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Rola P, Włodarczak S, Barycki M, Furtan Ł, Jastrzębski A, Kędzierska M, Doroszko A, Lesiak M, Włodarczak A. Safety and Efficacy of Orbital Atherectomy in the All-Comer Population: Mid-Term Results of the Lower Silesian Orbital Atherectomy Registry (LOAR). J Clin Med 2023; 12:5842. [PMID: 37762782 PMCID: PMC10532293 DOI: 10.3390/jcm12185842] [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: 08/11/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Coronary calcifications represent a challenging subset for the interventional cardiologist performing percutaneous coronary intervention (PCI) and are well-established risk factors for adverse outcomes. Adequate plaque modification prior to stent implantation is critical to achieve an optimal outcome following PCI. Recently, a novel orbital atherectomy device has been introduced into clinical practice to modify calcified plaques. We evaluated the mid-term safety and efficacy of OA in a high-risk "all-comers" population. METHODS We evaluated 96 consecutive patients with severely calcified coronary lesions who underwent PCI facilitated by the orbital atherectomy device. RESULTS In-hospital MACCE was 5.2% without target lesion revascularization. At 6-month follow-up, the MACCE rate was 10.4% with a concomitant TLR rate of 1%. CONCLUSIONS Our mid-term data showed good safety and efficacy of orbital atherectomy as a plaque-modifying tool in an all-comers cohort with severely calcified coronary lesions.
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Affiliation(s)
- Piotr Rola
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland;
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (S.W.); (A.J.)
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | - Łukasz Furtan
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland; (M.B.); (Ł.F.)
| | - Artur Jastrzębski
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (S.W.); (A.J.)
| | | | - Adrian Doroszko
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Faculty of Medicine, Wroclaw University of Science and Technology, 50-981 Wroclaw, Poland;
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, 61-848 Poznan, Poland;
| | - Adrian Włodarczak
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland;
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (S.W.); (A.J.)
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Rola P, Kulczycki JJ, Barycki M, Włodarczak S, Furtan Ł, Kędzierska M, Giniewicz K, Doroszko A, Lesiak M, Włodarczak A. Comparison of Orbital Atherectomy and Rotational Atherectomy in Calcified Left Main Disease: Short-Term Outcomes. J Clin Med 2023; 12:4025. [PMID: 37373718 DOI: 10.3390/jcm12124025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Coronary calcifications, particularly in left main disease (LMD), are independently associated with adverse outcomes of percutaneous coronary intervention (PCI). Adequate lesion preparation is pivotal to achieve favorable short- and long-term outcomes. Rotational atherectomy devices have been used in contemporary practice to obtain adequate preparation of the calcified lesions. Recently, novel orbital atherectomy (OA) devices have been introduced to clinical practice to facilitate the preparation of the lesion. The objective of this study is to compare the short-term safety and efficacy of orbital and rotational atherectomy for LMD. METHODS we retrospectively evaluated a total of 55 consecutive patients who underwent the LM PCI supported by either OA or RA. RESULTS The OA group consisted of 25 patients with a median SYNTAX Score of 28 (26-36). The Rota group consisted of 30 patients with a median SYNTAX Score of 28 (26-33.1) There were no statistical differences in MACCE between the RA and OA subpopulations when recorded in-hospital (6.7% vs. 10.3% p = 0.619) as well as in a 1-month follow-up after the procedure (12% vs. 16.6% p = 0.261). CONCLUSION OA and RA seem to be similarly safe and effective strategies for preparating the lesion in the high-risk population with calcified LMD.
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Affiliation(s)
- Piotr Rola
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland
| | - Jan Jakub Kulczycki
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland
| | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland
| | - Łukasz Furtan
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland
| | | | | | - Adrian Doroszko
- Clinical Department of Internal Medicine and Occupational Diseases, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, 61-848 Poznan, Poland
| | - Adrian Włodarczak
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland
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Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Allana S, Egred M, Jneid H, Mashayekhi K, Di Mario C, Krestyaninov O, Khelimski D, Milkas A, Sandoval Y, Burke MN, Brilakis ES. An algorithmic approach to balloon undilatable coronary lesions. Catheter Cardiovasc Interv 2023; 101:355-362. [PMID: 36579411 DOI: 10.1002/ccd.30531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
Balloon undilatable lesions are lesions that have been successfully crossed by both a guidewire and a balloon but cannot be expanded despite multiple high-pressure balloon inflations. Balloon undilatable lesions can be de novo or in-stent. We describe a systematic, algorithmic approach to treat both de novo and in-stent balloon undilatable lesions using various techniques, such as high-pressure balloon inflation, plaque modification balloons, intravascular lithotripsy, very high-pressure balloon inflation, coronary atherectomy, laser coronary angioplasty, and extraplaque lesion crossing. Knowledge of the various techniques can increase the efficiency, success and safety of the procedure.
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Affiliation(s)
- Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Salman Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hani Jneid
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Texas, Houston, USA
| | | | - Carlo Di Mario
- Division of Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Dmitrii Khelimski
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Anastasios Milkas
- Division of Cardiology, Athens Naval and Veterans Hospital, Athens, Greece
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota, Minneapolis, USA
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Hu G, Qi X, Li B, Ge T, Li X, Liu Z, Li J, Zhang X, Li Y, Zhang S, Wang Y, Zhao T, Zhang B, Xu Q. A Single-Center Study Using IVUS to Guide Rotational Atherectomy for Chronic Renal Disease's Calcified Coronary Artery. J Multidiscip Healthc 2023; 16:1085-1093. [PMID: 37155552 PMCID: PMC10122852 DOI: 10.2147/jmdh.s405174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/31/2023] [Indexed: 05/10/2023] Open
Abstract
Objective To assess the effectiveness and safety of an IVUS-guided rotational atherectomy (RA) percutaneous coronary intervention (PCI) in chronic renal patients with complex coronary calcification who are at risk for contrast-related acute kidney injury (AKI). Methods From October 2018 to October 2021, 48 patients with chronic renal disease who were receiving PCI with RA at the General Hospital of NingXia Medical University were informed for data collection for this research. They were randomly assigned to the IVUS-guided RA group and the Standard RA group, which did not use IVUS. According to a clinical expert consensus document on rotational atherectomy in China, both PCI procedures were performed. The intravascular ultrasound (IVUS) results from the study group were used to describe the morphology of the lesion and to guide the selection of burrs, balloons, and stents. IVUS and angiography were used to evaluate the outcome in the end. IVUS-guided RA PCI and Standard RA PCI groups' effects and results were contrasted. Results There were no appreciable differences in the clinical baseline characteristics between the IVUS-guided RA PCI group and the Standard RA PCI group. The average estimated glomerular filtration rate (eGFR) of two groups was (81.42 ± 20.22 vs 82.34 ± 22.19) mL/min/1.73 m2. Most of them (45.8% vs 54.2%) was in stage 60-90 mL/min/1.73m2. When compared to the standard RA PCI group, RA in IVUS-Guided group was more performed electively (87.5% vs 58.3%; p = 0.02). The IVUS-guided RA PCI group was associated with shorter fluoroscopy time (20.6 ± 8.4 vs 36 ± 22; p<0.01) and less contrast amount (32 ±16 vs 184 ±116mL; p<0.01) than Standard-RA group. Five patients in the Standard RA PCI group developed contrast-induced nephropathy, which was 5 times than the IVUS-guided RA PCI group (20.8% VS 4.1%; p=0.19). Conclusion In chronic renal patients with complex coronary calcification, an IVUS-guided RA PCI technique is effective and safe. It can also lower the volume of contrast and perhaps the incidence of contrast-related AKI.
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Affiliation(s)
- Guangxin Hu
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
- Correspondence: Guangxin Hu, Email
| | - Xijuan Qi
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Ben Li
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Ting Ge
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Xi Li
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Zhijun Liu
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Jiaxing Li
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Xuemei Zhang
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - YinPing Li
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Shichang Zhang
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Yajuan Wang
- Department of Pharmacy, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Tingting Zhao
- Department of Respiratory Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Botao Zhang
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
| | - Qingbin Xu
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China
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The power of gold: a tip for an uncrossable ostial lesion. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:226-227. [PMID: 34400928 PMCID: PMC8356839 DOI: 10.5114/aic.2021.107506] [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: 02/02/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
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Tomasiewicz B, Kubler P, Zimoch W, Kosowski M, Wańha W, Ładziński S, Rakotoarison O, Ochała A, Wojakowski W, Reczuch K. Acute Angulation and Sequential Lesion Increase the Risk of Rotational Atherectomy Failure. Circ J 2021; 85:867-876. [PMID: 33883385 DOI: 10.1253/circj.cj-20-1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the study was to assess anatomical and procedural predictors of clinical and procedural failure of rotational atherectomy (RA) in an all-comers population.Methods and Results:A total of 534 consecutive patients who underwent RA were included in a double-center observational study. The primary composite endpoint consisted of: rota-wire introduction failure, burr-passage failure, periprocedural complications and procedure-related major adverse events. The second primary endpoint included rota-wire introduction failure and burr-passage failure. The primary endpoint occurred in 76 (14.2%) patients and the second primary endpoint occurred in 64 (12%) Periprocedural complications occurred in 23 (4.3%) and procedure-related adverse events in 23 (4.3%) patients. Multivariable analysis revealed angulation on lesion ≤90° (HR=2.18, 95% CI: 1.21-3.94, P=0.0096) and sequential lesion (HR=1.89, 95% CI: 1.01-3.54, P=0.046) as independent predictors of no clinical success of RA. Multivariable analysis revealed again that angulation on lesion ≤90° (HR=2.26, 95% CI: 1.16-4.40, P=0.02) and sequential lesion (HR=3.77, 95% CI: 1.64-8.69, P<0.01) as independent predictors of no procedural success of RA. CONCLUSIONS The presence of an acute angulation on lesion and sequential lesion are independent determinants of clinical and procedural failure of RA. Further research is necessary to establish a score predicting RA failure, which can help in preproceduralrisk stratification of patients undergoing complex percutaneous coronary intervention with RA.
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Affiliation(s)
- Brunon Tomasiewicz
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
| | - Piotr Kubler
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
| | - Wojciech Zimoch
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
| | - Michał Kosowski
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Szymon Ładziński
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Oscar Rakotoarison
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
| | - Andrzej Ochała
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia
| | - Krzysztof Reczuch
- Department of Heart Diseases, Wroclaw Medical University.,Centre for Heart Diseases, University Hospital
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Utility of the SYNTAX Score in the risk stratification
of patients undergoing rotational atherectomy. Arch Med Sci Atheroscler Dis 2020; 5:e313-e319. [PMID: 34820544 PMCID: PMC8609370 DOI: 10.5114/amsad.2020.103373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction The SYNTAX Score (SS) evaluates the angiographic complexity of coronary artery disease to assess the cardiovascular risk after coronary revascularization. The aim of the study was to evaluate whether SS results are associated with in-hospital and 1-year outcomes of patients undergoing percutaneous coronary intervention (PCI) requiring rotational atherectomy (RA). Material and methods We analyzed data of 207 consecutive patients who underwent PCI with RA. Patients were divided into two groups: those with high SS (> 33 points) and those with low/intermediate SS (0–33 points). Results In 21 (10%) patients SS was high and 186 (90%) patients had low/intermediate SS. Patients with high SS were older (76 vs. 71 years, p = 0.008) and more frequently diagnosed with chronic kidney disease (38% vs. 18%, p = 0.03) and heart failure (71% vs. 30%, p = 0.0001). In patients with high SS the RA procedure was longer (p = 0.004), required more contrast (p = 0.005) and higher radiation doses (p = 0.04), and contrast-induced nephropathy was more frequent (14% vs. 2%, p = 0.001). Conclusions In our RA patients there was no significant difference between the frequency of in-hospital and 1-year adverse cardiovascular events depending on the SS result. High SS correlates only with parameters describing the extensity and technical complexity of the procedure. However, the unavailability of other risk assessment tools in this population raises the need to create a new more specific risk score for patients requiring RA.
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Janas A, Milewski K, Buszman P, Kolarczyk-Haczyk A, Trendel W, Pruski M, Wojakowski W, Buszman P, Kiesz RS. Comparison of long-term outcomes after directional versus rotational atherectomy in peripheral artery disease. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:76-81. [PMID: 32368239 PMCID: PMC7189125 DOI: 10.5114/aic.2020.93914] [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: 01/31/2019] [Accepted: 08/11/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The rate of atherectomy utilization in peripheral artery diseases (PAD) is growing. The two atherectomy devices available on the market and used most frequently are the directional and rotational ones. Nonetheless, there is a lack of direct comparison between these two types of atherectomy in PAD. AIM To compare the long-term outcomes after PAD endovascular revascularization with two types of atherectomies: rotational (AR) (Phoenix Philips) and directional (AD) (SilverHawk Medtronic). MATERIAL AND METHODS This was a single-center, retrospective study of obstructive and symptomatic PAD patients who underwent revascularization with atherectomy. The endpoints were considered as target lesion revascularization (TLR), death, amputations and bailout stenting (BS). RESULTS The AR group consisted of 97 patients, while the AD group consisted of 85 individuals. There were no significant differences between the groups in terms of baseline characteristics except for an increased critical limb ischemia (CLI) prevalence in the AR group. The mean follow-up for AD and AR was 282.6 ±147.4 and 255.7 ±186.1 days, respectively (p = 0.44). There were no significant differences in the death rate (AD: 1 (1.7%) vs. AR: 5 (5.7%); p = 0.54), amputations (AD: 2 (2.3%) vs. AR: 5 (5.7%); p = 0.45) or bailout stenting (AD: 2 (2.3%) vs. AR: 3 (3.2%); p = 0.74), whereas TLR was more frequent in the AD group (AD: 25 (29%) vs. AR: 15 (15.9%; p = 0.03). The Kaplan-Meier analysis showed no significant differences between the groups in time to TLR, amputation or death. CONCLUSIONS In this hypothesis-generating study the AR had a lower rate of TLR when compared to the AD. Nevertheless, this should be confirmed in further controlled randomized trials.
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Affiliation(s)
- Adam Janas
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Krzysztof Milewski
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Piotr Buszman
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | | | - Wojciech Trendel
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Maciej Pruski
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Wojciech Wojakowski
- Third Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Paweł Buszman
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
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