Aggressive plaque modification with rotational atherectomy and cutting balloon for optimal stent expansion in calcified lesions

Objective To evaluate the factors affecting optimal stentt expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy （RA） and a cutting balloon （CB）. Methods From January 2014 to May 2015, 92 patients with moderate to severe coronary calcified lesions underwent rotational atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital （Beijing, China） were included in this study, They were divided into a rotational artherectomy combined with cutting balloon （RACB） group （46 patients treated with RA followed by CB angioplasty） and an RA group （46 patients treated with RA followed by plain balloon angioplasty）. Another 40 patients with similar severity of their calcified lesions treated with plain old balloon angioplasty （POBA） were de- mographically matched to the other groups and defined as the POBA group. All patients received a drug-eluting stent after plaque prepara- tion. Lumen diameter and lumen diameter stenosis （LDS） were measured by quantitative coronary angiography at baseline, after RA, after dilatation, and after stenting. Optimal stent expansion was defined as the final LDS 〈 10%. Results The initial and post-RA LDS values were similar among the three groups. However, after dilatation, the LDS significantly decreased in the RACB group （from 54.5% ± 8.9% to 36.1%＋ 7.1%） but only moderately decreased （from 55.7% ± 7.8% to 46.9% ± 9.4%） in the RA group （time × group, P 〈 0.001）. After stenting, there was a higher rate of optimal stent expansion in the RACB group （71.7% in the RACB group, 54.5% in the RA group, and 15% in the POBA group, P 〈 0.001）, and the final LDS was significantly diminished in the RACB group compared to the other two groups （6.0% ± 2.3%, 10.8% ± 3.3%, 12.7% ± 2.1%, P 〈 0.001）. Moreover, an LDS 〈 40% after plaque preparation （OR = 2.994, 95% CI： 1.297-6.911） was associated with optimal stent expansion, which also had a positive correlation with the appearance of a calcified ring split （r = 0,581, P 〈 0.001）. Conclusions Aggressive plaque modification with RA and CB achieve more optimal stent expansion. An LDS ≤ 40% after plaque modification was a predictive factor for optimal stent expansion in calcified lesions. This parameter was also associated with the presence of calcified ring split.

Optimized strategy of rotational atherectomy of underexpanded coronary stents in patients with acute coronary syndrome

BACKGROUND:Stent under-expansion is a main cause of acute coronary syndrome(ACS),which can lead to serious clinical outcomes.The rotational atherectomy of underexpanded coronary stents(academically called stent ablation,SA)by intravascular ultrasound(IVUS)may provide more visual reference in the intervention.We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique.METHODS:A total of 11 patients with ACS who underwent SA between April 2017 and January 2019 were analyzed.Clinical follow-ups were obtained either by telephone call or by scheduled visit.Clinical end-points included periprocedural and postprocedural myocardial infarction,stent thrombosis,target lesion revascularization,and major adverse cardiac events.RESULTS:The mean age of patients was 69.6±6.5 years,and five(45.5%)patients were males.All cases presented with unstable angina and were admitted with ACS.All patients required at least two burrs during the intervention and the size of the burr was selected based on the data of minimum lumen diameter(MLD),and the fi rst and the second burr/stent MLD ratios were 0.93(0.88-0.99)and 1.09(1.02-1.14),respectively.Nine patients were treated with drug-eluting stents and two were treated with drug-coated balloons.There were no complications including no fl ow,perforation,or burr entrapment during the intervention.No in-hospital deaths or major adverse cardiac events were documented during the follow-up period.In our study,less contrast agent and a lower dose of radiation were used during the intervention.CONCLUSIONS:SA guided by IVUS can reduce the risk of complications,assess the results of surgery,inform the selection of stent size,and decrease the required dose of radiation and contrast.

Therapeutic effect of rotational atherectomy with implantation of drug eluting stent in heavily coronary calcified patients

Background Rotational atherectomy （RA） could facilitate the percutaneous coronary intervention （PCI） in heavily coronary calcified patients. The effectiveness and safety of this technique needs to be further evaluated. Methods ＆ Results Eighty patients who underwent RA in our center from September 2011 to June 2014 were enrolled. The mean age was 72.4 ± 10.4 years. The left ventricular ejection frac- tion （LVEF） was average 52.3% ± 8.48% and the estimated glomerular filtration rate was 73.2 ± 3.20 mL/min per 1.73 m2. The coronary lesions were complex, with Syntax score 29.5 ± 9.86. The diameter of reference vessel was 3.4 ± 0.45 mm and the average diameter stenosis of target vessels was 80% ~ 10%. All the patients were deployed with drug eluting stents （DES） successfully aiter RA. The patients were followed up for 12-18 months. Kaplan-Meier plots estimated the survival rate was 93.4% and the cumulative incidence of major adverse cardiac and cerebral events （MACCE） was 25.4%. Bleeding and procedural-related complications were quite low. COX proportional hazards model for multivariate analysis demonstrated that diabetes, LVEF and maximum pressure of postdilatation were the predictors of MACCE. Conclusions RA followed by implantation of DES was effective and safe for heavily coronary calcified patients. Diabetes, LVEF and maximum pressure ofpostdilatation were predictive for MACCE.

“One-man” bailout technique for high-speed rotational atherectomy——assisted percutaneous coronary intervention in an octogenarian

Heavily calcified coronary lesions continue to represent a challenge for percutaneous coronary intervention(PCI),as they are difficult to dilate,and it is difficult to deliver and implant drug-eluting stents(DES)properly.Poor stent deployment is associated with high rates of periprocedural complications and suboptimal long-term clinical outcomes.[1]Thanks to the introduction of several adjunctive PCI tools,like cutting and scoring balloons,and to the novel intravascular lithotripsy technology,the treatment of such lesions has become increasingly feasible,predictable and safe.

Complex coronary lesions and rotational atherectomy:one hospital's experience

Objective:To evaluate the safety and effectiveness of rotational atherectomy followed by drug eluting stent (DES) implantation in patients with complex coronary lesions. Methods:From August 2006 to August 2012, 253 consecutive patients with 289 lesions and who underwent rotational atherectomy in our center were enrolled in this study. Results:The overall procedure success rate was 98% with the cost of two (0.8%) coronary perforations, three (1.2%) dissections, five (2.0%) slow flows or no flows, three (1.2%) peri-procedure myocardial infarctions, and two (0.8%) in hospital deaths. During follow-up (mean three years), one (0.4%) patient died, two (0.8%) patients had acute myocardial infarction, 14 (5.5%) had restenosis, and target lesion revascularization occurred in eight patients (3.2%). Conclusions:Rotational atherectomy followed by DES implantation is a safe and effective technique for patients with complex coronary lesions, especially calcified and non-dilatable lesions.

Acute- and Long-term Outcomes of Rotational Atherectomy followed by Cutting Balloon versus Plain Balloon before Drug-Eluting Stent Implantation for Calcified Coronary Lesions

Background： Coronary calcification is a major determinant ofstent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy （RA） followed by cutting balloon （CB） versus plain balloon before drug-eluting stent implantation for calcified coronary lesions. Methods： From June April 2013 to March 2016, a total of 127 patients with moderately or severely calcified coronary lesions were treated with RA. Patients were divided into two groups according to the balloon type after RA： RA＋CB group （n = 75） and RA＋plain balloon group （n = 52）. Minimal lumen diameter and acute lumen gain were analyzed by quantitative coronary angiography. In-hospital and long-term （〉1 year） outcomes were recorded. Multivariate Cox regression analysis was performed to determine the independent predictors of in-stent restenosis.Results： The mean age of the patients was 65.5 years, and 76.4% were men. Total lesion length and minimal lumen diameter at baseline were similar in the two groups. After RA and balloon dilation, the lumen diameter was significantly larger in the RA＋CB group than in the RA＋plain balloon group （1.57 ±0.46 mm vs. 1.10 ± 0.40 mm, t = 4.123, P 〈 0.001）. The final lumen diameter was also larger in the RA＋CB group compared to that in the RA group （2.81± 0.41 mm vs. 2.60± 0.25 ram, t = 2.111, P = 0.039）. Moreover, patients receiving RA and CB tended to have larger final lumen gain （2.15 - 0.48 mm vs. 1.95 ± 0.47 mm, t = 1.542, P = 0.132）. Multivariate Cox regression analysis indicated that the strategy of RA＋CB was a significant protective factor against long-term （〉1 year） in-stent restenosis （hazard ratio： 0.136, 95% confidence interval： 0.020-0.936, P = 0.043）. Conclusions： In patients with moderately or severely calcified lesions, a strategy of RA followed by CB before stent implantation can increase lumen diameter and acute lumen gain. This strategy is safe with lower risk of long-term in-stent restenosis.

Transradial coronary rotational atherectomy using 5-French guiding catheters

Transradial coronary stenting using 5-French （5F） guiding catheters has been associated with a higher procedural success rate, a lower frequency of vascular access complications and is well tolerated, particularly in the subgroup of patients with small radial artery diameters.

Direct versus pre- dilated rotational atherectomy for treating calcified coronary lesions

Objective To compare the efficacy of direct and pre-dilated atherectomy(RA)for treating the patients with calcified coronary lesions.Methods A total of 137coronary artery disease(CAD)patients receiving RA treatment in our hospital from 2010-04 to 2014-09were retrospectively studied.The ischemic related

Performance of novel 3D printing tools in removing coronary-artery calcification tissue

Rotational atherectomy is an effective treatment for severe vascular calcification obstruction,and relies on high-speed grinding(typically 130,000–210,000 r/min)with miniature grinding tools to remove calcified tissue and restore blood flow.However,reports of intraoperative complications are common because of the grinding force,temperature,and debris directly acting on the body during the grinding process,which can easily cause damage to patients.In this study,three novel grinding tools were designed and fabricated and a series of experiments have been conducted to analyze the effects of tool geometry and parameters on grinding performance,that is,force,temperature,and specimen surface morphology.The results show that these tools can effectively remove simulated calcified tissue and that they have two motions,rotation and revolution,in the tube.At higher rotational speeds,grinding force and temperature increase noticeably,while the amount of debris decreases significantly.In addition,by observing the surface morphology of the specimens,we concluded that the material removal rate per unit time is influenced by both rotational speed and tool geometry,and that high rotational speed and a rough tool surface can improve the material removal rate efficiently.