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Catheterization and Cardiovascular... Jan 2021Stent under-expansion (rather than intimal hyperplasia) may be the cause of in-stent restenosis. Later expansion of coronary stents that were not fully deployed...
Stent under-expansion (rather than intimal hyperplasia) may be the cause of in-stent restenosis. Later expansion of coronary stents that were not fully deployed initially, can be difficult. Atherectomy is one method of facilitating late stent expansion, but too few patients have been treated to determine the risk benefit ratio.
Topics: Atherectomy; Coronary Angiography; Coronary Restenosis; Feasibility Studies; Humans; Stents; Treatment Outcome
PubMed: 33460265
DOI: 10.1002/ccd.29452 -
Heart, Lung & Circulation Dec 2022Coronary artery calcification is prevalent in coronary heart disease with its progression being predictive of future adverse cardiac events. Its presence is considered... (Review)
Review
Coronary artery calcification is prevalent in coronary heart disease with its progression being predictive of future adverse cardiac events. Its presence is considered to be a marker of interventional procedural complexity. Several adjunctive percutaneous coronary intervention tools, such as modifying balloons, atherectomy devices and intravascular lithotripsy, now exist to successfully treat calcified lesions. In this state-of-the-art review, a step-wise progression of strategies is described to modify coronary plaque, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. Technology has advanced greatly over the past few decades and we discuss how future technologies might shape percutaneous intervention.
Topics: Humans; Atherectomy, Coronary; Vascular Calcification; Coronary Artery Disease; Percutaneous Coronary Intervention; Plaque, Atherosclerotic; Treatment Outcome; Coronary Angiography
PubMed: 36150953
DOI: 10.1016/j.hlc.2022.08.009 -
Cardiovascular Revascularization... Oct 2023
Topics: Humans; Atherectomy, Coronary; Coronary Artery Disease; Angioplasty, Balloon, Coronary; Heart; Lithotripsy
PubMed: 37263851
DOI: 10.1016/j.carrev.2023.05.011 -
Cardiovascular Journal of AfricaThe aim was to assess the safety and efficacy of rotational atherectomy followed by drug-eluting balloon (DEB) in patients with a high risk of bleeding.
AIM
The aim was to assess the safety and efficacy of rotational atherectomy followed by drug-eluting balloon (DEB) in patients with a high risk of bleeding.
METHODS
A retrospective review was carried out of hospital records of consecutive patients who underwent the hybrid procedure.
RESULTS
The average age of the 23 patients was 74 years. Risk factors for bleeding included renal failure (35%), oral anticoagulation use (26%) and peptic ulcer disease (35%). All patients had procedural success. No bleeding was reported over the 24-month follow-up period. Dual antiplatelet therapy was stopped successfully in six patients (26%) at three months. Two patients had confirmed target-lesion failure (restenosis). Two patients died over the study period but the cause of death was not known to be cardiovascular disease related.
CONCLUSIONS
For patients at high risk of bleeding who require rotablation, the use of a drug-eluting balloon may be a safe, effective alternative.
Topics: Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Atherectomy; Atherectomy, Coronary; Coronary Angiography; Coronary Disease; Drug-Eluting Stents; Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 33179716
DOI: 10.5830/CVJA-2020-050 -
Catheterization and Cardiovascular... Mar 2016Calcified lesions are associated with lower rates of successful percutaneous coronary intervention (PCI), greater stent thrombosis, and increased target vessel...
Calcified lesions are associated with lower rates of successful percutaneous coronary intervention (PCI), greater stent thrombosis, and increased target vessel revascularization. Women undergoing PCI are more often older than men and likely to present with severe lesion calcification. The ORBIT II study, for the first time compares the effect of the orbital atherectomy system (OAS) in men and women undergoing PCI for severely calcified lesions. Although the adjusted risk of severe dissections was higher in women, the incidence of in-hospital and 30-day outcomes was similar to men. Randomized comparisons of the OAS with rotational atherectomy and with stenting without atherectomy are needed to further elucidate sex-based differences in calcified lesion PCI.
Topics: Atherectomy; Atherectomy, Coronary; Female; Humans; Male; Percutaneous Coronary Intervention; Treatment Outcome; Vascular Calcification
PubMed: 26994977
DOI: 10.1002/ccd.26492 -
International Journal of Clinical... Oct 2021Optical coherence tomography (OCT) is a novel adjunct in the field of medicine. The objective of this systematic review was to evaluate the role of OCT in the field of... (Review)
Review
BACKGROUND
Optical coherence tomography (OCT) is a novel adjunct in the field of medicine. The objective of this systematic review was to evaluate the role of OCT in the field of contemporary endovascular surgery in terms of its utility in diagnostics and interventions in peripheral arterial disease (PAD).
METHOD
A systematic search of literature published from 1st January 2009 to 1st August 2019 was identified from PubMed, Ovid and Cochrane library database with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The pre-defined selection inclusion criteria were clinical applications of OCT in vascular surgery in relation to diagnostics and interventions. Keywords used included OCT, PAD, endovascular procedures and atherectomy.
RESULTS
From an initial search of 310 articles, 27 articles were included in this systematic review: 15 articles were related to diagnostics: peripheral arterial disease was the most studied condition (n = 8), other conditions included in-stent restenosis (n = 4), fibromuscular dysplasia (n = 2) and acute limb ischaemia (n = 1); 12 articles were related to intervention: an OCT-guided crossing catheter was the most used assisting device (n = 10), with an OCT-guided atherectomy device used in four of these studies.
CONCLUSION
Although there is currently no level 1 evidence to suggest routine use of OCT in the diagnosis and treatment of PAD, current literature suggests that the use of OCT is safe and effective. The OCT real-time vessel wall structural images clearly distinguish normal anatomy from plaque pathology, and are of great advantage both in the accurate diagnosis and treatment of target lesion, especially in reducing the amount of radiation in the endovascular procedure.
Topics: Atherectomy; Humans; Ischemia; Peripheral Arterial Disease; Plaque, Atherosclerotic; Tomography, Optical Coherence
PubMed: 34258814
DOI: 10.1111/ijcp.14628 -
Journal of Vascular Surgery Mar 2022
Topics: Atherectomy; Humans; Intermittent Claudication
PubMed: 35190147
DOI: 10.1016/j.jvs.2021.09.030 -
JACC. Cardiovascular Interventions Mar 2021The aim of this study was to describe physician practice patterns and examine physician-level factors associated with the use of atherectomy during index...
OBJECTIVES
The aim of this study was to describe physician practice patterns and examine physician-level factors associated with the use of atherectomy during index revascularization for patients with femoropopliteal peripheral artery disease.
BACKGROUND
There are minimal data to support the routine use of atherectomy over angioplasty and/or stenting for the endovascular treatment of peripheral artery disease.
METHODS
Medicare fee-for-service claims (January 1 to December 31, 2019) were used to identify all beneficiaries undergoing elective first-time femoropopliteal peripheral vascular intervention (PVI) for claudication or chronic limb-threatening ischemia. Hierarchical logistic regression was used to evaluate patient- and physician-level characteristics associated with atherectomy.
RESULTS
A total of 58,552 patients underwent index femoropopliteal PVI by 1,627 physicians. There was a wide distribution of physician practice patterns in the use of atherectomy, ranging from 0% to 100% (median 55.1%). Independent characteristics associated with atherectomy included treatment for claudication (vs. chronic limb-threatening ischemia; odds ratio [OR]: 1.51), patient diabetes (OR: 1.09), physician male sex (OR: 2.08), less time in practice (OR: 1.41 to 2.72), nonvascular surgery specialties (OR: 2.78 to 5.71), physicians with high volumes of femoropopliteal PVI (OR: 1.67 to 3.51), and physicians working primarily at ambulatory surgery centers or office-based laboratories (OR: 2.19 to 7.97) (p ≤ 0.03 for all). Overall, $266.8 million was reimbursed by Medicare for index femoropopliteal PVI in 2019. Of this, $240.6 million (90.2%) was reimbursed for atherectomy, which constituted 53.8% of cases.
CONCLUSIONS
There is a wide distribution of physician practice patterns for the use of atherectomy during index PVI. There is a critical need for professional guidelines outlining the appropriate use of atherectomy in order to prevent overutilization of this technology, particularly in high-reimbursement settings.
Topics: Aged; Atherectomy; Femoral Artery; Humans; Intermittent Claudication; Male; Medicare; Peripheral Arterial Disease; Retrospective Studies; Risk Factors; Treatment Outcome; United States; Vascular Patency
PubMed: 33736774
DOI: 10.1016/j.jcin.2021.01.004 -
The Journal of Cardiovascular Surgery Apr 2019Endovascular treatment for peripheral artery occlusive disease carries unresolved problem of restenosis. Treatment modalities in areas of high mechanical stress like... (Review)
Review
Endovascular treatment for peripheral artery occlusive disease carries unresolved problem of restenosis. Treatment modalities in areas of high mechanical stress like popliteal artery and common femoral artery remains challenging. New-generation devices improved the results of stent therapy in this anatomical territory, but could impact on future surgical options if they are needed. Vessel preparation prior to drug (paclitaxel)-coated balloons (DCB) angioplasty leads to better paclitaxel penetration into the arterial wall and improved drug uptake. The "leave nothing behind" strategies, DCB angioplasty and combined directional atherectomy (DA) and antirestenotic therapy (DAART), can theoretically overcome the problems caused by the mobility of the knee joint. However, calcified and longer lesions remain a challenging subset that is less responsive to DCBs, resulting in higher provisional stent rates. For the treatment of long and calcified femoropopliteal lesions, vessel preparation with DA before DCB angioplasty seems to be safe in mid-term follow-up and might have benefits in more challenging lesion subsets that are at higher risk for acute and chronic technical treatment failure of percutaneous transluminal angioplasty, including DCB angioplasty, such as severely calcified lesions. Treatment with DA+DCB resulted in both increased technical success and fewer flow-limiting dissections compared with treatment with DCB alone. In concept of "leave nothing behind" therapies for isolated popliteal artery lesions, DAART was associated with a higher primary patency rate than DCB angioplasty alone.
Topics: Angioplasty, Balloon; Atherectomy; Cardiovascular Agents; Coated Materials, Biocompatible; Constriction, Pathologic; Humans; Paclitaxel; Peripheral Arterial Disease; Recurrence; Risk Factors; Treatment Outcome; Vascular Access Devices; Vascular Patency
PubMed: 30650962
DOI: 10.23736/S0021-9509.19.10866-X -
Catheterization and Cardiovascular... Oct 2022To evaluate the feasibility and safety of coronary orbital atherectomy (OA) for the treatment of calcified ostial lesions.
OBJECTIVES
To evaluate the feasibility and safety of coronary orbital atherectomy (OA) for the treatment of calcified ostial lesions.
BACKGROUND
Percutaneous coronary intervention (PCI) is increasingly being completed in complex patients and lesions. OA is effective for severely calcified coronary lesions; however, there is a dearth of evidence on the use of OA in ostial lesions, especially with long-term outcome data.
METHODS
Data were obtained from a retrospective analysis of patients who underwent OA of heavily calcified ostial lesions followed by stent implantation from December 2010 to June 2019 at two high-volume PCI centers. Kaplan-Meier analysis was utilized to assess the primary endpoints of 30-day, 1-year, and 2-year freedom-from (FF) major adverse cardiac events (MACE: death, myocardial infarction, or target vessel revascularization), stroke, and stent thrombosis (ST).
RESULTS
A total of 56 patients underwent OA to treat heavily calcified ostial coronary lesions. The mean age was 72 years with a high prevalence of diabetes (55%) and heart failure (36%), requiring hemodynamic support (14%). There was high FF angiographic complications (93%), and at 30-day, 1-year, and 2-year, a high FF-MACE (96%, 91%, and 88%), stroke (98%, 96%, and 96%), and ST (100%), respectively.
CONCLUSIONS
This study represents the largest real-world experience of coronary OA use in heavily calcified ostial lesions with long-term outcomes over 2 years. The main finding in this retrospective analysis is that, despite the complex patients and lesions included in this analysis, OA appears to be a feasible and safe treatment option for calcified coronary ostial lesions.
Topics: Aged; Atherectomy; Atherectomy, Coronary; Coronary Angiography; Coronary Artery Disease; Humans; Percutaneous Coronary Intervention; Retrospective Studies; Severity of Illness Index; Stroke; Thrombosis; Treatment Outcome; Vascular Calcification
PubMed: 35989487
DOI: 10.1002/ccd.30369