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Circulation Journal : Official Journal... May 2021The aim of the study was to assess anatomical and procedural predictors of clinical and procedural failure of rotational atherectomy (RA) in an all-comers... (Observational Study)
Observational Study
BACKGROUND
The aim of the study was to assess anatomical and procedural predictors of clinical and procedural failure of rotational atherectomy (RA) in an all-comers population.Methods and Results:A total of 534 consecutive patients who underwent RA were included in a double-center observational study. The primary composite endpoint consisted of: rota-wire introduction failure, burr-passage failure, periprocedural complications and procedure-related major adverse events. The second primary endpoint included rota-wire introduction failure and burr-passage failure. The primary endpoint occurred in 76 (14.2%) patients and the second primary endpoint occurred in 64 (12%) Periprocedural complications occurred in 23 (4.3%) and procedure-related adverse events in 23 (4.3%) patients. Multivariable analysis revealed angulation on lesion ≤90° (HR=2.18, 95% CI: 1.21-3.94, P=0.0096) and sequential lesion (HR=1.89, 95% CI: 1.01-3.54, P=0.046) as independent predictors of no clinical success of RA. Multivariable analysis revealed again that angulation on lesion ≤90° (HR=2.26, 95% CI: 1.16-4.40, P=0.02) and sequential lesion (HR=3.77, 95% CI: 1.64-8.69, P<0.01) as independent predictors of no procedural success of RA.
CONCLUSIONS
The presence of an acute angulation on lesion and sequential lesion are independent determinants of clinical and procedural failure of RA. Further research is necessary to establish a score predicting RA failure, which can help in preproceduralrisk stratification of patients undergoing complex percutaneous coronary intervention with RA.
Topics: Atherectomy, Coronary; Coronary Angiography; Coronary Artery Disease; Humans; Percutaneous Coronary Intervention; Retrospective Studies; Risk Factors; Treatment Outcome; Vascular Calcification
PubMed: 33883385
DOI: 10.1253/circj.CJ-20-1222 -
BMC Cardiovascular Disorders Jan 2024Interventional cardiologists face challenges in managing chronic total occlusion (CTO) lesions, with conflicting results when comparing rotational atherectomy (RA) to... (Meta-Analysis)
Meta-Analysis Review
Safety and feasibility of rotational atherectomy (RA) versus conventional stenting in patients with chronic total occlusion (CTO) lesions: a systematic review and meta-analysis.
BACKGROUND AND AIM
Interventional cardiologists face challenges in managing chronic total occlusion (CTO) lesions, with conflicting results when comparing rotational atherectomy (RA) to conventional PCI. This meta-analysis aims to provide a critical evaluation of the safety and feasibility of RA in CTO lesions.
METHODS
PubMed, Scopus, Web of Science, Ovid, and Cochrane central library until April 2023 were searched for relevant studies. MACE was our primary outcomes, other outcomes were all cause of death, cardiac death, MI, and TVR. Also, we reported angiographic outcomes as technical success, procedural success, and procedural complications in a random effect model. The pooled data was analyzed using odds ratio (OR) with its 95% CI using STATA 17 MP.
RESULTS
Seven studies comprising 5494 patients with a mean follow-up of 43.1 months were included in this meta-analysis. Our pooled analysis showed that RA was comparable to PCI to decrease the incidence of MACE (OR = 0.98, 95% CI [0.74 to 1.3], p = 0.9). Moreover, there was no significant difference between RA and conventional PCI in terms of other clinical or angiographic outcomes.
CONCLUSION
Our study showed that RA had comparable clinical and angiographic outcomes as conventional PCI in CTO lesions, which offer interventional cardiologists an expanded perspective when addressing calcified lesions.
PROSPERO REGISTRATION
CRD42023417362.
Topics: Humans; Atherectomy, Coronary; Chronic Disease; Coronary Occlusion; Feasibility Studies; Percutaneous Coronary Intervention; Risk Factors; Treatment Outcome
PubMed: 38166554
DOI: 10.1186/s12872-023-03673-2 -
Cardiovascular Revascularization... Jun 2022Rotational atherectomy (RA) plays a central role in the treatment of heavily calcified coronary artery lesions. Our aim was to compare periprocedural characteristics and... (Meta-Analysis)
Meta-Analysis
BACKGROUND/PURPOSE
Rotational atherectomy (RA) plays a central role in the treatment of heavily calcified coronary artery lesions. Our aim was to compare periprocedural characteristics and outcomes of planned (PA) vs. bailout (BA) rotational atherectomy.
METHODS
We conducted a systematic review and performed a meta-analysis on studies which compared PA vs. BA strategy.
RESULTS
Five studies fulfilled the inclusion criteria, pooling a total of 2120 patients. There was no difference in procedural success, PA vs. BA risk ratio (RR) 1.03 and 95% confidence interval (95% CI) 0.99-1.07. Compared to BA, PA was associated with a shorter procedural time [mean difference (MD) -25.88 min, 95% CI -35.55 to -16.22], less contrast volume (MD -43.71 ml, 95% CI -69.17 to -18.25), less coronary dissections (RR 0.50, 95% CI 0.26-0.99), fewer stents (MD -0.20, 95% CI -0.29 to -0.11), and a trend favouring less periprocedural myocardial infarctions (MI) (RR 0.77, 95% CI 0.54-1.11). There was no difference in major adverse cardiovascular events on follow-up (RR 1.04, 95% CI 0.62-1.74), death (RR 0.98, 95% CI 0.59-1.64), MI (RR 1.16, 95% CI 0.62-2.18), target vessel revascularization (RR 1.40, 95% CI 0.83 to 2.36), stroke (RR 1.50, 95% CI 0.46-4.86) or stent thrombosis (RR 0.82, 95% CI 0.06-10.74); all PA vs. BA comparisons.
CONCLUSIONS
Compared to bailout RA, planned RA resulted in significantly shorter procedural times, less contrast use, lesser dissection rates and fewer stents used. The bailout RA approach appears to enhance periprocedural risk, but there is no difference on mid-term outcomes.
Topics: Atherectomy, Coronary; Coronary Artery Disease; Humans; Myocardial Infarction; Retrospective Studies; Stents; Treatment Outcome; Vascular Calcification
PubMed: 34627732
DOI: 10.1016/j.carrev.2021.09.013 -
Journal of Interventional Cardiology Dec 2013Rotational atherectomy (RA) is used as a debulking technique prior to stenting in some specialized cardiac centers for calcified coronary lesions amenable to... (Review)
Review
OBJECTIVES AND BACKGROUND
Rotational atherectomy (RA) is used as a debulking technique prior to stenting in some specialized cardiac centers for calcified coronary lesions amenable to percutaneous coronary intervention (PCI). A specific possible complication, burr entrapment, is unusual but carries serious risks and may sometimes necessitate surgery as a rescue procedure. However, different modalities using a percutaneous approach were proposed as a bail-out. We aim to propose a framework for possible management for trapped RA burr.
METHODS AND RESULTS
A literature review of the most relevant cases of entrapped burr during PCI was performed. Twelve cases were reported and different solutions were discussed. Surgery was needed in only 1 patient to retrieve the trapped burr, and in all the other cases, different percutaneous solutions were successful to retract the trapped device.
CONCLUSIONS
These cases illustrate that burr entrapment during RA, albeit rare, may occur and may transform a relatively simple PCI to a procedure failure. Although prevention is better than treatment, the operators should be aware of such serious complication and they should keep in mind that various possible percutaneous solutions may be successful to retrieve the burr and to avoid surgery.
Topics: Adult; Aged; Aged, 80 and over; Atherectomy, Coronary; Female; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Stents
PubMed: 24308659
DOI: 10.1111/joic.12075 -
Circulation. Cardiovascular... Oct 2018
Topics: Atherectomy, Coronary; Percutaneous Coronary Intervention
PubMed: 30354648
DOI: 10.1161/CIRCINTERVENTIONS.118.007367 -
The Journal of Cardiovascular Surgery Feb 2022The purpose of this study was to define patient and anatomical factors associated with technical results specific to rotational atherectomy. Controversy exists...
BACKGROUND
The purpose of this study was to define patient and anatomical factors associated with technical results specific to rotational atherectomy. Controversy exists surrounding appropriate utilization of atherectomy to treat femoral-popliteal atherosclerosis. Importantly, the existence of different atherectomy devices and lack of technical reports highlighting variables that impact outcomes obscures the ability to assess perioperative performance.
METHODS
The nonindustry sponsored, Multicentric National Registry on the use of rotational atherectomy in femoral-popliteal occlusive atherosclerotic disease (MORPHEAS) database was queried. The MORPHEAS investigators included experienced providers at four centers who previously had not utilized rotational atherectomy. The primary endpoint was flow-limiting dissection and/or >50% recoil resulting in stent-placement while a secondary endpoint included peripheral thromboembolism incidence.
RESULTS
One hundred thirteen patients were enrolled. Only femoropopliteal occlusions were included in the analysis and anatomic distribution and calcification severity were depicted separately. The most common adjunctive therapy was drug-coated balloon angioplasty (84%; N.=96). Flow-limiting dissection was identified in 16% (N.=18) and thromboembolism occurred in 4% (N.=4). Diabetes increased risk of thromboembolism (P=0.03) while lesion length ≥8.0 cm (P=0.07) and SFA-popliteal adductor canal location (P=0.01) were associated with flow-limiting dissection. In multivariable analysis, SFA-popliteal adductor canal occlusion had a 4.7-fold risk of perioperative complications (OR=4.7, 95%CI: 1.1-21.0; P=0.04).
CONCLUSIONS
Rotational atherectomy was characterized by reproducible performance among four centers; however, diabetic patients, as well as those with long-segment, heavily calcified SFA-popliteal adductor canal occlusion present greatest risk of complications.
Topics: Angioplasty, Balloon; Atherectomy; Constriction, Pathologic; Femoral Artery; Humans; Peripheral Arterial Disease; Popliteal Artery; Registries; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 35179338
DOI: 10.23736/S0021-9509.21.12159-7 -
Journal of Vascular Surgery Aug 2021Despite published guidelines and data for Medicare patients, it is uncertain how younger patients with intermittent claudication (IC) are treated. Additionally, the... (Observational Study)
Observational Study
OBJECTIVE
Despite published guidelines and data for Medicare patients, it is uncertain how younger patients with intermittent claudication (IC) are treated. Additionally, the degree to which treatment patterns have changed over time with the expansion of endovascular interventions and outpatient centers is unclear. Our goal was to characterize IC treatment patterns in the commercially insured non-Medicare population.
METHODS
The IBM MarketScan Commercial Database, which includes more than 8 billion US commercial insurance claims, was queried for patients newly diagnosed with IC from 2007 to 2016. Patient demographics, medication profiles, and open/endovascular interventions were evaluated. Time trends were modeled using simple linear regression and goodness-of-fit was assessed with coefficients of determination (R). A patient-centered cohort sample and a procedure-focused dataset were analyzed.
RESULTS
Among 152,935,013 unique patients in the database, there were 300,590 patients newly diagnosed with IC. The mean insurance coverage was 4.4 years. The median patients age was 58 years and 56% of patients were male. The prevalence of statin use was 48% among patients at the time of IC diagnosis and increased to 52% among patients after one year from diagnosis. Interventions were performed in 14.3%, of whom 20% and 6% underwent two or more and three or more interventions, respectively. The median time from diagnosis to intervention decreased from 230 days in 2008 days to 49 days in 2016 (R = 0.98). There were 16,406 inpatient and 102,925 ambulatory interventions for IC over the study period. Among ambulatory interventions, 7.9% were performed in office-based/surgical centers. The proportion of atherectomies performed in the ambulatory setting increased from 9.7% in 2007 to 29% in 2016 (R = 0.94). In office-based/surgical centers, 57.6% of interventions for IC used atherectomy in 2016. Atherectomy was used in ambulatory interventions by cardiologists in 22.6%, surgeons in 15.2%, and radiologists in 13.6% of interventions. Inpatient atherectomy rates remained stable over the study period. Open and endovascular tibial interventions were performed in 7.9% and 7.8% of ambulatory and inpatient IC interventions, respectively. Tibial bypasses were performed in 8.2% of all open IC interventions.
CONCLUSIONS
There has been shorter time to intervention in the treatment of younger, commercially insured patients with IC, with many receiving multiple interventions. Statin use was low. Ambulatory procedures, especially in office-based/surgical centers, increasingly used atherectomy, which was not observed in inpatient settings.
Topics: Age Factors; Ambulatory Care; Atherectomy; Cardiologists; Databases, Factual; Endovascular Procedures; Female; Hospitalization; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Intermittent Claudication; Male; Medicare; Middle Aged; Practice Patterns, Physicians'; Quality Indicators, Health Care; Radiologists; Retrospective Studies; Surgeons; Time Factors; Time-to-Treatment; Treatment Outcome; United States; Vascular Surgical Procedures
PubMed: 33548437
DOI: 10.1016/j.jvs.2020.10.090 -
Journal of the American College of... Jan 2002In-stent restenosis (ISR) is a novel pathobiologic process, histologically distinct from restenosis after balloon angioplasty and comprised largely of neointima... (Review)
Review
In-stent restenosis (ISR) is a novel pathobiologic process, histologically distinct from restenosis after balloon angioplasty and comprised largely of neointima formation. As percutaneous coronary intervention increasingly involves the use of stents, ISR is also becoming correspondingly more frequent. In this review, we examine the available studies of the histology and pathogenesis of ISR, with particular reference to porcine and other animal models. An overview of mechanical treatments is then provided, which includes PTCA, directional coronary atherectomy and high speed rotational atherectomy. Radiation-based therapies are discussed, including a summary of current problems associated with this modality of treatment. Finally, novel strategies for the prevention of ISR are addressed, including novel developments in stents and stent coatings, conventional drugs, nucleic acid-based drugs and gene transfer. Until recently, limited pharmacologic and mechanical treatment options have been available for both treatment and prevention of ISR. However, recent advances in gene modification and gene transfer therapies and, more particularly, in local stent-based drug delivery systems make it conceivable that the incidence of ISR will now be seriously challenged.
Topics: Angioplasty, Balloon, Coronary; Animals; Atherectomy, Coronary; Coronary Restenosis; Disease Models, Animal; Gene Transfer Techniques; Humans; Stents
PubMed: 11788206
DOI: 10.1016/s0735-1097(01)01742-9 -
European Journal of Vascular and... Dec 2022
Topics: Humans; Atherectomy, Coronary; Constriction, Pathologic; Angioplasty, Balloon; Atherectomy; Stents; Treatment Outcome; Femoral Artery; Peripheral Arterial Disease; Popliteal Artery; Vascular Patency; Coated Materials, Biocompatible
PubMed: 36216236
DOI: 10.1016/j.ejvs.2022.10.014 -
The Journal of Invasive Cardiology Feb 2022In this study, we aimed to describe the immediate and long-term vascular effects of OAS in patients with peripheral arterial disease (PAD) and moderate to severely...
OBJECTIVE
In this study, we aimed to describe the immediate and long-term vascular effects of OAS in patients with peripheral arterial disease (PAD) and moderate to severely calcified lesions.
BACKGROUND
Debulking the calcified atherosclerotic plaque with the orbital atherectomy system (OAS) can potentially enhance vessel compliance and increase the chance of reaching a desirable angioplasty result.
METHODS
A total of 7 patients were evaluated both at baseline and at 6-month follow-up. Following a diagnostic peripheral angiogram, patients with significant SFA disease had a baseline intravascular optical coherence tomography (IV-OCT) and the lesion was treated with OAS. Repeat IV-OCT was performed after atherectomy and after drug-coated balloon, if used. Patients were also evaluated with angiography and IV-OCT imaging at their 6-month follow-up.
RESULTS
The majority of tissue removed was fibrous tissue. During follow-up, luminal volume increased for 4 of the 7 patients from baseline to 6-month follow-up and decreased in 3 patients. On average there was a 6% increase of luminal volume (P<.01 compared with baseline). A recent virtual histology algorithm was used for automatic classification of IV-OCT images unaided by any reader. The algorithm used convolutional neural networks to identify regions as either calcium, fibrous, or lipid plaque, and it agreed with an expert reader 82% of the time.
CONCLUSION
To the best of our knowledge, the current report is the first to describe vascular effects of OAS in medial calcified lesions immediately after and at follow-up using IV-OCT in patients with severe PAD.
Topics: Atherectomy; Atherectomy, Coronary; Coronary Artery Disease; Humans; Peripheral Arterial Disease; Plaque, Atherosclerotic; Time Factors; Treatment Outcome; Vascular Calcification
PubMed: 35058375
DOI: No ID Found