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Circulation. Cardiovascular... Oct 2023
Topics: Humans; Calcium; Treatment Outcome; Coronary Artery Disease; Atherectomy, Coronary; Percutaneous Coronary Intervention; Vascular Calcification; Coronary Angiography
PubMed: 37847767
DOI: 10.1161/CIRCINTERVENTIONS.123.013538 -
JACC. Cardiovascular Interventions Sep 2023
PubMed: 37704300
DOI: 10.1016/j.jcin.2023.06.034 -
European Heart Journal Nov 2023Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely...
Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely calcified coronary artery disease has grown substantially. This has been prompted on one side by the clinical demand for the continuous increase in life expectancy, the sustained expansion of the primary PCI networks worldwide, and the routine performance of revascularization procedures in elderly patients; on the other side, the availability of new and dedicated technologies such as orbital atherectomy and intravascular lithotripsy, as well as the optimization of the rotational atherectomy system, has increased operators' confidence in attempting more challenging PCI. This current EAPCI clinical consensus statement prepared in collaboration with the EURO4C-PCR group describes the comprehensive management of patients with heavily calcified coronary stenoses, starting with how to use non-invasive and invasive imaging to assess calcium burden and inform procedural planning. Objective and practical guidance is provided on the selection of the optimal interventional tool and technique based on the specific calcium morphology and anatomic location. Finally, the specific clinical implications of treating these patients are considered, including the prevention and management of complications and the importance of adequate training and education.
Topics: Humans; Aged; Percutaneous Coronary Intervention; Calcium; Vascular Calcification; Coronary Artery Disease; Coronary Stenosis; Polymerase Chain Reaction; Treatment Outcome; Coronary Angiography
PubMed: 37208199
DOI: 10.1093/eurheartj/ehad342 -
Annales de Cardiologie Et D'angeiologie Dec 2023Severe coronary artery calcification, too often underestimated, increases the complexity of percutaneous coronary interventions. Atherectomy is one of preferred approach...
Severe coronary artery calcification, too often underestimated, increases the complexity of percutaneous coronary interventions. Atherectomy is one of preferred approach for the preparation of calcified lesions before stent placement. Orbital atherectomy is a new method that has proven to be safe and effective in the preparation of calcium plaques (ORBIT I and ORBIT II studies). The recent introduction in France allows to perform a prospective registry named REFORCE. Its main objective is to include 300 patients in order to evaluate security and safety of the device in France during routine use.
Topics: Humans; Atherectomy, Coronary; Vascular Calcification; Stents; Treatment Outcome; Prospective Studies; Severity of Illness Index; Time Factors; Coronary Artery Disease; Percutaneous Coronary Intervention; Registries; Coronary Angiography
PubMed: 37897857
DOI: 10.1016/j.ancard.2023.101686 -
Journal of Clinical Medicine Nov 2023In order to improve the percutaneous treatment of coronary artery calcifications (CAC) before stent implantation, methods such as rotational atherectomy (RA), orbital... (Review)
Review
In order to improve the percutaneous treatment of coronary artery calcifications (CAC) before stent implantation, methods such as rotational atherectomy (RA), orbital atherectomy (OA), and coronary intravascular lithotripsy (IVL) were invented. These techniques use different mechanisms of action and therefore have various short- and long-term outcomes. IVL employs sonic waves to modify CAC, whereas RA and OA use a rapidly rotating burr or crown. These methods have specific advantages and limitations, regarding their cost-efficiency, the movement of the device, their usefulness given the individual anatomy of both the lesion and the vessel, and the risk of specified complications. This study reviews the key findings of peer-reviewed articles available on Google Scholar with the keywords RA, OA, and IVL. Based on the collected data, successful stent delivery was assessed as 97.7% for OA, 92.4% for IVL, and 92.5% for RA, and 30-day prevalence of MACE (Major Adverse Cardiac Events) in OA-10.4%, IVL-7.2%, and RA-5%. There were no significant differences in the 1-year MACE. Compared to RA, OA and IVL are cost-effective approaches, but this is substantially dependent on the reimbursement system of the particular country. There is no standard method of CAC modification; therefore, a tailor-made approach is required.
PubMed: 38068298
DOI: 10.3390/jcm12237246 -
The Surgical Clinics of North America Aug 2023As the number of patients affected by peripheral arterial disease continues to increase, new technical approaches and devices have been developed to provide effective... (Review)
Review
As the number of patients affected by peripheral arterial disease continues to increase, new technical approaches and devices have been developed to provide effective and durable treatment options that will lead to improved outcomes. While the mainstay of endovascular intervention remains mostly balloon-based, several innovative techniques and technologies are in development that may provide new solutions. This review highlights recent endovascular advancements in the management of chronic limb-threatening ischemia and additional adjunctive devices that are needed to improve lesion patency, reduce the need for reintervention, and lead to better patient-centered functional outcomes.
Topics: Humans; Limb Salvage; Treatment Outcome; Endovascular Procedures; Peripheral Arterial Disease; Ischemia; Risk Factors
PubMed: 37455037
DOI: 10.1016/j.suc.2023.05.002 -
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