An algorithmic approach to balloon undilatable coronary lesions

Rempakos, Athanasios; Kostantinis, Spyridon; Şimşek, Bahadir; Karácsonyi, Judit; Allana, Salman; Egred, Mohaned; Jneid, Hani; Mashayekhi, Kambis; Mario, Carlo Di; Krestyaninov, Oleg; Khelimskii, Dmitrii; Μιλκασ, Αναστασιοσ; Sandoval, Yader; Burke, M. Nicholas; Brilakis, Emmanouil S.

doi:10.1002/ccd.30531

Cited by 5 publications

(3 citation statements)

References 37 publications

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“…This is a complex maneuver that requires experience in CTO dissection and re-entry techniques. Furthermore, there is a higher risk of perforation and extraplaque hematoma formation [ 116 ].…”

Section: Balloon Assisted Subintimal Entry Technique (Base)mentioning

confidence: 99%

Coronary calcifications, the Achilles heel in coronary interventions

Dawood,

Elwany,

Abdelgawad

et al. 2024

pwki

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Percutaneous coronary intervention in severely calcified coronaries has been associated with higher rates of procedural complications, including myocardial infarction and death in addition to increased frequency of coronary revascularization on an intermediate and long-term basis. The SYNTAX score, which is designed to assess the complexity of coronary artery disease and aids in choosing a revascularization method, allocates two points per lesion when there is heavy calcification present on fluoroscopy. With the advent of novel multimodality imaging technologies, the detection and evaluation of coronary calcifications improved significantly over the last decade. Several tools are now available for modifying calcified lesions including different types of dedicated balloons and atherectomy devices, which may create some degree of confusion regarding the suitable application of each instrument. The aim of this review is to cover this vital topic from different aspects. First, we tried to provide an overview on the pathophysiology and types of coronary calcification and its risk factors. Then, we outlined the available imaging modalities for the evaluation of calcified coronary lesions, highlighting the points of strength and weakness of each of them. A comprehensive discussion of calcium-modifying techniques was elaborated, summarizing their mechanism of action, pros and cons, and possible complications. Finally, an integrated algorithm was proposed for the best management of calcified coronary lesions.

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Section: Balloon Assisted Subintimal Entry Technique (Base)mentioning

confidence: 99%

Coronary calcifications, the Achilles heel in coronary interventions

Dawood,

Elwany,

Abdelgawad

et al. 2024

pwki

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“…The algorithm in Figure 6 was created from review of previously published calcium management schemes, 37,[71][72][73][74][75] as well as the literature in the current article. Figure 6 emphasizes the importance of first attempting balloon dilation of the calcified stenosis with highpressure balloons to determine if plaque modification is required as assessed by intravascular imaging scoring systems.…”

Section: Best Practices To Incorporate Ivl Into Calcium Managementmentioning

confidence: 99%

Review of intravascular lithotripsy for treating coronary, peripheral artery, and valve calcifications

Gruslova,

Inanc,

Cilingiroglu

et al. 2023

Cathet Cardio Intervent

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Management of intracoronary calcium (ICC) continues to be a challenge for interventional cardiologists. There have been significant advances in calcium treatment devices. However, there still exists a knowledge gap regarding which devices to choose for the treatment of ICC. The purpose of this manuscript is to review the principles of intravascular lithotripsy (IVL) and clinical data. The technique of IVL will then be compared to alternative calcium treatment devices. Clinical data will be reviewed concerning the treatment of coronary, peripheral artery and valvular calcifications. Controversies to be discussed include how to incorporate IVL into your practice, what is the best approach for treating calcium subtypes, how to approach under‐expanded stents, what is the ideal technique for performing IVL, how safe is IVL, whether imaging adds value when performing IVL, and how IVL fits into a treatment program for peripheral arteries and calcified valves.

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“…A high-pressure balloon, delivering 24 to 36 Pa of dilatation pressure, can mechanically disrupt the dense fibrous tissue in the stenotic segment, thus enhancing the success rate of percutaneous balloon dilatation angioplasty in treating these lesions. Studies have suggested that the patency rate of high-pressure balloon treatment for refractory arteriovenous fistula stenosis is approximately 39% to 43% six months after surgery [ 12 , 13 ]. High-pressure balloons have been widely applied for the treatment of refractory arteriovenous fistula stenosis [ 14 ]; however, whether to use a high-pressure balloon or a cutting balloon for patients with stenosis of the internal arteriovenous fistula remains controversial [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of cutting balloon angioplasty versus high-pressure balloon angioplasty for the treatment of arteriovenous fistula stenoses in patients undergoing hemodialysis: Systematic review and meta-analysis

Pang,

Chang,

Chang

et al. 2024

PLoS ONE

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This systematic review and meta-analysis aimed to assess and compare the therapeutic outcomes of cutting balloon angioplasty and high-pressure balloon angioplasty for arteriovenous fistula stenosis in hemodialysis patients. All studies indexed in PubMed, Embase, and Cochrane Library Web of Science were retrieved. The retrieval deadline was July 15, 2023. Risk of bias 2.0 was used to evaluate the quality of the included studies. Revman 5.4 software was used for data analysis. This review included three studies and 180 patients, with 90 patients in the cutting balloon angioplasty group and 90 patients in the high-pressure balloon angioplasty group. The results of the meta-analysis suggested that compared with high-pressure balloon angioplasty, cutting balloon angioplasty can improve primary lesion patency rates of internal arteriovenous fistulas at 6 months (relative risk, 1.45; 95% confidence interval, 1.08–1.96; P = 0.01). However, there were no significant differences between the technical success rate (relative risk, 0.99; 95% confidence interval, 0.93–1.05; P = 0.72) and clinical success rate (relative risk, 1.01; 95% confidence interval, 0.95–1.07; P = 0.73). Therefore, cutting balloon angioplasty is likely to increase primary lesion patency rates at 6 months. However, more high-quality, large-sample, multicenter, randomized controlled trials are needed for further validation due to the limited number of included studies.

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An algorithmic approach to balloon undilatable coronary lesions

Cited by 5 publications

References 37 publications

Coronary calcifications, the Achilles heel in coronary interventions

Coronary calcifications, the Achilles heel in coronary interventions

Review of intravascular lithotripsy for treating coronary, peripheral artery, and valve calcifications

Efficacy of cutting balloon angioplasty versus high-pressure balloon angioplasty for the treatment of arteriovenous fistula stenoses in patients undergoing hemodialysis: Systematic review and meta-analysis

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