- Association of excessive speed reduction with clinical factors during rotational atherectomy. [Journal Article]
- CRCardiovasc Revasc Med 2019 May 17
- CONCLUSIONS: RA of ostial RCA lesions was significantly associated with excessive speed reduction during RA, which implies that RA of ostial RCA lesions is technically more difficult than RA of non-ostial RCA lesions.
- Intentional switch between 1.5-mm and 1.25-mm burrs along with switch between rotawire floppy and extra-support for an uncrossable calcified coronary lesion. [Case Reports]
- JCJ Cardiol Cases 2019; 19(6):200-203
- Rotational atherectomy (RA) is considered to be the last resort for a severely calcified coronary artery lesion. Severe complications such as vessel perforation or burr entrapment is closely associat…
Rotational atherectomy (RA) is considered to be the last resort for a severely calcified coronary artery lesion. Severe complications such as vessel perforation or burr entrapment is closely associated with forceful burr manipulation during RA. The instructions for use of Rotablator (Boston Scientific, Marlborough, MA, USA) prohibit forceful burr manipulation when rotational resistance occurs. Nevertheless, RA operators tend to forcefully manipulate the burr if it cannot cross the lesion, because there has been no established strategy for an uncrossable lesion. We present a case with a severely calcified coronary lesion, which was uncrossable by a burr 1.5 mm with RotaWire Floppy (Boston Scientific). We intentionally switched 2 burrs (1.5-mm and 1.25-mm) and 2 RotaWires (Floppy and Extra-support) to cross the lesion. Uniquely, we downsized the burr (from 1.5-mm to 1.25-mm) initially for better penetration force, and upsized the burr (from 1.25-mm to 1.5-mm) finally for better contact to the calcification within the lesion. Our case suggests that 4 different types of combinations might work in a mutually complementary manner for an uncrossable calcified lesion. <Learning Objective: In rotational atherectomy, severe complications such as vessel perforation or burr entrapment are closely associated with forceful burr manipulation. We present a case with a severely calcified coronary lesion, which was uncrossable by a burr 1.5 mm with RotaWire Floppy. We intentionally switched 2 burrs and 2 RotaWires to cross the lesion. Our case suggests that 4 different types of combinations might work in a mutually complementary manner for an uncrossable calcified lesion.>.
- Safety of Rotational Atherectomy Using the Radial Access in Patients With Severe Aortic Stenosis. [Journal Article]
- AJAm J Cardiol 2019 May 09
- Despite frequent percutaneous coronary intervention (PCI) in calcified vessels of older patients, rotational atherectomy (RA) has not been endorsed in patients with severe aortic stenosis (AS) due to…
Despite frequent percutaneous coronary intervention (PCI) in calcified vessels of older patients, rotational atherectomy (RA) has not been endorsed in patients with severe aortic stenosis (AS) due to safety concerns and lack of data. We explored periprocedural safety and mortality in severe AS patients undergoing RA. Prospective anonymized clinical, echocardiographic, procedural and outcome data of patients undergoing RA PCI between January 2012 and July 2018 were retrospectively extracted from the institutional coronary database. Patients with severe AS undergoing RA PCI were 1:1 propensity matched with patients undergoing RA PCI in the absence of AS. Outcomes of interest were RA related periprocedural complications, 30-day and 1-year mortality. A prespecified subgroup analysis examined the influence of transcatheter aortic valve replacement on mortality following RA PCI. A total of 544 patients underwent RA PCI; 478 without AS and 66 with AS. Propensity matching yielded 35 matched pairs with improved balance in covariates of interest and no significant differences in baseline characteristics postmatching. In the matched cohort (n = 70) slow flow/no-reflow, coronary dissection, perforation, and hemodynamic instability were rare and not significantly different. Survival analyses revealed significantly higher 30-day (Log-Rank p = 0.02) and 1-year mortality (Log rank p = 0.02, HR 5.24 [95% CI 1.13 to 24.28]) in the severe AS group; driven by a fivefold increase in the hazard of death among patients who did not undergo transcatheter aortic valve replacement HR 4.98 [95% CI 1.03 to 24.1]. In conclusion, our study of 70 patients undergoing radial RA PCI suggests that it can be safely performed in patients with severe AS. Long-term outcomes after RA in patients with severe AS are determined by the presence of the valve disease and other co-morbidities.
- Combined Use of Excimer Laser and High-Speed Rotational Atherectomy to Overcome a Severely Calcified Lesion in Endovascular Therapy. [Case Reports]
- CRCase Rep Vasc Med 2019; 2019:1719035
- Although endovascular therapy (EVT) is commonly used in treatment of peripheral artery disease (PAD), severely calcified lesions pose a challenge, in spite of the technical advancement. In this repor…
Although endovascular therapy (EVT) is commonly used in treatment of peripheral artery disease (PAD), severely calcified lesions pose a challenge, in spite of the technical advancement. In this report, we discuss the case of a 74-year-old male with coronary artery disease and end-stage renal disease who presented at our institution with bilateral intermittent claudication. Angiography showed chronic total occlusion (CTO) of the right superficial femoral arteries (SFA). Because the bilateral external iliac arteries demonstrated moderate stenosis, we performed endovascular therapy on the right SFA-CTO using a contralateral approach. With the antegrade wire progressing into the subintimal space, direct distal-SFA puncture was performed and wire externalization was established. However, no devices (minimal balloon, microcatheter, or Crosser system) were able to pass the lesion in antegrade or retrograde manner, even though the child catheter support or needle cracking technique from outside/inside was applied. Therefore, we used a combination of an excimer laser and high-speed rotational atherectomy to overcome the severely calcified lesion. First, the excimer laser catheter (Turbo Elite 0.9 mm) ablated the entry to the CTO; however, it did not pass through completely. Thereafter, the thin microcatheter (Caravel) succeeded in crossing the CTO in an antegrade manner using the BAlloon Deployment using FORcible Manner (BADFORM) technique. After wire-exchange to the Rota-wire, rotational atherectomy (RotaLink Plus 1.5 mm) passed through the CTO. Subsequently, we could dilate the CTO lesion with a conventional balloon followed by bare metal stent deployment. The right ankle-brachial index of the patient improved from being unmeasurable to 0.79, and the intermittent claudication disappeared. This combination therapy, described as the "RASER" technique in coronary section, is accepted for reimbursement. However, these devices in EVT section are considered off-label use in Japan. Therefore, we have to refrain from frequent use of this strategy; however, this method provides an option for severely calcified lesions.
- Cell proliferation does occur following directional coronary atherectomy. [Journal Article]
- CICardiovasc Interv Ther 2019 May 14
- North American Expert Review of Rotational Atherectomy. [Journal Article]
- CCCirc Cardiovasc Interv 2019; 12(5):e007448
- Rotational atherectomy (RA) is an established tool in interventional cardiology for treatment of calcified coronary lesions. Over 3 decades of clinical experience and research, techniques have mature…
Rotational atherectomy (RA) is an established tool in interventional cardiology for treatment of calcified coronary lesions. Over 3 decades of clinical experience and research, techniques have matured and outcomes have improved. Heterogeneity exists, however, in RA utilization and technique. We assembled a group of experienced RA operators and device experts to summarize and critique key elements of contemporary RA technique, to identify areas of consensus and controversy, and to offer recommendations for optimal performance for the practicing interventional cardiologist. Evolution in RA strategy toward a focus on lesion modification to facilitate balloon angioplasty and stenting has underpinned major advances in procedural safety, including opportunity to use smaller caliber equipment and radial access. Optimal technique and improved safety have permitted exploratory use of RA for different lesion types and reevaluation of procedural requirements, including flush solution composition and transvenous pacing. Preparedness to manage complications remains paramount and recommendations for operators and institutions are outlined.
- [Rotational atherectomy (Rotablator®) : complementary technique in management of undilatable coronary lesions]. [Classical Article]
- RMRev Med Liege 2019 Sup; 74(S1):S39-S43
- In 40 years of existence, interventional cardiology has witnessed the introduction of numerous tools and techniques that have contributed to the important application's broadening of percutaneous tec…
In 40 years of existence, interventional cardiology has witnessed the introduction of numerous tools and techniques that have contributed to the important application's broadening of percutaneous techniques, particulary in anatomical situations previously unfavourable, and which were, at that time, subject to surgical revascularization. Among these hostiles situations, one of the principal consists in failure to adequately dilate the lesions and/or to the inability to deliver and implant a stent appropriately, situations frequently associated with a high rate of procedural complications and poor long-term clinical outcomes. Thanks to the development of complementary dedicated techniques such atherectomy device, the treatment of most fibrotic and heavily calcified lesions has become feasible and safe. The present article describes the rotational atherectomy procedure, its indications and its clinical results.
- Intravascular Lithotripsy for Calcific Coronary and Peripheral Stenoses. [Journal Article]
- EEuroIntervention 2019 May 07
- Heavily calcified lesions may be difficult to adequately dilate with conventional balloons and stents causing frequent peri-procedural complications and higher rates of target lesion revascularizatio…
Heavily calcified lesions may be difficult to adequately dilate with conventional balloons and stents causing frequent peri-procedural complications and higher rates of target lesion revascularization (TLR). High pressure non-compliant balloon angioplasty may be of insufficient force to modify calcium, and even when successful, may be limited in their ability to modify the entire calcified lesion. Scoring and cutting balloons hold theoretical value but data to support their efficacy is lacking, and because of their high lesion crossing profile, often fail to reach the target lesion. Rotational and orbital atherectomy target superficial calcium, however deep calcium, which may still impact vessel expansion and luminal gain, is not affected. Intravascular lithotripsy (IVL), based on lithotripsy for renal calculi, is a new technology which uses sonic pressure waves to disrupt calcium with minimal impact to soft tissue. Energy is delivered via a balloon catheter, analogous to contemporary balloon catheters, with transmission through diluted ionic contrast in a semi-compliant balloon inflated at low pressure with sufficient diameter to achieve contact with the vessel wall. With coronary and peripheral balloons approved in Europe, peripheral balloons approved in the United States and multiple new trials beginning, we review indications for these recently introduced devices, summarize clinical outcomes of available trials and describe the design of ongoing studies.
- Coronary lithotripsy for failed rotational atherectomy, cutting balloon, scoring balloon, and ultra-high-pressure non-compliant balloon. [Case Reports]
- CCCatheter Cardiovasc Interv 2019 Apr 24
- Calcified and undilatable stenosis still represents a challenge in percutaneous coronary interventions (PCI), due to the higher risk of suboptimal result with consequent worse clinical outcomes. Unfo…
Calcified and undilatable stenosis still represents a challenge in percutaneous coronary interventions (PCI), due to the higher risk of suboptimal result with consequent worse clinical outcomes. Unfortunately, the dedicated technologies and devices, such as specialized balloon and atherectomy systems, do not always provide adequate plaque modification and optimal vessel preparation allowing optimal stent delivery. The intravascular lithotripsy (IVL) is a technology derived from urology that has been tested in peripheral and coronary calcified plaques, with promising preliminary results. We present a case of a patient undergoing planned PCI of the right coronary artery targeting an undilatable lesion, already resistant to both specialized balloons and rotational atherectomy. Using the IVL system, we were able to break the calcium, guarantying optimal stent expansion with good final result.
New Search Next
- Risk of contrast-induced nephropathy in patients undergoing complex percutaneous coronary intervention. [Journal Article]
- IJInt J Cardiol 2019 Sep 01; 290:59-63
- CONCLUSIONS: Complex PCI is not associated with an increased risk of CIN in all-comers. Further studies should confirm our findings and investigate novel effective strategies to decrease the risk of this serious complication.