Percutaneous coronary intervention of moderate to severe calcified coronary lesions: Insights from the National Heart, Lung, and Blood Institute Dynamic Registry

Bangalore, Sripal; Vlachos, Helen; Selzer, Faith; Wilensky, Robert L.; Kip, Kevin E.; Williams, David O.; Faxon, David P.

doi:10.1002/ccd.22613

Cited by 77 publications

(43 citation statements)

References 16 publications

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“…During the mean three years of follow-up, 0.8% of patients had acute myocardial infarction, 0.4% died, 5.5% had restenosis, and 3.2% had target lesion revascularization. These results coincide well with those from recent published studies (Bangalore et al, 2011;Benezet et al, 2011;Dardas et al, 2011). Based on our experience, complications and MACE rates could be reduced by: increasing burr size step by step, using a reasonable burr/artery ratio (0.5-0.7), maintaining systolic blood pressure at ≥100 mmHg during the procedure, allowing enough time for observing coronary flow between two rotations, applying routine post-dilatation with non-compliant balloons, and using IVUS guidance for high risk patient subsets such as those with left main disease.…”

Section: Discussionsupporting

confidence: 93%

Complex coronary lesions and rotational atherectomy: one hospital’s experience

Jiang

Sun

Xiang

et al. 2012

J. Zhejiang Univ. Sci. B

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Abstract: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．

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Section: Discussionsupporting

confidence: 93%

Complex coronary lesions and rotational atherectomy: one hospital’s experience

Jiang

Sun

Xiang

et al. 2012

J. Zhejiang Univ. Sci. B

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“…Thus, coronary obstruction induced by calcium debris is not a contraindication for PCI, despite the associated risk of certain complications [11,12].…”

Section: Discussionmentioning

confidence: 99%

Acute coronary artery obstruction after aortic valve replacement surgery and role of transesophageal echocardiography

Jang¹,

Choi²,

Han³

et al. 2017

Anesth Pain Med

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Acute coronary artery obstruction is a rare but potentially fatal complication of aortic valve replacement (AVR) surgery [1,2]. This adverse event can be induced by sudden coronary spasm, embolization of calcium plaque on the coronary arterial walls or aortic root, or intraoperative iatrogenic events [3].We present the near-fatal case of a patient who experienced a significant left main coronary ostial obstruction immediately after weaning from cardiopulmonary bypass (CPB). In the case presented here, early detection of regional wall motion abnormalities (RWMAs) in the left coronary arterial territory using intraoperative transesophageal echocardiography (TEE) prevented delayed diagnosis and poor outcome. CASE REPoRTA 60-year-old woman was referred to our hospital with dys- Acute coronary artery obstruction is a rare but fatal complication of surgical aortic valve replacement (AVR). Sudden coronary spasm, embolization of calcium plaque, and surgical factors can induce acute coronary syndrome after AVR. Here, we report a case of left main coronary ostial obstruction that occurred immediately after weaning from cardiopulmonary bypass. This case highlights the importance of coronary ostial flow patency and assessment of regional wall motion abnormalities with intraoperative transesophageal echocardiography in AVR.

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“…9,10,12,32 Although routine use of rotational atherectomy did not improve outcomes after DES implantation, 5,6 such a device might technically be required in cases of tight and calcified lesions, to allow subsequent passage of balloons and stents. In most cases, the simple passage of a single burr is sufficient to smoothen the vessel lumen, or to disrupt the continuity of intravascular calcium rings, to enable subsequent balloon dilatation and stent implantation.…”

Section: Patient Selection For Coronary Orbital Atherectomy Systemmentioning

confidence: 99%

Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

Sotomi

Shlofmitz

Colombo

et al. 2016

Interventional Cardiology Review

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CoronaryFrom the early days of percutaneous coronary intervention (PCI) it became apparent that the presence of severe coronary calcification was a predictor of worse clinical outcomes. In the era of plain old balloon angioplasty, severe coronary calcification was associated with an increased risk of coronary dissection and procedural failure, while in the bare-metal stent era, it was associated with a higher incidence of in-stent restenosis and target lesions revascularisations (TLRs).1,2 The advent of drug-eluting stents (DES) changed the landscape of coronary intervention through the reduced risk of restenosis and TLR, thereby allowing the interventional treatment of complex lesions and high-risk patients.However, a recent patient-level pooled analysis from seven contemporary stent trials revealed that patients with severely calcified lesions still have worse clinical outcomes compared with those without severe coronary calcification.3 Patients with severe lesion calcification were less likely to have undergone complete revascularisation, resulting in a higher residual Syntax score, which is a powerful determinant of prognosis. The latest ACCF/AHA/SCAI and ESC/EACTS PCI guidelines and European expert consensus on rotational atherectomy state that rotational atherectomy has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with PCI. 7-12Rotational atherectomy should not be performed routinely for de novo lesions or in-stent restenosis. The purpose of this review is to provide insights for procedural considerations and patient selection from the currently available publications assessing the OAS. Diamondback 360 ® Coronary Orbital Atherectomy SystemThe Diamondback 360 ® Coronary OAS is the device to facilitate stent delivery in patients who are acceptable candidates for PCI due to de novo, severely calcified coronary artery lesions (see Figure 1).The Diamondback 360 ® Coronary OAS is the device to facilitate stent delivery in patients who are acceptable candidates for PCI due to AbstractDespite advances in technology, percutaneous coronary intervention (PCI) of severely calcified coronary lesions remains challenging.Rotational atherectomy is one of the current therapeutic options to manage calcified lesions, but has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with other PCI techniques due to unfavourable clinical outcome in long-term follow-up. However the results of orbital atherectomy presented in the ORBIT I and ORBIT II trials were encouraging. In addition to these encouraging data, necessity for sufficient lesion preparation before implantation of bioresorbable scaffolds lead to resurgence in the use of atherectomy. This article summarises currently available publications on orbital atherectomy (Cardiovascular Systems Inc.) and compares them with rotational atherectomy. KeywordsOrbital atherectomy system, percutaneous coronary intervention, severely calcified lesion

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Percutaneous coronary intervention of moderate to severe calcified coronary lesions: Insights from the National Heart, Lung, and Blood Institute Dynamic Registry

Cited by 77 publications

References 16 publications

Complex coronary lesions and rotational atherectomy: one hospital’s experience

Complex coronary lesions and rotational atherectomy: one hospital’s experience

Acute coronary artery obstruction after aortic valve replacement surgery and role of transesophageal echocardiography

Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

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