Acute directional coronary atherectomy prior to stenting in complex coronary lesions: ADAPTS study

Kiesz, R. Stefan; Rozek, Marius M.; Mego, David M.; Patel, Vipool; Ebersole, Douglas G.; Chilton, Robert

doi:10.1002/(sici)1097-0304(199810)45:2<105::aid-ccd1>3.0.co;2-g

Cited by 16 publications

(7 citation statements)

References 52 publications

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“…If this concept is true and hyperplasia is exacerbated by the first technique and reduced by the second technique, a reduction of restenosis rate should be expected when DCA precedes stent implantation. Studies conducted by our group [36][37][38], confirmed by smallerscale observations [39][40][41], have shown that debulking with DCA prior to stenting or aggressive rotablator reduces the restenosis rate in comparison with matched lesions treated with stenting alone (Fig. 3).…”

supporting

confidence: 53%

?Doctor, where did the plaque go??

Mario

Corvaja

Moussa

et al. 1999

Cathet. Cardiovasc. Intervent.

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supporting

confidence: 53%

?Doctor, where did the plaque go??

Mario

Corvaja

Moussa

et al. 1999

Cathet. Cardiovasc. Intervent.

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“…The ADAPTAS study, which used a non-randomized design, showed the efficacy of plaque volume reduction with directional atherectomy prior to stent placement in complex lesions such as CTO, ostial disease or long lesions. 5 Moreover, the preprocedural plaque volume of the target lesion positively correlates with restenosis in the settings of stent placement, 6 even in those cases of intracoronary radiation therapy after balloon angioplasty. 7 Based on these reports, our strategy for reducing plaque burden as much as possible with directional atherectomy and not implanting long stents was thought acceptable.…”

Section: Discussionmentioning

confidence: 99%

Distal Shower Embolization During Directional Coronary Atherectomy and Stenting for Diffuse Stenosis of Right Coronary Artery-Current Limitations of Intravascular Ultrasonography for Evaluating Fragile Plaque-

Sakai

Urasawa

Oyama

et al. 2004

Circ J

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A 74 year-old male with old anterior and inferior myocardial infarctions was treated with staged percutaneous coronary intervention. A chronic total occlusion of the middle segment of the left anterior descending branch was successfully stented during the first stage, and during the second stage, preprocedural intravascular ultrasonography (IVUS) revealed that the proximal segment of the right coronary artery was diffusely stenosed by mixed plaque. Directional coronary atherectomy under IVUS guidance was performed, but coronary slow flow appeared during the procedure. After successfully bailing out with intracoronary nicorandil, percutaneous thrombectomy and manual blood pumping, 2 coronary stents were implanted to fully cover the lesion. Quite contrary to expectation, the no-reflow phenomenon appeared just after post-dilatation and a repeat of the same maneuver could not completely recover coronary flow. Plaque fragility could not be predicted from the IVUS examination.

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“…These results have raised the question of whether debulking the lesion prior to stenting might actually modify the restenosis process by reducing intimal proliferation. Recent IVUS studies have supported this hypothesis by showing that residual plaque burden at the lesion site following stenting is predictive of late in‐stent intimal proliferation and restenosis [81, 82]. The investigators in the study by Prati et al [83] performed careful IVUS at baseline and at 6 months in 50 patients undergoing coronary stent implantation in native coronary arteries.…”

Section: Directional Coronary Atherectomymentioning

confidence: 99%

Rotational and directional coronary atherectomy

Bersin¹,

Simonton²

2003

Cathet Cardio Intervent

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Rotational atherectomy was developed as a secondgeneration vascular interventional device specifically to address lesions known to be difficult to manage with balloon angioplasty. Commercialized as the Rotablator, this device utilizes a high-speed rotating elliptical burr coated with a fine diamond abrasive to achieve plaque ablation [1]. The very fine diamond abrasive and flexible drive shaft were incorporated into the design to allow normal soft elastic components of the vessel wall to deflect away from the device so that tissue ablation occurs preferentially against the relatively hard and inelastic components of atheromatous plaque [2][3][4][5][6]. This unique property of differential plaque ablation makes the rotational atherectomy ideally suited for treatment of lesions that are unfavorable for balloon angioplasty, especially calcified lesions, bifurcation lesions, ostial stenoses, chronic total occlusions, and diffuse disease [7][8][9][10][11][12][13][14]. Since its introduction in 1990, the Rotablator has undergone a number of design modifications and changes in recommended technique. The device has been used for both lesion modification and plaque debulking on virtually all types of lesions. Its role in the stent era has also been evaluated. The present article summarizes what we have learned over the past decade about the use of the device to treat obstructive atherosclerosis in the coronary circulation. Patient SelectionAlthough much emphasis is placed on lesion selection in the application of rotational atherectomy, patient selection and clinical characteristics require special emphasis. The diamond abrasive of the Rotablator ablates atheromatous plaque into microparticles, which are not retrieved but rather washed out through the distal coronary circulation. Most ablated microparticles are Յ 10 m in diameter, but larger particles are also produced, which can obstruct microcirculation and cause ischemic complications or patchy microinfarctions [4,15]. Highspeed rotation of the burr also produces microcavitations as a result of the Bernoulli effect. The microcavitations are in a size range of 60 -90 m, which can also temporarily obstruct the microcirculation for 20 -30 sec [16]. Microparticulate embolization and microcavitation contribute to the slow flow and no-reflow, which occurs more frequently with this device than with others [16 -19]. Transient ischemic complications thus may be more frequent than with other devices, even though the incidence of non-Q-wave and Q-wave myocardial infarction are not necessarily increased [20]. Patients with compromised ventricular function, poor distal run-off, multivessel disease with contralateral coronary occlusions, and large plaque burdens (lesion lengths Ն 25 mm) are at greater risk for ischemic complications [21]. Use of this device in these settings, and in the last remaining conduit and with severely compromised LV function, is discouraged unless appropriate measures are taken to protect the patient from ischemic complications, including placement of an in...

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Acute directional coronary atherectomy prior to stenting in complex coronary lesions: ADAPTS study

Cited by 16 publications

References 52 publications

?Doctor, where did the plaque go??

?Doctor, where did the plaque go??

Distal Shower Embolization During Directional Coronary Atherectomy and Stenting for Diffuse Stenosis of Right Coronary Artery-Current Limitations of Intravascular Ultrasonography for Evaluating Fragile Plaque-

Rotational and directional coronary atherectomy

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