Five-Year Clinical Outcomes After Drug-Eluting Stent Implantation Following Rotational Atherectomy for Heavily Calcified Lesions

Jinnouchi, Hiroyuki; Kuramitsu, Shoichi; Shinozaki, Tomohiro; Takahashi, Hiromasa; Kobayashi, Yohei; Takeji, Yasuaki; Miura, Mizuki; Masuda, Hisaki; Matsumura, Yuichi; Yamaji, Yuhei; Sakakura, Kenichi; Domei, Takenori; Soga, Yoshimitsu; Hyodo, Makoto; Shirai, Shinichi; Ando, Koji

doi:10.1253/circj.cj-17-0564

Cited by 20 publications

(16 citation statements)

References 28 publications

(17 reference statements)

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“…For clinically similar variables, we selected the variable that we considered to be more clinically relevant. Basing on the literature [13,18] and clinically relevance, 13 candidate variables including demographic characteristics (age), life behavior (current smoker), medical situation (hypertension, diabetes, hyperlipidemia, hemodialysis, and left ventricular ejection fraction (LVEF)), lesion characteristics (reference vessel diameter and lesion length), and treatment (PCI strategy, maximum burr/artery ratio, and minimal lumen diameter (MLD) after PCI and statin used) were screened for independent risk factors for MACE and TLR within 2 years in univariate regression. Variables with P < 0.10 in univariate Cox models were entered into a multivariable Cox model.…”

Section: Discussionmentioning

confidence: 99%

“…However, the volume of RA was reported to vary widely in these two decades and between individual centers, ranging from 0.6%-20% [10,11]. In addition, the use of RA showed a trend of progressive decline due to the advent of the DES, the disappointingly high restenosis rate, and lack of impact on major adverse cardiac events (MACE) [12,13]. In fact, these studies mainly investigated the effect of RA in patients with low or moderate risk [8,14], including relatively young age (median 70 years) and less complex lesions (50-90%).…”

Section: Introductionmentioning

confidence: 99%

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Reappraisal Value of a Modified Rotational Atherectomy Technique in Contemporary Coronary Angioplasty Era

Dong

Hachinohe

Nie

et al. 2020

Journal of Interventional Cardiology

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Objectives. To introduce a modified rotational atherectomy (RA) procedure and investigate the early and midterm outcomes of the RA-facilitating diversified percutaneous coronary intervention (PCI) in a large group of aged patients with higher cardiovascular risk. Background. Previous studies about the outcomes of RA were limited with small sample size and low-risk population. Methods. Between January 2013 and November 2015, 1169 consecutive patients treated with modified RA-facilitated PCI were retrospectively enrolled, including de novo calcified lesions and in-stent restenosis. Patients were regularly followed up for at least 1 year. Major adverse cardiac events (MACE) were analyzed for all participants by different strategies. Cox regression analysis was performed to identify risk factors for the events. Results. The median age of patients was 75 years, with 11.7% of patients on maintenance hemodialysis. Most lesions (99.9%) were complex (American Heart Association type B2/C), and 68.3% were treated with RA + drug-eluting-stent (DES). Successful angiography was achieved in 97.8% cases, with 1.7% (20/1169) experiencing coronary perforation (including guidewire perforation). The incidence of MACE was 20.5% and 26.8% at 1-year and 2-year follow-up and were mainly driven by target lesion revascularization (TLR) (10.3% and 12.5%, respectively). The strategy of RA + DES had the lowest 2-year MACE, compared with the RA + drug-coated balloon and RA + plain old balloon angioplasty (14.5%, 30.5%, and 26.0%, respectively). Conclusions. The modified RA technique is a safe and effective tool in the contemporary PCI era, even in high-risk patients. The TLR rate was relatively high but acceptable in such complex lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reappraisal Value of a Modified Rotational Atherectomy Technique in Contemporary Coronary Angioplasty Era

Dong

Hachinohe

Nie

et al. 2020

Journal of Interventional Cardiology

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“…Although second-generation DES have been shown to signi cantly reduce the rate of target-vessel revascularization in large coronary arteries, the BASKET-PROVE study did not, however, identify a signi cant difference between in the rate of death or myocardial infarction between DES and BMS [12]. Of note, while the e cacy and safety of DES has been demonstrated in small-diameter vessels with heavily calci ed lesions, following ROTA [12,21], our study further demonstrates an angiographic success rate > 99% for the ROTA + DES strategy in heavily calci ed large vessels, with the rate of TLR also be acceptably low at 5.3%. Furthermore, regarding hemorrhagic tendency or medication non-adherence may lead physicians to choose a stent-less strategy, since DES requires a longer duration of dual antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 96%

Should We Still Do Plain Old Balloon Angioplasty following Rotational Atherectomy in Drug-Eluting Stent Era?

Dong¹,

Hachinohe²,

Zhiqiang³

et al. 2020

Preprint

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Background Drug-eluting stent (DES) is well known effective in severely calcified lesion after rotational atherectomy (ROTA). However, there are still some situations when metal stents should be avoided and plain old balloon angioplasty (POBA) emerges as the preferred option. The aim of present study is to explore that whether POBA is comparably effective to DES in large and calcified coronary pretreated by ROTA in clinical outcomes. Methods A retrospective analysis of consecutive patients treated for severely calcified lesions in large (≥ 3 mm) coronary using ROTA + DES or ROTA + POBA was performed. Major adverse cardiac events (MACE) including all cause/cardiac death and target lesion revascularization (TLR) at 1- and 2-year post-treatment, were compared between groups, with Cox regression analyses to identify independent predictors of TLR and MACE. Results The analysis included 285 cases in the ROTA + DES and 47 in the ROTA + POBA group, while no relevant between-group differences in clinical baseline characteristics were found. Of note, lesion length was greater in the ROTA + DES group (37.2 mm versus 19.3 mm, p < 0.001), with 8.4% lesions being chronic total occlusion in this group, but none in the ROTA + POBA group. The in-hospital/30-day mortality rate (5.3%, DES, and 6.4%, POBA), as well as the 12- and 24-month all-cause/cardiac mortality rate (9.3% and 7.7%, respectively) were not significantly different between groups. TLR rates were not significantly different between groups at 12-month (4.6%, DES, and 4.3%, POBA) and 24-month (5.3%, DES and 6.4%, POBA) respectively. Conclusions Outcomes were comparable for ROTA + DES and + POBA in severely calcified large coronary arteries intervention, with respect to mid-term death or TLR rate, especially for short lesion < 20 mm.

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“…Additionally, those risk factors interact with each other and contribute to periprocedural MI. Patients who require rotational atherectomy during the procedure usually have multiple risk factors of peri-procedural MI (2). These patients are more likely to be high age, and have the atherosclerotic risk factors (DM, hypertension and hyperlipidemia) and renal dysfunction (2).…”

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confidence: 99%

Peri-procedural myocardial infarction is all the same?

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Five-Year Clinical Outcomes After Drug-Eluting Stent Implantation Following Rotational Atherectomy for Heavily Calcified Lesions

Cited by 20 publications

References 28 publications

Reappraisal Value of a Modified Rotational Atherectomy Technique in Contemporary Coronary Angioplasty Era

Reappraisal Value of a Modified Rotational Atherectomy Technique in Contemporary Coronary Angioplasty Era

Should We Still Do Plain Old Balloon Angioplasty following Rotational Atherectomy in Drug-Eluting Stent Era?

Peri-procedural myocardial infarction is all the same?

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