Reduction in periprocedural enzyme elevation by abciximab after rotational atherectomy of type B2 lesions: Results of the Rota ReoPro randomized trial

Kini, Annapoorna; Reich, David; Marmur, Jonathan D.; Mitre, Cristina A.; Sharma, Samin K.

doi:10.1067/mhj.2001.119382

Cited by 55 publications

(29 citation statements)

References 23 publications

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“…This beneficial effect of the GP IIb/IIIa inhibitors underscores the importance of the activation of platelets and their interaction with atheromatous debris in causing slow flow and other adverse procedural events during RA. Abciximab is the most commonly used GP IIb/IIIa inhibitor and was shown to reduce both procedural morbidity and creatine kinase-MB (CK-MB) elevation by approximately 50% in a small randomized trial of 100 patients [8]. However, caution is advised in the upfront use of the GP IIb/IIIa inhibitors in angulated, heavily calcified lesions undergoing RA, where the risk of coronary perforation is increased.…”

Section: Adjunctive Therapiesmentioning

confidence: 97%

Current status of rotational atherectomy

Çavuşoğlu¹,

Kini²,

Marmur³

et al. 2004

Cathet Cardio Intervent

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112

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Despite the increasing use of percutaneous transluminal coronary angioplasty and intracoronary stent placement for the treatment of obstructive coronary artery disease, a large subset of coronary lesions cannot be adequately treated with balloon angioplasty and/or intracoronary stenting alone. Such lesions are often heavily calcified or fibrotic and undilatable with the present balloon technology and attempts to treat them with balloon angioplasty or intracoronary stent placement often lead to vessel dissection or incomplete stent deployment with resultant adverse outcomes. Rotational atherectomy remains a useful niche device for the percutaneous treatment of such complex lesions, usually as an adjunct to subsequent balloon angioplasty and/or intracoronary stent placement. In contrast to balloon angioplasty or stent placement that widen the coronary lumen by displacing atherosclerotic plaque, rotational atherectomy removes plaque by ablating the atherosclerotic material, which is dispersed into the distal coronary circulation. Other lesion subtypes amenable to treatment with this modality include ostial and branch-ostial lesions, chronic total occlusions, and in-stent restenosis. This review discusses the technique and principles of rotational atherectomy, the various treatment strategies for its use (including adjunctive pharmacotherapy), the lesion-specific applications for this device, and the complications unique to this modality. Recommendations are also made for its use in the current interventional era.

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Section: Adjunctive Therapiesmentioning

confidence: 97%

Current status of rotational atherectomy

Çavuşoğlu¹,

Kini²,

Marmur³

et al. 2004

Cathet Cardio Intervent

Self Cite

112

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“…In this context, the use of abciximab during RA has been shown to reduce procedural morbidity as well as the incidence, extent and severity of transient hypoperfusion [9,10]. However, this evidence is supported by small trials performed prior to the adoption of clopidogrel as the standard therapy in patients undergoing PCI [11,12].…”

Section: Introductionmentioning

confidence: 84%

“…Previous published studies showed that rotablation induces platelet activation, thus leading to platelet aggregation [18]. Small randomized trials found the benefit of abciximab during rotational atherectomy in reducing procedural morbidity, CK-MB elevation, as well as the incidence, extent and severity of transient hypoperfusion, as assessed by single-photon emission computed tomography [9,10].…”

Section: Discussionmentioning

confidence: 99%

Lack of Peri-Procedural Myocardial Necrosis Reduction from Abciximab in Patients on Dual Antiplatelet Therapy Revascularized with Rotational Atherectomy

Pinar-Bermdez¹

2013

J Clin Exp Cardiolog

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Rotational atherectomy allows plaque remodeling in severely calcified lesions and, prior to the adoption of clopidogrel as standard therapy, small trials showed that abciximab reduces transient hypoperfusion associated with the procedure. However, no studies have evaluated it among patients receiving dual antiplatelet therapy. This study aimed to evaluate whether abciximab reduces procedure-related myocardial injury in a non-selected population of patients receiving dual antiplatelet therapy. The study comprised a retrospective review of a nonselected cohort of 139 consecutive procedures of rotational atherectomy performed in patients pre-treated with dual antiplatelet therapy. Abciximab was administered in 48 (34.5%) patients, whereas 91 (65.5%) did not receive it. The only difference between groups was a higher rate of diabetes mellitus in the abciximab group (89% vs. 51%, p=0.001). The rate of procedural complications was 10.5% for patients with abciximab vs. 6.2% for patients without (p=0.537). After 24 hours, the peak of biomarkers of myocardial damage (CKmb and TnT) did not differ, and the rate of procedure-related myocardial injury was 23.9% with abciximab and 20.7% without (p=0.664). In a restricted analysis to diabetic patients (n=84), the rate of myocardial injury was 27.5% with abciximab vs. 18.6% without, (p=0.435). After adjusting by clinical and procedural parameters in a logistic regression model, abciximab use did not confer any significant reduction on procedure-related myocardial injury. In conclusion, in a non-selected cohort of patients receiving dual antiplatelet therapy, the administration of abciximab in the setting of rotational atherectomy did not reduce the incidence of procedure related myocardial injury.

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“…The trials included in this analysis encompassed a range of patient characteristics (e.g., UA, NSTEMI, and STEMI), therapeutic regimens (e.g., elective PCI, primary PCI), and adjunctive drugs. In another meta-analysis, which involved 19 trials of 20 137 patients, 30-day and 6-month mortality were both significantly reduced for those receiving IIb/IIIa receptor antagonists (Tables 24a and 24b) (64,111,112,191,195,198,200,201,442,443,(701)(702)(703)(704)(705)(706)(707)(708)(709)(710)(711)(712)(713)(714)(715)(716)(717). Thus, patients undergoing PCI can expect a lower 30-day mortality when GP IIb/IIIa therapy is utilized.…”

Section: Glycoprotein Iib/iiia Inhibitorsmentioning

confidence: 99%