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Cardiovascular Revascularization... May 2020
Topics: Atherectomy; Femoral Artery; Humans
PubMed: 32600797
DOI: 10.1016/j.carrev.2020.05.024 -
Catheterization and Cardiovascular... Jul 2017CTO lesions resisting balloon crossing are located in moderate/severe tortuous coronary arteries contain more moderate/severe calcification burden and carry a higher...
CTO lesions resisting balloon crossing are located in moderate/severe tortuous coronary arteries contain more moderate/severe calcification burden and carry a higher J-CTO score as compared with balloon crossable CTO lesions. CTO lesions resisting balloon crossing do not constitute a homogenous group. In 25% of the patients, the resisting CTO was caused by stent restenosis and thrombus is an integral component of CTO in addition to calcium and fibrosis. The excimer laser and rotational/orbital atherectomy are among useful debulking technologies capable of creating a "pilot recanalization channel" in the CTO that enables completion of the revasularization.
Topics: Atherectomy, Coronary; Coronary Angiography; Coronary Occlusion; Humans; Prevalence; Registries; Treatment Outcome
PubMed: 28707447
DOI: 10.1002/ccd.27167 -
Catheterization and Cardiovascular... Oct 2021The occurrence of same-day discharge following elective rotational atherectomy cases in England and Wales during 2007-2014 increased from approximately 7 to 36%....
The occurrence of same-day discharge following elective rotational atherectomy cases in England and Wales during 2007-2014 increased from approximately 7 to 36%. High-volume centers and transradial approach were associated with more likelihood of same-day discharge. As compared with patients who stayed for overnight observation following elective rotational atherectomy, those discharged the same day as the procedure had a similar rate of 30-day mortality (0.35 and 0.50%, respectively; p = 0.409).
Topics: Atherectomy, Coronary; Elective Surgical Procedures; Humans; Pandemics; Patient Discharge; Treatment Outcome
PubMed: 34596334
DOI: 10.1002/ccd.29909 -
EuroIntervention : Journal of EuroPCR... May 2015The interest in rotational atherectomy (RA) has increased over the past decade as a consequence of more complex and calcified coronary stenoses being attempted with...
The interest in rotational atherectomy (RA) has increased over the past decade as a consequence of more complex and calcified coronary stenoses being attempted with percutaneous coronary interventions. Yet adoption of RA is hampered by several factors: amongst others, by the lack of a standardised protocol. This European expert consensus document stems from the awareness of the large heterogeneity in the protocols adopted to perform rotational atherectomy. The objective of the present document is to provide some points of consensus among highly experienced operators on the most controversial steps of RA in an attempt to build the basis of a standardised and universally accepted protocol.
Topics: Atherectomy, Coronary; Consensus; Coronary Stenosis; Humans; Practice Patterns, Physicians'; Treatment Outcome; Vascular Calcification
PubMed: 25982648
DOI: 10.4244/EIJV11I1A6 -
Cardiovascular Revascularization... Apr 2021Excimer laser coronary atherectomy (ELCA) during percutaneous coronary intervention (PCI) has been in use for more than twenty years. While early experiences were not... (Review)
Review
Excimer laser coronary atherectomy (ELCA) during percutaneous coronary intervention (PCI) has been in use for more than twenty years. While early experiences were not favorable over balloon angioplasty alone, with improvement in operator technique, patient selection and technology, ELCA has established its own niche in contemporary PCI as a safe and effective atherectomy strategy. With growing experience in complex coronary interventions worldwide, ELCA has become one of the essential atherectomy tools offering unique advantages over other atherectomy devices. In the modern era, ELCA is commonly used for patients with in-stent restenosis, stent under expansion, balloon uncrossable lesions and chronic total occlusions. Technical success rates are reported to be >80% in most situations while procedural complication rates such as vessel dissection and perforation among others are reported to average 9% over the past 25 years with improvement over time. In this review, we provide a comprehensive systematic review of the ELCA system, its practical use, indications, and procedural techniques in the contemporary PCI era.
Topics: Atherectomy; Atherectomy, Coronary; Coronary Angiography; Humans; Lasers, Excimer; Percutaneous Coronary Intervention; Treatment Outcome
PubMed: 33158754
DOI: 10.1016/j.carrev.2020.10.016 -
Catheterization and Cardiovascular... Mar 2016Percutaneous coronary intervention of heavily calcified lesions can be challenging. Although the ROTAXUS trial did not demonstrate long-term clinical benefit with...
Percutaneous coronary intervention of heavily calcified lesions can be challenging. Although the ROTAXUS trial did not demonstrate long-term clinical benefit with routine rotational atherectomy, atherectomy remains an indispensable tool to achieve acute procedural success. Until new data becomes available determining when and how to optimally use coronary atherectomy depends heavily on personal experience and clinical judgment.
Topics: Atherectomy; Atherectomy, Coronary; Coronary Angiography; Coronary Artery Disease; Humans; Retrospective Studies; Treatment Outcome
PubMed: 26994979
DOI: 10.1002/ccd.26486 -
Journal of Endovascular Therapy : An... Jun 2022The aim of this study is to analyze the utilization pattern of atherectomy modalities and compare their outcomes.
PURPOSE
The aim of this study is to analyze the utilization pattern of atherectomy modalities and compare their outcomes.
MATERIALS AND METHODS
All patients undergoing atherectomy in the 2010-2016 Vascular Quality Initiative Database were identified. Utilization of orbital, laser, or excisional atherectomy was obtained. Characteristics and outcomes of patients treated for isolated femoropopliteal and isolated tibial disease by different modalities were compared.
RESULTS
Atherectomy use increased from 10.3% to 18.3% of all peripheral interventions (n = 122 938). Orbital atherectomy was most commonly used and increased from 59.4% in 2010 to 63.2% of all atherectomies in 2016, while laser atherectomy decreased from 19.2% to 13.1%. Atherectomy was mostly used for treatment of isolated femoropopliteal disease (51.1%), followed by combined femoropopliteal and tibial disease (25.8%) and isolated tibial disease (11.7%). In isolated femoropopliteal revascularization, excisional atherectomy was associated with higher rate of perforation (1.2%) compared with laser (0.4%) and orbital atherectomy (0.5%). The technical success of orbital atherectomy (96.7%) was lower compared with excisional atherectomy (98.7%). Concomitant stenting was significantly higher with laser atherectomy (43.0%) compared with orbital (27.2%) and excisional (26.1%) atherectomy. Nevertheless, there was no difference in 1-year primary patency, reintervention, major amputation, improvement in ambulatory status, or mortality. Multivariable analysis also demonstrated no difference in 1-year primary patency and major ipsilateral amputation among the modalities. In isolated tibial revascularization, there were no differences in perioperative outcomes among the modalities. Excisional atherectomy was associated with the highest 1-year primary patency (88.1%). After adjusting for confounders, excisional atherectomy remained associated with superior 1-year primary patency compared with orbital atherectomy (odds ratio [OR] = 2.59, 95% confidence interval [CI] = [1.18-5.68]), and excisional atherectomy remained associated with a lower rate of 1-year major ipsilateral amputation compared with laser atherectomy (OR = 0.29, 95% CI = [0.09-0.95]).
CONCLUSION
Atherectomy use has increased, driven primarily by orbital atherectomy. Despite significant variation in perioperative outcomes, there were no differences in 1-year outcomes among the different modalities when used for treating isolated femoropopliteal disease. In isolated tibial disease treatment, excisional atherectomy was associated with higher 1-year primary patency compared with orbital atherectomy and decreased major ipsilateral amputation rates compared with laser atherectomy. These differences warrant further investigation into the comparative effectiveness of atherectomy modalities in various vascular beds.
Topics: Atherectomy; Femoral Artery; Humans; Lasers; Lower Extremity; Peripheral Arterial Disease; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 34643142
DOI: 10.1177/15266028211050329 -
Journal of Interventional Cardiology Feb 2018
Topics: Atherectomy; Atherectomy, Coronary; Humans; Treatment Outcome; Vascular Calcification
PubMed: 29430783
DOI: 10.1111/joic.12487 -
International Heart Journal 2018
Topics: Atherectomy, Coronary; Autopsy; Coronary Angiography; Coronary Artery Disease; Equipment Design; Humans; Intraoperative Complications; Plaque, Atherosclerotic; Specimen Handling; Tomography, Optical Coherence; Vascular System Injuries
PubMed: 30259900
DOI: 10.1536/ihj.18-467 -
The Journal of Cardiovascular Surgery Feb 2022Surgical endarterectomy represents the gold standard for the treatment of atherosclerotic lesions of the groin vessels. Endovascular treatment such as atherectomy with...
INTRODUCTION
Surgical endarterectomy represents the gold standard for the treatment of atherosclerotic lesions of the groin vessels. Endovascular treatment such as atherectomy with or without drug coated angioplasty (DCA) of the so called no stenting zones, i.e. inguinal and popliteal vessels, is gaining growing acceptance as alternative option to open surgery. This systematic review aims to scrutiny the current clinical evidence regarding atherectomy and DCA for the common artery (CFA).
EVIDENCE ACQUISITION
We conducted an exhaustive research in multiple platforms (Medline, PubMed, Cochrane, Google Scholar, Embase) on studies over atherectomy and angioplasty for inguinal atherosclerotic lesions published between 2000 and 2021. As search strategy we used a wide list of MeSH items, words, synonyms. Bibliographies of review articles were checked for further relating studies regarding atherectomy of CFA. A qualitative and quantitative data analysis was carried out.
EVIDENCE SYNTHESIS
Fifteen studies were included in the qualitative review. Not all studies were focused only on atherectomy of inguinal vessels, despite including such treatment. Hence, data regarding this treatment were not exhaustive. A fairly homogeneous data analysis was possible in 7 of 15 studies. The remaining 8 studies were qualitatively analyzed but not included in the statistical analysis. In all 7 included studies directional atherectomy and DCA under filter protection were carried out. In this subgroup, overall, 497 patients were treated with atherectomy. Sixty-eight percent of the patients were males. Rutherford class from 1-3 dominated against 4-6 (63% vs. 37%). Mean technical success rate was 96%, with a primary and secondary patency rate of 92% and 98% respectively at one year. Procedure related vascular complications ranged from 1% to 6%.
CONCLUSIONS
Current literature about atherectomy for inguinal arteries is scant, data are inhomogeneous and so are treatment modalities. Nevertheless, the results of this systematic review suggest that this endovascular strategy is feasible with good short and midterm results. Prospective trials with larger patient cohorts are necessary to confirm these preliminary results.
Topics: Animals; Atherectomy; Humans; Peripheral Arterial Disease; Plaque, Atherosclerotic; Treatment Outcome
PubMed: 35179336
DOI: 10.23736/S0021-9509.21.12172-X