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Circulation Journal : Official Journal... Mar 2018
Topics: Atherectomy, Coronary; Coronary Artery Disease; Coronary Restenosis; Drug-Eluting Stents; Humans
PubMed: 29515046
DOI: 10.1253/circj.CJ-18-0170 -
Catheterization and Cardiovascular... May 2022To assess coronary orbital atherectomy (OA) use in Hispanic or Latino (HL) patients compared to non-HL patients.
OBJECTIVES
To assess coronary orbital atherectomy (OA) use in Hispanic or Latino (HL) patients compared to non-HL patients.
BACKGROUND
HL patients are at greater risk of cardiovascular disease mortality compared with Whites with similar coronary artery calcium (CAC) scores. The safety and efficacy of coronary atherectomy in the HL patient population is unknown due to the under-representation of minorities in clinical trial research.
METHODS
A retrospective analysis of consecutive patients undergoing coronary OA treatment of severely calcified lesions at the Mount Sinai Medical Center, Miami Beach, Florida (MSMCMB) was completed. From January 2014 to September 2020, a total of 609 patients from MSMCMB who underwent percutaneous coronary intervention with OA were identified in the electronic health records.
RESULTS
Of those identified, 350 (57.5%) had an ethnicity classification of HL. The overall mean age was 74 years and there was a high prevalence of diabetes in the HL group compared to the non-HL group (49.7% vs. 34.7%; p = 0.0003). Severe angiographic complications were uncommon and in-hospital freedom from major adverse cardiac events (MACE), a composite of cardiac death, MI, and stroke (ischemic or hemorrhagic cerebrovascular accidents), was 98.5% overall, with no significant difference between the HL and non-HL groups, despite the higher prevalence of diabetes in the HL group.
CONCLUSIONS
This study represents the largest real-world experience of OA use in HL versus non-HL patients. The main finding in this retrospective analysis is that OA can be performed safely and effectively in a high-risk population of HL patients.
Topics: Aged; Atherectomy; Atherectomy, Coronary; Coronary Angiography; Coronary Artery Disease; Diabetes Mellitus; Hispanic or Latino; Humans; Percutaneous Coronary Intervention; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome; Vascular Calcification
PubMed: 35312163
DOI: 10.1002/ccd.30158 -
Journal of Vascular Surgery Apr 1996The purpose of this study was to evaluate the outcomes of our 6-year experience with directional atherectomy used for treatment of stenoses in infrainguinal vein grafts.
PURPOSE
The purpose of this study was to evaluate the outcomes of our 6-year experience with directional atherectomy used for treatment of stenoses in infrainguinal vein grafts.
METHODS
From March 1988 to April 1994, 52 directional atherectomy procedures were undertaken in 42 patients to treat 67 stenoses in 44 vein grafts. Follow-up consisted of periodic physical examinations and graft surveillance; ankle/brachial indexes, pulse volume recordings, and color-flow duplex ultrasonography. Follow-up angiography (n = 18) was performed for recurrent symptoms, reproducible drop in ankle/brachial index of greater than 0.15, a twofold to threefold focal increase in peak systolic velocity, or incidentally during evaluation of the opposite leg.
RESULTS
Forty-nine of 52 (94%) procedures were technically successful. In two the residual diameter stenosis was greater than 30%, and in one atherectomy could not be performed. Complications were minor in six (11%) and major in three (6%): two acute graft occlusions and one delayed pseudoaneurysm at the atherectomy site. There were no deaths at 30 days. With a mean follow-up of 21 +/- 18 months, 36 of 44 grafts (82%) remained patent without restenosis; 6 others were patent but considered "failed"--5 (11%) with restenosis, 1 with a pseudoaneurysm; and 2 grafts (5%) occluded. Clinically 33 of 44 extremities (75%) were asymptomatic during follow-up. Claudication improved in five, recurred in three, and was unchanged in one. There was one below-knee amputation. Life-table analysis including all 52 procedures reveals cumulative primary atherectomy patency rates for the 44 grafts of 82%, 78%, and 78%, respectively, at 1, 2, and 3 years after atherectomy, and 86%, 83%, and 83% for the 67 individual stenoses treated.
CONCLUSIONS
Directional atherectomy of vein graft stenoses has high technical and clinical success rates, acceptably low morbidity rates, and offers better sustained patency rates than balloon angioplasty. Its long-term patency rate seems to approach that of surgical vein patch angioplasty.
Topics: Aged; Aged, 80 and over; Aneurysm; Angiography; Ankle; Atherectomy; Blood Flow Velocity; Blood Pressure; Blood Volume; Brachial Artery; Constriction, Pathologic; Female; Follow-Up Studies; Graft Occlusion, Vascular; Humans; Intermittent Claudication; Leg; Life Tables; Longitudinal Studies; Male; Middle Aged; Physical Examination; Pulse; Recurrence; Reproducibility of Results; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex; Vascular Patency; Veins
PubMed: 8627889
DOI: 10.1016/s0741-5214(96)80033-4 -
Journal of Interventional Cardiology Apr 2013The aim of this study was to appreciate the safety and effectiveness of transradial percutaneous coronary intervention (PCI) with rotational atherectomy for highly... (Review)
Review
OBJECTIVES
The aim of this study was to appreciate the safety and effectiveness of transradial percutaneous coronary intervention (PCI) with rotational atherectomy for highly calcified left main coronary artery (LMCA) disease in octogenarians.
BACKGROUND
Conventional surgery is still considered the preferred management for LMCA disease; but, when the lesion is severely calcified, and the patient is unsuitable for surgery, the interventional cardiologist faces a complex PCI traditionally approached by femoral access.
METHODS
Between June 2004 and December 2010, octogenarians with calcified LMCA disease who were primary denied for surgical revascularization were enrolled. Procedural success and major adverse cerebral and cardiovascular events (MACCE) including death, nonfatal myocardial infarction, target lesion revascularization (TLR), or stroke during long-term follow-up were evaluated.
RESULTS
Forty-two consecutive patients ≥80 years had undergone stenting for calcified LMCA disease (13 with rotational atherectomy, the "Rota" group, and 29 without rotational atherectomy, the "without Rota" group). Procedural success was good (92.3% vs. 96.6%, respectively, p = NS). Mean follow-up time was 25.7 ± 21.4 and 28 ± 32.3 months, respectively. There was a TLR in 25% and 11.1%, respectively; p = NS. No difference was detected in terms of overall in-hospital or long-term mortality or MACCE.
CONCLUSION
Rotational atherectomy followed by stent implantation by transradial approach, when applied to heavily calcified lesions, appeared to be a safe and effective strategy for the treatment of LMCA disease in octogenarians who were refused for surgery.
Topics: Aged; Aged, 80 and over; Atherectomy, Coronary; Coronary Artery Disease; Female; Follow-Up Studies; Humans; Male; Percutaneous Coronary Intervention; Postoperative Complications; Radial Artery; Retrospective Studies; Stents; Survival Rate; Tertiary Care Centers; Treatment Outcome; Vascular Calcification
PubMed: 23557587
DOI: 10.1111/joic.12026 -
Postgraduate Medical Journal Aug 1998Although contrast angiography is important in the diagnosis and treatment of atherosclerotic disease, it does have limitations. Intracoronary ultrasound more accurately... (Review)
Review
Although contrast angiography is important in the diagnosis and treatment of atherosclerotic disease, it does have limitations. Intracoronary ultrasound more accurately assesses the amount of atherosclerosis and has given us new insights into the pathophysiology of coronary plaque accumulation and remodelling. It also allows the monitoring of therapeutic intervention. Intracoronary ultrasound is a new gold standard. It does not obviate the need for angiography but provides complementary information that enables us to perform optimal interventional procedures.
Topics: Atherectomy; Cardiac Catheterization; Coronary Artery Disease; Humans; Stents; Ultrasonography, Interventional
PubMed: 9926120
DOI: 10.1136/pgmj.74.874.468 -
The Journal of Invasive Cardiology Feb 2021Vessel prepping is an essential component of an optimal strategy in treating infrainguinal peripheral arterial disease. Vessel prepping with atherectomy can be...
Vessel prepping is an essential component of an optimal strategy in treating infrainguinal peripheral arterial disease. Vessel prepping with atherectomy can be aggressive in certain lesion morphologies, such as severe calcium, total occlusion, or in-stent restenosis, or can target vessel compliance without aggressive debulking. Drug elution is likely to be enhanced by vessel prepping. Optimal vessel prepping requires precise imaging of the vessel size, plaque morphology, and lesion severity/length which cannot be assessed adequately by angiography. Also, intravascular ultrasound provides information post treatment on minimal luminal area gain, residual dissections, geometric miss, and stent apposition and expansion.
Topics: Atherectomy; Atherectomy, Coronary; Humans; Peripheral Arterial Disease; Stents; Treatment Outcome; Ultrasonography; Ultrasonography, Interventional
PubMed: 33443489
DOI: No ID Found -
Kardiologia Polska 2024
Topics: Humans; Calcium; Atherectomy; Atherectomy, Coronary; Treatment Outcome; Vascular Calcification; Coronary Artery Disease; Severity of Illness Index
PubMed: 38348618
DOI: 10.33963/v.phj.98836 -
Vascular and Endovascular Surgery Jan 2010Symptomatic atherosclerotic disease of the popliteal artery presents challenges for endovascular therapy. We evaluated the technical success, complications, and midterm... (Comparative Study)
Comparative Study
PURPOSE
Symptomatic atherosclerotic disease of the popliteal artery presents challenges for endovascular therapy. We evaluated the technical success, complications, and midterm outcomes of atherectomy and angioplasty involving the popliteal segment.
METHODS
We conducted a retrospective review of outcomes of popliteal artery intervention using atherectomy or angioplasty performed between 2003 and 2008.
RESULTS
A total of 56 patients (36% women, age 72.8 +/- 12.2 years, 77% critical limb ischemia) underwent popliteal atherectomy (n = 18) or angioplasty (n = 38). These patients had similar clinical characteristics, TransAtlantic Intersociety Consensus (TASC)/ TASC II classification, mean lesion length, and runoff scores. We observed a trend toward higher rates of technical success defined as <30% residual stenosis after atherectomy compared to angioplasty (94% vs 71%, P = .08). While angioplasty was associated with a higher frequency of arterial dissection (23% vs 0%, P = .003), atherectomy was associated with a higher rate of thromboembolic events (22% vs 0%, P = 0.01). Adjunctive stenting was used more frequently following angioplasty compared to atherectomy (45% vs 6%, P = .005). Thrombolysis was used to treat embolization in 4 patients in the atherectomy group. The improvement in the ankle-brachial index (ABI) was similar between the 2 treatment groups. Primary patency of the popliteal artery at 3, 6, and 12 months was 94%, 88%, and 75% in the atherectomy group and 89%, 82%, and 73% in the angioplasty group (P = not significant [NS]). There were no significant differences in limb salvage and freedom from reintervention at 1 year between the atherectomy and angioplasty groups.
CONCLUSIONS
Our experience with popliteal artery endovascular therapy indicates a distinct pattern of procedural complications with atherectomy compared to angioplasty but similar midterm patency, limb salvage, and freedom from intervention.
Topics: Aged; Aged, 80 and over; Angioplasty, Balloon; Arterial Occlusive Diseases; Atherectomy; Atherosclerosis; Constriction, Pathologic; Female; Humans; Kaplan-Meier Estimate; Limb Salvage; Male; Middle Aged; Popliteal Artery; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Severity of Illness Index; Stents; Thrombolytic Therapy; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 19942598
DOI: 10.1177/1538574409345028 -
EuroIntervention : Journal of EuroPCR... Jun 2013Rotational atherectomy (RA) is frequently performed to modify complex fibrocalcific coronary lesions with high procedural success. A stuck rotablator is a rare but... (Review)
Review
AIMS
Rotational atherectomy (RA) is frequently performed to modify complex fibrocalcific coronary lesions with high procedural success. A stuck rotablator is a rare but life-threatening complication. However, its description remains sporadic and it has never been systematically analysed. The aim of this analysis is to present our experience and summarise the available literature about stuck rotablator, and to identify risk factors and possible management strategies for this complication.
METHODS AND RESULTS
We analysed our experience of 442 RA procedures and identified four cases of stuck rotablator. Two of these cases were rotablations in freshly implanted stents. All cases were managed percutaneously. We further analysed the available literature and identified a total of 11 reports with 14 cases of a stuck rotablator burr; seven were managed surgically and seven with endovascular approaches. Based on our experience and the literature review we developed an algorithm to guide operators while managing this complication.
CONCLUSIONS
Entrapment of a rotablation burr is a rare but very serious complication of RA. Operators performing RA should be aware of this risk and be prepared to manage it adequately. In our experience, the risk seems to be higher when rotablating freshly implanted underexpanded stents.
Topics: Aged; Aged, 80 and over; Algorithms; Atherectomy, Coronary; Coronary Angiography; Coronary Artery Disease; Equipment Failure; Female; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Retrospective Studies; Risk Factors; Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 23793010
DOI: 10.4244/EIJV9I2A41 -
EuroIntervention : Journal of EuroPCR... Apr 2019We sought to evaluate procedural complications and one-year clinical outcomes for patients who underwent percutaneous coronary intervention (PCI) with orbital (OA) and...
AIMS
We sought to evaluate procedural complications and one-year clinical outcomes for patients who underwent percutaneous coronary intervention (PCI) with orbital (OA) and rotational atherectomy (RA).
METHODS AND RESULTS
From a total of 13,467 patients who underwent PCI in our hospital between January 2013 and June 2016, 1,149 consecutive patients were treated with atherectomy for moderately-severely calcified lesions (184 with OA, 965 with RA). Procedural complications were similarly observed in the two groups except for higher dissection and perforation rates with OA. Major adverse cardiovascular events (MACE) were defined as the composite of death, myocardial infarction or target lesion revascularisation. Multivariable adjusted analysis showed that OA use was associated with comparable adjusted one-year MACE compared to RA use (hazard ratio 0.79 [95% confidence interval 0.54-1.17], p=0.25). There were no significant differences in individual MACE endpoints. Furthermore, we studied 67 patients with OCT images. OCT analysis showed comparable tissue modification with a trend towards higher stent expansion with OA vs. RA.
CONCLUSIONS
OA use was associated with lower unadjusted but similar adjusted one-year MACE outcomes compared to RA with higher rates of dissection and device-induced perforation.
Topics: Atherectomy, Coronary; Coronary Angiography; Coronary Artery Disease; Humans; Percutaneous Coronary Intervention; Tomography, Optical Coherence; Treatment Outcome; Vascular Calcification
PubMed: 29957595
DOI: 10.4244/EIJ-D-17-01060