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Kereiakes DJ. Editorial: Intravascular lithotripsy for post-implant stent under-expansion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:24-25. [PMID: 37949718 DOI: 10.1016/j.carrev.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Dean J Kereiakes
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA.
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van Oort MJH, Al Amri I, Bingen BO, Cordoba-Soriano JG, Karalis I, Sanz-Sanchez J, Oliveri F, van der Kley F, Jukema JW, Jurado-Roman A, Montero-Cabezas JM. Procedural and clinical impact of intravascular lithotripsy for the treatment of peri-stent calcification. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:16-23. [PMID: 37923647 DOI: 10.1016/j.carrev.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Use of intravascular lithotripsy (IVL) for treating peri-stent calcification is increasing. However, this indication remains 'off-label'. We aimed to investigate the efficacy and clinical outcomes of in-stent IVL. METHODS Patients from five European centers who underwent in-stent IVL were included between 2019 and 2023. Demographic, clinical, procedural and follow-up data were collected from electronic hospital records. Angiographic and intracoronary imaging (ICI) data were analyzed in a centralized core-laboratory. RESULTS Of 101 patients (71.2 ± 9.2 years), 56(55 %) received in-stent IVL for late stent failure (median 109 days post-PCI) due to calcific neoatherosclerosis or extra-stent calcification(late-IVL), while 45(45 %) underwent bail-out IVL due to stent infraexpasion (immediate-IVL). Both late-IVL and immediate-IVL significantly improved angiographic %diameter stenosis (73.7[59.6-89.8]% to 16.4 [10.4-26.9]%;p < 0.0001 and 28.6[22.5-43.3]% to 14.1[10.3-29.4]%;p < 0.0001, and minimum lumen area (MLA) (3.4 ± 1.2 to 8.6 ± 2.5 mm2;p < 0.002 and 5.4 ± 1.9 to 7.3 ± 1.9;p < 0.0001).Device(98 %) and procedural success(80 %) were high. MACE rates in-hospital (2 %), 30-days (3 %),6-months(5 %) and 1-year(7 %) were low and comparable in both groups. Acute diameter gain was lower in immediate-IVL (2.1 ± 0.7 mm vs. 0.5 ± 0.4 mm;p < 0.0001). This, however, was explained by significant differences in pre-IVL angiographic and ICI parameters (%diameter stenosis 73.7[59.6-89.8] vs. 28.6[22.5-43.3]%; p < 0.0001 and MLA (3.4 ± 1.2 vs 5.4 ± 1.9 mm2; p < 0.0001), whereas post-IVL percentage diameter stenosis (16.4(10.4-26.9) vs. 14.1(10.3-29.4);p = 0.914) and MLA (8.6 ± 2.5vs. 7.4 ± 1.9 mm2;p = 0.064) in late- and immediate-IVL were comparable. CONCLUSIONS IVL in-stent due to peri-stent calcification is an effective strategy, both late and immediately after stent implantation. Overall, MACE rates at short- and mid-term were low and comparable in both groups, although clinical findings should be taken with caution.
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Affiliation(s)
- Martijn J H van Oort
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Juan G Cordoba-Soriano
- Department of Cardiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Ioannis Karalis
- Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece.
| | - Jorge Sanz-Sanchez
- Department of Cardiology, Hospital Universitari I Politecnic La Fe, Valencia, Spain
| | - Federico Oliveri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
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Senguttuvan NB, Singh H, Kumar BV, Kongara RC, Abdulkader RS, Anandaram A, Krishnamurthy P, Balasubramaniyan JV, Sadhanandham S, Ramesh S, Manokar P, Muralidharan TR, Murthy JSN, Thanikachalam S. Safety and Efficacy of OPN Balloon in Patients With Calcified Coronary Artery Disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 54:25-30. [PMID: 36842933 DOI: 10.1016/j.carrev.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Patients with symptomatic calcified coronary lesions have poor outcomes. Such lesions require additional atherectomy devices for bed preparation. AIM To assess the safety and efficacy of OPN balloon in patients with calcified coronary lesions. METHODS This is an investigator-initiated, prospective, observational study. The primary outcome of the study was a procedural success. RESULTS We studied 71 patients (133 lesions). Maximum lesions were located in LAD [46.6 %]. The OPN balloon was used for pre-dilatation alone in 28.6 % (Pre-stent OPN group), post-dilatation alone in 63.2 % of lesions (Post-stent OPN group), and in both situations in 8.3 % of lesions with procedural success in 98.5 % of patients. Further dilatation with different NC balloons was required in both groups (30 %). The median (IQR) OPN balloon diameter in the pre- and post-stent OPN group were 2.5 (2.5, 3.0) and 3.0 (3.0,3.0) mm (p = 0.001), respectively. The difference between the diameter of the stent and OPN balloon used in pre-stent OPN group was 0.5 (0.2, 0.5) mm while it was 0.0 (0.0,0.2) mm in the post-stent OPN group (p < 0.001). Eight complications and two deaths occured. Distal shaft rupture was also noticed. CONCLUSION OPN balloon is safe, and effective in treating calcified coronary lesions. We propose to undersize the balloon by 0.5 mm for pre-dilatation followed by 0.25 mm larger NC balloon if needed. In the post-dilatation group, use a 1:1 size balloon in a non-tortuous straight segment. Use imaging especially when (1) the pressure taken more than the rated burst pressure, (2) an OPN balloon size is ≥3 mm (3) using 1:1 size OPN balloon in a tortuous segment.
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Affiliation(s)
- Nagendra Boopathy Senguttuvan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
| | - Harsimran Singh
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Balakrishnan Vinod Kumar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Rahul Chowdary Kongara
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | | | - Asuwin Anandaram
- Department of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Preetam Krishnamurthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Jayanthy Venkata Balasubramaniyan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Shanmugasundram Sadhanandham
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Sankaran Ramesh
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Panchanatham Manokar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Thoddi Ramamurthy Muralidharan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Jayanthy S N Murthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Sadagopan Thanikachalam
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
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Zhang J, Stouffer GA. Drill as Needed: The Safety of Rotational Atherectomy in Acute Coronary Syndromes. Am J Cardiol 2023:S0002-9149(23)00419-8. [PMID: 37385928 DOI: 10.1016/j.amjcard.2023.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Jiandong Zhang
- Division of Cardiology; The McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina
| | - George A Stouffer
- Division of Cardiology; The McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina.
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Seiler T, Attinger-Toller A, Cioffi GM, Madanchi M, Teufer M, Wolfrum M, Moccetti F, Toggweiler S, Kobza R, Bossard M, Cuculi F. Treatment of In-Stent Restenosis Using a Dedicated Super High-Pressure Balloon. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:29-35. [PMID: 36085285 DOI: 10.1016/j.carrev.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Treatment of in-stent restenosis (ISR) is challenging and treatment failure rate remains high. Correction of stent under-expansion and neointimal compression using the twin-layer OPN™ highly non-compliant balloon (NCB) at high pressure (>30 atm) may lead to increased luminal gain and thus better clinical outcomes. We evaluated periprocedural safety and clinical long-term outcomes after ISR treatment using the OPN™ NCB in a real-world population. METHODS From an ongoing registry, consecutive ISR patients treated with the OPN™ NCB at a tertiary cardiology center in Switzerland were analyzed. We evaluated procedural efficacy, periprocedural complications, target lesion/vessel failure (TLF/TVF), and major adverse cardiovascular events (MACE). RESULTS Totally, 208 ISR lesions were treated in 188 patients (mean age 68 ± 13 years, 78 % males). Most lesions were moderately to heavily calcified (89 %), the majority (70.2 %) had complex lesion characteristics (AHA Type B2/C lesions) and 50.5 % were non-focal ISR lesions. After ISR treatment using high pressure pre- and post-dilatation (mean pressure 33 ± 6 atm) with the OPN™ NCB device, the rate of major complications was low (0.96 % coronary perforation, 4 % major dissections, 1.9 % no-reflow and 0.5 % acute vessel closure). At 1-year follow-up, MACE occurred in 19.7 %; 15.4 % patients had TVF; MI and stent thrombosis was found in 5.9 % and 2.1 % of all patients, respectively; and 5 patients died. CONCLUSIONS For ISR treatment, using the super non-compliant OPN™ balloon at very high pressures is safe. Moreover, its use might lead to a low rate of TLF/TVF during long-term follow-up, but this requires further evaluation in dedicated comparative trials.
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Affiliation(s)
- Thomas Seiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | | | | | - Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Mario Teufer
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland; Medical School, University of Zurich, Zurich, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland.
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Basavarajaiah S, Ielasi A, Raja W, Naneishvili T, Testa L, Popolo Rubbio A, Mastrangelo A, Bartorelli AL, Bhatia G, Choudhury A, Sundara-Raman A, Buono A, Sharma V, Cortese B, Marchesi A, Pitt M, Raju P, Wassef N. Long-term outcomes following intravascular lithotripsy (IVL) for calcified coronary lesions: A Real-World Multicenter European Study. Catheter Cardiovasc Interv 2022; 101:250-260. [PMID: 36525378 DOI: 10.1002/ccd.30519] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To explore the long-term clinical outcomes following intravascular lithotripsy (IVL) in calcified coronary lesions from a real-world population. BACKGROUND IVL is a relatively new but promising modality for treating coronary calcified lesions, but there is a dearth of long-term outcome data from real-world patients. METHODS This was a multicenter, observational study in which we enrolled all patients treated with IVL from November 2018 to February 2021 from eight centers in Europe and the United Kingdom. Procedural success, complications, and clinical outcomes (cardiac death, target vessel myocardial infarction [TVMI], target lesion revascularization [TLR], and MACE [major adverse cardiac events, the composite of cardiac death, TVMI, and TLR]) were assessed. RESULTS In total, 273 patients with a mean age of 72 ± 9.1 years were treated with IVL. Major comorbidities included diabetes mellitus (n = 110, 40%) and chronic kidney disease (n = 45, 16%). Acute coronary syndrome accounted for 48% (n = 132) of patients, while 52% (n = 141) had stable angina. De novo lesions and in-stent restenosis accounted for 79% and 21% of cases, respectively. Intravascular imaging was used in 33% (n = 90) of patients. An upfront IVL strategy was adopted in 34% (n = 92), while the rest were bailout procedures. Adjuvant rotational atherectomy ("RotaTripsy") was required in 11% (n = 31) of cases. The procedural success was 99%. During a median follow-up of 687 days (interquartile range: 549-787), cardiac death occurred in 5% (n = 14), TVMI in 3% (n = 8), TLR in 6% (n = 16), and MACE rate was 11% (n = 30). CONCLUSION This is the largest multicenter registry with a long-term follow-up showing the remarkably high procedural success of IVL use in calcified coronary lesions with low rates of hard endpoints and MACE.
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Affiliation(s)
| | | | - Waseem Raja
- Heartlands Hospital, University Hospitals, Birmingham, UK
| | | | - Luca Testa
- Institution Policlinico San Donato, Milan, Italy
| | | | | | - Antonio L Bartorelli
- Centro Cardiologico, Monzino, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gurbir Bhatia
- Heartlands Hospital, University Hospitals, Birmingham, UK
| | | | | | | | | | | | | | - Michael Pitt
- Heartlands Hospital, University Hospitals, Birmingham, UK
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Rota-Lithotripsy as a Novel Bail-Out Strategy for Highly Calcified Coronary Lesions in Acute Coronary Syndrome. Biomedicines 2022; 10:biomedicines10112795. [DOI: 10.3390/biomedicines10112795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Heavily calcified lesions in acute coronary syndrome (ACS) still represent a challenging subset for percutaneous coronary intervention (PCI). Rota-lithotripsy—a marriage of rotational atherectomy and intravascular lithotripsy—has recently been introduced to clinical practice as a novel therapeutic option. Methods: This study is among the to present the 6-month clinical outcomes of rota-lithotripsy when performed in the ACS setting. The study cohort consisted of 15 consecutive ACS patients who underwent a rota-lithotripsy-PCI due to the presence of a highly calcified, undilatable lesion. Results: The procedural success ratio reached 100%. During the 6-month follow-up, in two of the patients, instances of MACE (major adverse cardiac events) occurred, including one fatal event. Additionally, during the observation period, one target lesion failure, due to subacute stent thrombosis, was identified. Conclusions: Rotational atherectomy with the subsequent use of shockwave intravascular lithotripsy appears to be a safe and effective therapeutic bail-out option for the management of highly calcified coronary artery lesions. Despite, these initial favorable outcomes, carrying out a large number of studies with long-term observations is still necessary in order to establish the potential benefits and shortcomings of rota-lithotripsy.
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8
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Pradhan A, Vishwakarma P, Bhandari M, Sethi R. Intravascular lithotripsy for coronary calcium: A case report and review of the literature. World J Cardiol 2022; 14:496-507. [PMID: 36187430 PMCID: PMC9523272 DOI: 10.4330/wjc.v14.i9.496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/06/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coronary calcium poses a challenge for the interventional cardiologist often leading to stent under-expansion and subsequent ischemic events. Aggressive balloon post-dilatation though helpful is usually inadequate. Multiple plaque ablation techniques are in vogue, but they are technically demanding and are not without complications. Shockwave intravascular lithotripsy (S-IVL) has emerged as a user-friendly and effective mechanism for calcium management with a high safety margin. A series of trials (DISRUPT CAD I-IV) have demonstrated both short-term and long-term safety and efficacy of the technique. As experience with the technique grows more and more, therapy areas like stent restenosis are being covered by the S-IVL.
CASE SUMMARY We report a series of 2 cases successfully managed with S-IVL therapy at our center. The first case is of a 57-year-old smoker who presented with acute coronary syndrome. His left anterior descending coronary artery revealed calcified 90% stenosis on angiogram and a combination of superficial-deep calcium on intracoronary imaging. The calcium was treated with 20 pulses of S-IVL to create discontinuity and a sirolimus eluting drug-eluting stent was successfully implanted. The second case is that of an elderly lady who presented with stable angina and demonstrated diffuse calcified lesions in the left anterior descending artery on angiogram. She also demonstrated a mixture of superficial and deep seated calcium zones on imaging. S-IVL therapy was applied to generate fractures in calcium, and two overlapping drug-eluting stents were implanted successfully without any complications.
CONCLUSION S-IVL is an emerging, efficient, user-friendly and safe therapy for managing intracoronary calcium in routine interventional practice.
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Affiliation(s)
- Akshyaya Pradhan
- Department of Cardiology, King George Medical University, Lucknow 226006, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George Medical University, Lucknow 226006, Uttar Pradesh, India
| | - Monika Bhandari
- Department of Cardiology, King George Medical University, Lucknow 226006, Uttar Pradesh, India
| | - Rishi Sethi
- Department of Cardiology, King George Medical University, Lucknow 226006, Uttar Pradesh, India
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9
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Kawashima H, Serruys PW, Hara H, Ono M, Gao C, Wang R, Garg S, Sharif F, de Winter RJ, Mack MJ, Holmes DR, Morice MC, Kappetein AP, Thuijs DJFM, Milojevic M, Noack T, Mohr FW, Davierwala PM, Onuma Y. 10-Year All-Cause Mortality Following Percutaneous or Surgical Revascularization in Patients With Heavy Calcification. JACC Cardiovasc Interv 2022; 15:193-204. [PMID: 34973904 DOI: 10.1016/j.jcin.2021.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess 10-year all-cause mortality in patients with heavily calcified lesions (HCLs) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). BACKGROUND Limited data are available on very long term outcomes in patients with HCLs according to the mode of revascularization. METHODS This substudy of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study assessed 10-year all-cause mortality according to the presence of HCLs within lesions with >50% diameter stenosis and identified during the calculation of the anatomical SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score among 1,800 patients with the 3-vessel disease and/or left main disease randomized to PCI or CABG in the SYNTAX trial. Patients with HCLs were further stratified according to disease type (3-vessel disease or left main disease) and assigned treatment (PCI or CABG). RESULTS The 532 patients with ≥1 HCL had a higher crude mortality rate at 10 years than those without (36.4% vs 22.3%; HR: 1.79; 95% CI: 1.49-2.16; P < 0.001). After adjustment, an HCL remained an independent predictor of 10-year mortality (HR: 1.36; 95% CI: 1.09-1.69; P = 0.006). There was a significant interaction in mortality between treatment effect (PCI and CABG) and the presence or absence of HCLs (Pinteraction = 0.005). In patients without HCLs, mortality was significantly higher after PCI than after CABG (26.0% vs 18.8%; HR: 1.44; 95% CI: 0.97-1.41; P = 0.003), whereas in those with HCLs, there was no significant difference (34.0% vs 39.0%; HR: 0.85; 95% CI: 0.64-1.13; P = 0.264). CONCLUSIONS At 10 years, the presence of an HCL was an independent predictor of mortality, with a similar prognosis following PCI or CABG. Whether HCLs require special consideration when deciding the mode of revascularization beyond their current contribution to the anatomical SYNTAX score deserves further evaluation. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972).
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Affiliation(s)
- Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, Massy, France
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | | | - Piroze M Davierwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
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10
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Coronary lithotripsy - a state of the art review. Trends Cardiovasc Med 2022; 33:215-222. [PMID: 35045278 DOI: 10.1016/j.tcm.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/24/2022]
Abstract
Lesion calcification is frequently encountered during percutaneous coronary intervention and has been directly linked to procedural complications and future cardiac events. Intravascular lithotripsy is a novel balloon-based modality that does not rely on barotrauma or debulking, but converts electrical energy into mechanical energy creating sonic pressure waves that selectively disrupt calcium. The present review provides an overview of its mechanism of action, the available evidence on its safety and efficacy and indications for use.
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11
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Intravascular Lithotripsy facilitated Percutaneous Coronary Intervention in patients with Calcific Disease: Shockwave makes a difference. Trends Cardiovasc Med 2022; 33:223-224. [PMID: 35066150 DOI: 10.1016/j.tcm.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/15/2022] [Indexed: 11/21/2022]
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12
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Kassimis G, Theodoropoulos KC, Didagelos M, Ziakas A. Successful off-label use of rotational atherectomy in ST-segment elevation myocardial infarction: A case report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:272-275. [PMID: 34801421 DOI: 10.1016/j.carrev.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/31/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Rotational atherectomy (RA) in ST-segment elevation myocardial infarction (STEMI) is uncommon and its use in a thrombotic lesion is labelled a contraindication by its manufacturer due to the concern for further increase in platelet activation and aggregation by the spinning burr or distal embolization of the thrombotic material promoting no-reflow (NR). However, thrombus burden varies significantly in the STEMI setting and can be classified according to the thrombolysis in myocardial infarction (TIMI) thrombus grade (TG). This case demonstrates the successful off-label use of RA-assisted primary percutaneous coronary intervention to facilitate treatment of a heavily calcified ostial right coronary artery lesion with low thrombotic burden (TIMI TG 0) in an octogenarian STEMI patient. Atherectomy drug cocktails, intracoronary vasodilators, short burr runs and avoidance of rotating the burr at slower than minimum approved rotational speed contribute to atherectomy success and decrease the chances of NR.
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Affiliation(s)
- George Kassimis
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos C Theodoropoulos
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Jinnouchi H, Tsukui T, Yamamoto K, Seguchi M, Wada H, Fujita H. Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction. Sci Rep 2021; 11:21403. [PMID: 34725407 PMCID: PMC8560938 DOI: 10.1038/s41598-021-00832-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/19/2021] [Indexed: 11/22/2022] Open
Abstract
In percutaneous coronary intervention (PCI) to the culprit lesion of acute myocardial infarction (AMI), unsuccessful guidewire crossing causes immediate poor outcomes. It is important to determine the factors associated with unsuccessful guidewire crossing in AMI lesions. The purpose of this study was to find factors associated with difficulty in crossing the culprit lesion of AMI. We defined the difficult group when the guidewire used to cross the culprit lesion was a polymer jacket type guidewire or a stiff guidewire. We included 937 patients, and divided those into the non-difficult group (n = 876) and the difficult group (n = 61). Proximal reference diameter was significantly smaller in the difficult group than in the non-difficult group (p < 0.001), and degree of calcification was severer in the difficult group than in the non-difficult group (p < 0.001). In the multivariate stepwise logistic regression analysis, proximal reference diameter [odds ratio (OR) 0.313, 95% confidence interval (CI) 0.185–0.529, p < 0.001)], previous PCI (OR 3.065, 95% CI 1.612–5.830, p = 0.001), moderate-severe calcification (OR 4.322, 95% CI 2.354–7.935, p < 0.001), blunt type obstruction (OR 12.646, 95% CI 6.805–23.503, p < 0.001), and the presence of collateral to the culprit lesion (OR 2.110, 95% CI 1.145–3.888, p = 0.017) were significantly associated with difficulty in crossing the culprit lesion. In conclusion, previous PCI, calcification, blunt type obstruction, and the presence of collateral were associated with difficulty in crossing the culprit lesion, whereas proximal reference diameter was inversely associated with difficulty. Our study provides a reference to recognize the difficulty in crossing the culprit lesions of AMI for PCI operators, especially junior operators.
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Affiliation(s)
- Shun Ishibashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
| | - Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
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14
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Kawamura Y, Yoshimachi F, Murotani N, Karasawa Y, Nagamatsu H, Yamamoto Y, Kudo T, Ikari Y. Coronary orbital atherectomy using a five-French guiding catheter. Cardiovasc Interv Ther 2021; 37:498-505. [PMID: 34554382 DOI: 10.1007/s12928-021-00813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
Recently, the efficacy was demonstrated of the Diamondback 360® Coronary Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St. Paul, MN, USA) for treating calcified coronary lesions in percutaneous coronary intervention (PCI). The safety and feasibility of OAS application through a 5-Fr guiding catheter (GC) which is less invasive and reduces access site complications were validated. This sequential, retrospective, observational study was conducted in a single center from September 2018 to May 2020. The primary endpoint was a successful PCI with the OAS. Secondary endpoints were major adverse complications related to PCI with the OAS, including coronary dissection, perforation, side branch loss, need for an unexpected cardiac assist device, access site complications, and major adverse cardiac and cerebrovascular events. 33 PCIs in 30 patients (mean age 72 ± 11 years; male, 83.3%) were surveyed. All PCIs were successfully completed with OAS application through a 5-Fr GC. Coronary perforation after the OAS procedure occurred in one case (3.0%). Severe coronary dissection occurred in three cases (9.1%), and procedural myocardial infarction in two cases (6.1%). Regarding PCIs performed with the 5-Fr GC, the OAS is a safe and feasible strategy for calcified plaque modification.
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Affiliation(s)
- Yota Kawamura
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan.
| | - Fuminobu Yoshimachi
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan
| | - Nana Murotani
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan
| | - Yuka Karasawa
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan
| | - Hirofumi Nagamatsu
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan
| | - Yoshiya Yamamoto
- Division of Cardiology, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-cho Hachioji City, Tokyo, 192-0032, Japan
| | - Takeaki Kudo
- Division of Cardiology, Department of Internal Medicine, Miyakonojo Medical Association Hospital, Miyakonojo, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
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15
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Shockwave intravascular lithotripsy and drug-coated balloon angioplasty in calcified coronary arteries: preliminary experience in two cases. J Geriatr Cardiol 2021; 18:689-691. [PMID: 34527034 PMCID: PMC8390929 DOI: 10.11909/j.issn.1671-5411.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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Successful coronary lithotripsy after unsuccessful rotational atherectomy - use of complementary tools for treatment of undilatable calcified coronary artery stenosis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:228-229. [PMID: 34400929 PMCID: PMC8356843 DOI: 10.5114/aic.2021.107507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022] Open
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17
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Han F, Zheng H, Zheng X, Jin H, Wang Z, Zeng H, Qiu C, Liu J, Zhu Y. [Efficacy of intravascular ultrasound-guided rotational atherectomy combined with cutting balloon for pretreatment of severe coronary artery calcified lesions]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1044-1049. [PMID: 34308854 DOI: 10.12122/j.issn.1673-4254.2021.07.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of intravascular ultrasound (IVUS)-guided rotational atherectomy (RA) combined with cutting balloon for pretreatment of severe calcified lesions in the coronary artery before stent placement. METHODS A total of 120 patients with severe coronary artery calcifications detected by IVUS that required percutaneous coronary intervention (PCI) were recruited from our hospital between January, 2016 to January, 2019. The patients were randomized into two groups for pretreatment of the lesions with semicompliant balloon (SB group, 60 cases) or RA combined with CB (RA+CB group, 60 cases), and drug-eluting stents were implanted after the procedure. The immediate success rate of PCI, vascular parameters detected by IVUS after PCI, and the rates of residual stenosis < 10% were compared between the two groups. The incidences of intraoperative complications and major adverse cardiac events (MACE) within 24 months after the surgery were also observed in the two groups. RESULTS The immediate success rate was significantly higher in RA+CB group than in SB group (P=0.032). After pretreatment and stent placement, the minimum stent lumen diameter (P=0.035), minimum stent lumen cross-sectional area (P=0.029), immediate lumen acquisition, immediate lumen cross-sectional area acquisition and the rate of residual stenosis < 10% were all significantly higher in RA+CB group than in SB group (P < 0.001). The patients in RA+ CB group showed obviously less residual stenosis of lumen cross-sectional area than those in SB group after the surgery (χ2= 7.859, P=0.005). The incidences of intraoperative complications (χ2=5.997, P=0.014) and MACE within 24 months after the operation (χ2=4.285, P=0.038) were significantly lower in RA+CB group than in SB group. CONCLUSION For patients with severe coronary artery calcifications eligible for PCI, RA combined with CB angioplasty can significantly improve the success rate of immediate PCI, expand the lumen diameter and cross-sectional area of the stent after PCI, enhance immediate lumen gain, and reduce the incidence of intraoperative complications and MACE after the operation.
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Affiliation(s)
- F Han
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - H Zheng
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - X Zheng
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - H Jin
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - Z Wang
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - H Zeng
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - C Qiu
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - J Liu
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
| | - Y Zhu
- First Ward of Department of Cardiology, Jiaozuo People's Hospital, Jiaozuo 454002, China
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18
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Kassimis G, Ziakas A, Didagelos M, Theodoropoulos KC, Patoulias D, Voultsos P, Papadopoulos C, Rocchiccioli P, Karamasis GV, Alexopoulos D, Sianos G. Shockwave coronary intravascular lithotripsy system for heavily calcified de novo lesions and the need for a cost-effectiveness analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:128-134. [PMID: 34246610 DOI: 10.1016/j.carrev.2021.06.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022]
Abstract
The optimal management for severely calcified coronary artery disease is multi-adjunctive. Different strategies with dedicated devices should be available in the cardiac catheterization laboratory with their selection depending on the nature of the calcific disease and its anatomical distribution. Shockwave Intravascular Lithotripsy (S-IVL) system offers a novel option for lesion preparation of heavily calcified plaques in coronary and peripheral vessels. S-IVL is based on the fundamental principles of lithotripsy, a technology that has been used to modify renal stones for over 30 years. Pulsatile mechanical energy is used to fragment selectively amorphous calcium, sparing soft tissue. S-IVL has the potential of more widespread adoption because of its proven safety, efficacy and operational simplicity, but cost-effectiveness of such advanced technology will need to be analyzed.
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Affiliation(s)
- George Kassimis
- 2nd Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Greece; 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece.
| | - Antonios Ziakas
- 2nd Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Matthaios Didagelos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece; Interventional Cardiology Department, West of Scotland Heart and Lung Centre, Golden Jubilee National, Hospital, Clydebank, United Kingdom
| | | | - Dimitrios Patoulias
- 2nd Propaedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Petros Voultsos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Christodoulos Papadopoulos
- 3rd Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Paul Rocchiccioli
- Interventional Cardiology Department, West of Scotland Heart and Lung Centre, Golden Jubilee National, Hospital, Clydebank, United Kingdom
| | - Grigoris V Karamasis
- 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Alexopoulos
- 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George Sianos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
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19
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Kassimis G, Ziakas A, Didagelos M, Theodoropoulos KC, Hadjimiltiades S. How Should I Get Prepared for and Treat Rota Burr Entrapment in a Focally Underexpanded and Restenosed Stent: A Case Report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:197-200. [PMID: 34031007 DOI: 10.1016/j.carrev.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Although high-speed rotational atherectomy has been successfully used in selected cases of stent underexpansion secondary to heavy peri-stent calcification, a higher risk of burr entrapment demands extreme caution and surgical back-up on site. The main cause of this complication is the lack of diamond dust on the back end of the burr, which prevents backward ablation of tissues when retracted. To date, only few reports of successful burr retrieval using percutaneous bailout techniques have been published. We report a case of burr entrapment within a previously implanted left circumflex artery stent which was successfully recaptured using the dual catheter technique; following the retrieval the patient underwent routine percutaneous coronary intervention.
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Affiliation(s)
- George Kassimis
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Antonios Ziakas
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos C Theodoropoulos
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Hadjimiltiades
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Efficacy and safety of intravascular lithotripsy in calcified coronary lesions: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:73-82. [PMID: 34024748 DOI: 10.1016/j.carrev.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) is a recently introduced therapeutic modality in the management of calcified coronary lesions (CCAD). IVL delivers sonic pressure waves to modulate calcium, hence promote vessel compliance and optimize stent deployment. METHODS We performed a comprehensive literature search for studies that evaluated the utility of adjunctive IVL. The primary outcomes of our study were the clinical success, defined as the ability of IVL to produce residual diameter stenosis <50% (RDS < 50%) after stenting with no evidence of in-hospital major adverse cardiac events, and the angiographic success, defined as success in facilitating stent delivery with RDS < 50% and without serious angiographic complications. The secondary outcomes included post-IVL and post-stenting changes in lumen area, calcium angle, and the maximum calcium thickness. Proportional analysis was used for binary data and mean difference was used for continuous data. All meta-analyses were conducted using a random-effect model and 95% confidence intervals (CIs) were included. RESULTS A total of eight single-arm observational studies, including 980 patients (1011 lesions), were included. 48.8% of the patients presented with acute coronary syndrome. Severe calcifications were present in 97% of lesions. Clinical success was achieved in 95.4% of patients (95%CI:92.9%-97.9%). Angiographic success was achieved in 97% of patients (95%CI:95%-99%). There was an overall increase in postprocedural lumen area as well as significant reduction of calcium angle and maximum calcium thickness. CONCLUSIONS IVL seems to have excellent efficacy and safety in the management of CCAD. However, adequately powered RCTs are needed to evaluate IVL compared to other calcium/plaque modifying techniques.
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21
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Agrawal Y, Zoltowska D, Nazroo JYR, Halabi AR. Impella-Assisted Intracoronary Lithotripsy of Severely Calcified Left Main Coronary Artery Bifurcation for NSTEMI With Cardiogenic Shock. Cureus 2021; 13:e14772. [PMID: 34094737 PMCID: PMC8164825 DOI: 10.7759/cureus.14772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
High calcification of coronary artery plaque is a frequent cause of suboptimal stent expansion, which can result in stent thrombosis and restenosis. Shockwave intravascular lithotripsy (S-IVL) represents a new frontier in the treatment of highly calcified coronary lesions. It can be an excellent alternative to intracoronary atherectomy in extremely high-risk lesions. We present a case of a 57-year-old man with known severe coronary artery disease (CAD) who presented with non-ST segment elevation myocardial infarction (NSTEMI), cardiogenic shock and was successfully treated with impella-assisted shockwave-intravascular lithotripsy permitting successful percutaneous intervention of a high-risk left main coronary artery (LMCA) bifurcation in-stent restenosis.
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Affiliation(s)
- Yashwant Agrawal
- Interventional Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, USA.,Interventional Cardiology, Ascension Health, Kalamazoo, USA
| | - Dominika Zoltowska
- Cardiology, University of Florida College of Medicine, Jacksonville, USA
| | | | - Abdul R Halabi
- Interventional Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, USA
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22
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Gonzálvez-García A, Jiménez-Valero S, Galeote G, Moreno R, López de Sá E, Jurado-Román A. "RotaTripsy: Combination of rotational atherectomy and intravascular lithotripsy in heavily calcified coronary lesions: A case series". CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:179-184. [PMID: 33903037 DOI: 10.1016/j.carrev.2021.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/10/2021] [Accepted: 04/10/2021] [Indexed: 01/26/2023]
Abstract
Heavily calcified coronary lesions increase the complexity of percutaneous coronary interventions (PCI) and represent a challenge for interventional cardiologists. They are an important cause of stent underexpansion and poor clinical outcome. Nowadays, there are different dedicated devices which enhance the chances of success. Rotational atherectomy is the first-line modality which permits to cross balloons or stents through severe calcified lesions. However, when circumferential deep calcium plaques exist may not be enough to achieve adequate expansion of these devices. In these cases, the complementary use of intracoronary lithotripsy ("RotaTripsy") can be an effective approach that further modifies the calcified plaque and enables optimal stent implantation. We present the first case series undergoing PCI using "RotaTripsy" technique.
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Affiliation(s)
- Ariana Gonzálvez-García
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Santiago Jiménez-Valero
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Guillermo Galeote
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Raúl Moreno
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | | | - Alfonso Jurado-Román
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain.
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23
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Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Jinnouchi H, Wada H, Fujita H. Clinical Factors Associated with Long Fluoroscopy Time in Percutaneous Coronary Interventions to the Culprit Lesion of Non-ST-Segment Elevation Myocardial Infarction. Int Heart J 2021; 62:282-289. [PMID: 33731534 DOI: 10.1536/ihj.20-634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) were comparable or even worse than those with ST-segment elevation myocardial infarction (STEMI). Although successful percutaneous coronary intervention (PCI) to the culprit lesions of NSTEMI would improve the clinical outcomes, some PCI require long fluoroscopy time, reflecting the difficulty of PCI. This study aims to find clinical factors associated with long fluoroscopy time in PCI to the culprit lesion of NSTEMI. We included 374 patients and divided those into the conventional fluoroscopy time (n = 302) and long fluoroscopy time (n = 72) groups according to the quintiles of fluoroscopy time. Clinical and angiographic parameters were compared between the two groups. Calcification and tortuosity were significantly more severe in the long fluoroscopy time group than in the conventional fluoroscopy time group. The prevalence of previous coronary artery bypass grafting (CABG) and bifurcation lesions was significantly greater in the long fluoroscopy time group than in the conventional fluoroscopy time group. In the multivariate stepwise logistic regression analysis, previous CABG (odds ratio [OR], 3.368; 95% confidence interval [CI], 1.407-8.064; P = 0.006), bifurcation lesion (OR, 2.407; 95% CI, 1.285-4.506; P = 0.006), excessive tortuosity (versus mild to moderate tortuosity; OR, 4.095; 95% CI, 1.159-14.476; P = 0.029), and moderate to severe calcification (versus none to mild; OR, 5.792; 95% CI, 3.254-10.310; P < 0.001) were significantly associated with long fluoroscopy time. In conclusion, previous CABG, bifurcation, excessive tortuosity, and moderate to severe calcification were associated with long fluoroscopy time. Our study provided a reference for PCI operators to identify the difficulties in PCI to the culprit lesion of NSTEMI.
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Affiliation(s)
- Shun Ishibashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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24
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Li J, Tan Y, Zhou P, Liu C, Zhao H, Song L, Zhou J, Chen R, Wang Y, Zhao X, Chen Y, Yan H. Association of Trimethylamine N-Oxide Levels and Calcification in Culprit Lesion Segments in Patients With ST-Segment-Elevation Myocardial Infarction Evaluated by Optical Coherence Tomography. Front Cardiovasc Med 2021; 8:628471. [PMID: 33718451 PMCID: PMC7943451 DOI: 10.3389/fcvm.2021.628471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/01/2021] [Indexed: 01/17/2023] Open
Abstract
The presence of calcified plaques is one of the pathological phenotypes of acute coronary syndrome (ACS) and can be frequently found in culprit lesion segments. Trimethylamine N-oxide (TMAO) is reported to be involved in vascular calcification and plaque instability. This study investigated the relationship between plasma TMAO levels and calcified lesions in culprit lesion segments in STEMI patients. A prospective series of 179 patients with STEMI were enrolled, and calcified lesions from 127 patients were analyzed by OCT. The plasma TMAO levels were measured by using stable isotope dilution liquid chromatography tandem mass spectrometry. Patients were divided into two groups according to the median plasma TMAO level. The prevalence of intimal calcified lesions in the high TMAO group was significantly higher than that in the low TMAO group (90.6 vs. 57.1%, p < 0.001; 84.4 vs. 44.4%, p < 0.001). After adjustment of traditional risk factors and medication history, patients with calcification in their culprit lesion segments had higher plasma TMAO levels than those without calcification. Moreover, plasma TMAO levels were significantly positively associated with the parameters of calcium burden, including maximal calcification arc (r = 0.392, p < 0.001), maximal calcification thickness (r = 0.443, p < 0.001), and calcified length (r = 0.466, p < 0.001). These results suggested that the level of TMAO is significantly correlated with the incidence of calcification in the culprit lesion segment, and the measurement of TMAO levels might improve clinical management in patients with heavy calcification. Clinical Trial Registration: This study is registered at ClinicalTrials.gov as NCT03593928.
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Affiliation(s)
- Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Tan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Xiamen Cardiovascular Hospital, Xiamen University, Fujian, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
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25
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Chiang CSM, Alan Chan KC, Lee M, Chan KT. Orbital-Tripsy: Novel Combination of Orbital-Atherectomy and Intravascular-Lithotripsy, in Calcified Coronaries After Failed Intravascular-Lithotripsy. JACC Case Rep 2020; 2:2437-2444. [PMID: 34317190 PMCID: PMC8305089 DOI: 10.1016/j.jaccas.2020.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/03/2022]
Abstract
Calcified coronary lesions are notorious for posing technical difficulty during angioplasty. Fortunately, more devices are available to tackle coronary calcifications. However, there remain difficult cases whereby a single modality is insufficient. Here we report the feasibility and success of a case, using Novo combination of Shockwave Lithotripsy after Orbital Atherectomy. (Level of Difficulty: Intermediate.).
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Key Words
- CABG, coronary artery bypass grafting
- IVL, intravascular lithotripsy
- LM, left main
- MLA, minimal luminal area
- OA, orbital atherectomy
- OCT, optical coherence tomography
- PCI, percutaneous coronary intervention
- RA, rotational atherectomy
- RCA, right coronary artery
- TVD, triple vessel disease
- coronary angiography
- coronary calcium score
- imaging
- myocardial ischemia
- percutaneous coronary intervention
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Affiliation(s)
| | - Ka Chun Alan Chan
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Michael Lee
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Kam Tim Chan
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
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26
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Kassimis G, Banning AP. Reply to the Letter to the Editor Entitled "Intravascular Lithotripsy Facilitated Cardiovascular Interventions". Angiology 2020; 72:98. [PMID: 33021101 DOI: 10.1177/0003319720963603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- George Kassimis
- 2nd Cardiology Department, 69200Aristotle University of Thessaloniki, Hippokration Hospital, Greece.,1st Cardiology Department, AHEPA General Hospital, 69200Aristotle University of Thessaloniki, Greece
| | - Adrian P Banning
- Oxford Heart Centre, 11269John Radcliffe Hospital, Oxford, United Kingdom
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27
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Demarchi A, Ugo F, Cavallino C, Rametta F. Very late stent expansion with intracoronary lithotripsy: a case report. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33204993 PMCID: PMC7649517 DOI: 10.1093/ehjcr/ytaa228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/03/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022]
Abstract
Background Underexpanded stent in heavily calcified coronary lesion is common and persists over years. It is related to long-term failure and negative outcomes. Treatment of this situation after many years with intracoronary lithotripsy (ICL-Shockwave®) could be an option. Case summary We report a case of a man with underexpanded coronary stent implanted 11 years earlier. Optical coherence tomography highlighted the mechanism of stent underexpansion showing the presence of calcium stones under the old struts. Intracoronary lithotripsy crushed calcium under the stent struts causing its geometric change (from elliptical to round shape) and a consequent better transmission of the true radial force of the old stent. Discussion Heavily calcified coronary lesions lead to stent underexpansion which persists over years. Intracoronary lithotripsy could be a very late option to manage this unfavourable common result.
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Affiliation(s)
- Andrea Demarchi
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Fabrizio Ugo
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Chiara Cavallino
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Francesco Rametta
- Division of Cardiology, S. Andrea Hospital, Corso Mario Abbiate 21, 13100 Vercelli, Italy
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28
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Aziz A, Bhatia G, Pitt M, Choudhury A, Hailan A, Upadhyaya S, Lee L, Testa L, Casenghi M, Ielasi A, Cortese B, Rides H, Basavarajaiah S. Intravascular lithotripsy in calcified‐coronary lesions: A real‐world observational, European multicenter study. Catheter Cardiovasc Interv 2020; 98:225-235. [PMID: 32936532 DOI: 10.1002/ccd.29263] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Amir Aziz
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust Sutton Coldfield, Birmingham UK
| | - Gurbir Bhatia
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust Sutton Coldfield, Birmingham UK
| | - Michael Pitt
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust Sutton Coldfield, Birmingham UK
| | | | | | | | - Leong Lee
- City Hospital Birmingham, Sandwell and West Birmingham NHS Trust Birmingham UK
| | - Luca Testa
- Institution Policlinico San Donato Milan Italy
| | | | | | | | - Hannah Rides
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust Sutton Coldfield, Birmingham UK
| | - Sandeep Basavarajaiah
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust Sutton Coldfield, Birmingham UK
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29
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Finnegan P, Jefferies J, Margey R, Hennigan B. Coronary lithotripsy: a novel approach to intra-coronary calcification with 'cracking' results? THE BRITISH JOURNAL OF CARDIOLOGY 2020; 27:21. [PMID: 35747090 PMCID: PMC9205228 DOI: 10.5837/bjc.2020.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Coronary lithotripsy is a novel approach to percutaneous coronary intervention (PCI). It is based on well-established technology dating back to 1980 when lithotripsy was first used to treat renal calculi. Its application in cardiovascular medicine is a more recent development that involves using a low-pressure lithotripsy balloon to deliver unfocused acoustic pulse waves in a circumferential mechanical energy distribution. This causes fracturing of calcification within the surrounding vasculature, facilitating optimal stent deployment. This article aims to review recent clinical experience and the published data regarding intravascular lithotripsy (IVL). All relevant articles were identified via PubMed using keywords including "intravascular lithotripsy", "shockwave" and "coronary". All studies that contained published datasets regarding IVL with patient numbers >50 were included for review. There were 116 results found. After reviewing all the publications, articles were then tabulated and 17 were found to be relevant, including only four clinical studies. In this review we found that intracoronary lithotripsy for heavily calcified arteries appears to be a safe, effective, easy-to-use method of dealing with an otherwise technically-challenging and high-risk scenario. It appears to carry low risk, uses low pressures, and exerts its effects on both superficial and deep intravascular calcium. Further prospective data with long-term follow-up will be required to explore both the off-label uses of IVL (such as post-stent dilatation), and the long-term patency of these vessels.
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Affiliation(s)
- Paula Finnegan
- Resident Medical Officer, The Mater Private Hospital, Citygate, Mahon, Cork, Republic of Ireland
| | - John Jefferies
- Resident Medical Officer, The Mater Private Hospital, Citygate, Mahon, Cork, Republic of Ireland
| | - Ronan Margey
- Consultant Interventional Cardiologist, and Senior Clinical Lecturer, University College Cork, The Mater Private Hospital, Citygate, Mahon, Cork, Republic of Ireland
| | - Barry Hennigan
- Consultant Interventional Cardiologist, and Senior Clinical Lecturer, University College Cork, The Mater Private Hospital, Citygate, Mahon, Cork, Republic of Ireland
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30
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Truesdell AG, Khuddus MA, Martinez SC, Shlofmitz E. Calcified Lesion Assessment and Intervention in Complex Percutaneous Coronary Intervention: Overview of Angioplasty, Atherectomy, and Lithotripsy. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2020.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Calcific coronary artery disease intervention is associated with uniformly worse short-term procedural and long-term clinical results compared with treatment of non-calcified lesions. Multiple intravascular imaging tools currently exist to aid the identification and detailed characterization of intracoronary calcium, and guide appropriate follow-on management strategies. Several unique device therapies, to include angioplasty, atherectomy, and lithotripsy may be employed to enhance lesion preparation, stent implantation and optimization, and improve patient outcomes. Current low use of both imaging and ablative technologies in the US offers significant future opportunities for improving the comprehensive evaluation and management of these complex lesion subsets and patients.
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Affiliation(s)
- Alexander G Truesdell
- Virginia Heart, Falls Church, VA; Inova Heart and Vascular Institute, Falls Church, VA
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31
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Kassimis G, Didagelos M, De Maria GL, Kontogiannis N, Karamasis GV, Katsikis A, Sularz A, Karvounis H, Kanonidis I, Krokidis M, Ziakas A, Banning AP. Shockwave Intravascular Lithotripsy for the Treatment of Severe Vascular Calcification. Angiology 2020; 71:677-688. [PMID: 32567327 DOI: 10.1177/0003319720932455] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified coronary and peripheral artery lesions are difficult to dilate appropriately with conventional balloons during percutaneous intervention, and the use of several adjunctive strategies of plaque modification has been suggested. Intravascular lithotripsy (IVL) offers a novel option for lesion preparation of severely calcified plaques in coronary and peripheral vessels. It is unique among all technologies in its ability to modify calcium circumferentially and transmurally, thus modifying transmural conduit compliance. In this article, we summarize the currently available evidence on this technology, and we highlight its best clinical application through appropriate patient and lesion selection, with the main objective of optimizing stent delivery and implantation, and subsequent improved short- and long-term outcomes. We believe that the IVL balloon will transform the market, as it is easy to use, with predictable results. However, cost-effectiveness of such advanced technology will need to be considered.
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Affiliation(s)
- George Kassimis
- 2nd Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Greece.,1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Matthaios Didagelos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Nestoras Kontogiannis
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom
| | | | - Athanasios Katsikis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Agata Sularz
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Haralambos Karvounis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Ioannis Kanonidis
- 2nd Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Miltiadis Krokidis
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Antonios Ziakas
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Adrian P Banning
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom
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32
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Venuti G, Piedimonte G, Castellana C, Ferrarotto L, Guarracini S, Azzalini L, Manna AL. Using the coronary lithotripsy system for coronary artery disease. Future Cardiol 2020; 17:59-71. [PMID: 32530304 DOI: 10.2217/fca-2020-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Severe coronary artery calcification increases percutaneous treatment complexity and the risk of intraprocedural complications, affecting acute and long-term outcomes. Current use of specialty balloons and atherectomy technologies is limited due to the higher risk of complications, degree of technical difficulty and operator experience. Intravascular lithotripsy (IVL) is a novel technology for severe calcified coronary artery disease that facilitates vessel preparation, enhancing vessel compliance. IVL system emits sonic waves that penetrate through vascular layers and disrupt both superficial and deep calcium, leaving the soft tissue unharmed. The purpose of the present review is to provide a summary of the evidence currently available on this therapy, including a practical description of the components and function of the shockwave coronary IVL system.
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Affiliation(s)
- Giuseppe Venuti
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | - Giulio Piedimonte
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | - Carmelo Castellana
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | - Luigi Ferrarotto
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | | | - Lorenzo Azzalini
- The Zena & Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alessio La Manna
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
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33
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"One-man" bailout technique for high-speed rotational atherectomy-assisted percutaneous coronary intervention in an octogenarian. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2020; 17:61-63. [PMID: 32095135 PMCID: PMC7008103 DOI: 10.11909/j.issn.1671-5411.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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34
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Alawami M, Thirunavukarasu S, Ahmed J, El‐Omar M. Intravascular lithotripsy to treat an underexpanded coronary stent: 4‐Month angiographic and OCT follow‐up. Catheter Cardiovasc Interv 2020; 96:1251-1257. [DOI: 10.1002/ccd.28738] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/27/2019] [Accepted: 01/11/2020] [Indexed: 01/17/2023]
Affiliation(s)
| | | | - Javed Ahmed
- Manchester Heart Center, Manchester Royal Infirmary, Department of Cardiology, Newcastle Upon Tyne Hospitals NHS Trust
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35
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Wong SC. Editorial: Is Extreme High-Pressure Balloon the Answer to "Undilatable" Lesions? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1088-1089. [PMID: 31870526 DOI: 10.1016/j.carrev.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 01/17/2023]
Affiliation(s)
- S Chiu Wong
- Cardiac Cath Lab, F433, Division of Cardiology, Weill Cornell Medicine, 520 E 70th Street, New York, NY 10021, United States of America; NY Presbyterian Hospital - Cornell Campus, United States of America.
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36
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Sorini Dini C, Nardi G, Ristalli F, Mattesini A, Hamiti B, Di Mario C. Contemporary Approach to Heavily Calcified Coronary Lesions. ACTA ACUST UNITED AC 2019; 14:154-163. [PMID: 31867062 PMCID: PMC6918474 DOI: 10.15420/icr.2019.19.r1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022]
Abstract
Percutaneous treatment of heavily calcified coronary lesions still represents a challenge for interventional cardiology, with higher risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. Good characterisation of calcium distribution with multimodal imaging is important to improve the successful treatment of these lesions. The use of traditional or new dedicated devices for the treatment of calcified lesions allows better lesion preparation; therefore, it is important that we know the different mechanisms and technical features of these devices.
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Affiliation(s)
- Carlotta Sorini Dini
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy.,Cardiology Division, Spedali Riuniti Livorno, Italy
| | - Giulia Nardi
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Francesca Ristalli
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Brunilda Hamiti
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
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37
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Forero MNT, Daemen J. The Coronary Intravascular Lithotripsy System. ACTA ACUST UNITED AC 2019; 14:174-181. [PMID: 31867065 PMCID: PMC6918618 DOI: 10.15420/icr.2019.18.r1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/08/2019] [Indexed: 12/16/2022]
Abstract
Calcified lesions often mean percutaneous intervention results are suboptimal and increase the risk of procedural complications and future adverse events. Available plaque-modifying devices rely on tissue compression or debulking, with the intention of fracturing calcium and facilitating optimal stent deployment. In contrast, coronary intravascular lithotripsy delivers unfocused, circumferential, pulsatile mechanical energy to safely disrupt the calcium within the target lesion. The present review summarises the evidence available so far on this therapy and includes a practical description of the components and function of the Shockwave Intravascular Lithotripsy System (Shockwave Medical).
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Affiliation(s)
| | - Joost Daemen
- Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
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