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.

“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.

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.