Rotational Atherectomy in Acute Coronary Syndrome: A Meta-Analysis

Qaqish, Omar; Sharma, Sharan Prakash; Kumar, Amarendra; Patel, Kelsey; Mohammed, Khalid; Venigalla, Praveen; Ojha, Abhishek; Sareen, Nishtha; Goddla, Vikram; Dabaja, Abed; Kondur, Ashok

doi:10.1016/j.carrev.2022.02.020

Cited by 5 publications

(5 citation statements)

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“…Several studies have con rmed that RA is feasible in ACS patients, with comparable procedural complications and short-term MACE [12][13][14][15] . Our study demonstrated a similar cardiac death rate of about 2.5% following RA in ACS patients.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…However, the use of RA in patients with ACS remains controversial, considering the plaques are often unstable and even thrombotic, while thrombus-rich lesions are currently considered one of the contraindications for RA [9][10][11] . Despite some existing studies suggesting that RA PCI is technically feasible and safe in ACS patients with comparable procedural complications and short-term major adverse cardiac events (MACE) [12][13][14][15] , few studies focused on RA in ACS patients.Given that rotablation speed considerably varies among different interventional cardiologists, and studies on the relationship between RA speed and prognosis in patients presenting with ACS are limited, the rotation speed remains a contentious topic.This study aimed to compare the incidence of complications during the perioperative period after low-speed (130,000-150,000 rpm) and high-speed (160,000-220,000 rpm) RA in ACS patients.…”

mentioning

confidence: 99%

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The incidence of complication in the perioperative period of rotational atherectomy in patients with acute coronary syndrome: A retrospective study of low-speed versus high-speed

Qiu

et al. 2023

Preprint

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Background The safety and efficacy of rotational atherectomy (RA) in acute coronary syndrome (ACS) patients treated with different rotational speeds remain unclear.Methods This was an observational retrospective registry. Between February 2017 and January 2022, a total of 283 ACS patients were treated with RA. The patients were divided into two groups: the low-speed group (130,000-150,000rpm,182 cases) and the high-speed group (160,000-220,000rpm,101 cases) according to the maximum RA speed. The primary outcome was the occurrence of hypotension, vasospasm, dissection, slow flow, perforation, bradyarrhythmia, burr entrapment, rotawire fracture during RA, as well as the incidence of heart failure, stent thrombosis, and cardiac death during hospitalization.Results Patients in the low-speed RA group experienced a higher incidence of vasospasm during RA operation (15.4% versus 6.9%, p = 0.040), whereas the incidence of slow blood flow was higher in the high-speed RA group (16.5% versus 27.7%, p = 0.031). There was no significant difference in other complications between the two groups. Moreover, logistic regression analysis identified rotational speed (160,000-220,000rpm) as a predictor of slow flow during RA operation (OR = 1.900, 95%CI:1.006–3.588, p = 0.048). For every 10,000 rpm increase in rotational speed, the risk of slow flow increased by 27% (OR = 1.273, 95% CI: 1.047–1.547, p = 0.015).Conclusion ACS patients treated with a lower RA speed (130,000-150,000 rpm) had a higher risk of vasospasm, while in patients where higher speeds were used (160,000-220,000 rpm ), a higher incidence of slow flow was identified. High rotational speed (160,000-220,000 rpm) is an independent risk factor for slow flow during RA in ACS patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The incidence of complication in the perioperative period of rotational atherectomy in patients with acute coronary syndrome: A retrospective study of low-speed versus high-speed

Qiu

et al. 2023

Preprint

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“…To tackle these highly demanding lesions, several debulking modalities (such as rotational, orbital, and laser atherectomy, or the recently introduced shockwave intravascular lithotripsy) have become a part of contemporary clinical practice. Despite the well-established safety and efficiency of the atherectomy devices, utilization in the ACS subset is burdened with worse outcomes compared to stable patients [ 26 , 27 ]. Due to the novelty of the shockwave device, the evidence supporting the use of S-IVL in the ACS subset comes mainly from case reports, studies or low-number registries, which is encouraging [ 28 , 29 , 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Rota-Lithotripsy as a Novel Bail-Out Strategy for Highly Calcified Coronary Lesions in Acute Coronary Syndrome

Rola

Furtan

Włodarczak³

et al. 2022

Biomedicines

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Background: Heavily calcified lesions in acute coronary syndrome (ACS) still represent a challenging subset for percutaneous coronary intervention (PCI). Rota-lithotripsy—a marriage of rotational atherectomy and intravascular lithotripsy—has recently been introduced to clinical practice as a novel therapeutic option. Methods: This study is among the to present the 6-month clinical outcomes of rota-lithotripsy when performed in the ACS setting. The study cohort consisted of 15 consecutive ACS patients who underwent a rota-lithotripsy-PCI due to the presence of a highly calcified, undilatable lesion. Results: The procedural success ratio reached 100%. During the 6-month follow-up, in two of the patients, instances of MACE (major adverse cardiac events) occurred, including one fatal event. Additionally, during the observation period, one target lesion failure, due to subacute stent thrombosis, was identified. Conclusions: Rotational atherectomy with the subsequent use of shockwave intravascular lithotripsy appears to be a safe and effective therapeutic bail-out option for the management of highly calcified coronary artery lesions. Despite, these initial favorable outcomes, carrying out a large number of studies with long-term observations is still necessary in order to establish the potential benefits and shortcomings of rota-lithotripsy.

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“…10 Trong một phân tích gộp hồi cứu 1237 bệnh nhân ACS cũng cho kết quả tương tự, kết luận được đưa ra là RA khả thi cho bệnh nhân ASC khi so sánh với nhóm RA thường quy trong ngắn hạn nhưng có xu hướng làm tăng MACE trong dài hạn. 11…”

Section: đặC đIểm Về Chẩn đOán Bệnhunclassified

Kết quả của thủ thuật khoan phá mảng xơ vữa vôi hoá động mạch vành bằng Rotablator tại Viện Tim mạch Việt Nam, Bệnh viện Bạch Mai

Nguyễn,

Phạm,

Phạm

et al. 2024

TC Tim mạch học VN

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Mở đầu: Can thiệp động mạch vành vôi hóa hiện nay vẫn đang là thách thức với các bác sĩ can thiệp. Trên thế giới đã có một số nghiên cứu về can thiệp động mạch vành vôi hóa bằng Rotablator, nhưng tại Việt Nam vẫn còn chưa có nghiên cứu nào về vấn đề này. Mục tiêu: Đánh giá kết quả sớm và trung hạn trong vòng 3 tháng của can thiệp động mạch vành vôi hóa bằng Rotablator. Đối tượng và phương pháp: Các bệnh nhân được khoan phá mảng xơ vữa trong quá trình can thiệp động mạch vành tại Viện Tim mạch Việt Nam - Bệnh viện Bạch Mai từ năm 2019 đến năm 2022, gồm 33 bệnh nhân. Kết quả: Tỷ lệ thành công của thủ thuật khoan phá mảng xơ vữa cao, đạt tỷ lệ 97,2%. Tỷ lệ bảo tồn được nhánh bên khi sử dụng RA cao (86,4%). Các biến chứng liên quan đến quá trình khoan mảng xơ vữa thấp (tỷ lệ chậm dòng chảy, lóc tách nặng ĐMV, biến chứng đường vào đều có tỷ lệ 2,8%), không có biến chứng nặng đòi hỏi phải xử trí cấp cứu. Đa số bệnh nhân cải thiện được triệu chứng đau thắt ngực và mức độ khó thở sau 3 tháng theo dõi. Không có bệnh nhân nào có biến cố tim mạch chính trong vòng 3 tháng theo dõi. Kết luận: Thủ thuật khoan phá mảng xơ vữa vôi hoá động mạch vành bằng Rotablator thực hiện tại Viện Tim mạch Việt Nam - Bệnh viện Bạch Mai có tính an toàn cao, không có BN tử vong khi can thiệp.

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Rotational Atherectomy in Acute Coronary Syndrome: A Meta-Analysis

Cited by 5 publications

References 36 publications

The incidence of complication in the perioperative period of rotational atherectomy in patients with acute coronary syndrome: A retrospective study of low-speed versus high-speed

The incidence of complication in the perioperative period of rotational atherectomy in patients with acute coronary syndrome: A retrospective study of low-speed versus high-speed

Rota-Lithotripsy as a Novel Bail-Out Strategy for Highly Calcified Coronary Lesions in Acute Coronary Syndrome

Kết quả của thủ thuật khoan phá mảng xơ vữa vôi hoá động mạch vành bằng Rotablator tại Viện Tim mạch Việt Nam, Bệnh viện Bạch Mai

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