Very high-pressure dilatation for undilatable coronary lesions: indications and results with a new dedicated balloon

Secco, Gioel Gabrio; Ghione, Matteo; Mattesini, Alessio; Dall’Ara, Gianni; Ghilencea, Liviu; Kılıçkesmez, Kadriye Orta; Luca, Giuseppe De; Fattori, Rossella; Parisi, Rosario; Marino, Paolo; Lupi, Alessandro; Foin, Nicolas; Mario, Carlo Di

doi:10.4244/eijy15m06_04

Cited by 91 publications

(59 citation statements)

References 22 publications

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“…Calcified coronary lesions remain challenging to deal with, even for experienced operators. Current available options to deal with underexpanded stents include: aggressive dilatation with super high‐pressure or cutting balloons, laser excimer therapy and RA. The first one, has showed favorable safety profile and reached 92% of acceptable post‐dilatation luminal gain in a recent registry of 91 lesions .…”

Section: Discussionmentioning

confidence: 99%

“…Current available options to deal with underexpanded stents include: aggressive dilatation with super high‐pressure or cutting balloons, laser excimer therapy and RA. The first one, has showed favorable safety profile and reached 92% of acceptable post‐dilatation luminal gain in a recent registry of 91 lesions . Nevertheless, only 30% of the lesions were in context of stent optimization and in case of failure RA was used.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes of rotational atherectomy of underexpanded stents. A single center experience

Hernández-Enrı́quez

Campelo‐Parada

Lhermusier

et al. 2018

J Interven Cardiology

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ObjectivesTo analyze the procedural and long‐term outcomes of the use of rotational atherectomy (RA) in underexpanded stents in our cohort and to provide an overview of currently available data on this technique.BackgroundStent underexpansion (SU) has been related to stent thrombosis and restenosis. RA has been used to treat undilatable SU as a bail‐out strategy with encouraging results.MethodsThis is an observational, single‐center study. We included patients who underwent stentablation between 2013 and 2017. Baseline demographics, procedural results, in‐hospital major adverse cardiac events (MACE), and long‐term follow‐up MACE were retrospectively collected.ResultsA total of 11 patients (90.9% males, mean age 65.4 ± 18.6) were included in this study. Median left ventricle ejection fraction was 53.5% [46.2‐55]. Median calculated Syntax score was 16 [9‐31] and 45.5% of patients were admitted for acute coronary syndrome. Radial approach was used in 63.6% of cases. Most patients only required one burr (45% used a 1.5 mm diameter burr) during the intervention. Procedural success was achieved in 90.9% of the cases. Acute lumen gain was 42.7% [30.7‐61.49]. There were no in‐hospital deaths or MACE. At a median follow‐up of 26 months, only one patient (9.1%) suffered MACE in the context of acute coronary syndrome, and two patients (18.2%) required non‐target lesion revascularization. No deaths were reported.ConclusionsRA of under expanded stents is a feasible option with a high rate of procedural success. At long‐term follow‐up, all of them were alive and 90.9% of patients remained free from MACE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of rotational atherectomy of underexpanded stents. A single center experience

Hernández-Enrı́quez

Campelo‐Parada

Lhermusier

et al. 2018

J Interven Cardiology

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“…3 for a model experiment example of HPPD with a OPN NC balloon). Our group recently reported the safety and efficacy of OPN balloons for treatment with DES of highly resistant coronary lesions nonresponsive to conventional NC balloon inflation [24]. In devices highly sensitive to excessive volume expansion as BVS, a balloon that guarantees an extremely low growth even at 40 atm increases the safety of BVS optimization.…”

Section: Discussionmentioning

confidence: 99%

Is high pressure postdilation safe in bioresorbable vascular scaffolds? Optical coherence tomography observations after noncompliant balloons inflated at more than 24 atmospheres

Fabris

Caiazzo

Kılıç

et al. 2015

Cathet Cardio Intervent

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“…There is a lack of evidence if routine use of NCBs for lesion preparation improves stent expansion. In fact, the concept of high-pressure predilatation and postdilatation, meaning usage of inflation pressures of ≥20 atmospheres (atm), has only been propagated on the basis of case reports and case series 6–8…”

Section: Introductionmentioning

confidence: 99%

Performing percutaneous coronary interventions with predilatation using non-compliant balloons at high-pressure versus conventional semi-compliant balloons: insights from two randomised studies using optical coherence tomography

et al. 2020

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IntroductionStent underexpansion is a predictor of in-stent-restenosis and stent thrombosis. Semi-compliant balloons (SCBs) are generally used for lesion preparation. It remains unknown whether routine predilatation using non-compliant balloons (NCBs) improves stent expansion in ordinary coronary lesions.MethodsThe PREdilatation by high-pressure NC balloon catheter for better vessel preparation and Optimal lesion preparation with non-compliant balloons for the implantation of bioresorbable vascular scaffolds studies randomised patients presenting with stable coronary artery disease or non-ST-elevation myocardial infarction requiring stent implantation to lesion preparation using NCBs versus SCBs. Stent expansion index (SEI-minimal luminal area/mean luminal area on optical coherence tomography) and periprocedural complications were compared.ResultsWe enrolled 104 patients: 53 patients (54 lesions) vs 51 patients (56 lesions) to the NCB and SCB groups, respectively. Predilatation pressure was higher in the NCB group (24±7 atmospheres (atm) vs 14±3 atm, p<0.0001). Postdilatation using NCBs was performed in 41 (76%) lesions vs 46 (82%) lesions pretreated with NCBs versus SCBs (p=0.57). Similar pressures were used for postdilatation with NCB in both groups (23±8 atm vs 23±9 atm, p=0.65). SEI after stent implantation was 0.88±0.13 in the NCB vs 0.85±0.14 in the SCB group (p=0.18). After postdilatation, SEI increased to 0.94±0.13 in the NCB group vs 0.88±0.13 in the SCB group (p=0.02). No relevant complications occurred.ConclusionsIn simple coronary lesions, predilatation/postdilatation with NCBs at high pressures appears to result in better scaffold and stent expansion. Using SCBs only for predilatation might lead to inadequate stent expansion and postdilatation with NCBs might only partially correct this. Predilatation and postdilatation using NCBs at high pressure is safe.Trial registration numberClinicalTrials.gov no. NCT03518645.

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Very high-pressure dilatation for undilatable coronary lesions: indications and results with a new dedicated balloon

Abstract: When conventional NC balloons fail, the new OPN NC dedicated high-pressure balloon provides an effective and safe alternative strategy for the dilatation of resistant coronary lesions.

Cited by 91 publications

References 22 publications

Long‐term outcomes of rotational atherectomy of underexpanded stents. A single center experience

Long‐term outcomes of rotational atherectomy of underexpanded stents. A single center experience

Is high pressure postdilation safe in bioresorbable vascular scaffolds? Optical coherence tomography observations after noncompliant balloons inflated at more than 24 atmospheres

Performing percutaneous coronary interventions with predilatation using non-compliant balloons at high-pressure versus conventional semi-compliant balloons: insights from two randomised studies using optical coherence tomography

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