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Veeraraghavan S, Kidambi BR. "Full thickness calcium fracture by coronary intravascular lithotripsy on optical coherence tomography (OCT)" - cross it, crack it!! Acta Cardiol 2024; 79:252-253. [PMID: 38236664 DOI: 10.1080/00015385.2024.2304463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/06/2024] [Indexed: 04/18/2024]
Affiliation(s)
- Sriram Veeraraghavan
- Department of Cardiology, SRM Medical College and Research Centre, Potheri, Tamil Nadu, India
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Allali A, Abdel-Wahab M, Elbasha K, Mankerious N, Traboulsi H, Kastrati A, El-Mawardy M, Hemetsberger R, Sulimov DS, Neumann FJ, Toelg R, Richardt G. Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials. Clin Res Cardiol 2023; 112:1143-1163. [PMID: 35482101 PMCID: PMC10450020 DOI: 10.1007/s00392-022-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE-CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions.
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Affiliation(s)
- Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany.
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Hussein Traboulsi
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | | | - Rayyan Hemetsberger
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Franz-Josef Neumann
- Cardiology Department, Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
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Gonzálvez-García A, Jiménez-Valero S, Galeote G, Moreno R, Jurado-Román A. RotaTripsy, not only a bail-out strategy for heavily calcified coronary lesions. Cardiovasc Revasc Med 2021; 35:189. [PMID: 34253477 DOI: 10.1016/j.carrev.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 01/18/2023]
Affiliation(s)
| | | | - Guillermo Galeote
- Interventional Cardiology Unit, La Paz University Hospital, Madrid, Spain
| | - Raúl Moreno
- Interventional Cardiology Unit, La Paz University Hospital, Madrid, Spain
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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". Cardiovasc Revasc Med 2021; 35:179-184. [PMID: 33903037 DOI: 10.1016/j.carrev.2021.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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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Lee SN, Her SH, Jang WY, Moon D, Moon KW, Yoo KD, Lee K, Choi IJ, Lee JH, Lee JH, Lee SR, Lee SW, Yun KH, Lee HJ. Impact of chronic total occlusion lesions on clinical outcomes in patients receiving rotational atherectomy: results from the ROCK registry. Heart Vessels 2021. [PMID: 33837813 DOI: 10.1007/s00380-021-01849-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to investigate the impact of chronic total occlusion (CTO) on clinical outcomes in patients with calcified coronary lesions receiving rotational atherectomy (RA). This multi-center registry enrolled consecutive patients with calcified coronary artery disease who underwent RA during percutaneous coronary intervention (PCI) from 9 tertiary centers in Korea between January 2010 and October 2019. The primary outcome was target-vessel failure (TVF) which included the composite of cardiac death, target-vessel myocardial infarction (TVMI), and target-vessel revascularization (TVR). A total of 583 lesions were enrolled in this registry and classified as CTO (n = 42 lesions, 7.2%) and non-CTO (n = 541 lesions, 92.8%). The CTO group consisted of younger patients who were more likely to have a history of previous percutaneous coronary intervention or coronary artery bypass graft surgery. The incidence of the primary outcome was 14.1% and 16.7% for the non-CTO group and CTO group, respectively. The primary outcomes observed in the two groups were not significantly different (log-rank p = 0.736). The 18-month clinical outcomes of the CTO group were comparable to those of the non-CTO group in multivariate analysis. About 7% of patients requiring RA have CTO lesions and these patients experience similar clinical outcomes compared with those having non-CTO lesions. Use of RA for CTO lesions was safe despite higher procedural complexity.
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Seif S, Kumar A, Arya S, Karthikeyan VJ. Intravascular lithotripsy to treat an underexpanded coronary stent during index procedure: A case report study. Avicenna J Med 2021; 11:54-57. [PMID: 33520792 PMCID: PMC7839257 DOI: 10.4103/ajm.ajm_200_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Management of heavily calcified lesions during percutaneous coronary intervention (PCI) is often associated with high incidence of complications and long-term adverse outcomes. There is growing evidence of the efficacy of intravascular lithotripsy (IVL) in de novo coronary lesion preparation; however, little experience has been documented within freshly deployed stent underexpansion. We report a 66-year-old male with a marked stent underexpansion despite extensive lesion preparation due to severe underlying calcification. The stent was resistant to balloon postdilatation; therefore, IVL was applied, resulting in excellent stent expansion. IVL could be considered for treating acute stent underexpansion caused by severe underlying calcification.
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Affiliation(s)
- Sherif Seif
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Cardiology Department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Abhishek Kumar
- Cardiology Department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Sanjay Arya
- Cardiology Department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Vellore J Karthikeyan
- Cardiology Department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
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Chiou WR, Liao FC, Su MI, Cheng HY, Chen YT, Lin WH, Lee YH, Lin PL, Wang KT. The Use and Clinical Outcomes of Single-Burr Rotational Atherectomy: The Experience of a Local Hospital in Taiwan. Acta Cardiol Sin 2020; 36:233-239. [PMID: 32425438 DOI: 10.6515/acs.202005_36(3).20190922a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Treating heavily calcified lesions is a challenge and is associated with high re-stenosis and target lesion revascularization (TLR). Before stent implantation, lesions must be adequately prepared using rotational atherectomy (RA), which has shown favorable results. The study aims to report our hospital's clinical outcomes when using rotational atherectomy on complex and heavily calcified coronary lesions with a single-burr strategy. Methods We retrospectively analyzed 58 patients who underwent percutaneous coronary interventions with RA at our center between December 2006 and April 2017. Data on immediate post-procedural events and major adverse cardiovascular events were collected during follow-up, including cardiovascular death, myocardial infarction, TLR, target vessel revascularization (TVR) and stroke. Results Of the 58 patients and 90 lesions treated over 10 years, 88 lesions (97.8%) used only one burr. The intervention procedure success rate was 100%. During a mean follow-up of 41.2 months, 6 patients experienced acute coronary syndrome, 12 required TLR, 2 needed TVR, and 6 died due to a cardiovascular event. We divided lesions into 5 categories. The prevalence of lesions and the burr size most commonly used were: category 1 (ostial lesion, 8.9%, 1.75 mm), category 2 (focal lesion, 20%, 1.75 mm), category 3 (intermediate lesion, 13.3%, 1.5 mm), category 4a (long, looser lesion, 26.7%, 1.5 mm), and category 4b (long, rigid lesion, 31.1%, 1.25 mm). Conclusions Rather than a routine step-by-step strategy for RA, this study shows convincing evidence supporting the use of this device to treat complex calcified coronary lesions using a single-burr strategy.
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Affiliation(s)
- Wei-Ru Chiou
- Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung.,Department of Medicine, Mackay Medical College, New Taipei
| | | | - Min-I Su
- Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung
| | - Hsiao-Yang Cheng
- Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung
| | - Yun-Tzy Chen
- Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung
| | - Wen-Hsiung Lin
- Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung
| | - Ying-Hsiang Lee
- Department of Medicine, Mackay Medical College, New Taipei.,Cardiovascular Center, MacKay Memorial Hospital, Taipei
| | - Po-Lin Lin
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Kuang-Te Wang
- Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung.,Department of Medicine, Mackay Medical College, New Taipei
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Allali A, Abdel-Wahab M, Richardt G. Two-year Optical Coherence Tomography Findings after Balloon-Only Treatment of Bioresorbable Scaffold Restenosis in a Calcified Coronary Lesion: A Case Report. Cardiol Ther 2016; 5:223-8. [PMID: 27473345 DOI: 10.1007/s40119-016-0068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Indexed: 11/09/2022] Open
Abstract
We report a case of a 65-year-old female patient treated with an everolimus-eluting bioresorbable scaffold (BRS) after rotational atherectomy of a severely calcified lesion of the left anterior descending coronary artery. The implanted BRS restenosed 10 months after implantation and was treated with a scoring balloon followed by drug-eluting balloons with good immediate and long-term results. To the best of our knowledge, this is the first report of a balloon-only treatment of a restenosis occurring more than 6 months after BRS implantation; angiographic and optical coherence tomography images after treatment and at two-year follow-up are presented.
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