Impact of target lesion calcification on coronary stent expansion after rotational atherectomy

Henneke, Karl‐Heinz; Regar, Evelyn; König, Andreas; Werner, F.; Klauss, V.; Metz, Jonas A.; Theisen, K.; Mudra, Harald

doi:10.1016/s0002-8703(99)70463-1

Cited by 62 publications

(37 citation statements)

References 24 publications

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“…This enables better expansion of the stent. [12][13][14] However, limited numbers of institutions perform RA because they must meet certain standards. Therefore, some institutions treat all but the most calcified lesions with plain old balloon angioplasty (POBA) and stent implantation.…”

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confidence: 99%

Initial and Long-Term Outcomes of Sirolimus-Eluting Stents for Calcified Lesions Compared With Bare-Metal Stents

et al. 2007

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SUMMARYThe aim of this study was to compare the initial and long-term outcomes of sirolimuseluting stents (SES) and bare-metal stents (BMS) in patients with calcified lesions without performing rotational atherectomy.The subjects were 79 consecutive lesions (38 in the SES group and 41 in the BMS group) which were confirmed to have superficially calcified lesions by intravascular ultrasound. In all lesions, the stent was implanted after predilatation with a balloon.The patient characteristics were not different between the 2 groups. All procedures were successfully performed in both groups. Vessel area was significantly smaller in the SES group than in the BMS group (11.01 ± 3.88 mm 2 versus 13.08 ± 3.49 mm 2 , P < 0.005), as was the lumen area (5.41 ± 2.31mm 2 versus 6.48 ± 2.04 mm 2 , P < 0.005). Minimum stent area was significantly smaller in the SES group than in the BMS group (5.61 ± 1.54 mm 2 versus 6.69 ± 1.74 mm 2 , P < 0.01). In cases in whom angiographic follow-ups were performed, the late loss was significantly smaller in the SES group than in the BMS group (0.19 ± 0.49 mm versus 0.76 ± 0.48 mm, P < 0.001). The restenosis rate was significantly lower in the SES group than in the BMS group (8.8% versus 33.3%, P < 0.05) and the TLR rate tended to be lower in the SES group (7.9% versus 19.5%). Stent thrombosis was not observed in either group.The results suggest that SES are more effective than BMS and can be used safely when treating calcified lesions if predilatation with a balloon is possible. (Int Heart J 2007; 48: 137-147)

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confidence: 99%

Initial and Long-Term Outcomes of Sirolimus-Eluting Stents for Calcified Lesions Compared With Bare-Metal Stents

et al. 2007

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“…13,29,30 Although the CT calcification grade is known to predict the expansion of coronary stents 15 and has been suggested to be a relative contraindication to CAS, 8,16 few investigators use plaque morphology to help guide the choice of treatment 19 or to predict the immediate or long-term morphological success of CAS procedures.…”

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confidence: 99%

Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting

Pelz¹,

Lownie²,

Lee³

et al. 2015

JNS

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C arotid angioplasty and stenting (CAS) has evolved into an alternative to carotid endarterectomy (CEA) for the treatment of atherosclerotic carotid stenosis, particularly since the publication of the Carotid Revascularization Endarterectomy versus Stent Trial (CREST) in 2010. 4 In the CREST, as in most other randomized controlled trials and large case series, the standard technical protocols include the use of embolic protection devices (EPDs), self-expanding stents (SESs), and balloons preand postdilation. It has, however, been shown that EPDs do not catch all debris generated by balloons and that these expensive devices may cause complications themselves. 10Every pass of a device through an atherosclerotic stenosis generates distal emboli.2,31 Balloon angioplasty, both before and after stent insertion, releases significant amounts of embolic debris 20,24,26,28,33 and often results in significant hemodynamic instability, defined as bradycardia (< 60 beats/min) and hypotension (systolic blood pressure < 90 mm Hg).27 Some major centers now rarely perform prestent balloon angioplasty, deliberately undersize poststent abbreviatioNs CAS = carotid angioplasty and stenting; CEA = carotid endarterectomy; CREST = Carotid Revascularization Endarterectomy versus Stent Trial; CTA = CT angiography; EPD = embolic protection device; NASCET = North American Symptomatic Carotid Endarterectomy Trial; PCS = primary carotid stenting; PLAC = Predicting Long-term outcome with Angioplasty of the Carotid artery; PSV = peak systolic velocity; SES = self-expanding stent. obJect Carotid angioplasty and stenting has emerged as an alternative to carotid endarterectomy for the treatment of atherosclerotic carotid stenosis. Primary carotid stenting, performed using self-expanding stents alone without deliberate use of embolic protection devices and balloon angioplasty, has been shown to be effective and faster, cheaper, and potentially safer than conventional techniques. However, the long-term morphological results of this technique have not been established. The aim of this study was to determine whether preprocedural carotid plaque imaging at the site of maximal stenosis by using CT angiography (CTA) could predict the long-term morphological outcome of primary carotid stenting. methods One hundred eighty-one patients were treated over an 11-year period. Preprocedural CTA was performed in 102 of these. A morphological scale (the Predicting Long-term outcome with Angioplasty of the Carotid artery [PLAC] Scale), with grades from 0 to 4 and A or B, was used to evaluate the circumferential degree of plaque calcification, and the presence or absence of soft plaque. All patients were followed using duplex carotid ultrasound and plain radiographs. Satisfactory morphological outcome was defined as a peak systolic velocity < 120 cm/s and internal carotid artery/common carotid artery ratio < 1.4. results The average follow-up duration was 29.7 months (median 24.5 months, range 0.3-87 months). Univariate logistic regression demonstrated that a low ca...

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“…Even when a guidewire is successfully passed through the lesion, severe coronary artery stenosis, such as severe calcification or CTO, can prevent the passing of a conventional balloon or a microcatheter. Ablation with high-speed rotational atherectomy is efficacious for these lesions, but requires exchange of a guidewire for a RotaWire (Boston Scientific, Miami, FL) before ablation, 4 and the exchange procedure is not always successful when there is not a catheter passing through the lesion.…”

Section: Discussionmentioning

confidence: 99%

Rescuing an Entrapped Guidewire Using a Tornus Catheter

Cho

Park

Kim

et al. 2007

Circ J

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Impact of target lesion calcification on coronary stent expansion after rotational atherectomy

Cited by 62 publications

References 24 publications

Initial and Long-Term Outcomes of Sirolimus-Eluting Stents for Calcified Lesions Compared With Bare-Metal Stents

Initial and Long-Term Outcomes of Sirolimus-Eluting Stents for Calcified Lesions Compared With Bare-Metal Stents

Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting

Rescuing an Entrapped Guidewire Using a Tornus Catheter

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