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Judit Karacsonyi, Ehrin J Armstrong, Huu Tam D Truong, Ryan Tsuda, Damianos G Kokkinidis, Jose Roberto Martinez-Parachini, Aya J Alame, Barbara A Danek, Aris Karatasakis, Michele Roesle, Houman Khalili, Imre Ungi, Subhash Banerjee, Emmanouil S Brilakis, Bavana V Rangan
BACKGROUND: The contemporary use and outcomes of excimer laser coronary atherectomy (ELCA) in percutaneous coronary intervention (PCI) are not well described. METHODS: We examined the baseline clinical and angiographic characteristics and procedural outcomes of 130 target lesions in 121 consecutive PCIs (n = 116 patients) in which ELCA was performed at three United States Department of Veterans Affairs (VA) medical centers between 2008 and 2016. RESULTS: Mean age was 68...
March 15, 2018: Journal of Invasive Cardiology
Jun Shiraishi, Nariko Koshi, Yuki Matsubara, Tetsuro Nishimura, Akira Shikuma, Keisuke Shoji, Daisuke Ito, Masayoshi Kimura, Eigo Kishita, Yusuke Nakagawa, Masayuki Hyogo, Takahisa Sawada
BACKGROUND: Experiences of rotational atherectomy (RA) followed by drug-coated balloon (DCB) dilation alone (RA/DCB) for de novo coronary artery lesion have been limited. CASE SERIES: Case 1 (65 year-old male) with silent myocardial ischemia and hemodialysis had old anterior myocardial infarction and intact LM/LCx, and underwent RA/DCB against a diffuse calcified lesion in the proximal LAD and a tandem lesion in the proximal RCA. Case 2 (88 year-old female) with post-infarction unstable angina had severe thrombocytopenia and anemia due to myelodysplastic syndrome (platelet 6000/μL, hemoglobin 8...
February 12, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Asaad A Khan, George D Dangas
Several chronic total occlusions (CTOs) may be undilatable despite successful wire passage; several techniques can be used for lesion preparation, such as high-pressure balloon inflations, rotational atherectomy laser, cutting balloon, and scoring balloons. Presence of moderate to severe calcification and lesion length over 40 mm in association with comorbidities, such as diabetes mellitus and reduced ejection fraction, may contribute to making a CTO lesion undilatable. Still, appropriate therapy selection for a patient with CTO should be individualized and procedure safety attended to...
March 1, 2018: Catheterization and Cardiovascular Interventions
Hoyle L Whiteside, Supawat Ratanapo, Arun Nagabandi, Deepak Kapoor
INTRODUCTION: Elective insertion of a percutaneous circulatory assist device (PCAD) in high-risk patients is considered a reasonable adjunct to percutaneous coronary intervention (PCI). There is limited data examining the safety and efficacy of rotational atherectomy (RA) without hemodynamic support in patients with reduced left ventricular ejection fraction (LVEF). METHODS: We retrospectively identified 131 consecutive patients undergoing RA without elective PCAD over a three-year period...
February 9, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Abdullah Almasoud, Daniel Walters, Ehtisham Mahmud
The feasibility, safety, and high technical success of robotically assisted percutaneous coronary intervention (PCI) for the treatment of both simple and complex coronary disease has been demonstrated. As the current generation robotic platform is limited to a rapid exchange system, orbital or rotational atherectomy cannot be performed robotically. However, excimer laser coronary atherectomy is performed with a rapid exchange catheter but its feasibility during robotically assisted PCI is unknown. We report the successful use of laser atherectomy during two complex robotically assisted PCI procedures using the CorPath GRX robotic system...
March 9, 2018: Catheterization and Cardiovascular Interventions
Tae-Hoon Kim, Nelson Chavarria, Khagendra Dahal, Michael Azrin, Juyong Lee
Repeated restenotic events are common in superficial femoral artery and as of late, Viabahn stent grafts have been FDA (U.S. Food & Drug Administration) approved. Viabahn have been particularly attractive given that they provided a physical barrier for the development of neointimal hyperplasia. This particular feature however, also underscores one of the main limitations of the therapy; providing a physical barrier of collateral circulation and predisposing to acute limb ischemia. Viabahn endograft thrombosis is characterized by stent edge stenosis and endograft thrombosis...
December 25, 2017: Annals of Vascular Diseases
Tadayuki Uetani, Tetsuya Amano
No abstract text is available yet for this article.
March 8, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Damiano Regazzoli, Daisuke Hachinohe, Ozan M Demir, Mauro Carlino, Julien Lemoine, Satoru Mitomo, Enrico Poletti, Max Amor, Antonio Colombo, Lorenzo Azzalini
Candidates for percutaneous coronary revascularization are becoming progressively older and more complex. A combination of factors related to the patient, lesion, and/or hemodynamic conditions may increase the risk of adverse events. Therefore, when a high-risk procedure is identified, it is crucial to provide the patient with adequate support in order to safely perform percutaneous coronary intervention (PCI). We report the case of a 77-year-old man with moderate left ventricular dysfunction and stage IV chronic kidney disease who underwent successful recanalization of a chronically occluded left anterior descending artery...
February 7, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Jianming Guo, Lianrui Guo, Zhu Tong, Xixiang Gao, Zhonggao Wang, Yongquan Gu
BACKGROUND: Despite increased interest in treating common femoral artery (CFA) with endovascular technology, there is little data regarding the long-term outcomes of different endovascular treatment modalities. We report the results after endovascular therapy of symptomatic obstructions of the CFA in a single center. METHODS: We retrospectively reviewed the records of consecutive patients with eligible CFA lesions who were treated with endovascular methods between 2011 and 2013...
February 28, 2018: Annals of Vascular Surgery
Piotr Kübler, Wojciech Zimoch, Michał Kosowski, Brunon Tomasiewicz, Artur Telichowski, Krzysztof Reczuch
INTRODUCTION: Transfemoral approach (TFA) may be preferred access site in order to facilitate complex percutaneous procedures such as rotational atherectomy (RA). Notwithstanding, there is a growing evidence that transradial approach (TRA) is associated with lower access site complication rates and even lower mortality. The aim was to assess in-hospital and 1-year outcomes in patients undergoing RA using TRA, in comparison to TFA. METHODS: A single center observational study included all consecutive patients, who underwent RA from 2010 to 2015...
February 21, 2018: Journal of Interventional Cardiology
Rajkumar Doshi, Evan Shlofmitz, Perwaiz Meraj
Objective Percutaneous revascularization for patients with peripheral arterial disease has become a treatment of choice for many symptomatic patients. The presence of severe arterial calcification presents many challenges for successful revascularization. Atherectomy is an adjunctive treatment option for patients with severe calcification undergoing percutaneous intervention. We sought to analyze the impact of atherectomy on in-hospital outcomes, length of stay, and cost in the percutaneous treatment of peripheral arterial disease...
January 1, 2018: Vascular
Kei Yamamoto, Kenichi Sakakura, Yousuke Taniguchi, Yoshimasa Tsurumaki, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
Because rotational atherectomy (RA) has several unique complications, such as burr entrapment, vessel perforation, and slow flow, it is important for interventional cardiologists to be familiar with bailout procedures for such complications. The principal part of bailout procedures is to keep a guidewire in the target coronary artery during the procedure. However, it is not easy to keep a guidewire in the same position during the removal of a burr because the length of the RA guidewires is 300 cm, and the removal of a burr requires collaboration between the primary operator and an assistant...
February 20, 2018: International Heart Journal
Jin-Woo Kim, You-Hong Lee, Jae-Hyeong Park, Jae-Hwan Lee
Stentablation by rotational atherectomy has been reported as an option to correct underexpanded stents. Due to concerns of excessive stent damage, distal embolization of metal particles, excessive heat generation, and burr entrapment in the stent, stentablation has been considered the last choice to manage underexpanded stents. Here, we report a case of a stuck and entrapped atherectomy burr inside an underexpanded and undilatable stent, which made withdrawal of therotablation burr during rotational atherectomy difficult...
February 20, 2018: International Heart Journal
Michael S Lee, Richard A Shlofmitz, Evan Shlofmitz, Pratyaksh K Srivastava, Jeremy Kong, Cindy Grines, George Revytak, Jeffrey W Chambers
OBJECTIVES: We assessed the safety and efficacy of orbital atherectomy to modify severely calcified coronary plaque prior to stent implantation in patients with small vessel (2.5mm) disease. BACKGROUND: Severe coronary artery calcification increases the risk of adverse clinical events during percutaneous coronary intervention (PCI). Patients who undergo PCI of small vessels have worse clinical outcomes including higher rates of perforation and dissection. The outcomes of orbital atherectomy of small diameter vessels (2...
October 3, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Michael S Lee, Richard A Shlofmitz, Brad J Martinsen, Sanjum Sethi, Jeffrey W Chambers
OBJECTIVES: We investigated the safety and efficacy of coronary orbital atherectomy to treat severely calcified lesions prior to stenting based upon age. BACKGROUND: The ORBIT II study reported the safety and efficacy with orbital atherectomy in 443 patients with severely calcified lesions. Elderly patients undergoing percutaneous coronary intervention may be at increased risk for major adverse cardiac events (MACE) and death compared with younger patients. METHODS: Patients were stratified according to age (≥75 year old [174/443, 39...
January 31, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Edward Koifman, Hector M Garcia-Garcia, Kayode O Kuku, Alexandre H Kajita, Kyle D Buchanan, Arie Steinvil, Toby Rogers, Nelson L Bernardo, Robert Lager, Robert A Gallino, Itsik Ben-Dor, Augusto D Pichard, Rebecca Torguson, Jiaxiang Gai, Lowell F Satler, Ron Waksman
We aimed to compare the safety and efficacy of rotational atherectomy (RA) and orbital atherectomy (OA) during percutaneous coronary intervention in an all-comer population with severely calcified lesions. We included all patients who underwent percutaneous coronary intervention with OA or RA in our institution from October 2013 until October 2016. Comparison of baseline and procedural characteristics, along with acute complication rates and postprocedural cardiac enzyme elevation, was performed. There were 191 RA and 57 OA patients...
February 13, 2018: American Journal of Cardiology
Daoyuan Si, Guohui Liu, Yaliang Tong, Yuquan He
RATIONALE: Inadequate stent expansion due to rigid calcified may result in restenosis lesions, but the available options are limited. PATIENT CONCERNS: We report a case via the trans-radial approach of the severely underexpanded freshly deployed stent due to heavily calcified plaques DIAGNOSES:: Coronary angiography revealed that there was no adequate expansion of the freshly deployed stent. INTERVENTIONS: Under the guide of intravascular ultrasound (IVUS), rotational atherectomy (RA) successfully ablated the stent layers and the protruding calcified plaque...
February 2018: Medicine (Baltimore)
Michael Megaly, Yader Sandoval, Matthew P Lillyblad, Emmanouil S Brilakis
BACKGROUND: Coronary atherectomy, orbital or rotational, is frequently used for plaque modification in patients with heavily calcified lesions. Atherectomy can be associated with clinically significant bradyarrhythmias or transient atrioventricular block requiring temporary pacemaker insertion, mainly in lesions involving the right coronary artery or a dominant left circumflex artery. Bradyarrhythmias may be mediated by endogenous release of adenosine from red blood cell breakdown. Aminophylline, an adenosine antagonist, can prevent adenosine-mediated bradyarrhythmias...
February 15, 2018: Journal of Invasive Cardiology
Mario Iannaccone, Salvatore Colangelo, Carlo Di Mario, Roberto Garbo
No abstract text is available yet for this article.
February 13, 2018: EuroIntervention
Stewart M Benton, Gautam Kumar
No abstract text is available yet for this article.
February 2018: Journal of Interventional Cardiology
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