Rotational atherectomy and new‐generation drug‐eluting stent implantation

Hachinohe, Daisuke; Kashima, Yoshifumi; Kanno, Daitaro; Kobayashi, Ken; Sugie, Takuro; Tadano, Yutaka; Watanabe, Tetsuya; Shitan, Hidemasa; Fujita, Tsutomu

doi:10.1002/ccd.27446

Cited by 15 publications

(11 citation statements)

References 23 publications

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“…Rotation atherectomy (ROTA), used to remove plaque and, thus, reduce the severity of calci cation, can be effective in facilitating balloon dilation in modern cardiac catheterization settings [4]. In agreement with previously published ndings [5], we have previously reported on the effectiveness of combining ROTA with drug-eluting stents (ROTA + DES) for the treatment of calci ed lesions [6]. However, there are still some situations as adverse bleeding effects, medication nonadherence or large side branch ostial lesion, which may lead physicians to choose stent-less strategy and POBA emerges as the preferred option.…”

Section: Introductionsupporting

confidence: 84%

“…In accordance with Japanese insurance policy, a maximum of two burrs were used, when required. A modi ed ROTA technique was used in all cases, as per the clinical guidelines at our institution, previously described [6]. The standard of a stent/lumen ratio 1:1-1:1.02 for DES implantation was used, with the target lesion pretreated using su cient rotablation and balloon dilatation.…”

Section: Methodsmentioning

confidence: 99%

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Should We Still Do Plain Old Balloon Angioplasty following Rotational Atherectomy in Drug-Eluting Stent Era?

Dong¹,

Hachinohe²,

Zhiqiang³

et al. 2020

Preprint

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Background Drug-eluting stent (DES) is well known effective in severely calcified lesion after rotational atherectomy (ROTA). However, there are still some situations when metal stents should be avoided and plain old balloon angioplasty (POBA) emerges as the preferred option. The aim of present study is to explore that whether POBA is comparably effective to DES in large and calcified coronary pretreated by ROTA in clinical outcomes. Methods A retrospective analysis of consecutive patients treated for severely calcified lesions in large (≥ 3 mm) coronary using ROTA + DES or ROTA + POBA was performed. Major adverse cardiac events (MACE) including all cause/cardiac death and target lesion revascularization (TLR) at 1- and 2-year post-treatment, were compared between groups, with Cox regression analyses to identify independent predictors of TLR and MACE. Results The analysis included 285 cases in the ROTA + DES and 47 in the ROTA + POBA group, while no relevant between-group differences in clinical baseline characteristics were found. Of note, lesion length was greater in the ROTA + DES group (37.2 mm versus 19.3 mm, p < 0.001), with 8.4% lesions being chronic total occlusion in this group, but none in the ROTA + POBA group. The in-hospital/30-day mortality rate (5.3%, DES, and 6.4%, POBA), as well as the 12- and 24-month all-cause/cardiac mortality rate (9.3% and 7.7%, respectively) were not significantly different between groups. TLR rates were not significantly different between groups at 12-month (4.6%, DES, and 4.3%, POBA) and 24-month (5.3%, DES and 6.4%, POBA) respectively. Conclusions Outcomes were comparable for ROTA + DES and + POBA in severely calcified large coronary arteries intervention, with respect to mid-term death or TLR rate, especially for short lesion < 20 mm.

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Section: Introductionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Should We Still Do Plain Old Balloon Angioplasty following Rotational Atherectomy in Drug-Eluting Stent Era?

Dong¹,

Hachinohe²,

Zhiqiang³

et al. 2020

Preprint

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“…Stent underexpansion is a risk factor for ISR . Although high‐pressure balloon inflation using noncompliant or scoring balloons is effective in some cases, calcification surrounding the initial stent prevents optimal balloon expansion . There may be two possible mechanisms in RA for stent underexpansion: (i) RA cut the underexpanded stent by differential cutting and (ii) calcified or inelastic tissue within and surrounding the implanted stent is ablated .…”

Section: Discussionmentioning

confidence: 99%

“…PCI and RA were performed according to the clinical standard at our center, as described elsewhere . ISR was treated when diameter stenosis was more than 70% or 50‐70% in the presence of ischemic symptoms or documented ischemia by functional test.…”

Section: Methodsmentioning

confidence: 99%

Treatment for in‐stent restenosis requiring rotational atherectomy

Hachinohe

Kashima

Hirata

et al. 2018

J Interven Cardiology

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“…In the past 5 years, the Sapporo Cardio Vascular Clinic (SCVC) has modified the RA technique and achieved favorable results for complex PCI [15]. With the purpose of better assessing the performance of RA, this study introduced the use of the modified RA technique, and retrospectively evaluated the "real-world" outcomes of the technique in a large group of patients with high risk in the contemporary coronary angioplasty era.…”

Section: Introductionmentioning

confidence: 99%

Reappraisal Value of a Modified Rotational Atherectomy Technique in Contemporary Coronary Angioplasty Era

Dong

Hachinohe

Nie

et al. 2020

Journal of Interventional Cardiology

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Objectives. To introduce a modified rotational atherectomy (RA) procedure and investigate the early and midterm outcomes of the RA-facilitating diversified percutaneous coronary intervention (PCI) in a large group of aged patients with higher cardiovascular risk. Background. Previous studies about the outcomes of RA were limited with small sample size and low-risk population. Methods. Between January 2013 and November 2015, 1169 consecutive patients treated with modified RA-facilitated PCI were retrospectively enrolled, including de novo calcified lesions and in-stent restenosis. Patients were regularly followed up for at least 1 year. Major adverse cardiac events (MACE) were analyzed for all participants by different strategies. Cox regression analysis was performed to identify risk factors for the events. Results. The median age of patients was 75 years, with 11.7% of patients on maintenance hemodialysis. Most lesions (99.9%) were complex (American Heart Association type B2/C), and 68.3% were treated with RA + drug-eluting-stent (DES). Successful angiography was achieved in 97.8% cases, with 1.7% (20/1169) experiencing coronary perforation (including guidewire perforation). The incidence of MACE was 20.5% and 26.8% at 1-year and 2-year follow-up and were mainly driven by target lesion revascularization (TLR) (10.3% and 12.5%, respectively). The strategy of RA + DES had the lowest 2-year MACE, compared with the RA + drug-coated balloon and RA + plain old balloon angioplasty (14.5%, 30.5%, and 26.0%, respectively). Conclusions. The modified RA technique is a safe and effective tool in the contemporary PCI era, even in high-risk patients. The TLR rate was relatively high but acceptable in such complex lesions.

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Rotational atherectomy and new‐generation drug‐eluting stent implantation

Abstract: A good debulking with RA followed by new-generation DES implantation is recommended for patients with an excessive amount of calcified and fibrotic plaque, as this will likely improve the clinical outcomes.

Cited by 15 publications

References 23 publications

Should We Still Do Plain Old Balloon Angioplasty following Rotational Atherectomy in Drug-Eluting Stent Era?

Should We Still Do Plain Old Balloon Angioplasty following Rotational Atherectomy in Drug-Eluting Stent Era?

Treatment for in‐stent restenosis requiring rotational atherectomy

Reappraisal Value of a Modified Rotational Atherectomy Technique in Contemporary Coronary Angioplasty Era

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