Beneficial effect of rotational atherectomy with low platform speed on late outcomes

Uetani, Tadayuki; Ishii, Hideki; Sakai, Shin-ichi; Watanabe, Junji; Kanashiro, Masaaki; Ichimiya, Shingo; Murohara, Toyoaki

doi:10.1016/j.ijcard.2003.03.014

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…Revascularization procedures (angioplasty/atherectomy, stenting and bypass grafting) are effective in restoring vascular patency and carry low periprocedural complication rates; however, their therapeutic efficacy is limited by restenosis, the first-year incidence of which varies from 17–51% after bare-metal stent deployment [1,2,3] to 30–58% after angioplasty/atherectomy [4, 5]. Similarly, cardiac transplantation, the treatment of choice for ischaemic heart failure, is currently limited by transplant arteriopathy (TA) developing in up to 60% of recipients within the first post-transplant year [6].…”

Section: Introductionmentioning

confidence: 99%

Synergistic Suppression of Rat Neointimal Hyperplasia by Rapamycin and Imatinib Mesylate: Implications for the Prevention of Accelerated Arteriosclerosis

et al. 2006

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Background: Accelerated arteriosclerosis remains a major limitation to therapeutic interventions such as angioplasty, stent deployment, and solid organ transplantation. Rapamycin, a powerful new immunosuppressant set to replace calcineurin inhibitors in the transplant setting, and imatinib mesylate, a receptor tyrosine kinase inhibitor, are both angioprotective. Here, we explored the pharmacological and therapeutic interactions of these two agents in a rat model of neointimal hyperplasia. Methods: Wistar rats, subjected to balloon catheter-induced aortic injury, received daily drug treatment until postoperative day 14 and were subsequently sacrificed or followed up to day 40 without further treatment. Development of neointimal lesions was assessed histologically and immunohistochemically. Steady-state rapamycin levels in whole blood were determined by HPLC-UV. Results: Rapamycin and imatinib, administered individually or in combination, produced no signs of overt toxicity. Continuous postoperative therapy with either rapamycin (0.5–1.5 mg/kg/day) or imatinib (2– 50 mg/kg/day) dose-dependently suppressed neointimal hyperplasia on day 14. Combined treatment (0.5 or 1 + 10 mg/kg/day, respectively) showed a trend towards synergistic action on day 14. Withdrawal of medication on day 14 nullified the early therapeutic effect of either agent by day 40. In contrast, early combination therapy (1 + 10 mg/kg/day) achieved long-term suppression of neointimal hyperplasia by approximately 81%. Notably, coadministration of imatinib appeared to reduce exposure to rapamycin, although this finding did not reach statistical significance. Conclusions: Short-term combination therapy with rapamycin and imatinib is well tolerated and produces synergistic, sustained suppression of neointimal hyperplasia in rats. Subject to clinical evaluation, this new drug regimen may afford definitive prophylaxis against accelerated arteriosclerosis.

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Section: Introductionmentioning

confidence: 99%

Synergistic Suppression of Rat Neointimal Hyperplasia by Rapamycin and Imatinib Mesylate: Implications for the Prevention of Accelerated Arteriosclerosis

et al. 2006

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“…Considering these facts, LSRA was recommended to reduce platelet activation and thermal injury in clinical practice. A previous clinical study also reported that LSRA is superior to HSRA in terms of 1-year restenosis rate [7].…”

Section: Discussionmentioning

confidence: 99%

“…However, recent studies show that a safe range of RA speed is between 135,000 and 180,000 rpm. Lower platform speeds are reported to be associated with disadvantages, such as burr lodging and difficulty in passage of the burr to the distal lesion, while high platform speed increases platelet activation and thrombotic complications, such as slow flow and no reflow [5–7]. Although recent studies have led to a better understanding of optimal platform speed, little is known about the association between platform speed and acute lumen gain.…”

Section: Introductionmentioning

confidence: 99%

A Novel Rotablator Technique (Low-Speed following High-Speed Rotational Atherectomy) Can Achieve Larger Lumen Gain: Evaluation Using Optimal Frequency Domain Imaging

Yamamoto

Yada

Matsuda

et al. 2019

Journal of Interventional Cardiology

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Background. While the evaluation of burr speed was discussed regarding platelet aggregation, the association between platform speed and acute lumen gain of rotational atherectomy remains unknown. Methods. Through the evaluation of the potential of low-speed rotational atherectomy (LSRA) in in-vitro experiments, minimum lumen diameter (MLD) and minimum lumen area (MLA) after conventional high-speed rotational atherectomy (HSRA group) and those after LSRA following HSRA (LSRA+HSRA group) treated by 1.5 mm burrs were measured by optical frequency domain imaging (OFDI) in 30 consecutive human lesions. Results. The in-vitro experiments demonstrated that MLD and MLA after LSRA+HSRA were significantly larger (MLD: LSRA+HSRA=1.50 ±0.05 mm, HSRA= 1.43 ±0.05 mm, p=0.015; MLA: LSRA+HSRA= 1.90 ±0.17 mm2, HSRA= 1.71±0.11 mm2, and p= 0.037), requiring more crossing attempts (LSRA= 134 ±20 times, HSRA= 72 ±11 times, and p< 0.001). In human studies, there was no significance in reference vessel diameter and lesion length before the procedure between two groups. MLDs after LSRA+HSRA were significantly larger than those in HSRA (LSRA+HSRA= 1.22 ±0.16 mm, HSRA= 1.07 ±0.14 mm, and p= 0.0078), while MLAs after LSRA+HSRA tended to be larger (LSRA+HSRA= 1.79 ±0.51 mm2, HSRA= 1.55 ±0.47 mm2, and p= 0.19). There was no significance in the occurrence of in-hospital complication, including slow flow or no reflow, major dissection, and procedural myocardial infarction, between LSRA+HSRA and HSRA. Conclusions. LSRA can achieve larger lumen gain compared, whereas HSRA can pass calcified lesions easily. Combination of LSRA and HSRA is a safe and feasible strategy for severely calcified lesions in clinical practice.

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“…Our study showed that there was no significant differences in the occurence of six-month TVR in CHD patients with different rotational speed. Uetani et al [20] demonstrated that RA with a low platform speed (150,000-160,000 rpm) can be performed and yield a lower incidence of 1-year restenosis compared to a high platform speed (170,000-190,000 rpm). Unfortunately, endovascular imaging such as IVUS and optical coherence tomography (OCT), was not performed on all patients in our study, and thus data such as minimum lumen area was lacking.…”

Section: Discussionmentioning

confidence: 99%

Rotational Atherectomy in Coronary Heart Disease Patients with Different Rotational Speed: In Hospital and Six-Month Outcomes

Wu¹,

Qiu²,

Hu³

et al. 2023

Rev. Cardiovasc. Med.

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Background: Rotational atherectomy (RA) is an important technique for the management of severe coronary calcification. However, optimal rotational speed is yet to be defined. Methods: A total of 372 coronary heart disease (CHD) patients were retrospectively analyzed between February 2017 and January 2022. The patients were divided into four groups based on the maximum RA speed: group 1 (<150,000 rpm, 76 cases), group 2 (150,000 rpm, 156 cases), group 3 (160,000 rpm, 90 cases) and group 4 (≥170,000 rpm, 50 cases). The outcomes analyzed were procedural complications, six-months major cardiovascular and cerebrovascular events (MACCE) and chronic heart failure. Results: Patients in group 4 had a higher incidence of slow flow during the RA operation (p = 0.025). There was no significant difference in other complications among the four groups, as well as six-month MACCE. After adjusting for confounding factors, increase in rotational speed led to a higher probability of slow flow (p for non-linearity = 0.131; adjusted model) and MACCE (p for non-linearity = 0.183; adjusted model). Logistic regression analysis showed that rotational speed was a predictor of slow flow during RA operation (OR = 1.25, 95% CI: 1.05~1.49, p = 0.01). Moreover, the analysis demonstrated that individuals with lower rotational speed (<150,000 rpm) were at 230% higher risk of vasospasm compared with a higher rotational speed (160,000 rpm) (OR = 3.3, 95% CI: 1.08~10.09, p = 0.036). Conclusions: CHD patients treated with a rotational speed of ≥170,000 rpm had a higher risk of slow flow after RA. Rotational speed is an independent risk factor for slow flow in CHD patients. Moreover, a rotational speed of <150,000 rpm was associated with a higher risk of vasospasm compared with rotational speed of 160,000 rpm. There was no significant difference in six-month outcomes in comparison to elective CHD patients with different rotational speeds, and the probability of MACCE was intensified with increase in rotational speed.

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Beneficial effect of rotational atherectomy with low platform speed on late outcomes

Cited by 8 publications

References 26 publications

Synergistic Suppression of Rat Neointimal Hyperplasia by Rapamycin and Imatinib Mesylate: Implications for the Prevention of Accelerated Arteriosclerosis

Synergistic Suppression of Rat Neointimal Hyperplasia by Rapamycin and Imatinib Mesylate: Implications for the Prevention of Accelerated Arteriosclerosis

A Novel Rotablator Technique (Low-Speed following High-Speed Rotational Atherectomy) Can Achieve Larger Lumen Gain: Evaluation Using Optimal Frequency Domain Imaging

Rotational Atherectomy in Coronary Heart Disease Patients with Different Rotational Speed: In Hospital and Six-Month Outcomes

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