11 results on '"Calcified coronary lesions"'
Search Results
2. Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials.
- Author
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Allali A, Abdel-Wahab M, Elbasha K, Mankerious N, Traboulsi H, Kastrati A, El-Mawardy M, Hemetsberger R, Sulimov DS, Neumann FJ, Toelg R, and Richardt G
- Subjects
- Humans, Coronary Angiography methods, Treatment Outcome, Randomized Controlled Trials as Topic, Retrospective Studies, Atherectomy, Coronary methods, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Vascular Calcification diagnosis, Vascular Calcification surgery, Drug-Eluting Stents
- Abstract
With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE-CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions., (© 2022. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
3. "RotaTripsy": Combination of Rotational Atherectomy and Intravascular Lithotripsy in Heavily Calcified Coronary Lesions: A Case Series.
- Author
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Gonzálvez-García A, Jiménez-Valero S, Galeote G, Moreno R, López de Sá E, and Jurado-Román A
- Subjects
- Coronary Angiography, Humans, Treatment Outcome, Atherectomy, Coronary, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Lithotripsy, Percutaneous Coronary Intervention adverse effects, Vascular Calcification diagnostic imaging, Vascular Calcification therapy
- Abstract
Heavily calcified coronary lesions increase the complexity of percutaneous coronary interventions (PCI) and represent a challenge for interventional cardiologists. They are an important cause of stent underexpansion and poor clinical outcome. Nowadays, there are different dedicated devices which enhance the chances of success. Rotational atherectomy is the first-line modality which permits to cross balloons or stents through severe calcified lesions. However, when circumferential deep calcium plaques exist may not be enough to achieve adequate expansion of these devices. In these cases, the complementary use of intracoronary lithotripsy ("RotaTripsy") can be an effective approach that further modifies the calcified plaque and enables optimal stent implantation. We present the first case series undergoing PCI using "RotaTripsy" technique., Competing Interests: Declaration of competing interest Nothing to declare., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
4. Impact of chronic total occlusion lesions on clinical outcomes in patients receiving rotational atherectomy: results from the ROCK registry.
- Author
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Lee SN, Her SH, Jang WY, Moon D, Moon KW, Yoo KD, Lee K, Choi IJ, Lee JH, Lee JH, Lee SR, Lee SW, Yun KH, and Lee HJ
- Subjects
- Chronic Disease, Coronary Angiography, Humans, Registries, Risk Factors, Treatment Outcome, Atherectomy, Coronary adverse effects, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Coronary Occlusion diagnosis, Coronary Occlusion surgery, Percutaneous Coronary Intervention
- Abstract
The aim of this study was to investigate the impact of chronic total occlusion (CTO) on clinical outcomes in patients with calcified coronary lesions receiving rotational atherectomy (RA). This multi-center registry enrolled consecutive patients with calcified coronary artery disease who underwent RA during percutaneous coronary intervention (PCI) from 9 tertiary centers in Korea between January 2010 and October 2019. The primary outcome was target-vessel failure (TVF) which included the composite of cardiac death, target-vessel myocardial infarction (TVMI), and target-vessel revascularization (TVR). A total of 583 lesions were enrolled in this registry and classified as CTO (n = 42 lesions, 7.2%) and non-CTO (n = 541 lesions, 92.8%). The CTO group consisted of younger patients who were more likely to have a history of previous percutaneous coronary intervention or coronary artery bypass graft surgery. The incidence of the primary outcome was 14.1% and 16.7% for the non-CTO group and CTO group, respectively. The primary outcomes observed in the two groups were not significantly different (log-rank p = 0.736). The 18-month clinical outcomes of the CTO group were comparable to those of the non-CTO group in multivariate analysis. About 7% of patients requiring RA have CTO lesions and these patients experience similar clinical outcomes compared with those having non-CTO lesions. Use of RA for CTO lesions was safe despite higher procedural complexity., (© 2021. Springer Japan KK, part of Springer Nature.)
- Published
- 2021
- Full Text
- View/download PDF
5. Stent underexpansion due to heavy coronary calcification resistant to rotational atherectomy: A case for coronary lithoplasty?
- Author
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Tovar Forero MN, Van Mieghem NM, and Daemen J
- Subjects
- Aged, 80 and over, Coronary Artery Disease diagnostic imaging, Humans, Male, Severity of Illness Index, Treatment Outcome, Vascular Calcification diagnostic imaging, Angioplasty, Balloon, Coronary instrumentation, Atherectomy, Coronary, Coronary Artery Disease therapy, Lithotripsy, Stents, Vascular Calcification therapy
- Abstract
Stent underexpansion is frequently observed in calcified coronary lesions and increases the risk of future adverse cardiac events. Current plaquemodification techniques might not be suitable when calcium deposition is circumferential and deep inside the vessel wall. We report a case during which coronary lithoplasty was used as an adjuvant therapy to improve severe stent underexpansion after failed atherectomy and high-pressure non-compliant balloon dilatations., (© 2019 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals, Inc.)
- Published
- 2020
- Full Text
- View/download PDF
6. Rational use of rotational atherectomy in calcified lesions in the drug-eluting stent era: Review of the evidence and current practice.
- Author
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Tian W, Lhermusier T, Minha S, and Waksman R
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- Angioplasty, Balloon, Coronary adverse effects, Atherectomy, Coronary adverse effects, Coronary Angiography methods, Coronary Artery Disease diagnostic imaging, Coronary Restenosis diagnostic imaging, Coronary Restenosis epidemiology, Coronary Restenosis therapy, Evidence-Based Medicine, Female, Follow-Up Studies, Humans, Male, Randomized Controlled Trials as Topic, Risk Assessment, Survival Rate, Time Factors, Treatment Outcome, Vascular Calcification diagnostic imaging, Vascular Calcification mortality, Angioplasty, Balloon, Coronary methods, Atherectomy, Coronary methods, Coronary Artery Disease therapy, Drug-Eluting Stents, Vascular Calcification therapy
- Abstract
Percutaneous coronary interventions of calcified coronary lesions are associated with worse clinical outcomes compared with noncalcified lesions and are still considered a technical challenge for interventional cardiologists. Rotational atherectomy (RA) can effectively optimize lesion preparation through plaque modification of heavily calcified coronary lesions. However, in conventional balloon angioplasty and bare metal stent eras, the use of RA was not associated with a significant improvement in restenosis and target lesion revascularization in patients with calcified lesions. Drug-eluting stents (DES) dramatically reduced the rates of restenosis and major adverse cardiac events. In the DES era, the need for RA is therefore questionable. Recently, some studies have reported clinical outcomes of patients with calcified lesions treated with DES and RA. In this article, we aim to critically review results from these randomized and observational clinical studies assessing the use of RA in the DES era., (Copyright © 2015. Published by Elsevier Inc.)
- Published
- 2015
- Full Text
- View/download PDF
7. Is There an Advantage of Ultrathin-Strut Drug-Eluting Stents over Second- and Third-Generation Drug-Eluting Stents?
- Author
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Gherasie, Flavius-Alexandru, Valentin, Chioncel, and Busnatu, Stefan-Sebastian
- Subjects
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PRASUGREL , *SURGICAL stents , *ST elevation myocardial infarction , *PERCUTANEOUS coronary intervention , *DRUG coatings , *DELAYED hypersensitivity , *KOUNIS syndrome - Abstract
In patients undergoing percutaneous coronary intervention, the second-generation drug-eluting stents (DES) are considered the gold standard of care for revascularization. By reducing neointimal hyperplasia, drug-eluting coronary stents decrease the need for repeat revascularizations compared with conventional coronary stents without an antiproliferative drug coating. It is important to note that early-generation DESs were associated with an increased risk of very late stent thrombosis, most likely due to delayed endothelialization or a delayed hypersensitivity reaction to the polymer. Studies have shown a lower risk of very late stent thrombosis with developing second-generation DESs with biocompatible and biodegradable polymers or without polymers altogether. In addition, research has indicated that thinner struts are associated with a reduced risk of intrastent restenosis and angiographic and clinical results. A DES with ultrathin struts (strut thickness of 70 µm) is more flexible, facilitates better tracking, and is more crossable than a conventional second-generation DES. The question is whether ultrathin eluting drug stents suit all kinds of lesions. Several authors have reported that improved coverage with less thrombus protrusion reduced the risk of distal embolization in patients with ST-elevation myocardial infarction (STEMI). Others have described that an ultrathin stent might recoil due to low radial strength. This could lead to residual stenosis and repeated revascularization of the artery. In CTO patients, the ultrathin stent failed to prove non-inferiority regarding in-segment late lumen loss and showed statistically higher rates of restenosis. Ultrathin-strut DESs with biodegradable polymers have limitations when treating calcified (or ostial) lesions and CTOs. However, they also possess certain advantages regarding deliverability (tight stenosis, tortuous lesions, high angulation, etc.), ease of use in bifurcation lesions, better endothelialization and vascular healing, and reducing stent thrombosis risk. In light of this, ultrathin-strut stents present a promising alternative to existing DESs of the second and third generation. The aims of the study are to compare ultrathin eluting stents with second- and third-generation conventional stents regarding procedural performance and outcomes based on different lesion types and specific populations. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
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8. Intravascular lithotripsy to treat an underexpanded coronary stent during index procedure: A case report study
- Author
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Sherif Seif, Abhishek Kumar, Sanjay Arya, and Vellore J. Karthikeyan
- Subjects
calcified coronary lesions ,complication ,coronary artery disease ,intravascular lithotripsy ,percutaneous coronary intervention ,stent underexpansion ,stents ,Medicine - Abstract
Management of heavily calcified lesions during percutaneous coronary intervention (PCI) is often associated with high incidence of complications and long-term adverse outcomes. There is growing evidence of the efficacy of intravascular lithotripsy (IVL) in de novo coronary lesion preparation; however, little experience has been documented within freshly deployed stent underexpansion. We report a 66-year-old male with a marked stent underexpansion despite extensive lesion preparation due to severe underlying calcification. The stent was resistant to balloon postdilatation; therefore, IVL was applied, resulting in excellent stent expansion. IVL could be considered for treating acute stent underexpansion caused by severe underlying calcification.
- Published
- 2021
- Full Text
- View/download PDF
9. Intravascular lithotripsy to treat an underexpanded coronary stent during index procedure: A case report study
- Author
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Sanjay Arya, Sherif Seif, Abhishek Kumar, and Vellore J Karthikeyan
- Subjects
intravascular lithotripsy ,medicine.medical_specialty ,medicine.medical_treatment ,stent underexpansion ,Calcified coronary lesions ,Case Report ,complication ,030204 cardiovascular system & hematology ,Lithotripsy ,Balloon ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Coronary stent ,medicine ,030212 general & internal medicine ,cardiovascular diseases ,business.industry ,percutaneous coronary intervention ,Stent ,Percutaneous coronary intervention ,medicine.disease ,equipment and supplies ,surgical procedures, operative ,stents ,Conventional PCI ,Medicine ,Radiology ,business ,coronary artery disease ,Calcification - Abstract
Management of heavily calcified lesions during percutaneous coronary intervention (PCI) is often associated with high incidence of complications and long-term adverse outcomes. There is growing evidence of the efficacy of intravascular lithotripsy (IVL) in de novo coronary lesion preparation; however, little experience has been documented within freshly deployed stent underexpansion. We report a 66-year-old male with a marked stent underexpansion despite extensive lesion preparation due to severe underlying calcification. The stent was resistant to balloon postdilatation; therefore, IVL was applied, resulting in excellent stent expansion. IVL could be considered for treating acute stent underexpansion caused by severe underlying calcification.
- Published
- 2021
10. Stent underexpansion due to heavy coronary calcification resistant to rotational atherectomy: A case for coronary lithoplasty?
- Author
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Nicolas M. Van Mieghem, Maria Natalia Tovar Forero, Joost Daemen, and Cardiology
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,calcified coronary lesions ,stent expansion ,plaque modification ,Case Reports ,030204 cardiovascular system & hematology ,Rotational atherectomy ,Balloon ,coronary lithoplasty ,Calcium deposition ,Atherectomy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Adjuvant therapy ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,business.industry ,Stent ,General Medicine ,Coronary artery calcification ,shockwave balloon ,Cardiology ,CORONARY ARTERY DISEASE ,Cardiology and Cardiovascular Medicine ,business - Abstract
Stent underexpansion is frequently observed in calcified coronary lesions and increases the risk of future adverse cardiac events. Current plaquemodification techniques might not be suitable when calcium deposition is circumferential and deep inside the vessel wall. We report a case during which coronary lithoplasty was used as an adjuvant therapy to improve severe stent underexpansion after failed atherectomy and high‐pressure non‐compliant balloon dilatations.
- Published
- 2020
11. L’utilizzo delle tecniche di Aterectomia e Litotrissia per il trattamento di lesioni coronariche calcifiche: risultati intraprocedurali e a distanza in due centri ad alto volume
- Author
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Vizzari, Giampiero
- Subjects
intravascular lithotripsy ,calcific atherosclerosis ,cardiology ,calcified coronary lesions ,percutaneous coronary intervention ,Settore MED/11 - Malattie dell'Apparato Cardiovascolare ,coronary artery disease ,rotational atherectomy - Published
- 2019
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