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Interventional Cardiology Clinics Oct 2022Coronary complications are increasingly rare but remain fatal if not managed promptly and effectively. We review the incidence, management, and prevention of the most... (Review)
Review
Coronary complications are increasingly rare but remain fatal if not managed promptly and effectively. We review the incidence, management, and prevention of the most serious coronary complications including acute vessel closure from dissection, no-reflow, thrombosis, and air embolism as well as mechanical complications including perforation, stent dislodgment, and atherectomy burr entrapment.
Topics: Atherectomy, Coronary; Humans; Stents
PubMed: 36243489
DOI: 10.1016/j.iccl.2022.06.002 -
The Journal of Cardiovascular Surgery Apr 2023Atherectomy as an endovascular modality to treat peripheral arterial disease has gained traction over the past 10 years. Unlike most other available technologies,... (Review)
Review
Atherectomy as an endovascular modality to treat peripheral arterial disease has gained traction over the past 10 years. Unlike most other available technologies, atherectomy works by physically debulking atherosclerotic plaque via a variety of mechanisms being the femoropopliteal segment the most targeted one. The aims of this review were to detail the types of atherectomy available, existing evidence available for atherectomy use in the femoropopliteal segment as compared to other interventions, critical appraisal of its current use and the possible influences on its indication. Future steps regarding atherectomy usage and data presentation are also described.
Topics: Humans; Vascular Patency; Treatment Outcome; Femoral Artery; Peripheral Arterial Disease; Atherectomy; Popliteal Artery; Angioplasty, Balloon
PubMed: 36762509
DOI: 10.23736/S0021-9509.23.12544-4 -
Techniques in Vascular and... Jun 2016Peripheral atherectomy is a class of procedures that is rapidly increasing in volume. Multiple classes of devices exist, and newer variants are added to the market... (Review)
Review
Peripheral atherectomy is a class of procedures that is rapidly increasing in volume. Multiple classes of devices exist, and newer variants are added to the market annually. The devices see wide application for de novo lesions, in-stent restenosis, and adjunctive therapy for drug-coated balloons. The body of evidence supporting atherectomy is less robust than for many other peripheral therapies. The frequency and severity of complications from atherectomy can be significant compared with angioplasty and stenting, and familiarity with preventative and bailout techniques is essential for the interventionalist.
Topics: Aged; Angiography; Anticoagulants; Atherectomy; Embolic Protection Devices; Female; Humans; Lasers; Lower Extremity; Male; Middle Aged; Patient Selection; Peripheral Arterial Disease; Radiography, Interventional; Risk Factors; Treatment Outcome; Vascular Access Devices
PubMed: 27423994
DOI: 10.1053/j.tvir.2016.04.005 -
Journal of the American Heart... Nov 2022
Topics: Humans; Atherectomy; Peripheral Arterial Disease; Policy
PubMed: 36373835
DOI: 10.1161/JAHA.122.027422 -
Journal of Ultrasound in Medicine :... Oct 2019
Topics: Atherectomy, Coronary; Percutaneous Coronary Intervention; Ultrasonography, Interventional; United States
PubMed: 30719728
DOI: 10.1002/jum.14962 -
Interventional Cardiology Clinics Apr 2019Successful percutaneous coronary intervention (PCI) can be challenging in the presence of heavily calcified lesions. Severely calcified lesions are associated with worse... (Review)
Review
Successful percutaneous coronary intervention (PCI) can be challenging in the presence of heavily calcified lesions. Severely calcified lesions are associated with worse clinical outcomes. Recognition of calcification is important before stenting to ensure adequate stent expansion can be attained. Orbital atherectomy is a safe and effective method to ablate calcified plaque. Lesion preparation through plaque modification with orbital atherectomy before stent implantation can help to optimize the results of PCI in these complex lesions.
Topics: Atherectomy, Coronary; Coronary Artery Disease; Coronary Vessels; Humans; Vascular Calcification
PubMed: 30832940
DOI: 10.1016/j.iccl.2018.11.006 -
The Journal of Invasive Cardiology Dec 2019The use of debulking devices improved in the last few years, due to the expanding indications to percutaneous coronary angioplasty, involving an elevated number of... (Review)
Review
The use of debulking devices improved in the last few years, due to the expanding indications to percutaneous coronary angioplasty, involving an elevated number of coronary stenoses with heavy calcification. Rotational atherectomy has become one of the most used devices in this challenging scenario. The aim of this review is to analyze the components and the use of the Rotablator System (Boston Scientific) and to better understand helpful tips and tricks in order to face the most common complications occurring during the procedure.
Topics: Atherectomy, Coronary; Coronary Stenosis; Equipment Design; Humans; Intraoperative Complications; Vascular Calcification
PubMed: 31786529
DOI: No ID Found -
The American Journal of Cardiology Jun 2024
Topics: Humans; Atherectomy, Coronary; Female; Aged; Coronary Artery Disease; Middle Aged
PubMed: 38631603
DOI: 10.1016/j.amjcard.2024.04.006 -
Current Cardiology Reports Jul 2022Calcified atheroma is frequently encountered in peripheral vascular intervention. Standard treatment with balloon and/or stenting alone does poorly in these cases due to... (Review)
Review
PURPOSE OF THE REVIEW
Calcified atheroma is frequently encountered in peripheral vascular intervention. Standard treatment with balloon and/or stenting alone does poorly in these cases due to vessel recoil, suboptimal luminal gain, and inadequate stent expansion. In light of the above challenges with angioplasty and stenting for PAD, endovascular atherectomy has emerged as a novel technology for atheroma treatment and removal, offering the benefits of surgical endarterectomy in a minimally invasive percutaneous approach. This review outlines the endovascular atherectomy devices available in clinical practice to date, compares and contrasts their mode of action, summarizes the relevant published data on indication and role of atherectomy over other treatment modalities for PAD, and discusses the future prospective on this emerging technology.
RECENT FINDINGS
Currently, there are host of peripheral atherectomy devices available with unique mechanism of action and relative advantages and disadvantages. Despite these recent technological advancements, there remains a paucity of data from well-designed studies regarding the superiority of atherectomy as an adjunctive treatment versus standard treatment with balloon and stenting. Emerging data have supported its use to improve patency rates in conjunction with drug-coated balloons. Although associated risks, including distal embolization and perforation, are often marginal, the cost of these devices to the healthcare system necessitates further investment in to establishing level 1 data to support their use. Peripheral atherectomy has the potential to improve limb-related outcomes, potentially through reduced need for bail-out scaffolds and improved drug uptake. Nonetheless, further investment in the evidence foundation supporting these devices versus standard practices is required.
Topics: Angioplasty, Balloon; Atherectomy; Femoral Artery; Humans; Peripheral Arterial Disease; Plaque, Atherosclerotic; Retrospective Studies; Stents; Treatment Outcome; Vascular Patency
PubMed: 35536534
DOI: 10.1007/s11886-022-01709-1 -
Cardiovascular and Interventional... Jul 2017Traditional percutaneous balloon angioplasty and stent placement is based on mechanical plaque disruption and displacement within the arterial wall. On the contrary,... (Review)
Review
Traditional percutaneous balloon angioplasty and stent placement is based on mechanical plaque disruption and displacement within the arterial wall. On the contrary, transcatheter atherectomy achieves atherosclerotic plaque clearance by means of directional plaque excision or rotational plaque removal or laser plaque ablation. Debulking atherectomy may allow for a more uniform angioplasty result at lower pressures with consequently less vessel barotrauma and improved luminal gain, thereby decreasing the risk of plaque recoil and dissection that may require permanent metal stenting. It has been also argued that atherectomy may disrupt the calcium barrier and optimize drug transfer and delivery in case of drug-coated balloon applications. The authors discuss the various types of atherectomy devices available in clinical practice to date and critically appraise their mode of action as well as relevant published data in each case. Overall, amassed randomized and observational evidence indicates that percutaneous atherectomy of the femoropopliteal and infrapopliteal arteries may achieve high technical success rates and seems to lessen the frequency of bailout stenting, however, at the expense of increased risk of peri-procedural distal embolization. Long-term clinical outcomes reported to date do not support the superiority of percutaneous atherectomy over traditional balloon angioplasty and stent placement in terms of vessel patency or limb salvage. The combination of debulking atherectomy and drug-coated balloons has shown promise in early studies, especially in the treatment of more complex lesions. Unanswered questions and future perspectives of this continuously evolving endovascular technology as part of a broader treatment algorithm are discussed.
Topics: Algorithms; Atherectomy; Cytoreduction Surgical Procedures; Endovascular Procedures; Equipment Design; Femoral Artery; Humans; Limb Salvage; Peripheral Vascular Diseases; Randomized Controlled Trials as Topic; Stents; Vascular Patency
PubMed: 28451812
DOI: 10.1007/s00270-017-1649-6