Percutaneous Coronary Intervention of Complex Calcified Lesions With Drug‐Coated Balloon After Rotational Atherectomy

Rissanen, Tuomas T.; Uskela, Sanna; Siljander, Antti; Kärkkäinen, Jussi M.; Mäntylä, Pirjo; Mustonen, Juha; Eränen, Jaakko

doi:10.1111/joic.12366

Cited by 37 publications

(35 citation statements)

References 35 publications

(92 reference statements)

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“…To date, DCB has been approved for the treatment of in‐stent restenosis by the guidelines but there are many other emerging indications such as small vessels, bifurcations, diffuse disease, chronic total occlusions and calcified complex lesions . Data on the performance of DCB in de novo lesions of large coronaries have previously been scarce.…”

Section: Discussionmentioning

confidence: 99%

“…The 606 PCIs with paclitaxel‐coated DCB encompassing iopromide as a carrier agent (SeQuent Please, B. Braun) were performed between September 2009 and December 2013 in our institution. The only exclusion criteria for the current study were rotational atherectomy ( n = 82, published elsewhere) and in‐stent restenosis ( n = 37). Thus, the study cohort consisted of 487 PCIs done using DCB during this time period (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…So far, DCB has shown potential in small coronary vessels, in diffuse coronary artery disease (CAD) and bifurcations, where stenting may be technically challenging and offers suboptimal results . Recently, DCB has also been successfully used in more complex situations such as in chronic total occlusions and in calcified lesions after rotational atherectomy …”

Section: Introductionmentioning

confidence: 99%

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Percutaneous coronary intervention with drug‐coated balloon‐only strategy in stable coronary artery disease and in acute coronary syndromes: An all‐comers registry study

Uskela

Kärkkäinen

Eränen

et al. 2018

Cathet Cardio Intervent

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Objectives The aim of this single center all‐comers retrospective registry study was to assess the efficacy and safety of percutaneous coronary intervention (PCI) using drug‐coated balloon (DCB) in de novo lesions including large proximal coronary arteries. Methods A total of 487 PCIs were performed using paclitaxel‐coated DCB in 562 de novo lesions with the possibility for bailout stenting in a patient population presenting with stable coronary artery disease (CAD) or acute coronary syndrome (ACS). Half of the patients had at least one risk factor for bleeding. All of the treated lesions were de novo and 60% of DCBs used were ≥ 3.0 mm in diameter. The median follow‐up time was 18 months for MACE and 60 months for survival. Results The total mortality after DBC only strategy was 2.3 and 9.3% at 12 months in stable CAD and ACS, respectively. The 12‐month MACE rate was 7.1 and 12% in stable CAD and ACS. The rate of ischemia‐driven target lesion revascularization was only 1.4% in stable CAD and 2.8% after ACS at 12 months. Median duration of DAPT was one month. The 12 month rate of significant bleeding (Bleeding Academic Research Consortium types 2–5) was 5.9%. Acute vessel closure occurred only in one case (0.2%) after DCB treatment. Bailout stenting was used in 12% of lesions. Conclusions PCI using DCB‐only strategy with the possibility for provisional stenting is a safe and efficient in de novo coronary artery lesions in both stable CAD and ACS. This strategy may be useful especially in patients with high bleeding risk.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous coronary intervention with drug‐coated balloon‐only strategy in stable coronary artery disease and in acute coronary syndromes: An all‐comers registry study

Uskela

Kärkkäinen

Eränen

et al. 2018

Cathet Cardio Intervent

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“…A study reported that 19% of patients with ACS were successfully treated using ELCA alone without stenting. Another study showed that favorable outcomes were achieved by DCB applications following rotational atherectomy for calcified lesions without the help of stent deployment. Inspired by those studies, we proposed a novel approach with the use of a combination of the two aforementioned stent‐free devices.…”

Section: Introductionmentioning

confidence: 99%

Real‐life experience of a stent‐less revascularization strategy using a combination of excimer laser and drug‐coated balloon for patients with acute coronary syndrome

Harima¹,

Sairaku

Inoue³

et al. 2018

J Interven Cardiology

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“…Planned RA resulted in less contrast use, fluoroscopy time, fewer dissections, higher angiographic success, and reduced in‐hospital MACE. Similarly, Rissanen et al reported 82 heavily calcified lesions treated with RA followed by drug coated balloon (DCB) with excellent success and low bail out stenting (10%), TLR at 12 (1.5%) and 24 months (3.0%).…”

Section: Calcified Coronariesmentioning

confidence: 95%

Percutaneous coronary intervention: 2017 in review

Rao

Sheth

Grines

2018

J Interven Cardiology

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In an effort to keep the interventional community up-to-date with the abundant amount of new data, we have selected what we believe to be the most important publications in percutaneous coronary intervention from January 1, 2017 to 2 The overall rate of complete revascularization (CR) was 61.7%.In those patients with CR, there was no difference between CABG or PCI regarding death from any cause as well as composite of death, MI, and stroke at 5 year follow up, even at higher SYNTAX scores.However, compared to CABG with CR, PCI with incomplete revascularization put patients at a significant higher risk for similar endpoints. These studies suggest that the ability to achieve CR should be strongly considered when deciding between CABG and PCI in MVD.As we have learned from contemporary data on revascularization, certain subsets of patients have fared better with one revascularization strategy over another. An observational cohort study of multiple Swedish registries found that in patients with Type 1 diabetes and MVD, first multi-vessel revascularization with PCI was associated with higher risk of cardiac death, MI, and repeat revascularization although with similar all-cause mortality when compared to CABG. 3 This study indicates that CABG may be the preferred strategy in patients with Type 1 diabetes in need of multi-vessel revascularization, and is in agreement with earlier trials showing most of the benefit in patients treated with insulin, but not oral agents.In patients with low or intermediate SYNTAX score, PCI of unprotected left main with everolimus-eluting stents (EES) was shown to be noninferior to CABG with respect to a composite endpoint of death, stroke, and MI at 3 years in the EXCEL trial. 4 Of the 1905 patients randomized during the trial, 1788 patients were also followed for quality of life assessment to fully understand patient's perspective.

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Percutaneous Coronary Intervention of Complex Calcified Lesions With Drug‐Coated Balloon After Rotational Atherectomy

Abstract: This is the first study to show that PCI using DCB after preparation of calcified lesions with rotablation is safe and effective. This novel strategy may be considered especially in patients with a bleeding risk such as those using an oral anticoagulant.

Cited by 37 publications

References 35 publications

Percutaneous coronary intervention with drug‐coated balloon‐only strategy in stable coronary artery disease and in acute coronary syndromes: An all‐comers registry study

Percutaneous coronary intervention with drug‐coated balloon‐only strategy in stable coronary artery disease and in acute coronary syndromes: An all‐comers registry study

Real‐life experience of a stent‐less revascularization strategy using a combination of excimer laser and drug‐coated balloon for patients with acute coronary syndrome

Percutaneous coronary intervention: 2017 in review

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