Laser-assisted orbital or rotational atherectomy: a hybrid treatment strategy for balloon-uncrossable lesions

Sandoval, Yader; Lobo, Angie S.; Tajti, Péter; Brilakis, Emmanouil S.

doi:10.1016/j.hjc.2018.07.010

Cited by 13 publications

(8 citation statements)

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“…Several strategies are available to deal with balloon uncrossable lesions and in general, can be categorized into (a) plaque modification techniques, and (b) techniques that increase guide catheter support [ 18 ]. Attempted crossing with low-profile balloons (e.g., 1–1.5 mm diameter), grenadoplasty/balloon assisted microdissection (BAM) [ 19 ], and improved guide support with a guide extension [ 15 ] or anchor balloon are usually tried first [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Karácsonyi

Kostantinis

Şimşek

et al. 2023

JPM

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Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.

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Section: Discussionmentioning

confidence: 99%

Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Karácsonyi

Kostantinis

Şimşek

et al. 2023

JPM

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“…Egred reported three cases with severely calcified, undilatable coronary artery lesions that were unresponsive to either technique alone but responsive to the RASER approach with successful and satisfactory outcome 26 . Sandoval et al 27 reported successful laser‐assisted orbital and rotational atherectomy in two cases (mid RCA CTO & mid left anterior descending artery [LAD] CTO). Fernandez et al 28 reported that the RASER technique was successful in five severely calcified lesions.…”

Section: Combinationsmentioning

confidence: 99%

An algorithmic approach to balloon‐uncrossable coronary lesions

Elrayes

Xenogiannis

Nikolakopoulos

et al. 2020

Cathet Cardio Intervent

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Balloon uncrossable coronary lesions are lesions that cannot be crossed with a balloon after successful guidewire crossing. The strategies used to facilitate the treatment of such lesions can be classified into strategies that provide lesion modification and strategies that increase support. We describe a systematic, algorithmic approach to treat balloon uncrossable lesions, starting with use of small balloons, followed by increase in guide catheter support, use of microcatheters, wire cutting or puncture techniques, laser, atherectomy, and subintimal modification techniques. Sequential and simultaneous application of the aforementioned techniques can result in successful treatment of these challenging lesions.

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“…For heavy CAC, ELCA may provide sufficient plaque modification to allow microcatheter advancement to then switch to an atherectomy wire, which permits the use of atherectomy facilitating optimal balloon expansion and stenting (the RASER technique). 56,57…”

Section: Excimer Laser Coronary Atherectomymentioning

confidence: 99%

Contemporary treatment options for surmounting the conundrum of calcified coronaries

Dash¹,

Ahmed²,

Rohit³

2020

J Transcat Intervent

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Since the advent of balloon angioplasty in 1977, countless tools and techniques have been introduced and broadened the application of percutaneous coronary intervention in unprecedented anatomic settings. Heavily calcified coronary lesions traditionally continue to pose a challenge for percutaneous coronary intervention, since they are difficult to dilate adequately and/or there is inability to deliver and deploy drug eluting stents appropriately. Poor stent deployment is associated with increased procedural complications and suboptimal long-term outcomes. Thanks to the introduction of dedicated percutaneous coronary intervention tools, like cutting-and scoring balloons, atherectomy devices, and the novel intravascular lithotripsy technology, the treatment of such lesions has become increasingly feasible, safe and predictable. In this focused review, the author provides a summary of the principles, technique and contemporary evidence for various plaque modification strategies, with main objective of optimizing drug eluting stents delivery and deployment, translating into improved patient outcome.

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Laser-assisted orbital or rotational atherectomy: a hybrid treatment strategy for balloon-uncrossable lesions

Cited by 13 publications

References 1 publication

Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

An algorithmic approach to balloon‐uncrossable coronary lesions

Contemporary treatment options for surmounting the conundrum of calcified coronaries

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