Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We comp...Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We compared adults≥18 years old who underwent coronary atherectomy during inpatient PCI in 2016–2023 from the Vizient Clinical Data Base and compared outcomes in younger(<65 years),youngest-old(65–74 years),middle-old(75–84 years),and oldest-old(≥85 years)adults.Primary outcome was in-hospital mortality,and secondary outcomes included postprocedural complications.Results Among 47,337 patients who underwent coronary atherectomy,19,862(42.0%)were younger adults and 27,475(58.0%)were older adults,including 13,583 youngest-old,10,206 middle-old,and 3,686 oldest-old adults.Compared with younger adults,youngest-old adults had higher mortality(adjusted odds ratio[aOR]=1.37,P<0.001),ischemic stroke(aOR=1.35,P=0.005),gastrointestinal hemorrhage(GIH)(aOR=1.44,P<0.001),acute kidney injury(AKI)(aOR=1.43,P<0.001),tamponade(aOR=1.86,P<0.001),and pericardiocentesis(aOR=2.32,P<0.001).Middle-old adults had higher mortality(aOR=1.80,P<0.001),GIH(aOR=1.42,P=0.002),AKI(aOR=1.63,P<0.001),tamponade(aOR=2.52,P<0.001),and pericardiocentesis(aOR=3.13,P<0.001).Oldest-old adults had the highest odds for mortality(aOR=2.03,P<0.001),GIH(aOR=1.48,P=0.016),AKI(aOR=2.26,P<0.001),tamponade(aOR=3.86,P<0.001),and pericardiocentesis(aOR=4.21,P<0.001).There was a significant interaction(P-interaction=0.035)between atherectomy and age groups with regard to the odds of in-hospital mortality.Conclusions In this large claims-based study,in-hospital mortality,GIH,AKI,tamponade,and pericardiocentesis were higher in older adults compared with younger adults,in a stepwise manner by age group.展开更多
Objective:To evaluate the safety and effectiveness of rotational atherectomy followed by drug eluting stent(DES)implantation in patients with complex coronary lesions.Methods:From August 2006 to August 2012,253 consec...Objective:To evaluate the safety and effectiveness of rotational atherectomy followed by drug eluting stent(DES)implantation in patients with complex coronary lesions.Methods:From August 2006 to August 2012,253 consecutive patients with 289 lesions and who underwent rotational atherectomy in our center were enrolled in this study.Results:The overall procedure success rate was 98%with the cost of two(0.8%)coronary perforations,three(1.2%)dissections,five(2.0%)slow flows or no flows,three(1.2%)peri-procedure myocardial infarctions,and two(0.8%)in hospital deaths.During follow-up(mean three years),one(0.4%)patient died,two(0.8%)patients had acute myocardial infarction,14(5.5%)had restenosis,and target lesion revascularization occurred in eight patients(3.2%).Conclusions:Rotational atherectomy followed by DES implantation is a safe and effective technique for patients with complex coronary lesions,especially calcified and non-dilatable lesions.展开更多
Objective To evaluate the factors affecting optimal stentt expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy （RA） and a cutting balloon （CB）. Methods From January...Objective To evaluate the factors affecting optimal stentt expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy （RA） and a cutting balloon （CB）. Methods From January 2014 to May 2015, 92 patients with moderate to severe coronary calcified lesions underwent rotational atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital （Beijing, China） were included in this study, They were divided into a rotational artherectomy combined with cutting balloon （RACB） group （46 patients treated with RA followed by CB angioplasty） and an RA group （46 patients treated with RA followed by plain balloon angioplasty）. Another 40 patients with similar severity of their calcified lesions treated with plain old balloon angioplasty （POBA） were de- mographically matched to the other groups and defined as the POBA group. All patients received a drug-eluting stent after plaque prepara- tion. Lumen diameter and lumen diameter stenosis （LDS） were measured by quantitative coronary angiography at baseline, after RA, after dilatation, and after stenting. Optimal stent expansion was defined as the final LDS 〈 10%. Results The initial and post-RA LDS values were similar among the three groups. However, after dilatation, the LDS significantly decreased in the RACB group （from 54.5% ± 8.9% to 36.1%＋ 7.1%） but only moderately decreased （from 55.7% ± 7.8% to 46.9% ± 9.4%） in the RA group （time × group, P 〈 0.001）. After stenting, there was a higher rate of optimal stent expansion in the RACB group （71.7% in the RACB group, 54.5% in the RA group, and 15% in the POBA group, P 〈 0.001）, and the final LDS was significantly diminished in the RACB group compared to the other two groups （6.0% ± 2.3%, 10.8% ± 3.3%, 12.7% ± 2.1%, P 〈 0.001）. Moreover, an LDS 〈 40% after plaque preparation （OR = 2.994, 95% CI： 1.297-6.911） was associated with optimal stent expansion, which also had a positive correlation with the appearance of a calcified ring split （r = 0,581, P 〈 0.001）. Conclusions Aggressive plaque modification with RA and CB achieve more optimal stent expansion. An LDS ≤ 40% after plaque modification was a predictive factor for optimal stent expansion in calcified lesions. This parameter was also associated with the presence of calcified ring split.展开更多
Background Development of arterial dissection is thought to be an important key factor for bailout stenting in femoropopliteal disease. We aimed to evaluate the difference in dissection rate and outcomes between the t...Background Development of arterial dissection is thought to be an important key factor for bailout stenting in femoropopliteal disease. We aimed to evaluate the difference in dissection rate and outcomes between the treatment group with rotational atherectomy and with？out it. Methods From January 2011 to October 2016, we compared the angiography after balloon angioplasty （BA） of de-novo, femoropop？liteal, steno-occlusive lesions whether they were treated by rotational atherectomy prior to the BA or not. Fifty-nine lesions （8 occlusions; 3 involving popliteal segment; lesion length： 86.3 ± 66.8 mm） in 44 patients （29 males; mean age 66.9 ± 9.7 years） were enrolled for this review. Results Forty-two lesions were treated using rotational atherectomy, prior to BA while 17 were recanalized firstly by BA. Clinical and lesion characteristics were not different between the groups. However, the rate of significant arterial dissection （type C to F） was lower in the atherectomy group （88.2% vs. 42.9%; P = 0.001）. In multivariate analysis, use of the atherectomy device was the only risk factor for prevention of development of significant dissection （P = 0.013; OR = 0.12; 95% CI： 0.025？0.642）. Patients were treated either by the angioplasty alone, drug coated balloon or stent insertion. There was lower trend in target vessel revascularization and primary patency toward the atherectomy group （low rank P = 0.108 and 0.166）, however secondary patency was significantly better （low rank P = 0.001）. Conclusions Rotational atherec？tomy before BA reduced the rate of significant dissection and therefore, might be a valuable option for minimizing need of bailout stenting.展开更多
BACKGROUND:Stent under-expansion is a main cause of acute coronary syndrome(ACS),which can lead to serious clinical outcomes.The rotational atherectomy of underexpanded coronary stents(academically called stent ablati...BACKGROUND:Stent under-expansion is a main cause of acute coronary syndrome(ACS),which can lead to serious clinical outcomes.The rotational atherectomy of underexpanded coronary stents(academically called stent ablation,SA)by intravascular ultrasound(IVUS)may provide more visual reference in the intervention.We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique.METHODS:A total of 11 patients with ACS who underwent SA between April 2017 and January 2019 were analyzed.Clinical follow-ups were obtained either by telephone call or by scheduled visit.Clinical end-points included periprocedural and postprocedural myocardial infarction,stent thrombosis,target lesion revascularization,and major adverse cardiac events.RESULTS:The mean age of patients was 69.6±6.5 years,and five(45.5%)patients were males.All cases presented with unstable angina and were admitted with ACS.All patients required at least two burrs during the intervention and the size of the burr was selected based on the data of minimum lumen diameter(MLD),and the fi rst and the second burr/stent MLD ratios were 0.93(0.88-0.99)and 1.09(1.02-1.14),respectively.Nine patients were treated with drug-eluting stents and two were treated with drug-coated balloons.There were no complications including no fl ow,perforation,or burr entrapment during the intervention.No in-hospital deaths or major adverse cardiac events were documented during the follow-up period.In our study,less contrast agent and a lower dose of radiation were used during the intervention.CONCLUSIONS:SA guided by IVUS can reduce the risk of complications,assess the results of surgery,inform the selection of stent size,and decrease the required dose of radiation and contrast.展开更多
BACKGROUND Percutaneous coronary intervention can be challenging for ostial coronary artery lesions due to calcium burden and elastic fiber content.Excimer laser coronary atherectomy(ELCA)is a less common treatment fo...BACKGROUND Percutaneous coronary intervention can be challenging for ostial coronary artery lesions due to calcium burden and elastic fiber content.Excimer laser coronary atherectomy(ELCA)is a less common treatment for severe calcified coronary ostium lesions.CASE SUMMARY An 81-year-old male presented to the Cardiology Department of Qingdao Municipal Hospital with a 1-year history of chest pain.Coronary angiography showed severe calcific stenosis(approximately 90%)in the right coronary artery ostium.The right coronary artery ostium was unable to be advanced using a 2.5 mm×12.0 mm balloon(NC Sprinter,Medtronic,United States)or dilated using a 2.0 mm×12.0 mm balloon(Sprinter,Medtronic,United States).The patient underwent successful ELCA and balloon dilation of the calcified coronary ostium lesion.CONCLUSION ELCA appears to be a safe and effective treatment for the management of severe calcified coronary ostium lesions.展开更多
Background Rotational atherectomy （RA） could facilitate the percutaneous coronary intervention （PCI） in heavily coronary calcified patients. The effectiveness and safety of this technique needs to be further evalu...Background Rotational atherectomy （RA） could facilitate the percutaneous coronary intervention （PCI） in heavily coronary calcified patients. The effectiveness and safety of this technique needs to be further evaluated. Methods ＆ Results Eighty patients who underwent RA in our center from September 2011 to June 2014 were enrolled. The mean age was 72.4 ± 10.4 years. The left ventricular ejection frac- tion （LVEF） was average 52.3% ± 8.48% and the estimated glomerular filtration rate was 73.2 ± 3.20 mL/min per 1.73 m2. The coronary lesions were complex, with Syntax score 29.5 ± 9.86. The diameter of reference vessel was 3.4 ± 0.45 mm and the average diameter stenosis of target vessels was 80% ~ 10%. All the patients were deployed with drug eluting stents （DES） successfully aiter RA. The patients were followed up for 12-18 months. Kaplan-Meier plots estimated the survival rate was 93.4% and the cumulative incidence of major adverse cardiac and cerebral events （MACCE） was 25.4%. Bleeding and procedural-related complications were quite low. COX proportional hazards model for multivariate analysis demonstrated that diabetes, LVEF and maximum pressure of postdilatation were the predictors of MACCE. Conclusions RA followed by implantation of DES was effective and safe for heavily coronary calcified patients. Diabetes, LVEF and maximum pressure ofpostdilatation were predictive for MACCE.展开更多
A definitive, quantitative investigation has been performed to determine whether orbital atherectomy gives rise to cavitation. The investigation encompassed a synergistic interaction between in vitro experimentation a...A definitive, quantitative investigation has been performed to determine whether orbital atherectomy gives rise to cavitation. The investigation encompassed a synergistic interaction between in vitro experimentation and numerical simulation. The experimentation was performed in two independent fluid environments: 1) a transparent tube having a diameter similar to that of the superficial femoral artery and 2) a large, fluid-filled, open-topped container. All of the experimental and simulation work was based on the geometric model of the Diamondback 360 atherectomy device (Cardiovascular Systems, Inc., St. Paul, MN). Rotational speeds ranged from 80,000 to 214,000 rpm. The presence or absence of cavitation in the experiments was assessed by means of high-speed photography. The photographic images clearly display the fact that there was no cavitation. Flow visualization revealed the presence of fluid flows driven by pressure gradients created by the geometry of the rotating crown. The numerical simulations encompassed the fluid environments and the operating conditions of the experiments. The key result of the numerical simulation is that the minimum fluid pressure due to the rotational motion was approximately 50 times greater than the saturation vapor pressure of the fluid. Since the onset of cavitation requires that the fluid pressure falls below the saturation vapor pressure, the computational outcome strongly supports the experimental findings.展开更多
Heavily calcified coronary lesions continue to represent a challenge for percutaneous coronary intervention(PCI),as they are difficult to dilate,and it is difficult to deliver and implant drug-eluting stents(DES)prope...Heavily calcified coronary lesions continue to represent a challenge for percutaneous coronary intervention(PCI),as they are difficult to dilate,and it is difficult to deliver and implant drug-eluting stents(DES)properly.Poor stent deployment is associated with high rates of periprocedural complications and suboptimal long-term clinical outcomes.[1]Thanks to the introduction of several adjunctive PCI tools,like cutting and scoring balloons,and to the novel intravascular lithotripsy technology,the treatment of such lesions has become increasingly feasible,predictable and safe.展开更多
The aim of this prospective observational pilot study was to observe the impact of orbital atherectomy (OA) on the coronary microcirculation via coronary flow reserve (CFR) measurements. Fifteen subjects who had succe...The aim of this prospective observational pilot study was to observe the impact of orbital atherectomy (OA) on the coronary microcirculation via coronary flow reserve (CFR) measurements. Fifteen subjects who had successful OA and stent placement with no procedural complication were enrolled at 3 hospitals in the U.S. Baseline and hyperemic velocities were 16 ± 5.2 and 36 ± 14 cm/sec, respectively. The average CFR post-procedure was within the normal range at 2.23 ± 0.33. The observation of normal CFR following OA may be attributed to the orbital action of the device that allows for continuous flow during treatment, minimizing a bolus embolization effect which can impact microvascular function.展开更多
Objective:Stenting for coronary artery disease is generally accepted as a percutaneous coronary intervention(PCI),but there remain many challenges with this approach.Directional coronary atherectomy(DCA)can reduce pla...Objective:Stenting for coronary artery disease is generally accepted as a percutaneous coronary intervention(PCI),but there remain many challenges with this approach.Directional coronary atherectomy(DCA)can reduce plaque volume,and its use alone or in combination with drug-coated balloons can reduce stent implantation.However,clinical studies on DCA are limited,and its safety and effectiveness remain unclear.We aimed to evaluate the safety and effectiveness of the new DCA device-ATHEROCUT with intravascular ultrasound(IVUS)guidance.Methods:Between May 2015 and May 2018,45 patients with 48 lesions were treated electively with ATHEROCUT in Kusatsu Heart Center.We retrospectively analyzed in-hospital major adverse cardiac events(MACE),overall clinical follow-up MACE,complications rate,and dual antiplatelet therapy(DAPT)duration.Our definition of MACE included cardiac death,myocardial infarction,and target lesion revascularization(TLR).Our definition of complications included coronary perforation,thrombosis,and major bleeding.Results:The overall follow-up rate was 95.6%,and the average follow-up period was 453±320 days.In-hospital and overall MACE rates were 2.2%(TLR 0)and 11.1%(TLR 8.9%),respectively.There were no complications,except for one cerebral hemorrhage case(2.1%),which was considered irrelevant to the PCI procedure.The DAPT duration was 8.3±8.3 months,only 4.8±4.9 months in the subgroup that did not require another PCI.Conclusion:Using the ATHEROCUT device with IVUS guidance is safe,might be effective in selected patients and can shorten the DAPT period.展开更多
Objective:This study compared the long-term outcomes between rotational atherectomy(RA)for specific indications and on-label use of RA for severely calcified coronary lesions.Methods:Data for patients who underwent RA...Objective:This study compared the long-term outcomes between rotational atherectomy(RA)for specific indications and on-label use of RA for severely calcified coronary lesions.Methods:Data for patients who underwent RA between 2015 and 2020 in a single-center registry were analyzed.The specific indication group included patients with ostial lesions,unprotected left main coronary artery stenosis,chronic total occlusions,stent ablation,angulated lesions,and cardiac dysfunction,whereas patients with none of the above-mentioned characteristics were included in the on-label group.The primary endpoint was compared between groups.Results:A total of 176 patients in the on-label group and 125 patients in the specific indication group were included.Patient clinical characteristics were comparable between groups.The incidence of complications during the procedure was higher in the specific indication group than in the on-label group(20.0%vs.10.8%,P=0.018).No significant dif-ference was observed in in-hospital MACCE between groups(12.5%vs 9.7%,P=0.392).During 35(10–57)months of follow-up,MACCE occurred in 46 patients(15.3%).The incidence of MACCE was much higher in the specific indication group than the on-label group(25.6%vs 13.6%,P=0.034).Conclusions:RA for specific indications,compared with on-label use,had a higher incidence of complications dur-ing the procedure and poorer long-term clinical outcomes.展开更多
Background： Coronary calcification is a major determinant ofstent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy （RA） followed...Background： Coronary calcification is a major determinant ofstent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy （RA） followed by cutting balloon （CB） versus plain balloon before drug-eluting stent implantation for calcified coronary lesions. Methods： From June April 2013 to March 2016, a total of 127 patients with moderately or severely calcified coronary lesions were treated with RA. Patients were divided into two groups according to the balloon type after RA： RA＋CB group （n = 75） and RA＋plain balloon group （n = 52）. Minimal lumen diameter and acute lumen gain were analyzed by quantitative coronary angiography. In-hospital and long-term （〉1 year） outcomes were recorded. Multivariate Cox regression analysis was performed to determine the independent predictors of in-stent restenosis.Results： The mean age of the patients was 65.5 years, and 76.4% were men. Total lesion length and minimal lumen diameter at baseline were similar in the two groups. After RA and balloon dilation, the lumen diameter was significantly larger in the RA＋CB group than in the RA＋plain balloon group （1.57 ±0.46 mm vs. 1.10 ± 0.40 mm, t = 4.123, P 〈 0.001）. The final lumen diameter was also larger in the RA＋CB group compared to that in the RA group （2.81± 0.41 mm vs. 2.60± 0.25 ram, t = 2.111, P = 0.039）. Moreover, patients receiving RA and CB tended to have larger final lumen gain （2.15 - 0.48 mm vs. 1.95 ± 0.47 mm, t = 1.542, P = 0.132）. Multivariate Cox regression analysis indicated that the strategy of RA＋CB was a significant protective factor against long-term （〉1 year） in-stent restenosis （hazard ratio： 0.136, 95% confidence interval： 0.020-0.936, P = 0.043）. Conclusions： In patients with moderately or severely calcified lesions, a strategy of RA followed by CB before stent implantation can increase lumen diameter and acute lumen gain. This strategy is safe with lower risk of long-term in-stent restenosis.展开更多
Transradial coronary stenting using 5-French （5F） guiding catheters has been associated with a higher procedural success rate, a lower frequency of vascular access complications and is well tolerated, particularly i...Transradial coronary stenting using 5-French （5F） guiding catheters has been associated with a higher procedural success rate, a lower frequency of vascular access complications and is well tolerated, particularly in the subgroup of patients with small radial artery diameters.展开更多
Objective To compare the efficacy of direct and pre-dilated atherectomy(RA)for treating the patients with calcified coronary lesions.Methods A total of 137coronary artery disease(CAD)patients receiving RA treatment in...Objective To compare the efficacy of direct and pre-dilated atherectomy(RA)for treating the patients with calcified coronary lesions.Methods A total of 137coronary artery disease(CAD)patients receiving RA treatment in our hospital from 2010-04 to 2014-09were retrospectively studied.The ischemic related展开更多
BACKGROUND High-speed rotational atherectomy (HSRA) is most commonly used to modify calcified coronary artery lesions to facilitate stent deployment and expansion. The use of HSRA as an emergency rescue technique to r...BACKGROUND High-speed rotational atherectomy (HSRA) is most commonly used to modify calcified coronary artery lesions to facilitate stent deployment and expansion. The use of HSRA as an emergency rescue technique to release a fractured microcatheter has not been described. We report the use of HSRA in a case of a fracture trapped corsair tip that was impeding coronary flow causing a ST elevation myocardial infarct. CASE SUMMARY A 79 years old male was scheduled for elective percutaneous coronary intervention (PCI) to his left anterior descending artery (LAD). Given its calcific nature, a decision was made for upfront rotablation. During procedural preparations, the tip of an employed micro-catheter was separated from the shaft resulting in obstructing coronary flow and ST-segment elevation. The consensus was for an attempt bail out PCI strategy. A rotafloppy wire was advanced to the distal LAD using a corsair micro-catheter which was placed proximal to the occlusion site. Modification of the mid LAD segment was performed, resulting in mobilising the corsair tip, and deflecting it to a small diagonal branch. Following serial predilation, the procedure was completed using two overlapping drug eluting stents, jailing the corsair tip in the diagonal branch. The patient made uneventful recovery and was clinically stable at one year follow up. CONCLUSION HSRA may be offered as a bailed-out strategy to rescue fractured and jailed micro-catheter tip in high risk surgical cases.展开更多
Rotational atherectomy is an effective treatment for severe vascular calcification obstruction,and relies on high-speed grinding(typically 130,000–210,000 r/min)with miniature grinding tools to remove calcified tissu...Rotational atherectomy is an effective treatment for severe vascular calcification obstruction,and relies on high-speed grinding(typically 130,000–210,000 r/min)with miniature grinding tools to remove calcified tissue and restore blood flow.However,reports of intraoperative complications are common because of the grinding force,temperature,and debris directly acting on the body during the grinding process,which can easily cause damage to patients.In this study,three novel grinding tools were designed and fabricated and a series of experiments have been conducted to analyze the effects of tool geometry and parameters on grinding performance,that is,force,temperature,and specimen surface morphology.The results show that these tools can effectively remove simulated calcified tissue and that they have two motions,rotation and revolution,in the tube.At higher rotational speeds,grinding force and temperature increase noticeably,while the amount of debris decreases significantly.In addition,by observing the surface morphology of the specimens,we concluded that the material removal rate per unit time is influenced by both rotational speed and tool geometry,and that high rotational speed and a rough tool surface can improve the material removal rate efficiently.展开更多
文摘Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We compared adults≥18 years old who underwent coronary atherectomy during inpatient PCI in 2016–2023 from the Vizient Clinical Data Base and compared outcomes in younger(<65 years),youngest-old(65–74 years),middle-old(75–84 years),and oldest-old(≥85 years)adults.Primary outcome was in-hospital mortality,and secondary outcomes included postprocedural complications.Results Among 47,337 patients who underwent coronary atherectomy,19,862(42.0%)were younger adults and 27,475(58.0%)were older adults,including 13,583 youngest-old,10,206 middle-old,and 3,686 oldest-old adults.Compared with younger adults,youngest-old adults had higher mortality(adjusted odds ratio[aOR]=1.37,P<0.001),ischemic stroke(aOR=1.35,P=0.005),gastrointestinal hemorrhage(GIH)(aOR=1.44,P<0.001),acute kidney injury(AKI)(aOR=1.43,P<0.001),tamponade(aOR=1.86,P<0.001),and pericardiocentesis(aOR=2.32,P<0.001).Middle-old adults had higher mortality(aOR=1.80,P<0.001),GIH(aOR=1.42,P=0.002),AKI(aOR=1.63,P<0.001),tamponade(aOR=2.52,P<0.001),and pericardiocentesis(aOR=3.13,P<0.001).Oldest-old adults had the highest odds for mortality(aOR=2.03,P<0.001),GIH(aOR=1.48,P=0.016),AKI(aOR=2.26,P<0.001),tamponade(aOR=3.86,P<0.001),and pericardiocentesis(aOR=4.21,P<0.001).There was a significant interaction(P-interaction=0.035)between atherectomy and age groups with regard to the odds of in-hospital mortality.Conclusions In this large claims-based study,in-hospital mortality,GIH,AKI,tamponade,and pericardiocentesis were higher in older adults compared with younger adults,in a stepwise manner by age group.
基金Project(Nos.2009C33123 and 2007C13058)supported by the Science and Technology Project of Zhejiang Province,China
文摘Objective:To evaluate the safety and effectiveness of rotational atherectomy followed by drug eluting stent(DES)implantation in patients with complex coronary lesions.Methods:From August 2006 to August 2012,253 consecutive patients with 289 lesions and who underwent rotational atherectomy in our center were enrolled in this study.Results:The overall procedure success rate was 98%with the cost of two(0.8%)coronary perforations,three(1.2%)dissections,five(2.0%)slow flows or no flows,three(1.2%)peri-procedure myocardial infarctions,and two(0.8%)in hospital deaths.During follow-up(mean three years),one(0.4%)patient died,two(0.8%)patients had acute myocardial infarction,14(5.5%)had restenosis,and target lesion revascularization occurred in eight patients(3.2%).Conclusions:Rotational atherectomy followed by DES implantation is a safe and effective technique for patients with complex coronary lesions,especially calcified and non-dilatable lesions.
文摘Objective To evaluate the factors affecting optimal stentt expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy （RA） and a cutting balloon （CB）. Methods From January 2014 to May 2015, 92 patients with moderate to severe coronary calcified lesions underwent rotational atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital （Beijing, China） were included in this study, They were divided into a rotational artherectomy combined with cutting balloon （RACB） group （46 patients treated with RA followed by CB angioplasty） and an RA group （46 patients treated with RA followed by plain balloon angioplasty）. Another 40 patients with similar severity of their calcified lesions treated with plain old balloon angioplasty （POBA） were de- mographically matched to the other groups and defined as the POBA group. All patients received a drug-eluting stent after plaque prepara- tion. Lumen diameter and lumen diameter stenosis （LDS） were measured by quantitative coronary angiography at baseline, after RA, after dilatation, and after stenting. Optimal stent expansion was defined as the final LDS 〈 10%. Results The initial and post-RA LDS values were similar among the three groups. However, after dilatation, the LDS significantly decreased in the RACB group （from 54.5% ± 8.9% to 36.1%＋ 7.1%） but only moderately decreased （from 55.7% ± 7.8% to 46.9% ± 9.4%） in the RA group （time × group, P 〈 0.001）. After stenting, there was a higher rate of optimal stent expansion in the RACB group （71.7% in the RACB group, 54.5% in the RA group, and 15% in the POBA group, P 〈 0.001）, and the final LDS was significantly diminished in the RACB group compared to the other two groups （6.0% ± 2.3%, 10.8% ± 3.3%, 12.7% ± 2.1%, P 〈 0.001）. Moreover, an LDS 〈 40% after plaque preparation （OR = 2.994, 95% CI： 1.297-6.911） was associated with optimal stent expansion, which also had a positive correlation with the appearance of a calcified ring split （r = 0,581, P 〈 0.001）. Conclusions Aggressive plaque modification with RA and CB achieve more optimal stent expansion. An LDS ≤ 40% after plaque modification was a predictive factor for optimal stent expansion in calcified lesions. This parameter was also associated with the presence of calcified ring split.
文摘Background Development of arterial dissection is thought to be an important key factor for bailout stenting in femoropopliteal disease. We aimed to evaluate the difference in dissection rate and outcomes between the treatment group with rotational atherectomy and with？out it. Methods From January 2011 to October 2016, we compared the angiography after balloon angioplasty （BA） of de-novo, femoropop？liteal, steno-occlusive lesions whether they were treated by rotational atherectomy prior to the BA or not. Fifty-nine lesions （8 occlusions; 3 involving popliteal segment; lesion length： 86.3 ± 66.8 mm） in 44 patients （29 males; mean age 66.9 ± 9.7 years） were enrolled for this review. Results Forty-two lesions were treated using rotational atherectomy, prior to BA while 17 were recanalized firstly by BA. Clinical and lesion characteristics were not different between the groups. However, the rate of significant arterial dissection （type C to F） was lower in the atherectomy group （88.2% vs. 42.9%; P = 0.001）. In multivariate analysis, use of the atherectomy device was the only risk factor for prevention of development of significant dissection （P = 0.013; OR = 0.12; 95% CI： 0.025？0.642）. Patients were treated either by the angioplasty alone, drug coated balloon or stent insertion. There was lower trend in target vessel revascularization and primary patency toward the atherectomy group （low rank P = 0.108 and 0.166）, however secondary patency was significantly better （low rank P = 0.001）. Conclusions Rotational atherec？tomy before BA reduced the rate of significant dissection and therefore, might be a valuable option for minimizing need of bailout stenting.
基金the Chongqing Health Commission(2016ZDXM024)the Zhejiang Provincial Public Welfare Technology Research Project(LGF20H020012)the Scientifi c Research Project of the Department of Education in Zhejiang(Y21330290).
文摘BACKGROUND:Stent under-expansion is a main cause of acute coronary syndrome(ACS),which can lead to serious clinical outcomes.The rotational atherectomy of underexpanded coronary stents(academically called stent ablation,SA)by intravascular ultrasound(IVUS)may provide more visual reference in the intervention.We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique.METHODS:A total of 11 patients with ACS who underwent SA between April 2017 and January 2019 were analyzed.Clinical follow-ups were obtained either by telephone call or by scheduled visit.Clinical end-points included periprocedural and postprocedural myocardial infarction,stent thrombosis,target lesion revascularization,and major adverse cardiac events.RESULTS:The mean age of patients was 69.6±6.5 years,and five(45.5%)patients were males.All cases presented with unstable angina and were admitted with ACS.All patients required at least two burrs during the intervention and the size of the burr was selected based on the data of minimum lumen diameter(MLD),and the fi rst and the second burr/stent MLD ratios were 0.93(0.88-0.99)and 1.09(1.02-1.14),respectively.Nine patients were treated with drug-eluting stents and two were treated with drug-coated balloons.There were no complications including no fl ow,perforation,or burr entrapment during the intervention.No in-hospital deaths or major adverse cardiac events were documented during the follow-up period.In our study,less contrast agent and a lower dose of radiation were used during the intervention.CONCLUSIONS:SA guided by IVUS can reduce the risk of complications,assess the results of surgery,inform the selection of stent size,and decrease the required dose of radiation and contrast.
文摘BACKGROUND Percutaneous coronary intervention can be challenging for ostial coronary artery lesions due to calcium burden and elastic fiber content.Excimer laser coronary atherectomy(ELCA)is a less common treatment for severe calcified coronary ostium lesions.CASE SUMMARY An 81-year-old male presented to the Cardiology Department of Qingdao Municipal Hospital with a 1-year history of chest pain.Coronary angiography showed severe calcific stenosis(approximately 90%)in the right coronary artery ostium.The right coronary artery ostium was unable to be advanced using a 2.5 mm×12.0 mm balloon(NC Sprinter,Medtronic,United States)or dilated using a 2.0 mm×12.0 mm balloon(Sprinter,Medtronic,United States).The patient underwent successful ELCA and balloon dilation of the calcified coronary ostium lesion.CONCLUSION ELCA appears to be a safe and effective treatment for the management of severe calcified coronary ostium lesions.
文摘Background Rotational atherectomy （RA） could facilitate the percutaneous coronary intervention （PCI） in heavily coronary calcified patients. The effectiveness and safety of this technique needs to be further evaluated. Methods ＆ Results Eighty patients who underwent RA in our center from September 2011 to June 2014 were enrolled. The mean age was 72.4 ± 10.4 years. The left ventricular ejection frac- tion （LVEF） was average 52.3% ± 8.48% and the estimated glomerular filtration rate was 73.2 ± 3.20 mL/min per 1.73 m2. The coronary lesions were complex, with Syntax score 29.5 ± 9.86. The diameter of reference vessel was 3.4 ± 0.45 mm and the average diameter stenosis of target vessels was 80% ~ 10%. All the patients were deployed with drug eluting stents （DES） successfully aiter RA. The patients were followed up for 12-18 months. Kaplan-Meier plots estimated the survival rate was 93.4% and the cumulative incidence of major adverse cardiac and cerebral events （MACCE） was 25.4%. Bleeding and procedural-related complications were quite low. COX proportional hazards model for multivariate analysis demonstrated that diabetes, LVEF and maximum pressure of postdilatation were the predictors of MACCE. Conclusions RA followed by implantation of DES was effective and safe for heavily coronary calcified patients. Diabetes, LVEF and maximum pressure ofpostdilatation were predictive for MACCE.
文摘A definitive, quantitative investigation has been performed to determine whether orbital atherectomy gives rise to cavitation. The investigation encompassed a synergistic interaction between in vitro experimentation and numerical simulation. The experimentation was performed in two independent fluid environments: 1) a transparent tube having a diameter similar to that of the superficial femoral artery and 2) a large, fluid-filled, open-topped container. All of the experimental and simulation work was based on the geometric model of the Diamondback 360 atherectomy device (Cardiovascular Systems, Inc., St. Paul, MN). Rotational speeds ranged from 80,000 to 214,000 rpm. The presence or absence of cavitation in the experiments was assessed by means of high-speed photography. The photographic images clearly display the fact that there was no cavitation. Flow visualization revealed the presence of fluid flows driven by pressure gradients created by the geometry of the rotating crown. The numerical simulations encompassed the fluid environments and the operating conditions of the experiments. The key result of the numerical simulation is that the minimum fluid pressure due to the rotational motion was approximately 50 times greater than the saturation vapor pressure of the fluid. Since the onset of cavitation requires that the fluid pressure falls below the saturation vapor pressure, the computational outcome strongly supports the experimental findings.
文摘Heavily calcified coronary lesions continue to represent a challenge for percutaneous coronary intervention(PCI),as they are difficult to dilate,and it is difficult to deliver and implant drug-eluting stents(DES)properly.Poor stent deployment is associated with high rates of periprocedural complications and suboptimal long-term clinical outcomes.[1]Thanks to the introduction of several adjunctive PCI tools,like cutting and scoring balloons,and to the novel intravascular lithotripsy technology,the treatment of such lesions has become increasingly feasible,predictable and safe.
文摘The aim of this prospective observational pilot study was to observe the impact of orbital atherectomy (OA) on the coronary microcirculation via coronary flow reserve (CFR) measurements. Fifteen subjects who had successful OA and stent placement with no procedural complication were enrolled at 3 hospitals in the U.S. Baseline and hyperemic velocities were 16 ± 5.2 and 36 ± 14 cm/sec, respectively. The average CFR post-procedure was within the normal range at 2.23 ± 0.33. The observation of normal CFR following OA may be attributed to the orbital action of the device that allows for continuous flow during treatment, minimizing a bolus embolization effect which can impact microvascular function.
文摘Objective:Stenting for coronary artery disease is generally accepted as a percutaneous coronary intervention(PCI),but there remain many challenges with this approach.Directional coronary atherectomy(DCA)can reduce plaque volume,and its use alone or in combination with drug-coated balloons can reduce stent implantation.However,clinical studies on DCA are limited,and its safety and effectiveness remain unclear.We aimed to evaluate the safety and effectiveness of the new DCA device-ATHEROCUT with intravascular ultrasound(IVUS)guidance.Methods:Between May 2015 and May 2018,45 patients with 48 lesions were treated electively with ATHEROCUT in Kusatsu Heart Center.We retrospectively analyzed in-hospital major adverse cardiac events(MACE),overall clinical follow-up MACE,complications rate,and dual antiplatelet therapy(DAPT)duration.Our definition of MACE included cardiac death,myocardial infarction,and target lesion revascularization(TLR).Our definition of complications included coronary perforation,thrombosis,and major bleeding.Results:The overall follow-up rate was 95.6%,and the average follow-up period was 453±320 days.In-hospital and overall MACE rates were 2.2%(TLR 0)and 11.1%(TLR 8.9%),respectively.There were no complications,except for one cerebral hemorrhage case(2.1%),which was considered irrelevant to the PCI procedure.The DAPT duration was 8.3±8.3 months,only 4.8±4.9 months in the subgroup that did not require another PCI.Conclusion:Using the ATHEROCUT device with IVUS guidance is safe,might be effective in selected patients and can shorten the DAPT period.
基金This study was supported by the National Natural Science Foundation of China(grant No.81800316).
文摘Objective:This study compared the long-term outcomes between rotational atherectomy(RA)for specific indications and on-label use of RA for severely calcified coronary lesions.Methods:Data for patients who underwent RA between 2015 and 2020 in a single-center registry were analyzed.The specific indication group included patients with ostial lesions,unprotected left main coronary artery stenosis,chronic total occlusions,stent ablation,angulated lesions,and cardiac dysfunction,whereas patients with none of the above-mentioned characteristics were included in the on-label group.The primary endpoint was compared between groups.Results:A total of 176 patients in the on-label group and 125 patients in the specific indication group were included.Patient clinical characteristics were comparable between groups.The incidence of complications during the procedure was higher in the specific indication group than in the on-label group(20.0%vs.10.8%,P=0.018).No significant dif-ference was observed in in-hospital MACCE between groups(12.5%vs 9.7%,P=0.392).During 35(10–57)months of follow-up,MACCE occurred in 46 patients(15.3%).The incidence of MACCE was much higher in the specific indication group than the on-label group(25.6%vs 13.6%,P=0.034).Conclusions:RA for specific indications,compared with on-label use,had a higher incidence of complications dur-ing the procedure and poorer long-term clinical outcomes.
基金This study was supported by grants from National Natural Science Foundation of China （No. 81670222 and No. 81600209）, Beijing Municipal Science and Technology Commission （No. Z181100001718060）, Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support （No. ZYEX201710）, Beijing Municipal Administration of Hospitals＇ Youth Program （No. QML20160605）, Beijing Municipal Administration of Hospitals Incubating Program （No. PX2016048）, and Beijing Municipal Organization Department （No. 2016000021469G194）.
文摘Background： Coronary calcification is a major determinant ofstent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy （RA） followed by cutting balloon （CB） versus plain balloon before drug-eluting stent implantation for calcified coronary lesions. Methods： From June April 2013 to March 2016, a total of 127 patients with moderately or severely calcified coronary lesions were treated with RA. Patients were divided into two groups according to the balloon type after RA： RA＋CB group （n = 75） and RA＋plain balloon group （n = 52）. Minimal lumen diameter and acute lumen gain were analyzed by quantitative coronary angiography. In-hospital and long-term （〉1 year） outcomes were recorded. Multivariate Cox regression analysis was performed to determine the independent predictors of in-stent restenosis.Results： The mean age of the patients was 65.5 years, and 76.4% were men. Total lesion length and minimal lumen diameter at baseline were similar in the two groups. After RA and balloon dilation, the lumen diameter was significantly larger in the RA＋CB group than in the RA＋plain balloon group （1.57 ±0.46 mm vs. 1.10 ± 0.40 mm, t = 4.123, P 〈 0.001）. The final lumen diameter was also larger in the RA＋CB group compared to that in the RA group （2.81± 0.41 mm vs. 2.60± 0.25 ram, t = 2.111, P = 0.039）. Moreover, patients receiving RA and CB tended to have larger final lumen gain （2.15 - 0.48 mm vs. 1.95 ± 0.47 mm, t = 1.542, P = 0.132）. Multivariate Cox regression analysis indicated that the strategy of RA＋CB was a significant protective factor against long-term （〉1 year） in-stent restenosis （hazard ratio： 0.136, 95% confidence interval： 0.020-0.936, P = 0.043）. Conclusions： In patients with moderately or severely calcified lesions, a strategy of RA followed by CB before stent implantation can increase lumen diameter and acute lumen gain. This strategy is safe with lower risk of long-term in-stent restenosis.
文摘Transradial coronary stenting using 5-French （5F） guiding catheters has been associated with a higher procedural success rate, a lower frequency of vascular access complications and is well tolerated, particularly in the subgroup of patients with small radial artery diameters.
文摘Objective To compare the efficacy of direct and pre-dilated atherectomy(RA)for treating the patients with calcified coronary lesions.Methods A total of 137coronary artery disease(CAD)patients receiving RA treatment in our hospital from 2010-04 to 2014-09were retrospectively studied.The ischemic related
文摘BACKGROUND High-speed rotational atherectomy (HSRA) is most commonly used to modify calcified coronary artery lesions to facilitate stent deployment and expansion. The use of HSRA as an emergency rescue technique to release a fractured microcatheter has not been described. We report the use of HSRA in a case of a fracture trapped corsair tip that was impeding coronary flow causing a ST elevation myocardial infarct. CASE SUMMARY A 79 years old male was scheduled for elective percutaneous coronary intervention (PCI) to his left anterior descending artery (LAD). Given its calcific nature, a decision was made for upfront rotablation. During procedural preparations, the tip of an employed micro-catheter was separated from the shaft resulting in obstructing coronary flow and ST-segment elevation. The consensus was for an attempt bail out PCI strategy. A rotafloppy wire was advanced to the distal LAD using a corsair micro-catheter which was placed proximal to the occlusion site. Modification of the mid LAD segment was performed, resulting in mobilising the corsair tip, and deflecting it to a small diagonal branch. Following serial predilation, the procedure was completed using two overlapping drug eluting stents, jailing the corsair tip in the diagonal branch. The patient made uneventful recovery and was clinically stable at one year follow up. CONCLUSION HSRA may be offered as a bailed-out strategy to rescue fractured and jailed micro-catheter tip in high risk surgical cases.
基金supported by the National Natural Science Foundation of China(No.52205455)the Natural and Science Foundation of Fujian Province(No.2021J01560)+1 种基金the Education and Scientific Research Foundation for Young Teachers in Fujian Province(No.JAT190006)the Foreign Cooperation Project from Natural Science Foundation of Fujian Province of China(No.2020I0028).
文摘Rotational atherectomy is an effective treatment for severe vascular calcification obstruction,and relies on high-speed grinding(typically 130,000–210,000 r/min)with miniature grinding tools to remove calcified tissue and restore blood flow.However,reports of intraoperative complications are common because of the grinding force,temperature,and debris directly acting on the body during the grinding process,which can easily cause damage to patients.In this study,three novel grinding tools were designed and fabricated and a series of experiments have been conducted to analyze the effects of tool geometry and parameters on grinding performance,that is,force,temperature,and specimen surface morphology.The results show that these tools can effectively remove simulated calcified tissue and that they have two motions,rotation and revolution,in the tube.At higher rotational speeds,grinding force and temperature increase noticeably,while the amount of debris decreases significantly.In addition,by observing the surface morphology of the specimens,we concluded that the material removal rate per unit time is influenced by both rotational speed and tool geometry,and that high rotational speed and a rough tool surface can improve the material removal rate efficiently.
