Pre–Drug-Eluting Stent Debulking of Bifurcated Coronary Lesions

Tsuchikane, Etsuo; Aizawa, Tadanori; Tamai, Hideo; Igarashi, Yasumi; Kawajiri, Kenji; Ozawa, Noriyuki; Nakamura, Shigeru; Oku, Koji; Kijima, Mikihiro; Suzuki, Takahiko; Investigators, Perfect

doi:10.1016/j.jacc.2007.07.066

Cited by 43 publications

(41 citation statements)

References 12 publications

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“…The most provocative study to date on the use of DCA for bifurcation lesions was recently published by Tsuchikane et al based on the results of the PERFECT registry [75]. Ninety-nine patients were recruited for this study and all underwent plaque debulking prior to stenting with DES.…”

Section: Directional Coronary Atherectomymentioning

confidence: 99%

An evidence‐based approach to the use of rotational and directional coronary atherectomy in the era of drug‐eluting stents: When does it make sense?

Tran

Brown

Lasala

2008

Cathet Cardio Intervent

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Advances in percutaneous interventions have profoundly changed the way we manage patients with coronary and peripheral arterial disease. Though the use of stents, particularly drug-eluting stents, is the preferred method for revascularization because of ease of use and lower restenosis rates, there are many short comings. Ostial and bifurcation lesions as well as heavily calcified and tortuous arteries remain problematic. Mechanical debulking with rotational and direct coronary atherectomy may be beneficial in these situations. In this review, we present the general concepts of mechanical debulking and attempt to summarize the available data on its use in the setting of drug-eluting stents. In addition, we will discuss its special role in the management of peripheral arterial disease.

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Section: Directional Coronary Atherectomymentioning

confidence: 99%

An evidence‐based approach to the use of rotational and directional coronary atherectomy in the era of drug‐eluting stents: When does it make sense?

Tran

Brown

Lasala

2008

Cathet Cardio Intervent

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“…This would allow for pressed. PERFECT study 10) showed that DCA prior to stenting remarkably decreased adverse cardiac events and resulted in good clinical outcomes.…”

Section: Dca In the Futurementioning

confidence: 99%

“…On the other hand, there were some Japanese cardiologists, who strongly desire to revive the DCA device. They reported in 2007 that DCA was useful for limited patients, especially for bifurcated lesions including left main trunk (PERFECT Study) 10) . A new DCA catheter has been developed by NIPRO Corporation (Osaka, Japan) and was approved by the Japan Ministry of Health, Labor and Welfare in December 2014.…”

Section: Mikihiro Kijimamentioning

confidence: 99%

The Role of the Revived Directional Coronary Atherectomy (DCA)

Kijima

2016

J Jpn Coron Assoc

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─ 239 ─ I. BackgroundThe first successful coronary angioplasty was performed by Andrea Gruentzig in 1977. This procedure has become widely accepted around the world. However, there were 2 major limitations of this initial procedure ;1. Abrupt closure immediately after the procedure (approximately 5%). Restenosis at the chronic stage (approximately 40% to 50%).Directional coronary atherectomy (DCA) was developed by Dr. John Simpson and first became available in 1990 in the USA.DCA was expected to reduce the abrupt closure rate and the late restenosis of balloon angioplasty. However, the first large randomized clinical trial (CAVEAT study)1) failed to demonstrate the superiority of DCA compared to balloon angioplasty. Even though the restenosis rate was similar in both groups, the incidence of early-phase composite endpoint was higher in the atherectomy group than the angioplasty group. Thereafter, intravascular ultrasound (IVUS)-guided DCA was recommended to debulk the coronary artery plaque effectively and safely as the previous studies reported that 70% of coronary artery plaque was eccentric 2-4) . In the late 1990's, several studies demonstrated the superiority of DCA compared to balloon angioplasty using the IVUS-guided technique 5-7) . However, coronary stenting became available in 1994 ; and accordingly, the dual anti-platelet therapy was established in 1995. Many studies demonstrated that coronary stenting was effective to control abrupt closure and reduce restenosis compared to balloon angioplasty 8,9) . Consequently, many user-friendly stents were developed and became widely accepted due to the fact that stenting was simple, easy to perform, and effective. In addition, the drug-eluting stent (DES) first became available in 2001 and the restenosis rate was reduced to less than 10%. The Role of the Revived Directional Coronary Atherectomy (DCA) Mikihiro KijimaDirectional coronary atherectomy (DCA) was developed in 1990 in the USA and expected to reduce the abrupt closure rate and the late restenosis of balloon angioplasty. However, the first large randomized clinical trial (CAVEAT study) 1) failed to demonstrate the superiority of DCA compared to balloon angioplasty. Coronary stents became available in 1994 and were widely accepted, because stenting was simple, easy to perform, and effective. In addition, after the drug-eluting stent became available, DCA device users declined with the DCA catheter removed from the device market in 2008. On the other hand, there were some Japanese cardiologists, who strongly desire to revive the DCA device. They reported in 2007 that DCA was useful for limited patients, especially for bifurcated lesions including left main trunk (PERFECT Study) 10) . A new DCA catheter has been developed by NIPRO Corporation (Osaka, Japan) and was approved by the Japan Ministry of Health, Labor and Welfare in December 2014. This article introduces the newly developed DCA catheter and considers the role of this device in the drug-eluting stent era.

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“…However, following the introduction of DES, the role of debulking was restricted due to the dramatic benefit of restenosis reduction. One study suggested a viable role for debulking atherectomy even in the DES era for 99 patients with coronary bifurcations [64] . Of interest, debulking in the main branch and side branch for LMCA stenoses allowed single-stenting in 60 of the 63 LMCA bifurcation stenoses.…”

Section: Debulking Atherectomymentioning

confidence: 99%

Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Stenosis

Park¹,

Kim²

2012

Textbook of Interventional Cardiology

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Hemodynamically significant left main coronary artery stenosis (LMCA) is found in around 4% of diagnostic coronary angiograms and is known as unprotected LMCA stenosis if the left coronary artery and left circumflex artery has no previous patent grafts. Previous randomized studies have demonstrated a significant reduction in mortality when revascularization by coronary artery bypass graft (CABG) surgery was undertaken compared with medical treatment. Therefore, current practice guidelines do not recommend percutaneous coronary intervention (PCI) for such a lesion because of the proven benefit of surgery and high rates of restenosis with the use of bare metal stents. However, with the advent of drug-eluting stents (DES), the long term outcomes of PCI with DES to treat unprotected LMCA stenoses have been acceptable. Therefore, apart from the current guidelines, PCI for treatment of unprotected LMCA stenosis is often undertaken in individuals who are at a very high risk of CABG or refuse to undergo a sternotomy. Future randomized studies comparing CABG vs PCI using DES for treatment of unprotected LMCA stenosis would be a great advance in clinical knowledge for the adoption of appropriate treatment.

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Pre–Drug-Eluting Stent Debulking of Bifurcated Coronary Lesions

Abstract: Directional coronary atherectomy before DES implantation can possibly avoid complex stenting. This strategy may provide a good long-term outcome in patients with bifurcated lesions.

Cited by 43 publications

References 12 publications

An evidence‐based approach to the use of rotational and directional coronary atherectomy in the era of drug‐eluting stents: When does it make sense?

An evidence‐based approach to the use of rotational and directional coronary atherectomy in the era of drug‐eluting stents: When does it make sense?

The Role of the Revived Directional Coronary Atherectomy (DCA)

Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Stenosis

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