of Medicine, Aurora, CO
| | - Binita Shah
- Veterans Affairs New York Harbor Health Care System, New York, NY
- New York University School of Medicine, New York, NY
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19
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Gressler LE, Ramkumar N, Marinac-Dabic D, dosReis S, Goodney P, Daniel Mullins C, Shaya FT. The association of major adverse limb events and combination stent and atherectomy in patients undergoing revascularization for lower extremity peripheral artery disease. Catheter Cardiovasc Interv 2023; 102:688-700. [PMID: 37560820 DOI: 10.1002/ccd.30799] [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: 03/14/2023] [Revised: 06/12/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND The effectiveness of combined atherectomy and stenting relative to use of each procedure alone for the treatment of lower extremity peripheral artery disease has not been evaluated. AIMS The objective of this study was to evaluate the short- and long-term major adverse limb event (MALE) following the receipt of stenting, atherectomy, and the combination of stent and atherectomy. METHODS A retrospective cohort of patients undergoing atherectomy, stent, and combination stent atherectomy for lower extremity peripheral artery disease was derived from the Vascular Quality Initiative (VQI) data set. The primary outcome was MALE and was assessed in the short-term and long-term. Short-term MALE was assessed immediately following the procedure to discharge and estimated using logistic regression. Long-term MALE was assessed after discharge to end of follow-up and estimated using the Fine-Gray subdistribution hazard model. RESULTS Among the 46,108 included patients, 6896 (14.95%) underwent atherectomy alone, 35,774 (77.59%) received a stent, and 3438 (7.5%) underwent a combination of stenting and atherectomy. The adjusted model indicated a significantly higher odds of short-term MALE in the atherectomy group (OR = 1.35; 95% confidence interval [CI]:1.16-1.57), and not significantly different odds (OR = 0.93; 95% CI:0.77-1.13) in the combination stent and atherectomy group when compared to stenting alone. With regard to long-term MALE, the model indicated that the likelihood of experiencing the outcome was slightly lower (HR = 0.90; 95% CI:0.82-0.98) in the atherectomy group, and not significantly different (HR = 0.92; 95% CI:0.82-1.04) in the combination stent and atherectomy group when compared to the stent group. CONCLUSIONS Patients in the VQI data set who received combination stenting and atherectomy did not experience significantly different rates of MALE when compared with stenting alone. It is crucial to consider and further evaluate the influence of anatomical characteristics on treatment strategies and potential differential effects of comorbidities and other demographic factors on the short and long-term MALE risks.
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Affiliation(s)
- Laura E Gressler
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Susan dosReis
- College of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Philip Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - C Daniel Mullins
- College of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Fadia T Shaya
- College of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
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20
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Morita Y, Kashima Y, Yasuda Y, Kanno D, Hachinohe D, Sugie T, Endo A, Fujita T, Tanabe K. Burr entrapment in a percutaneous coronary intervention during rotational atherectomy: An experience with 3195 cases. J Invasive Cardiol 2023; 35. [PMID: 37984323 DOI: 10.25270/jic/23.00174] [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: 11/22/2023]
Abstract
OBJECTIVES Burr entrapment is a potentially life-threatening complication of rotational atherectomy (RA). However, owing to its infrequency, there have been no major reports on burr entrapment. This study aimed to evaluate the incidence, treatment, and outcomes of burr entrapment. METHODS This multicenter retrospective study analyzed patients who had undergone percutaneous coronary interventions (PCIs) and were treated by RA between May 2013 and March 2022. RESULTS Of the 22 640 PCI procedures, RA was performed in 3195 patients (14.1%), among whom burr entrapment occurred in 22 patients (0.69%). The mean patient age was 78 ± 8.7 years; 64% were male, and 32% were on dialysis. The entrapped burr size was 1.7 ± 0.2 mm, and the burr/artery ratio was 0.6 ± 0.1. In 20 patients (91%), the burr was extracted by strong manual pullback. The other patients underwent balloon angioplasty at the site of the entrapped burr, which might have provided space for successful burr withdrawal. Major adverse cardiac events occurred in 23% of patients. Tamponade requiring pericardiocentesis occurred in two patients (9%). No patients required emergency surgery or suffered an in-hospital death. CONCLUSIONS Burr entrapment occurred in 0.69% of patients who had undergone RA. Most burrs were extracted by a strong manual pullback. None required emergency surgery, and there were no in-hospital deaths. The results provide a treatment approach and prognosis for burr stuck in the use of RA.
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Affiliation(s)
- Yusuke Morita
- Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Japan.
| | - Yoshifumi Kashima
- Cardiovascular Medicine, Sapporo Heart Centre, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Yu Yasuda
- Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Daitaro Kanno
- Cardiovascular Medicine, Sapporo Heart Centre, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Daisuke Hachinohe
- Cardiovascular Medicine, Sapporo Heart Centre, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Takuro Sugie
- Cardiovascular Medicine, Sapporo Heart Centre, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Akihiro Endo
- Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Tsutomu Fujita
- Cardiovascular Medicine, Sapporo Heart Centre, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Kazuaki Tanabe
- Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Japan
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21
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Xue S, Zhang X, Peng Z, Wu X, Peng Z, Qin J, Lu X. Assessment of atherectomy treatment for Thromboangiitis Obliterans: A single center experience. Catheter Cardiovasc Interv 2023; 102:713-720. [PMID: 37706639 DOI: 10.1002/ccd.30801] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/29/2023] [Accepted: 07/28/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND AND AIMS Endovascular recanalizaiton (ER) has been proven to be a feasible method for Thromboangiitis Obliterans (TAO). The aims of this study were to evaluate the effectiveness and safety of atherectomy for TAO compared to nonatherectomy ER in our center. METHODS Patients diagnosed as TAO were reviewed from January 2016 to June 2021 in our center. Basic characteristics of patients before ER and perioperative data were collected and compared between the atherectomy and nonatherectomy groups. The vascular event-free survival and limb salvage were calculated to evaluate the prognosis of TAO patients after ERs. Logistic Regression and Cox Regression were used to identify the risk factors for technical failure and prognosis, respectively. RESULTS Seventy-two TAO patients with 79 lower limbs who met the criteria were included in this report. Compared with the nonatherectomy group, no significant improvement was identified in ER technical success, vascular event-free survival, or limb salvage in the atherectomy group. The total technical success rate was 91.1% (atherectomy group, 95.2%; nonatherectomy group, 89.7%), and the multiple limb involvement (p = 0.005; odds ratio [OR], 28.16; confidence interval [CI], 3.28-241.55) was the independent risk factor for technical failure. The total vascular event-free survival proportion was 66.05% and 58.40% at 1 and 3 years, respectively. Technical failure (OR, 5.61; 95% CI, 1.57-20.04; p = 0.008), and runoff grade 0 (OR, 3.28; 95% CI, 1.09-9.85; p = 0.034) were independent risk factors for vascular events. The total limb salvage proportion at 1 and 3 years was 95.84% and 92.53%, respectively. Technical failure (OR, 8.54; 95% CI, 1.71-40.73; p = 0.02) was identified as an independent risk factor for above ankle amputation. CONCLUSIONS No significant difference in prognosis was found between the atherectomy group and the nonatherectomy group during a midterm follow-up. The technical success of ER was crucial for TAO prognosis.
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Affiliation(s)
- Song Xue
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Xing Zhang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Zhaoxi Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Xiaoyu Wu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Zhiyou Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
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22
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Sanon O, Carnevale M, Indes J, Gao Q, Lipsitz E, Koleilat I. Incidence of Procedure-Related Complications in Patients Treated With Atherectomy in the Femoropopliteal and Tibial Vessels in the Vascular Quality Initiative. J Endovasc Ther 2023; 30:693-702. [PMID: 35466788 DOI: 10.1177/15266028221091900] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare procedural complications in patients undergoing atherectomy plus angioplasty (A+A) and plain balloon angioplasty (POBA). MATERIALS AND METHODS Patients in the Vascular Quality Initiative (VQI) registry undergoing first-time peripheral vascular intervention (PVI) were included. Those undergoing aortoiliac or pedal interventions, primary stenting, or hybrid procedures were excluded. Patients were stratified by lesion location (femoropopliteal [FP] or tibial [TIB]). The primary outcomes were target vessel dissection, distal embolization, and provisional stent placement. Secondary outcomes included postoperative complications and the need for subsequent interventions. RESULTS 12 499 patients undergoing FP (49.6% A+A) and 6736 patients undergoing TIB (17.0% A+A) interventions were identified. In the FP group, A+A was associated with greater intraoperative target vessel dissection (4.5% vs 2.6%, p<0.001), distal embolization (1.5% vs 0.7%, p =0.001), and provisional stent placement (1.5% vs 0%, p<0.001); and greater postoperative target vessel dissection (4.2% vs 2.0%, p<0.001) and distal embolization (0.9% vs 0.4%, p=0.034). In the TIB group, A+A was associated with fewer intraoperative vessel dissection (0.8% vs 2.3%, p=0.011) but greater provisional stent placement (0.3% vs 0%, p<0.001). TIB A+A was also associated with higher rates of technical success (97.6% vs 95.1%, p<0.001). CONCLUSIONS Atherectomy was associated with increased procedural-related complications in femoropopliteal, but not in tibial vessels. Future studies addressing lesion morphology, device design, and technique may help define its role in peripheral vascular interventions.
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Affiliation(s)
- Omar Sanon
- Department of Vascular Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Matthew Carnevale
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Jeffrey Indes
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Qi Gao
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Evan Lipsitz
- Department of Vascular Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Issam Koleilat
- Department of Surgery, Community Medical Center, RWJBarnabas Health, Tom's River, NJ, USA
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23
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Rao S, Hnatov A, Tarra T, Amparo A, Bhargava M. Crossing complex infrapopliteal lesions utilizing a front-end cutting technique: A report of two cases with a novel rotational atherectomy device. SAGE Open Med Case Rep 2023; 11:2050313X231198370. [PMID: 37711961 PMCID: PMC10498688 DOI: 10.1177/2050313x231198370] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Critical limb ischemia represents the most severe stage of peripheral vascular disease and patients often present with complex, calcified infrapopliteal lesions. Atherectomy is an endovascular treatment modality that can be used to debulk otherwise uncrossable lesions. We performed a retrospective, single-center, case report of two patients who presented with critical limb ischemia and whose complex and calcified infrapopliteal lesions were treated with the 1.5 mm Phoenix Atherectomy System after prior failed angioplasty attempts. The 1.5 mm Phoenix Atherectomy System successfully debulked each infrapopliteal lesion, and each patient achieved thrombolysis in myocardial infarction grade 3 flow of the target lesion. There were no device-related procedural complications or deaths. These cases demonstrate that the Phoenix Atherectomy System can be used to debulk complex, calcified infrapopliteal lesions to optimize endovascular treatment and improve outcomes for patients with critical limb ischemia. Further studies are warranted to validate the long-term safety and efficacy rates of the Phoenix Atherectomy System in a larger critical limb ischemia population.
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Affiliation(s)
| | - Anton Hnatov
- Vascular Solutions of North Carolina, Cary, NC, USA
| | | | - Amber Amparo
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kereiakes DJ. Atheroablation Imaging Insights. JACC Cardiovasc Interv 2023; 16:2137-2138. [PMID: 37704300 DOI: 10.1016/j.jcin.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Dean J Kereiakes
- Christ Hospital and Lindner Research Center, Cincinnati, Ohio, USA.
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25
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Farag M, van den Buijs D, Loh SX, Poels E, Ameloot K, Janssens L, Bennett J, Tahon J, Dens J, Egred M. Long-term clinical outcomes of excimer laser coronary atherectomy for the management of recurrent in-stent restenosis. J Invasive Cardiol 2023; 35:E365-E374. [PMID: 37769620] [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: 09/30/2023]
Abstract
BACKGROUND Recurrent in-stent restenosis (ISR) remains a serious problem. Optimal modification of the underlying mechanism during index percutaneous coronary intervention (PCI) is key to prevent ISR. Excimer laser coronary atherectomy (ELCA) has its own indications and is among others used in recurrent ISR in case of stent underexpansion and/or diffuse neointimal hyperplasia. We aimed to assess the long-term clinical outcomes of ELCA for the management of recurrent ISR. METHODS A multicenter, retrospective observational study was conducted. Patients with recurrent ISR who were additionally treated with ELCA were included. The primary outcome was major adverse cardiac events (MACE) defined as a composite of cardiovascular death, myocardial infarction, stroke, target lesion revascularization at 12 months, and longer term. RESULTS Between 2014 and 2022, 51 patients underwent PCI with the additional use ELCA for recurrent ISR. Primary outcome occurred in 6 patients (11.8%) at 12 months and in 12 patients (23.5%) at a median follow-up of 4 (1-6) years. Technical and procedural success were achieved in 92% and 90% of cases, respectively. Coronary perforation occurred in 2 patients as a result of distal wire perforation, but was not ELCA-related. There were no in-hospital MACE. CONCLUSIONS ELCA appears to be a safe method with acceptable long-term results for the management of recurrent ISR.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle-Upon-Tyne, Tyne and Wear, NE7 7DN, United Kingdom.
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26
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Julien HM, Wang Y, Curtis JP, Johnston-Cox H, Eberly LA, Wang GJ, Nathan AS, Fanaroff AC, Khatana SAM, Groeneveld PW, Secemsky EA, Eneanya ND, Vora AN, Kobayashi T, Barbery C, Chery G, Kohi M, Kirksey L, Armstrong EJ, Jaff MR, Giri J. Racial Differences in Presentation and Outcomes After Peripheral Arterial Interventions: Insights From the NCDR-PVI Registry. Circ Cardiovasc Interv 2023; 16:e011485. [PMID: 37339237 DOI: 10.1161/circinterventions.121.011485] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 05/03/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND We assess the rates of device use and outcomes by race among patients undergoing lower extremity peripheral arterial intervention using the American College of Cardiology National Cardiovascular Data Registry-Peripheral Vascular Intervention (PVI) registry. METHODS Patients who underwent PVI between April 2014 and March 2019 were included. Socioeconomic status was evaluated using the Distressed Community Index score for patients' zip codes. Multivariable logistic regression was used to assess factors associated with utilization of drug-eluting technologies, intravascular imaging, and atherectomy. Among patients with Centers for Medicare and Medicaid Services data, we compared 1-year mortality, rates of amputation, and repeat revascularizations. RESULTS Of 63 150 study cases, 55 719 (88.2%) were performed in White patients and 7431 (11.8%) in Black patients. Black patients were younger (67.9 versus 70.0 years), had higher rates of hypertension (94.4% versus 89.5%), diabetes (63.0% versus 46.2%), less likely to be able to walk 200 m (29.1% versus 24.8%), and higher Distressed Community Index scores (65.1 versus 50.6). Black patients were provided drug-eluting technologies at a higher rate (adjusted odds ratio, 1.14 [95% CI, 1.06-1.23]) with no difference in atherectomy (adjusted odds ratio, 0.98 [95% CI, 0.91-1.05]) or intravascular imaging (adjusted odds ratio, 1.03 [95% CI, 0.88-1.22]) use. Black patients experienced a lower rate of acute kidney injury (adjusted odds ratio, 0.79 [95% CI, 0.72-0.88]). In Centers for Medicare and Medicaid Services-linked analyses of 7429 cases (11.8%), Black patients were significantly less likely to have surgical (adjusted hazard ratio, 0.40 [95% CI, 0.17-0.96]) or repeat PVI revascularization (adjusted hazard ratio, 0.42 [95% CI, 0.30-0.59]) at 1 year compared with White patients. There was no difference in mortality (adjusted hazard ratio [0.8-1.4]) or major amputation (adjusted hazard ratio, 2.5 [95% CI, 0.8-7.6]) between Black and White patients. CONCLUSIONS Black patients presenting for PVI were younger, had higher prevalence of comorbidities and lower socioeconomic status. After adjustment, Black patients were less likely to have surgical or repeat PVI revascularization after the index PVI procedure.
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Affiliation(s)
- Howard M Julien
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.)
- Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.)
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.W.G., J.G.)
- Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (H.M.J., P.W.G., S.A.M.K.)
- Penn Cardiovascular Center for Health Equity and Social Justice, Philadelphia (H.M.J., L.A.E.)
| | - Yongfei Wang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y.W., J.P.C.)
- Center of Outcome Research and Evaluation Yale New Haven Health System, CT (Y.W., J.P.C.)
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y.W., J.P.C.)
- Center of Outcome Research and Evaluation Yale New Haven Health System, CT (Y.W., J.P.C.)
| | - Hillary Johnston-Cox
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.)
| | - Lauren A Eberly
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.)
- Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.)
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.W.G., J.G.)
- Penn Cardiovascular Center for Health Equity and Social Justice, Philadelphia (H.M.J., L.A.E.)
| | - Grace J Wang
- Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.)
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.W.G., J.G.)
| | - Ashwin S Nathan
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.)
- Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.)
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.W.G., J.G.)
| | - Alexander C Fanaroff
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.)
- Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.)
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.W.G., J.G.)
| | - Sameed Ahmed M Khatana
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.)
- Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.)
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.W.G., J.G.)
- Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (H.M.J., P.W.G., S.A.M.K.)
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.)
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.W.G., J.G.)
- Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (H.M.J., P.W.G., S.A.M.K.)
| | - Eric A Secemsky
- Department of Medicine, Harvard Medical School, Boston, MA (E.A.S.)
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A.S.)
| | - Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia (N.D.E.)
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (N.D.E.)
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (N.D.E.)
| | - Amit N Vora
- University of Pittsburgh Medical Center-Pinnacle, Wormleysburg, PA (A.N.V.)
| | - Taisei Kobayashi
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.)
- Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.)
| | - Carlos Barbery
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.)
| | - Godefroy Chery
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.)
| | - Maureen Kohi
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill (M.K.)
| | - Lee Kirksey
- Division of Vascular Surgery, Cleveland Clinic, OH (L.K.)
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO (E.J.A.)
- University of Colorado School of Medicine, Aurora (E.J.A.)
| | - Michael R Jaff
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston (M.R.J.)
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.)
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.W.G., J.G.)
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Krawisz AK, Pribish AM, Kennedy K, Secemsky EA. Variation in the Use of Orbital Atherectomy During Coronary Artery Intervention in the United States. J Soc Cardiovasc Angiogr Interv 2023; 2:100529. [PMID: 36778915 PMCID: PMC9910285 DOI: 10.1016/j.jscai.2022.100529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anna K. Krawisz
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Abby M. Pribish
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Eric A. Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Shammas NW, Shammas G, Christensen L, Jones-Miller S. Jetstream Atherectomy with Paclitaxel-Coated Balloons: Two-Year Outcome of the Prospective Randomized JET-RANGER Study. Vasc Health Risk Manag 2023; 19:133-137. [PMID: 36936551 PMCID: PMC10015974 DOI: 10.2147/vhrm.s403177] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/02/2023] [Indexed: 03/13/2023] Open
Abstract
Background The JET-RANGER study (NCT03206762) was a multicenter (11 US centers) randomized trial, core lab adjudicated, designed to demonstrate the superiority of Jetstream + Paclitaxel coated balloon (JET+PCB) versus angioplasty (PTA) + PCB in treating femoropopliteal (FP) arterial disease. The one-year primary endpoint of JET-RANGER has been recently published. The 2-year outcome data are presented in this report. Methods There were 43 patients who completed the 1-year follow-up. Two were lost to follow-up and one died prior to the 2-year follow-up, resulting in 40 patients. Fifteen patients were randomized to PTA+PCB and 25 patients to JET +PCB. Kaplan Meier Survival analysis was performed to estimate the freedom from TLR. Bailout stenting was not considered a TLR in this analysis. Statistical significance was determined by a p-value < 0.05. Results Freedom from TLR was similar between the 2 groups at 2 years. There was also no significant difference in the change of ABI between the PTA + PCB and JET + PCB from baseline at 6-months, (p-value = 0.7890), 1-year (p-value = 0.4070), and 2-year (p-value=0.7410). There was also no statistical difference between the JET + PCB and PTA + PCB arms for RCC improvement by one or more category, (p-value= 1.000). There were no minor or major amputations for either arm throughout the 2-year follow up. One JET + PCB patient died before the 2-year specified window. Conclusion JET + PCB had similar freedom from TLR and improvement in ABI and RCC at 2-year follow-up when compared to PTA + PCB with no difference in amputation or mortality between the 2 arms. Clinical Trial Registration NCT03206762.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation, Davenport, IA, USA
- Correspondence: Nicolas W Shammas, Research Director, Midwest Cardiovascular Research Foundation, 630 E 4th Street, Suite A, Davenport, IA, 52801, USA, Email
| | - Gail Shammas
- Midwest Cardiovascular Research Foundation, Davenport, IA, USA
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Murasato Y, Omura S, Fukuda S. Stentless Treatment for a Left Main Quadrifurcation Lesion. J Invasive Cardiol 2022; 34:E888-E889. [PMID: 36476823] [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: 06/17/2023]
Abstract
In this 69-year-old patient, a complex left main quadrifurcation lesion was treated with a stentless procedure, which resulted in sufficient dilation in each branch. Dual-antiplatelet therapy was continued for 3 months, followed by aspirin alone. The stentless treatment with DCB after sufficient plaque debulking with DCA can be useful in avoiding long-term dual antiplatelet therapy especially in patients with high-bleeding risk or those who plan to undergo the non-cardiac operation.
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Affiliation(s)
- Yoshinobu Murasato
- Department of Cardiology, National Hospital Organization, Kyushu Medical Center, 1-8-1, Jigyohama, Chuo, Fukuoka 810-8563, Japan.
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30
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Shammas NW, Shammas GA, Halupnik G, Fedele N, Comp K, Taleb EM, Jones-Miller S, Shammas AN, Shankarraman V. Auryon Laser in Peripheral Arterial Interventions: A Single-Center Experience (Auryon-SCE). J Invasive Cardiol 2022; 34:E428-E432. [PMID: 35551106] [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: 06/15/2023]
Abstract
BACKGROUND The Auryon 355-nm laser atherectomy system (AngioDynamics, Inc) showed a low rate of target-lesion revascularization (TLR) at 6-month follow-up in the investigational device exemption study. At present, real-world data are not available. In this study, we analyze major adverse events and 6-month outcomes with the Auryon laser system in treating infrainguinal arterial disease in all comers at a single center. METHODS Consecutive patients treated with the Auryon laser between September 2017 and March 2021 were retrospectively reviewed from a single operator at a single center. Demographic, procedural, angiographic, and outcome data were extracted from patients' medical records. Descriptive and survival analyses were performed. The study's primary endpoint was the assessment of freedom from TLR at 6-month follow-up. Secondary endpoints included acute procedural results, distal embolization, bailout stenting (dissection type D or higher by National Heart, Lung, and Blood Institute [NHLBI] classification, and/or residual narrowing >30%), unplanned major amputation, death, or vascular complications. RESULTS A total of 56 patients (65 procedures, 70 lesions) were enrolled. The mean age was 70.9 ± 10 years, 66.1% were males, 48.2% were diabetics, and 25% had limb ischemia. Of the 70 lesions, 31.4% had severe calcification, 38.6% were chronic total occlusions, and 48.6% were de novo disease (in-stent restenosis in 28.6%). The majority of treated vessels were femoropopliteal (88.6%) and 29.2% had 2 or more prior interventions. Mean stenosis was 91.3 ± 9.7% at baseline, 56.0 ± 17.3% post laser, and 11.4 ± 11.2% post final treatment. Lesion length was 117.1 ± 101.2 mm and treated length was 174.0 ± 116.0 mm. Bailout stenting occurred in 11/70 lesions (15.7%). There were no NHLBI type D dissections post laser and 1 type D dissection post laser + percutaneous transluminal angioplasty. A total of 47.1% received Lutonix drug-coated balloons (BD/Bard), 27.1% received In.Pact drug-coated balloons (Boston Scientific), and 1.4% received both. The probability of freedom from TLR per procedure was 95.6% at 6 months. CONCLUSION In a real-world cohort of patients with complex disease, the Auryon laser had excellent freedom from TLR at 6 months, although these findings need to be replicated in a randomized trial.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation, 630 East 4th Street, Davenport, IA 52803 USA.
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31
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Salem H, Mintz GS, Matsumura M, Zhang M, Usui E, Seike F, Fujimura T, Noguchi M, Hu X, Jin G, Li C, Fall KN, Ali ZA, Kirtane AJ, Collins MB, Kodali SK, Nazif TM, Leon MB, Moses JW, Karmpaliotis D, Maehara A. Reasons for lesion uncrossability as assessed by intravascular ultrasound. Catheter Cardiovasc Interv 2022; 99:2028-2037. [PMID: 35419936 DOI: 10.1002/ccd.30202] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/03/2022] [Accepted: 03/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of the current study was to use intravascular ultrasound (IVUS) to clarify anatomical and morphological lesion characteristics of uncrossable lesions. BACKGROUND Uncrossable lesions are not always severely calcified. The prevalence of uncrossable lesions that are nonseverely calcified as well as other mechanisms for uncrossability has not been well clarified. METHODS A total of 252 de novo uncrossable lesions in native coronary arteries that underwent either rotational or orbital atherectomy due to inability of any balloon to cross the lesion and 38 lesions with severe calcium in which IVUS crossed preatherectomy were included. Severe calcium is defined as maximum arc of calcium ≥270°. RESULTS Severe calcification was absent in 16% of uncrossable lesions, 83% of which had a significant vessel bend. Compared with crossable lesions with severe calcium, uncrossable lesions with severe calcium more often had a bend in the vessel (71% vs. 21%, p < 0.001) and a longer length of continuous severe calcium (median length of calcium ≥270° 3.8 mm vs. 1.9 mm, p = 0.001). Other than severe calcium (especially long continuous calcium) or a bend in the vessel, anatomical factors associated with uncrossabilty were aorto-ostial lesion location and small vessels. CONCLUSIONS Uncrossable lesions are not always severely calcified. The interaction of lesion morphology (continuous long and large arcs of calcium) and vessel geometry (bend in the vessel or ostial lesion location) affect lesion crossability.
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Affiliation(s)
- Hanan Salem
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Medicine Department, Tanta University Hospitals, Faculty of Medicine - Tanta University, Tanta, Egypt
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mingyou Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Eisuke Usui
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Fumiyasu Seike
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Tatsuhiro Fujimura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Masahiko Noguchi
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Xun Hu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Ge Jin
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Chenguang Li
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Khady N Fall
- Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael B Collins
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Susheel K Kodali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Tamim M Nazif
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey W Moses
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Dimitri Karmpaliotis
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
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Patel N, Bandyopadhyay D, Agarwal G, Chakraborty S, Kumar A, Hajra A, Amgai B, Krittanawong C, Martin L, Abbott JD, Mamas MA, Naidu SS. Outcomes of rotational atherectomy followed by cutting balloon versus plain balloon before drug-eluting stent implantation for calcified coronary lesions: A meta-analysis. Catheter Cardiovasc Interv 2022; 99:1741-1749. [PMID: 35366389 DOI: 10.1002/ccd.30159] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/11/2022] [Accepted: 03/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to compare outcomes of rotational atherectomy and cutting balloon (RACB) versus rotational atherectomy and plain balloon (RAPB) before drug-eluting stent (DES) implantation in calcified coronary lesions. METHODS Randomized controlled trials (RCT) and observational studies comparing RACB with RAPB were identified through a systematic search of published literature across multiple databases. Random effect meta-analysis was performed to compare the outcome between the two groups. RESULTS Four studies were included in the meta-analysis (three observational and one RCT) involving a total of 315 patients. 166 patients had RACB, and 149 patients had RAPB before DES placement with a median follow-up of 11.5 months. Compared with patients who had RAPB there was no difference in MACE (composite of death, myocardial infarction, and target vessel revascularization) (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.25-2.18], slow flow/no reflow (OR: 0.71; 95% CI: 0.23-2.16), all-cause mortality (OR: 2.02; 95% CI: 0.28-14.60), and device success rate (OR: 1.79; 95% CI: 0.28-11.18) in the RACB approach. There was a benefit towards less target lesion revascularization in the RACB group; however, this outcome was reported in two studies (OR: 0.29; 95% CI: 0.08-0.99). On meta-regression there was no association between age, sex, diabetes, or lesion location with MACE and all-cause mortality. The studies were homogenous across all outcomes. CONCLUSION RACB, as compared with RAPB, had a similar risk of MACE, all-cause mortality, device success, and complication, but a lower risk of target lesion revascularization.
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Affiliation(s)
- Neelkumar Patel
- Department of Cardiology, University of Kansas, Lawrence, Kansas, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Gaurav Agarwal
- Jersey City Medical Center, Jersey City, New Jersey, USA
| | | | - Ashish Kumar
- Crozer-Chester Medical Center, Philadelphia, Pennsylvania, USA
| | - Adrija Hajra
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Chayakrit Krittanawong
- Department of Cardiology, The Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA
| | - Lily Martin
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Dawn Abbott
- Department of Cardiology, Lifespan Cardiovascular Institute, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mamas A Mamas
- Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
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Nfor T, Dababneh E, Jan MF, Khitha J, Allaqaband SQ, Bajwa T, Mewissen MW. National trends and variability of atherectomy use for peripheral vascular interventions from 2010 to 2019. J Vasc Surg 2022; 76:778-785. [PMID: 35367566 DOI: 10.1016/j.jvs.2022.03.864] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/13/2022] [Accepted: 03/16/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Small, older studies suggest atherectomy devices have become common in peripheral vascular interventions (PVI) despite the paucity of strong clinical guidelines. We analyzed the 10-year trends in the use of atherectomy for PVI across the United States and identified main predictors of atherectomy use. METHODS Using the Vascular Quality Initiative Registry, we identified all patients who had endovascular PVI for occlusive lower-extremity arterial disease from 2010 to 2019. Procedures in which an atherectomy device was recorded as the primary or secondary device were classified as the atherectomy group. We calculated frequency of atherectomy use over time and across geographic regions. Using regression modeling, we identified factors that were independently associated with atherectomy use. RESULTS There were 205,377 procedures on 152,693 unique patients. Over 10 years, 16.6% of PVI procedures used atherectomy, increasing from 8.5% in 2010 to 19.7% in 2019, Ptrend <0.0001. Across 17 geographic regions, there was a significant difference in the prevalence of atherectomy use, ranging from 8.2% to 29%. The strongest predictor of atherectomy use was the procedure being done in an office setting (OR 10.08, 95% CI 9.17-11.09) or ambulatory center (OR 4.0, 95% CI 3.65-4.39) vs hospital setting. The presence of severe (OR 2.6, 95% CI 2.4-2.85) or moderate (OR 1.5, 95% CI 1.4-1.69) lesion calcification was also predictive of atherectomy use. Other predictors included elective status, insurance provider, lesion length, prior PVI, claudication symptoms, and diabetes mellitus. CONCLUSIONS Atherectomy use in PVI significantly increased between 2010 and 2019. There is wide regional variability in the use of atherectomy that seems to be driven more strongly by non-clinical factors.
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Affiliation(s)
- Tonga Nfor
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA.
| | - Ehab Dababneh
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - Jayant Khitha
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - Suhail Q Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - Tanvir Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - Mark W Mewissen
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
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Beohar N, Stone GW, Martinsen BJ, Parise H, Vinardell JM, Heimowitz T, Koelbl C, Leon MB, Kirtane AJ. Coronary orbital atherectomy treatment of Hispanic and Latino patients: A real-world comparative analysis. Catheter Cardiovasc Interv 2022; 99:1752-1757. [PMID: 35312163 PMCID: PMC9540752 DOI: 10.1002/ccd.30158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 11/09/2022]
Abstract
Objectives To assess coronary orbital atherectomy (OA) use in Hispanic or Latino (HL) patients compared to non‐HL patients. Background HL patients are at greater risk of cardiovascular disease mortality compared with Whites with similar coronary artery calcium (CAC) scores. The safety and efficacy of coronary atherectomy in the HL patient population is unknown due to the under‐representation of minorities in clinical trial research. Methods A retrospective analysis of consecutive patients undergoing coronary OA treatment of severely calcified lesions at the Mount Sinai Medical Center, Miami Beach, Florida (MSMCMB) was completed. From January 2014 to September 2020, a total of 609 patients from MSMCMB who underwent percutaneous coronary intervention with OA were identified in the electronic health records. Results Of those identified, 350 (57.5%) had an ethnicity classification of HL. The overall mean age was 74 years and there was a high prevalence of diabetes in the HL group compared to the non‐HL group (49.7% vs. 34.7%; p = 0.0003). Severe angiographic complications were uncommon and in‐hospital freedom from major adverse cardiac events (MACE), a composite of cardiac death, MI, and stroke (ischemic or hemorrhagic cerebrovascular accidents), was 98.5% overall, with no significant difference between the HL and non‐HL groups, despite the higher prevalence of diabetes in the HL group. Conclusions This study represents the largest real‐world experience of OA use in HL versus non‐HL patients. The main finding in this retrospective analysis is that OA can be performed safely and effectively in a high‐risk population of HL patients.
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Affiliation(s)
- Nirat Beohar
- Division of Cardiology at the Mount Sinai Medical Center, Columbia University, Miami Beach, Florida, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brad J Martinsen
- Clinical Scientific Affairs, Cardiovascular Systems, Inc., St. Paul, Minnesota, USA
| | - Helen Parise
- Cardiovascular Medicine, Yale University Medical Center, New Haven, Connecticut, USA
| | - Juan M Vinardell
- Division of Cardiology at the Mount Sinai Medical Center, Columbia University, Miami Beach, Florida, USA
| | - Todd Heimowitz
- Division of Cardiology at the Mount Sinai Medical Center, Columbia University, Miami Beach, Florida, USA
| | - Christian Koelbl
- Division of Cardiology at the Mount Sinai Medical Center, Columbia University, Miami Beach, Florida, USA
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
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Yoon JW, Choi W, Kim SM, Hur J. Treatment failure after rotational atherectomy and balloon angioplasty in recurrent cystic adventitial disease of the popliteal artery: a case report. J Int Med Res 2022; 50:3000605221086149. [PMID: 35301877 PMCID: PMC8943312 DOI: 10.1177/03000605221086149] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cystic adventitial disease (CAD), which usually affects the popliteal artery, is a rare vascular condition in which fluid accumulates in the sub-adventitial layer, compressing the lumen. Historically, surgical treatment is preferred over endovascular or minimally invasive techniques, due to its lower recurrence rates. Here, the case of a 67-year-old male patient, in whom rotational atherectomy was performed for recurrent CAD following surgical cyst excision and patch angioplasty is reported. The patient’s symptoms recurred one day after the rotational atherectomy procedure and repeat computed tomography angiography showed recurrence of the disease. Due to gradual worsening of the condition during 8 months of follow-up, left distal femoral artery to popliteal artery (below-the-knee) bypass surgery was performed using an ipsilateral reversed great saphenous vein graft. Follow-up has continued for 2 years without complications or requirement of additional treatment. This novel case is the first report of atherectomy attempted for recurrent CAD that led to an early recurrence. Our experience emphasises that additional surgical approaches should be selected over endovascular procedures for treating recurrent CAD.
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Affiliation(s)
- Jin Woo Yoon
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Republic of Korea
| | - Woosun Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Republic of Korea
| | - Suh Min Kim
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Republic of Korea
| | - Joonho Hur
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Republic of Korea
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Kawaji Q, Dun C, Walsh C, Sorber RA, Stonko DP, Abularrage CJ, Black JH, Perler BA, Makary MA, Hicks CW. Index Atherectomy Peripheral Vascular Interventions Performed for Claudication are Associated with More Reinterventions than Non-Atherectomy Interventions. J Vasc Surg 2022; 76:489-498.e4. [PMID: 35276258 PMCID: PMC9329163 DOI: 10.1016/j.jvs.2022.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/16/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Despite limited evidence supporting atherectomy alone over stenting/angioplasty as the index peripheral vascular intervention (PVI), the use of atherectomy has rapidly increased in recent years. We previously identified a wide distribution of atherectomy practice patterns among US physicians. The aim of this study was to investigate the association of index atherectomy with reintervention. METHODS 100% Medicare fee-for-service claims were used to identify all beneficiaries who underwent elective first-time femoropopliteal peripheral vascular intervention (PVI) for claudication between 1/1/2019-12/31/2019. Subsequent PVI reinterventions were examined through 6/30/2021. Kaplan-Meier curves were used to compare the rate of PVI reinterventions for patients who received index atherectomy vs. non-atherectomy procedures. Reintervention rates were also described for physicians by their overall atherectomy use (by quartile). A hierarchical Cox proportional hazard model was used to evaluate patient and physician-level characteristics associated with reinterventions. RESULTS A total of 15,246 patients underwent index PVI for claudication in 2019, of which 59.7% were atherectomy. After a median of 603 days (IQR 77, 784) of follow-up, 41.2% of patients underwent a PVI reintervention, including 48.9% of patients who underwent index atherectomy vs. 29.8% of patients who underwent index non-atherectomy (P<0.001). Patients treated by high physician users of atherectomy (quartile 4) received more reinterventions than patients treated by standard physician users (quartiles 1-3) (56.8% vs. 39.6%, P<0.001). After adjustment, patient factors association with PVI reintervention included receipt of index atherectomy (aHR 1.33, 95% CI 1.21-1.46), Black race (vs. White, aHR 1.18, 95% CI 1.03-1.34), diabetes (aHR 1.13, 95% CI 1.07-1.21), and urban residence (aHR 1.11, 95% CI 1.01-1.22). Physician factors associated with reintervention included male sex (aHR 1.52, 95% CI 1.12-2.04), high-volume PVI practices (aHR 1.23, 95% CI 1.10-1.37), and physicians with high use of index atherectomy (aHR 1.49, 95% CI 1.27-1.74). Vascular surgeons had a lower risk of PVI reintervention than Cardiologists (vs. Vascular, aHR 1.22, 95% CI 1.09-1.38), Radiologists (aHR 1.55, 95% CI 1.31-1.83), and other specialties (aHR 1.59, 95% CI 1.20-2.11). Location of services delivered was not associated with reintervention (P>0.05). CONCLUSIONS The use of atherectomy as an index PVI for claudication is associated with higher PVI reintervention rates compared to non-atherectomy procedures. Similarly, high physician users of atherectomy perform more PVI reinterventions than their peers. The appropriateness of using atherectomy for initial treatment of claudication needs critical reevaluation.
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Affiliation(s)
- Qingwen Kawaji
- Department of Plastics and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christi Walsh
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca A Sorber
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David P Stonko
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bruce A Perler
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Carey Business School, Johns Hopkins University, Baltimore, MD
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD.
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He Z, Wang H, Lin F, Ding W, Chen K, Zhang Z. The safety and efficacy of different endovascular treatments for in-stent restenosis of the femoropopliteal artery: A network meta-analysis. Vasc Med 2022; 27:239-250. [PMID: 35164613 DOI: 10.1177/1358863x211070327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Femoropopliteal artery in-stent restenosis (ISR) remains a challenging treatment. We performed a network meta-analysis (NWM) for femoropopliteal artery ISR to explore the safety and efficacy of endovascular therapeutic strategies. Methods: The MEDLINE, Embase, Web of Science, and Cochrane databases were used as data sources. The network meta-analysis (NWM) approach used random-effects models based on the frequentist framework. We compared technical success rate, primary patency, target lesion revascularization (TLR), and major amputation at the 12-month follow-up for femoropopliteal artery ISR. Results: In total, 14 eligible studies (10 prospective and four retrospective; 1348 patients; and eight treatment modalities - standard balloon angioplasty (SBA), drug-coated balloon (DCB), peripheral cutting balloon angioplasty (PCBA), Viabahn endoprosthesis (VBE), directional atherectomy (DA), excimer laser atherectomy (ELA), and combinations - were included. The primary patency rates (at 6 months) were significantly higher for DCB and ELA+DCB than for SBA and ELA+SBA. ELA+DCB had higher primary patency rates (at 12 months) than ELA+SBA and SBA. The technical success rates were significantly lower for DCB and SBA than for VBE. The major amputation rates were significantly lower for ELA+DCB than for DCB. Based on the surface values under the cumulative ranking curve (SUCRA), ELA+DCB was considered the best treatment in terms of primary patency at 6 months (SUCRA = 91.1), primary patency at 12 months (SUCRA = 82.3), and TLR (SUCRA = 83.4). Conclusion: ELA+DCB showed positive encouraging results in primary patency (6, 12 months), TLR, and major amputation in femoropopliteal ISR. The efficacy and safety of ELA+DCB are worthy of further investigation. (PROSPERO Registration No.: CRD42021246674).
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Affiliation(s)
- Zhipeng He
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Haoran Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Feng Lin
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Wenjie Ding
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Ke Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Zhigong Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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Shishehbor MH, Griffin J, Crowder W, Kucher T, León LR, McClure JM, Sood A, Montero-Baker M. Acute Real-World Outcomes From the Phoenix Post-Approval Registry. J Invasive Cardiol 2022; 34:E1-E7. [PMID: 34928815] [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: 06/14/2023]
Abstract
OBJECTIVES An evaluation of the 30-day safety and performance outcomes of the Phoenix atherectomy system (Philips Volcano Corporation) was performed in real-world patients with peripheral artery disease (PAD). METHODS The Phoenix Post-Approval Registry is an all-comer study that enrolled patients with infrainguinal PAD. Patients treated with the Phoenix atherectomy system were followed for 30 days to observe device-related complications. Outcomes evaluated include procedural (final target lesion(s) residual stenosis of ≤30% after treatment with Phoenix and any other adjunctive therapy) and technical success (defined as achieving a post-Phoenix [prior to any adjunctive therapy] residual diameter stenosis of ≤50%), target-vessel revascularization (TVR), target-lesion revascularization (TLR), target-limb amputation, ankle brachial index, Rutherford clinical category, and wound, ischemia, foot infection (WIfI) classification. RESULTS Of the 500 patients enrolled, 259 had CLI, including 26.3% with Rutherford class 6. Procedural success rates were 97.3% for non-CLI patients and 98.2% for CLI patients. Technical success rates were 71.5% for non-CLI patients and 77.9% for CLI patients. Complication rates post Phoenix atherectomy were <1%. Through the 30-day follow-up, there were 6 patients (1.3%; 2 claudicants, 4 CLIs) who underwent TLR and 8 patients who underwent TVR. There were no major amputations in the non-CLI and CLI cohorts. In the CLI cohort, 16/235 (6.8%) underwent minor amputations. Higher stages of Rutherford class and WIfI classification were associated with amputations at 30 days. CONCLUSION The Phoenix atherectomy system is a safe and effective treatment option in the acute setting for patients with PAD, including those with advanced Rutherford class. Randomized controlled trials are needed to confirm these results.
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Affiliation(s)
- Mehdi H Shishehbor
- Professor of Medicine, Case Western Reserve University School of Medicine, University Hospitals, 11100 Euclid Avenue, Lakeside 3rd floor, Cleveland, OH 44106 USA.
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Zaidan M, Alkhalil M, Alaswad K. Calcium Modification Therapies in Contemporary Percutaneous Coronary Intervention. Curr Cardiol Rev 2022; 18:e281221199533. [PMID: 34963434 PMCID: PMC9241119 DOI: 10.2174/1573403x18666211228095457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 12/31/2020] [Revised: 07/02/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022] Open
Abstract
Coronary Artery Calcification (CAC) has been known to be associated with worse Percutaneous Coronary Intervention (PCI) short- and long-term outcomes. Nowadays, with the increased prevalence of the risk factors leading to CAC in the population and also more PCI procedures done in older patients and with the growing number of higher-risk cases of Chronic Total Occlusion (CTO) PCI and PCI after Coronary Artery Bypass Grafting (CABG), severe cases of CAC are now encountered on a daily basis in the catheterization lab and remain a big challenge to the interventional community, making it crucial to identify cases of severe CAC and plan a CAC PCI modification strategy upfront. Improved CAC detection with intravascular imaging helped identify more of these severe CAC cases and predict response to therapy and stent expansion based on CAC distribution in the vessel. Multiple available therapies for CAC modification have evolved over the years. Familiarity with the specifics and special considerations and limitations of each of these tools are essential in the choice and application of these therapies when used in severe CAC treatment. In this review, we discuss CAC pathophysiology, modes of detection, and different available therapies for CAC modification.
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Affiliation(s)
- Mohammad Zaidan
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Mohammad Alkhalil
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK.,Department of Cardiology, Vascular Biology, Newcastle University, Newcastle- upon-Tyne, UK
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
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40
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Cubero-Gallego H, Gonzalo N, Tizon-Marcos H, Salvatella N, Garcia-Guimaraes M, Negrete A, McInerney A, Millan R, Vaquerizo B. Primary Angioplasty of Calcified Coronary Lesions Using Coronary Lithotripsy in Acute ST-Segment Elevation Myocardial Infarction. J Invasive Cardiol 2021; 33:E970-E973. [PMID: 34783676] [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: 06/13/2023]
Abstract
BACKGROUND This study reports procedural and short-term clinical outcomes from a real-world series with the use of coronary lithotripsy in the context of primary angioplasty in ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS This was a prospective registry conducted at 2 hospitals, which included 10 patients who presented a culprit calcified lesion within acute STEMI and underwent coronary lithotripsy during primary angioplasty, between July 2019 and July 2020. Mean age was 69.2 ± 11.8 years, and there was a high proportion of hypertension (70%) and dyslipidemia (60%). All lesions (type B/C) were predilated with a semicompliant balloon. Coronary lithotripsy was performed in all cases once macroscopic thrombus was successfully retrieved by thrombus aspiration catheter. Before lithotripsy, rotational atherectomy was used in 1 case and cutting balloon was used in 2 cases. On average, coronary lithotripsy required the use of 1 lithotripsy balloon (range, 1-2) delivering a mean of 70 pulses. Two lithotripsy balloons were ruptured during lithotripsy therapy without any adverse event. Successful coronary lithotripsy was achieved in 90%. There were no periprocedural cardiac complications. CONCLUSIONS Coronary lithotripsy seems to be a safe and effective technique in patients with STEMI and a culprit calcified lesion undergoing primary angioplasty for calcium modification in the absence of angiographic thrombus, and a suitable option to achieve adequate stent expansion and apposition.
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41
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Cosgrove C, Mahadevan K, Spratt JC, McEntegart M. The Impact of Calcium on Chronic Total Occlusion Management. Interv Cardiol 2021; 16:e30. [PMID: 34754332 PMCID: PMC8559150 DOI: 10.15420/icr.2021.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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: 01/05/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022] Open
Abstract
Coronary artery calcification is prevalent in chronic total occlusions (CTO), particularly in those of longer duration and post-coronary artery bypass. The presence of calcium predicts lower procedural success rates and a higher risk of complications of CTO percutaneous coronary intervention. Adjunctive imaging, including pre-procedural computed tomography and intracoronary imaging, are useful to understand the distribution and morphology of the calcium. Specialised guidewires and microcatheters, as well as penetration, subintimal entry and luminal re-entry techniques, are required to cross calcific CTOs. The use of both atherectomy devices and balloon-based calcium modification tools has been reported during CTO percutaneous coronary intervention, although they are limited by concerns regarding safety and efficacy in the subintimal space.
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Affiliation(s)
- Claudia Cosgrove
- St George's University Hospitals NHS Foundation Trust London, UK
| | | | - James C Spratt
- St George's University Hospitals NHS Foundation Trust London, UK
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42
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Zhang M, Matsumura M, Usui E, Noguchi M, Fujimura T, Fall KN, Zhang Z, Nazif TM, Parikh SA, Rabbani LE, Kirtane AJ, Collins MB, Leon MB, Moses JW, Karmpaliotis D, Ali ZA, Mintz GS, Maehara A. Intravascular Ultrasound-Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions. Circ Cardiovasc Interv 2021; 14:e010296. [PMID: 34665658 DOI: 10.1161/circinterventions.120.010296] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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] [Indexed: 01/18/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Mingyou Zhang
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, The First Hospital of Jilin Univeristy, Changchun, Jilin, China (M.Z.)
| | - Mitsuaki Matsumura
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Eisuke Usui
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Masahiko Noguchi
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Tatsuhiro Fujimura
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Khady N Fall
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Zixuan Zhang
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Tamim M Nazif
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Sahil A Parikh
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - LeRoy E Rabbani
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Ajay J Kirtane
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Michael B Collins
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Martin B Leon
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Jeffrey W Moses
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,DeMatteis Cardiovascular Institute, St. Francis Hospital, Roslyn, NY (J.W.M., Z.A.A.)
| | - Dimitri Karmpaliotis
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Ziad A Ali
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,DeMatteis Cardiovascular Institute, St. Francis Hospital, Roslyn, NY (J.W.M., Z.A.A.)
| | - Gary S Mintz
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Akiko Maehara
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
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Bai H, Fereydooni A, Zhang Y, Tonnessen BH, Guzman RJ, Chaar CIO. Trends in Utilization and Outcomes of Orbital, Laser, and Excisional Atherectomy for Lower Extremity Revascularization. J Endovasc Ther 2021; 29:389-401. [PMID: 34643142 DOI: 10.1177/15266028211050329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study is to analyze the utilization pattern of atherectomy modalities and compare their outcomes. MATERIALS AND METHODS All patients undergoing atherectomy in the 2010-2016 Vascular Quality Initiative Database were identified. Utilization of orbital, laser, or excisional atherectomy was obtained. Characteristics and outcomes of patients treated for isolated femoropopliteal and isolated tibial disease by different modalities were compared. RESULTS Atherectomy use increased from 10.3% to 18.3% of all peripheral interventions (n = 122 938). Orbital atherectomy was most commonly used and increased from 59.4% in 2010 to 63.2% of all atherectomies in 2016, while laser atherectomy decreased from 19.2% to 13.1%. Atherectomy was mostly used for treatment of isolated femoropopliteal disease (51.1%), followed by combined femoropopliteal and tibial disease (25.8%) and isolated tibial disease (11.7%). In isolated femoropopliteal revascularization, excisional atherectomy was associated with higher rate of perforation (1.2%) compared with laser (0.4%) and orbital atherectomy (0.5%). The technical success of orbital atherectomy (96.7%) was lower compared with excisional atherectomy (98.7%). Concomitant stenting was significantly higher with laser atherectomy (43.0%) compared with orbital (27.2%) and excisional (26.1%) atherectomy. Nevertheless, there was no difference in 1-year primary patency, reintervention, major amputation, improvement in ambulatory status, or mortality. Multivariable analysis also demonstrated no difference in 1-year primary patency and major ipsilateral amputation among the modalities. In isolated tibial revascularization, there were no differences in perioperative outcomes among the modalities. Excisional atherectomy was associated with the highest 1-year primary patency (88.1%). After adjusting for confounders, excisional atherectomy remained associated with superior 1-year primary patency compared with orbital atherectomy (odds ratio [OR] = 2.59, 95% confidence interval [CI] = [1.18-5.68]), and excisional atherectomy remained associated with a lower rate of 1-year major ipsilateral amputation compared with laser atherectomy (OR = 0.29, 95% CI = [0.09-0.95]). CONCLUSION Atherectomy use has increased, driven primarily by orbital atherectomy. Despite significant variation in perioperative outcomes, there were no differences in 1-year outcomes among the different modalities when used for treating isolated femoropopliteal disease. In isolated tibial disease treatment, excisional atherectomy was associated with higher 1-year primary patency compared with orbital atherectomy and decreased major ipsilateral amputation rates compared with laser atherectomy. These differences warrant further investigation into the comparative effectiveness of atherectomy modalities in various vascular beds.
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Affiliation(s)
- Halbert Bai
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arash Fereydooni
- Department of Surgery, Division of Vascular Surgery, Stanford Health Care, Stanford, CA, USA
| | - Yawei Zhang
- Yale School of Public Health, New Haven, CT, USA
| | - Britt H Tonnessen
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Krishnan P, Tarricone A, Gee A, Farhan S, Kamran H, Kapur V, Gujja K, Kini A, Sharma S. Analysis of Interwoven Nitinol Stenting for the Treatment of Critical Limb Ischemia: Outcomes From an Average 3-Year Follow-up Period. Angiology 2021; 73:407-412. [PMID: 34617824 DOI: 10.1177/00033197211043406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We assessed the clinical outcomes of patients with critical limb-threatening ischemia (CLTI) who underwent interwoven nitinol stent (Supera) implantation for significant stenoses of the femoropopliteal segment. In this retrospective cohort study, 116 consecutive patients with CLTI who were treated with Supera stents between September 2015 and March 2020 were included in this analysis. Primary endpoint analysis was completed for amputation-free survival, target lesion revascularization (TLR), and mortality. After a mean follow-up time of 3.4 years, 21 (18%) patients had undergone amputations, 3 (2.6%) died, and, overall, the amputation-free survival rate was 81%. TLR occurred in 21 (18%) patients, resulting in the freedom from target lesion revascularization of 82%. The average Wagner score for all patients was 2.8 ± 1.1. A subgroup analysis of 57 patients revealed a median ulcer size of 3.0 cm2 [1.65, 9.0], with complete healing for 45 patients by 20 months. The Wagner score of this subgroup decreased by an average of 3.4 ± .9 points. Supera stents can be used together with other endovascular therapies and are a safe and effective treatment modality for CLTI.
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Affiliation(s)
- Prakash Krishnan
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arthur Tarricone
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allen Gee
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Serdar Farhan
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Haroon Kamran
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vishal Kapur
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karthik Gujja
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annapoorna Kini
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samin Sharma
- Icahn School of Medicine at the Mount Sinai Hospital, The Zena and Michael A. Weiner Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Feldman DN, Klein AJP. Atherectomy in Peripheral Vascular Interventions: Time to Follow the Guidelines? JACC Cardiovasc Interv 2021; 14:689-691. [PMID: 33736775 DOI: 10.1016/j.jcin.2021.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Dmitriy N Feldman
- Department of Medicine, Greenberg Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
| | - Andrew J P Klein
- Piedmont Heart Institute, Piedmont Healthcare, Atlanta, Georgia, USA
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Hicks CW, Holscher CM, Wang P, Dun C, Abularrage CJ, Black JH, Hodgson KJ, Makary MA. Use of Atherectomy During Index Peripheral Vascular Interventions. JACC Cardiovasc Interv 2021; 14:678-688. [PMID: 33736774 DOI: 10.1016/j.jcin.2021.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 11/02/2020] [Revised: 12/11/2020] [Accepted: 01/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to describe physician practice patterns and examine physician-level factors associated with the use of atherectomy during index revascularization for patients with femoropopliteal peripheral artery disease. BACKGROUND There are minimal data to support the routine use of atherectomy over angioplasty and/or stenting for the endovascular treatment of peripheral artery disease. METHODS Medicare fee-for-service claims (January 1 to December 31, 2019) were used to identify all beneficiaries undergoing elective first-time femoropopliteal peripheral vascular intervention (PVI) for claudication or chronic limb-threatening ischemia. Hierarchical logistic regression was used to evaluate patient- and physician-level characteristics associated with atherectomy. RESULTS A total of 58,552 patients underwent index femoropopliteal PVI by 1,627 physicians. There was a wide distribution of physician practice patterns in the use of atherectomy, ranging from 0% to 100% (median 55.1%). Independent characteristics associated with atherectomy included treatment for claudication (vs. chronic limb-threatening ischemia; odds ratio [OR]: 1.51), patient diabetes (OR: 1.09), physician male sex (OR: 2.08), less time in practice (OR: 1.41 to 2.72), nonvascular surgery specialties (OR: 2.78 to 5.71), physicians with high volumes of femoropopliteal PVI (OR: 1.67 to 3.51), and physicians working primarily at ambulatory surgery centers or office-based laboratories (OR: 2.19 to 7.97) (p ≤ 0.03 for all). Overall, $266.8 million was reimbursed by Medicare for index femoropopliteal PVI in 2019. Of this, $240.6 million (90.2%) was reimbursed for atherectomy, which constituted 53.8% of cases. CONCLUSIONS There is a wide distribution of physician practice patterns for the use of atherectomy during index PVI. There is a critical need for professional guidelines outlining the appropriate use of atherectomy in order to prevent overutilization of this technology, particularly in high-reimbursement settings.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peiqi Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kim J Hodgson
- Department of Vascular Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Silalahi TDA, Suwita CS. Successful rotational atherectomies for calcified left main stenosis with distal aneurysms in the elderly. Clin Case Rep 2021; 9:e04465. [PMID: 34295487 PMCID: PMC8283865 DOI: 10.1002/ccr3.4465] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/22/2021] [Accepted: 06/01/2021] [Indexed: 11/08/2022] Open
Abstract
In complex calcified LM lesions, RA is an effective and safe alternative for resolving stenosis. As a plaque modifier, RA can allow an optimal stent deployment. Nevertheless, in limited availability of intravascular imaging, well-preparedness against incidental angiography findings is mandatory. Distal aneurysm is not a contraindication provided that the team has the necessary experience.
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Affiliation(s)
- Todung D. A. Silalahi
- Cardiovascular DivisionInternal Medicine DepartmentKrida Wacana Christian UniversityJakarta BaratIndonesia
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Yiğit G. Early outcomes of novel Temren atherectomy device combined with drug-coated balloon angioplasty for treatment of femoropopliteal lesions. Vascular 2021; 30:739-748. [PMID: 34180304 DOI: 10.1177/17085381211029819] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In this study, perioperative properties and early outcomes of patients who underwent combined Temren rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty treatment for complex femoropopliteal lesions in a single center were reported. METHODS Between June 2019 and February 2020, 40 patients who underwent combined Temren RA and DCB treatment due to critical lower limb ischemia or claudication-limiting daily living activities were retrospectively evaluated. RESULTS The mean age of patients was 73.2 ± 7.8 years and the majority of the patients were male (65%). Of the patients, 17 had critical limb ischemia and 23 had lifestyle-limiting claudication. Pathologies were total occlusion in 33 limbs and critical stenosis in seven limbs. Nine patients previously underwent endovascular intervention or surgery. The mean total occlusion length was 140.9 ± 100.9 (range, 20-360) mm in patients with chronic total occlusion. There was an additional iliac artery pathology in 5 and below the knee pathology in 8 patients. Rotational atherectomy was possible in all cases. Flow-limiting dissection was seen in six patients (15%). Provisional stent was performed to these patients. Following Temren RA, all patients underwent DCB. Adequate vascular lumen (less than 30% stenosis) was provided in all patients and the symptoms regressed. No distal embolization was encountered. Access site complications (17.5%) were small hematoma in four patients, ecchymosis in two patients, and pseudoaneurysm of the femoral artery in one patient. The mean follow-up was 13.55 ± 4.2 (range, 1-18) months. Re-occlusion was seen in three patients (7.5%) (n = 2 at 2 months and n = 1 at 4 months). Of these patients, two had required open revascularization via femoropopliteal bypass graft with common, superficial femoral, and popliteal artery endarterectomy and one had required femoro-posterior tibial artery bypass. Four minor toe amputations (10%) were performed to reach complete wound healing in the critical limb ischemia patients. A below-knee amputation was performed in a 94-year-old patient with long segment stenosis at the end of a 1-month follow-up period. There was no mortality after follow-ups. The Kaplan-Meier estimator estimated the rate of freedom from target lesion revascularization (TLR) which was 92.3%. The decrease in the Rutherford levels after the procedure was found to be statistically significant in 36 patients (p < 0.001). The increase in the ankle-brachial index after the procedure was found to be statistically significant in 36 patients (p < 0.001). CONCLUSIONS Combined use of Temren RA with adjunctive DCB is safe and effective method with high rates of primary patency and freedom from TLR and low rates of complication in the treatment of femoropopliteal lesions.
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Affiliation(s)
- Görkem Yiğit
- Department of Cardiovascular Surgery, 233009Yozgat State Hospital, Yozgat, Turkey
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Rastan A, Brodmann M, Böhme T, Macharzina R, Noory E, Beschorner U, Flügel PC, Bürgelin K, Neumann FJ, Zeller T. Atherectomy and Drug-Coated Balloon Angioplasty for the Treatment of Long Infrapopliteal Lesions: A Randomized Controlled Trial. Circ Cardiovasc Interv 2021; 14:e010280. [PMID: 34092093 DOI: 10.1161/circinterventions.120.010280] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Aljoscha Rastan
- Medizinische Universitätsklinik, Angiologie, Kantonsspital Aarau, Switzerland (A.R.)
| | - Marianne Brodmann
- Angiologische Abteilung, LKH-Universitäts-Klinikum Graz, Austria (M.B.)
| | - Tanja Böhme
- Universitäts-Herzzentrum Freiburg, Kardiologie und Angiologie II, Bad Krozingen, Germany (T.B., R.M., E.N., U.B., P.F., K.B., F.N., T.Z.)
| | - Roland Macharzina
- Universitäts-Herzzentrum Freiburg, Kardiologie und Angiologie II, Bad Krozingen, Germany (T.B., R.M., E.N., U.B., P.F., K.B., F.N., T.Z.)
| | - Elias Noory
- Universitäts-Herzzentrum Freiburg, Kardiologie und Angiologie II, Bad Krozingen, Germany (T.B., R.M., E.N., U.B., P.F., K.B., F.N., T.Z.)
| | - Ulrich Beschorner
- Universitäts-Herzzentrum Freiburg, Kardiologie und Angiologie II, Bad Krozingen, Germany (T.B., R.M., E.N., U.B., P.F., K.B., F.N., T.Z.)
| | - Peter-Christian Flügel
- Universitäts-Herzzentrum Freiburg, Kardiologie und Angiologie II, Bad Krozingen, Germany (T.B., R.M., E.N., U.B., P.F., K.B., F.N., T.Z.)
| | - Karlheinz Bürgelin
- Universitäts-Herzzentrum Freiburg, Kardiologie und Angiologie II, Bad Krozingen, Germany (T.B., R.M., E.N., U.B., P.F., K.B., F.N., T.Z.)
| | - Franz-Josef Neumann
- Universitäts-Herzzentrum Freiburg, Kardiologie und Angiologie II, Bad Krozingen, Germany (T.B., R.M., E.N., U.B., P.F., K.B., F.N., T.Z.)
| | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg, Kardiologie und Angiologie II, Bad Krozingen, Germany (T.B., R.M., E.N., U.B., P.F., K.B., F.N., T.Z.)
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Parikh PB, Weber-Fishkin S, George S, Kane J, Pyo R. Balloon Aortic Valvuloplasty With Same-Setting Complex Percutaneous Coronary Intervention in the TAVR Era: A Case Series. J Invasive Cardiol 2021; 33:E479-E482. [PMID: 34077385] [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: 06/12/2023]
Abstract
BACKGROUND The use of balloon aortic valvuloplasty (BAV) prior to same-setting complex percutaneous coronary intervention (PCI) in patients with severe aortic stenosis (AS) and concomitant severe coronary artery disease (CAD) has not been well studied in the era of transcatheter aortic valve replacement (TAVR). METHODS We reviewed 379 BAVs performed between January 2016 and April 2020 at an academic tertiary-care medical center. Overall, 327 BAVs were performed in the setting of TAVR. Of the remaining 52 BAVs, 20 were performed immediately prior to same-setting complex PCI. We examined the baseline and procedural data, and clinical outcomes of these cases. RESULTS Mean patient age was 81 ± 9 years and 70% were men. Chronic kidney disease (40%), diabetes mellitus (35%), and atrial fibrillation (35%) were the most prevalent comorbidities. Rotational atherectomy was performed in 75% of cases and Impella device was utilized in 15%. PCI of distal left main coronary artery and proximal left anterior descending coronary artery was performed in 30% and 80% of cases, respectively. Mean contrast volume was 149 ± 61 mL, fluoroscopy time was 37 ± 20 minutes, total skin dose was 2821 ± 1931 mGy, and total area dose was 18651 ± 12090 μGy/m². Rate of in-hospital complications was low, with a 0% mortality and stroke rate. Eighty percent of patients were referred for TAVR; 70% went on to undergo successful TAVR and 10% deferred TAVR due to improvement in symptoms. CONCLUSIONS BAV with same-setting complex PCI is safe and feasible in patients with severe AS and severe CAD awaiting TAVR.
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Affiliation(s)
- Puja B Parikh
- Transcatheter Aortic Valve Replacement Program, Division of Cardiology, Stony Brook University Medical Center Health Sciences Center, T16-080, Stony Brook, NY 11794-8160 USA.
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