Intravascular ultrasound enhances the safety of rotational atherectomy

Sakakura, Kenichi; Yamamoto, Kei; Taniguchi, Yousuke; Tsurumaki, Yoshimasa; Momomura, Shin‐ichi; Fujita, Hideo

doi:10.1016/j.carrev.2017.09.012

Cited by 33 publications

(28 citation statements)

References 24 publications

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“…Second, our results may be useful for establishing an educational program for junior RA operators. Because many literatures regarding RA and imaging devices have been published 1,[3][4][5][6][7][8][9][10] , even junior RA operators may be able to select an appropriate burr size, RotaWire, and RA strategy as long as an imaging device can cross the lesion before RA. However, as we shown here, there were many lesions that an IVUS catheter cannot cross, and the incidence of slow flow was greater in IVUS-uncrossable lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, many groups rigorously published research articles regarding RA with intravascular imaging devices 3 , 4 , 6 – 9 . Moreover, several review articles explain the interpretation of intravascular imaging findings in RA to facilitate use of imaging devices in RA 1 , 5 , 10 . However, there are few literatures focusing on the situation when an intravascular imaging device could not cross the severely calcified lesion before RA.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, intravascular imaging devices have been frequently used in current PCI with RA 7 – 9 . Moreover, the intravascular imaging may be helpful in the selection of initial burr sizes or RotaWires (BOSTON SCIENTIFIC, Marlborough, MA, USA), especially for operators with insufficient experiences in RA 10 .…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the incidence of slow flow after rotational atherectomy with IVUS-crossable versus IVUS-uncrossable calcified lesions

Sakakura

Taniguchi

Yamamoto

et al. 2020

Sci Rep

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Although the usefulness of intravascular ultrasound (iVUS) in rotational atherectomy (RA) has been widely recognized, an IVUS catheter may not cross the target lesion because of severe calcification. The aim of this study was to compare the incidence of slow flow following RA between IVUS-crossable versus IVUS-uncrossable calcified lesions. We included 284 RA lesions, and divided into an IVUScrossable group (n = 150) and an IVUS-uncrossable group (n = 134). The primary endpoint was slow flow just after RA. The incidence of slow flow (TIMI flow grade ≤ 2) was significantly greater in the IVUS-uncrossable group than in the IVUS-crossable group (26.1% vs. 10.7%, p = 0.001). The incidence of severe slow flow (TIMI grade ≤ 1) was also greater in the IVUS-uncrossable group than in the IVUS-crossable group (9.7% vs. 2.7%, p = 0.022). The multivariate logistic regression model showed a significant association between slow flow and pre-IVUS uncrossed lesions (vs. crossed lesions: odds ratio 2.103, 95% confidence interval 1.047-4.225, p = 0.037). In conclusion, the incidence of slow flow/ severe slow flow just after RA was significantly greater in the IVUS-uncrossable lesions than in the IVUS-crossable lesions. Our study suggests the possibility that the IVUS-crossability can be used as a risk stratification of severe calcified lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of the incidence of slow flow after rotational atherectomy with IVUS-crossable versus IVUS-uncrossable calcified lesions

Sakakura

Taniguchi

Yamamoto

et al. 2020

Sci Rep

Self Cite

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“…Because intravascular imaging devices such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) can provide additional information regarding calcification beyond angiography [3][4][5][6], the use of intravascular imaging devices may help operators to avoid serious complications during RA. In fact, operators can choose an appropriate initial burr (1.25 mm, 1.5 mm, or ≥ 1.75 mm) or RotaWire (floppy or extra-support type) based on IVUS or OCT images [7]. Moreover, since current imaging devices are low profile [8], it is reasonable to attempt intravascular imaging before RA.…”

Section: Introductionmentioning

confidence: 99%

Comparison of complications with a 1.25-mm versus a 1.5-mm burr for severely calcified lesions that could not be crossed by an intravascular ultrasound catheter

Sakakura

Taniguchi

Yamamoto

et al. 2019

Cardiovasc Interv and Ther

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Since intravascular imaging such as intravascular ultrasound (IVUS) can provide useful information for rotational atherectomy (RA), intravascular imaging should be attempted before RA. However, some calcified lesions do not allow imaging catheters to cross before RA. Although small burrs (1.25 mm or 1.5 mm) should be selected for such tight lesions, it is unknown whether a 1.25-mm burr or 1.5-mm burr is safer as the initial burr. The aim of this study was to compare the incidence of complications with a 1.25-mm versus a 1.5-mm burr as the initial burr for IVUS-uncrossable lesions. This was a retrospective, single-center study. A total of 109 IVUS-uncrossable lesions were included, and were divided into a 1.25-mm group (n =52) and a 1.5-mm group (n =57). The incidence of slow flow just after RA was not different between the 2 groups (1.25mm group: 25%, 1.5-mm group: 31.6%, P =0.45). The incidence of peri-procedural MI with slow flow was not different and equally low in the 2 groups (1.25-mm group: 1.9%, 1.5-mm group: 3.5%, P =0.61). The use of the 1.5-mm burr as the initial burr was not significantly associated with slow flow after controlling for chronic renal failure on hemodialysis and reference diameter (vs. 1.25-mm: OR 2.34, 95% CI 0.89-6.19, P =0.09). In conclusion, the incidence of complications following RA was comparable between the 1.25-mm and the 1.5-mm burrs as the initial burr for IVUS-uncrossable lesions. The present study provides insights into the selection of an appropriate burr for IVUS-uncrossable lesions.

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“…Most surprising was that the overall use of IVUS in patients undergoing atherectomy was 10.4%, which was not dissimilar to the overall IVUS use in the United States in an all‐comer population . Intravascular imaging is of increased importance in calcified lesions and those undergoing treatment with adjunctive atherectomy . Coronary calcification is considerably underappreciated on angiography alone .…”

mentioning

confidence: 99%

Comment on “Modern‐Day Nationwide Utilization of Intravascular Ultrasound and Its Impact on the Outcomes of Percutaneous Coronary Intervention With Coronary Atherectomy in the United States”

Shlofmitz

Chen

Dheendsa

et al. 2019

J of Ultrasound Medicine

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Intravascular ultrasound enhances the safety of rotational atherectomy

Cited by 33 publications

References 24 publications

Comparison of the incidence of slow flow after rotational atherectomy with IVUS-crossable versus IVUS-uncrossable calcified lesions

Comparison of the incidence of slow flow after rotational atherectomy with IVUS-crossable versus IVUS-uncrossable calcified lesions

Comparison of complications with a 1.25-mm versus a 1.5-mm burr for severely calcified lesions that could not be crossed by an intravascular ultrasound catheter

Comment on “Modern‐Day Nationwide Utilization of Intravascular Ultrasound and Its Impact on the Outcomes of Percutaneous Coronary Intervention With Coronary Atherectomy in the United States”

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