Treatment for in‐stent restenosis requiring rotational atherectomy

Hachinohe, Daisuke; Kashima, Yoshifumi; Hirata, Kazuya; Kanno, Daitaro; Kobayashi, Ken; Sugie, Takuro; Tadano, Yutaka; Watanabe, Tetsuya; Shitan, Hidemasa; Haraguchi, Takuya; Enomoto, Morio; Sato, Katsuhiko; Fujita, Tsutomu

doi:10.1111/joic.12558

Cited by 15 publications

(6 citation statements)

References 27 publications

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“…The calcified character of ISR in HD patients poses a great challenge in treatment. In a previous series, we found that ROTAfacilitated PCI was a safe and efficient technique for the treatment of ISR but was still related to a high MACE rate (25). Further, in our present data of HD patients, ISR lesions had an even worse outcome than de novo lesions.…”

Section: Discussionsupporting

confidence: 50%

Predictors of clinical outcome after rotational atherectomy-facilitated percutaneous coronary intervention in hemodialysis patients

Dong¹,

Hachinohe²,

Nie³

et al. 2021

Ann Palliat Med

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Background: Percutaneous coronary intervention (PCI) in hemodialysis patients with severely calcified and diffused lesions is associated with extremely high rates of major adverse cardiovascular events (MACE), even when facilitated by rotational atherectomy (ROTA). Potential risk factors for MACE with ROTAfacilitated PCI in hemodialysis patients should be identified. Methods:We retrospectively analyzed a consecutive cohort of patients from the Sapporo Cardiovascular Clinic database, who were on maintenance hemodialysis with severe calcified lesions and treated with ROTAfacilitated PCI. Clinical and interventional procedure characteristics were collected and compared between patients with and without MACE, defined as all-cause death, hospitalization due to heart failure, definite stent thrombosis, or target lesion revascularization (TLR) at 1-year follow-up. The individual outcomes of MACE and TLR in the cohort were presented as Kaplan-Meier percentages. Cox regression analyses were performed to identify independent predictors of MACE.Results: A total of 138 patients undergoing hemodialysis and followed up for 362. 50 (243.75, 382.25) days.Sixty-one patients in the cohort had MACE, most of which were TLR (47.5%, 29/61). Cumulative all-cause death at 30-day and 1-year follow-up were 6.52% and 18.8%, respectively. Patients with right coronary artery (RCA) lesions, in-stent restenosis (ISR) lesions, and were more likely to have MACE, even with larger reference vessel diameter and greater acute gain after PCI. Cox regression analysis demonstrated that ISR lesion was positively associated with both MACE (HR 3.21, 95% CI: 1.59-6.48) and TLR (HR 5.08, 95% CI: 1.78-14.47), latter of which was also proved to be significantly related to greater acute gain (HR 1.95, 95% CI: 1.12-3.39). In subgroup analysis, RCA was found to be positively associated with MACE in de novo lesion (HR 2.83, 95% CI: 1.28-6.28).

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Section: Discussionsupporting

confidence: 50%

Predictors of clinical outcome after rotational atherectomy-facilitated percutaneous coronary intervention in hemodialysis patients

Dong¹,

Hachinohe²,

Nie³

et al. 2021

Ann Palliat Med

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“…21 Rotational atherectomy is also applied to restenotic lesions caused by underexpansion, but long-term outcomes have not been satisfactory. 22 In the present study and although atherectomy was applied in patients with under-expanded stents, the final MLD was similar between those with and without atherectomy. The impact of atherectomy should be studied in the future.…”

Section: Discussionsupporting

confidence: 44%

Prevalence and Impact of Neoatherosclerosis on Clinical Outcomes After Percutaneous Treatment of Second-Generation Drug-Eluting Stent Restenosis

Chen

Matsumura

Mintz

et al. 2022

Circ: Cardiovascular Interventions

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Background: Clinical and morphological factors associated with lipidic versus calcified neoatherosclerosis within second-generation drug-eluting stents and the impact of lipidic versus calcified neoatherosclerosis on long-term outcomes after repeat intervention have not been well studied. Methods: A total of 512 patients undergoing optical coherence tomography before percutaneous coronary intervention for second-generation drug-eluting stents in-stent restenosis were included. Neoatherosclerosis was defined as lipidic or calcified neointimal hyperplasia in ≥3 consecutive frames or ruptured lipidic neointimal hyperplasia. The primary outcome was target lesion failure (cardiac death, target vessel myocardial infarction, definite stent thrombosis, or clinically driven target lesion revascularization). Results: The overall prevalence of neoatherosclerosis was 28.5% (146/512): 56.8% lipidic, 30.8% calcified, and 12.3% both lipidic and calcific. The prevalence increased as a function of time from stent implantation: 20% at 1 to 3 years, 30% at 3 to 7 years, and 75% >7 years. Renal insufficiency, poor lipid profile, and time from stent implantation were associated with lipidic neoatherosclerosis, whereas severe renal insufficiency, female sex, and time from stent implantation were associated with calcified neoatherosclerosis. Multivariable Cox regression revealed that female sex and lipidic neoatherosclerosis were associated with more target lesion failure, whereas stent age and final minimum lumen diameter after reintervention were related to lower target lesion failure. Calcified neoatherosclerosis was not related to adverse events after reintervention for in-stent restenosis given a large enough minimum lumen diameter was achieved. Conclusions: Lipidic but not calcified neoatherosclerosis was associated with poor subsequent outcomes after repeat revascularization if optimal stent expansion was achieved in lesions with calcified neoatherosclerosis.

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“…In a retrospective analysis of 200 patients undergoing RA for ISR, 12-month TLR rates were lower for drug-coated balloon angioplasty (27.3%) compared with conventional balloon angioplasty (40.7%) or DES implantation (35.0%), suggesting that for severe ISR requiring a debulking strategy, drug-coated balloon angioplasty following RA might be the most effective treatment option. [42] Other reports have also reported favourable results with drug-coated balloon angioplasty following RA for severe ISR. [43] Nonetheless, stent ablation with RA should be used with extreme caution by highly experienced operators, ideally with on-site surgical backup.…”

Section: Indications and Clinical Outcomesmentioning

confidence: 99%

Rotational Atherectomy: A Contemporary Appraisal

et al. 2019

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Rotational atherectomy (RA) is an atheroablative technology that enables percutaneous coronary intervention for complex, calcified coronary lesions. RA works on the principle of ‘differential cutting’ and preferentially ablates hard, inelastic, calcified plaque. The objective of RA use has evolved from plaque debulking to plaque modification to enable balloon angioplasty and optimal stent expansion. The clinical experience over the past 30 years has informed the current best practices for RA with use of smaller burr sizes, short ablation runs a ‘pecking’ motion, and avoidance of sudden decelerations. This has led to significant improvements in procedural safety and a reduced rate of associated complications. This article reviews the principles, clinical indications, contemporary evidence, technical considerations and complications associated with the use of RA.

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Treatment for in‐stent restenosis requiring rotational atherectomy

Abstract: TLR at 12 months is dismal. RA is not effective for ISR requiring RA. In unfavorable settings, DCB angioplasty following RA is the most effective treatment option in patients with ISR requiring debulking strategy.

Cited by 15 publications

References 27 publications

Predictors of clinical outcome after rotational atherectomy-facilitated percutaneous coronary intervention in hemodialysis patients

Predictors of clinical outcome after rotational atherectomy-facilitated percutaneous coronary intervention in hemodialysis patients

Prevalence and Impact of Neoatherosclerosis on Clinical Outcomes After Percutaneous Treatment of Second-Generation Drug-Eluting Stent Restenosis

Rotational Atherectomy: A Contemporary Appraisal

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