Risk Factors for the Development of Slow Flow During Rotational Coronary Atherectomy

Sharma, Sanjeev; Dangas, George; Mehran, Roxana; Duvvuri, Srinivas; Kini, Annapoorna; Cocke, Thomas; Kakarala, Venu; Cohen, Adam Max; Marmur, Jonathan D.; Ambrose, John A.

doi:10.1016/s0002-9149(97)00325-1

Cited by 53 publications

(34 citation statements)

References 15 publications

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“…Sharma and colleagues treated 57% of their patients with rotational atherectomy, whereas in this analysis only 16%, a figure much closer to the national average, 7 were so treated. Not surprisingly, inasmuch as rotational atherectomy probably increases the risk of "slow flow" and CK-MB elevation, 8,9 the incidence of CK elevation in the previous study was higher than in this study, despite comparable timing of its ascertainment. Second, there were important differences in the statistical methods used to attempt to minimize the influence of differences between patients treated with or without BBs.…”

Section: Discussioncontrasting

confidence: 60%

β-Blockers Before Percutaneous Coronary Intervention Do Not Attenuate Postprocedural Creatine Kinase Isoenzyme Rise

et al. 2001

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Background-␤-blocker (BB) use reduces infarct size in spontaneously occurring nonreperfused infarcts but probably does not change infarct size in patients treated with reperfusion therapy. A recent observational study suggested that BB use concurrent with percutaneous coronary intervention (PCI) decreased the risk of creatine kinase (CK)-MB elevation. The cogency of such a conclusion is dependent on the ability to risk-adjust for the multiple differences in patients treated with and without BBs. Methods and Results-Using propensity score and multivariate regression analyses, 6200 consecutive patients were analyzed to assess the relationship between BB use before PCI and per protocol-measured CK and CK-MB rise. There were several highly significant (PϽ0.001) differences between patients with and without BB treatment (eg, age, prior infarction, unstable angina

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Section: Discussioncontrasting

confidence: 60%

β-Blockers Before Percutaneous Coronary Intervention Do Not Attenuate Postprocedural Creatine Kinase Isoenzyme Rise

et al. 2001

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“…Caution must also be given to patients with lesion lengths >25 mm, angina at rest, severe LV dysfunction, and poor distal run off because they are at increased risk for ischemic complications [24]. Patients with target lesions in a dominant right coronary artery or left circumflex artery should receive prophylactic temporary pacemakers due to increased risk of heart block.…”

Section: Basics Of Rotational Atherectomymentioning

confidence: 99%

An evidence‐based approach to the use of rotational and directional coronary atherectomy in the era of drug‐eluting stents: When does it make sense?

Tran

Brown

Lasala

2008

Cathet Cardio Intervent

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Advances in percutaneous interventions have profoundly changed the way we manage patients with coronary and peripheral arterial disease. Though the use of stents, particularly drug-eluting stents, is the preferred method for revascularization because of ease of use and lower restenosis rates, there are many short comings. Ostial and bifurcation lesions as well as heavily calcified and tortuous arteries remain problematic. Mechanical debulking with rotational and direct coronary atherectomy may be beneficial in these situations. In this review, we present the general concepts of mechanical debulking and attempt to summarize the available data on its use in the setting of drug-eluting stents. In addition, we will discuss its special role in the management of peripheral arterial disease.

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“…In such cases, the GP IIb/IIIa inhibitor should be administered after the completion of RA. One of the potentially disastrous complications of RA is the development of coronary slow flow/no-reflow [9]. Coronary slow flow/no-reflow is defined as a decrease or cessation of blood flow in the absence of an apparent occlusive dissection or spasm and is believed to occur as a result of distal microparticle embolization.…”

Section: Adjunctive Therapiesmentioning

confidence: 99%

Current status of rotational atherectomy

Çavuşoğlu¹,

Kini²,

Marmur³

et al. 2004

Cathet Cardio Intervent

114

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Despite the increasing use of percutaneous transluminal coronary angioplasty and intracoronary stent placement for the treatment of obstructive coronary artery disease, a large subset of coronary lesions cannot be adequately treated with balloon angioplasty and/or intracoronary stenting alone. Such lesions are often heavily calcified or fibrotic and undilatable with the present balloon technology and attempts to treat them with balloon angioplasty or intracoronary stent placement often lead to vessel dissection or incomplete stent deployment with resultant adverse outcomes. Rotational atherectomy remains a useful niche device for the percutaneous treatment of such complex lesions, usually as an adjunct to subsequent balloon angioplasty and/or intracoronary stent placement. In contrast to balloon angioplasty or stent placement that widen the coronary lumen by displacing atherosclerotic plaque, rotational atherectomy removes plaque by ablating the atherosclerotic material, which is dispersed into the distal coronary circulation. Other lesion subtypes amenable to treatment with this modality include ostial and branch-ostial lesions, chronic total occlusions, and in-stent restenosis. This review discusses the technique and principles of rotational atherectomy, the various treatment strategies for its use (including adjunctive pharmacotherapy), the lesion-specific applications for this device, and the complications unique to this modality. Recommendations are also made for its use in the current interventional era.

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Risk Factors for the Development of Slow Flow During Rotational Coronary Atherectomy

Cited by 53 publications

References 15 publications

β-Blockers Before Percutaneous Coronary Intervention Do Not Attenuate Postprocedural Creatine Kinase Isoenzyme Rise

β-Blockers Before Percutaneous Coronary Intervention Do Not Attenuate Postprocedural Creatine Kinase Isoenzyme Rise

An evidence‐based approach to the use of rotational and directional coronary atherectomy in the era of drug‐eluting stents: When does it make sense?

Current status of rotational atherectomy

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