Feasibility and safety of minimal-contrast IVUS-guided rotational atherectomy for complex calcified coronary artery disease

Allali, Abdelhakim; Traboulsi, Hussein; Sulimov, Dmitriy S.; Abdel‐Wahab, Mohamed; Woitek, Felix; Hemetsberger, Rayyan; Mankerious, Nader; Elbasha, Karim; Richardt, Gert

doi:10.1007/s00392-021-01906-y

Cited by 7 publications

(4 citation statements)

References 26 publications

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“…At first, when interpreting these test results, we assumed that the methods of intravascular imaging are associated with prolonged duration of the procedure or the amount of the administered contrast media -however, nothing could be further from the truth. Currently, the common trend is reducing the administered contrast during CA and PCI procedures [20]. In our opinion, the greater amount of contrast and exposure to radiation when using IVUS or OCT currently in Poland is rather related to increasingly frequent use of these imaging methods in more and more complex procedures.…”

Section: Discussionmentioning

confidence: 99%

Factors determining the frequency of optical coherence tomography and intravascular ultrasound use in patients treated with percutaneous coronary interventions in recent years: Analysis based on a large national registry

Januszek,

Siudak,

Malinowski

et al. 2023

Kardiol Pol

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Background: Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have demonstrated improvement in the clinical outcome of patients undergoing percutaneous coronary intervention (PCI). Aims:We aimed to examine the frequency of implementing OCT and IVUS during coronary angiography (CA) and PCI in everyday practice in Poland. Factors related to the more common choice of these imaging techniques were determined. Methods: Data from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI)were procured for analysis. Between January 2014 and December 2021, we extracted data on 1 452 135 CAs, 11 710 using IVUS (0.8%) and 1471 with OCT (0.1%) and 838 297 PCIs, 15 436 with IVUS (1.8%) and 1680 with OCT (0.2%). We assessed the determining factors for applying IVUS and OCT via multiple regression logistics models. Results:The frequency of applying IVUS during CAs and PCIs increased significantly between the years 2014 and 2021. In 2021, it reached 1.54% for CAs and 4.42% for PCIs, while for OCT, there was a rise regarding the CA group, namely 0.13% in 2021, and, in the PCI group, 0.43%. Age was one of the factors significantly associated with the frequency of using IVUS/OCT during CA/PCI, which was confirmed by multivariate analysis (Odds ratio: 0.981 for IVUS and 0.973 for OCT use with PCI). Conclusion:The frequency at which IVUS and OCT were used has undergone a significant increase in previous years. This increase can be largely attributed to the current reimbursement policies. Further improvement is required for this frequency to be at a satisfactory level.

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Section: Discussionmentioning

confidence: 99%

Factors determining the frequency of optical coherence tomography and intravascular ultrasound use in patients treated with percutaneous coronary interventions in recent years: Analysis based on a large national registry

Januszek,

Siudak,

Malinowski

et al. 2023

Kardiol Pol

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“…This could be successful in preventing contrast-related AKI. 5 In a cohort of 31 patients with severe CKD, Ali et al 31–33 showed that intravascular imaging guidance allowed for safe PCI with zero contrast. The later series, however, excluded individuals with significant calcification in tortuous vessels and only performed RA on two lesions.…”

Section: Discussionmentioning

confidence: 99%

“… 2–4 The technically challenging procedure known as percutaneous coronary intervention (PCI) of severely calcified coronary lesions is typically linked with a high contrast volume consumption, which raises the risk of contrast-related acute renal injury. 5 …”

Section: Introductionmentioning

confidence: 99%

A Single-Center Study Using IVUS to Guide Rotational Atherectomy for Chronic Renal Disease’s Calcified Coronary Artery

Hu¹,

Qi²,

Li³

et al. 2023

JMDH

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Objective To assess the effectiveness and safety of an IVUS-guided rotational atherectomy (RA) percutaneous coronary intervention (PCI) in chronic renal patients with complex coronary calcification who are at risk for contrast-related acute kidney injury (AKI). Methods From October 2018 to October 2021, 48 patients with chronic renal disease who were receiving PCI with RA at the General Hospital of NingXia Medical University were informed for data collection for this research. They were randomly assigned to the IVUS-guided RA group and the Standard RA group, which did not use IVUS. According to a clinical expert consensus document on rotational atherectomy in China, both PCI procedures were performed. The intravascular ultrasound (IVUS) results from the study group were used to describe the morphology of the lesion and to guide the selection of burrs, balloons, and stents. IVUS and angiography were used to evaluate the outcome in the end. IVUS-guided RA PCI and Standard RA PCI groups’ effects and results were contrasted. Results There were no appreciable differences in the clinical baseline characteristics between the IVUS-guided RA PCI group and the Standard RA PCI group. The average estimated glomerular filtration rate (eGFR) of two groups was (81.42 ± 20.22 vs 82.34 ± 22.19) mL/min/1.73 m 2 . Most of them (45.8% vs 54.2%) was in stage 60–90 mL/min/1.73m 2 . When compared to the standard RA PCI group, RA in IVUS-Guided group was more performed electively (87.5% vs 58.3%; p = 0.02). The IVUS-guided RA PCI group was associated with shorter fluoroscopy time (20.6 ± 8.4 vs 36 ± 22; p<0.01) and less contrast amount (32 ±16 vs 184 ±116mL; p<0.01) than Standard-RA group. Five patients in the Standard RA PCI group developed contrast-induced nephropathy, which was 5 times than the IVUS-guided RA PCI group (20.8% VS 4.1%; p=0.19). Conclusion In chronic renal patients with complex coronary calcification, an IVUS-guided RA PCI technique is effective and safe. It can also lower the volume of contrast and perhaps the incidence of contrast-related AKI.

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“…Imaging devices such as IVUS or OCT is useful in RA [77][78][79][80][81][82][83][84]. In this document, we recommend to use IVUS or OCT before, during, and after RA.…”

Section: Imaging Devices In Ramentioning

confidence: 99%

Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023

Sakakura

Ito

Shibata³

et al. 2023

Cardiovasc Interv and Ther

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The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidences regarding rotational atherectomy (RA) in 2020. Because the revascularization strategy to severely calcified lesions is the hottest topic in contemporary percutaneous coronary intervention (PCI), many evidences related to RA have been published since 2020. Latest advancements have been incorporated in this updated expert consensus document.

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Feasibility and safety of minimal-contrast IVUS-guided rotational atherectomy for complex calcified coronary artery disease

Cited by 7 publications

References 26 publications

Factors determining the frequency of optical coherence tomography and intravascular ultrasound use in patients treated with percutaneous coronary interventions in recent years: Analysis based on a large national registry

Factors determining the frequency of optical coherence tomography and intravascular ultrasound use in patients treated with percutaneous coronary interventions in recent years: Analysis based on a large national registry

A Single-Center Study Using IVUS to Guide Rotational Atherectomy for Chronic Renal Disease’s Calcified Coronary Artery

Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023

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