Rotational atherectomy in resistant chronic total occlusions

Pagnotta, Paolo; Briguori, Carlo; Mango, Ruggiero; Visconti, Gabriella; Focaccio, Amelia; Belli, Guido; Presbitero, Patrizia

doi:10.1002/ccd.22504

Cited by 73 publications

(58 citation statements)

References 30 publications

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“…RA with subsequent bare metal stent (BMS) or drug‐eluting stent (DES) implantation improves the clinical outcomes of patients with calcified coronary artery disease (CAD) 1, 2, 3, 4, 5, 6, 7, 8 and procedure‐related major adverse cardiac events (MACE) along with mid‐ to long‐term mortality have all been at acceptable levels. Nonetheless, RA is still a technically demanding method requiring scrupulous execution, which may explain why it is seldom used in everyday interventional practice 9, 10, 11. Present‐day RA is, in our view, thus preserved for diffuse, highly calcified, severely fibrotic lesions: stenoses that seem or prove refractory to balloon manipulation efforts.…”

Section: Introductionmentioning

confidence: 99%

Clinical predictors of mortality following rotational atherectomy and stent implantation in high‐risk patients: A single center experience

Édes

Ruzsa

Szabó

et al. 2015

Cathet Cardio Intervent

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ObjectivesOur aim was to assess the procedural success and determine the clinical predictors of postprocedure mortality, following rotational atherectomy (RA) and stenting in high‐risk patients.BackgroundRA is mainly used to facilitate stenting in complex lesions. Outcomes involving RA and stenting have been investigated, yet high‐risk patients have not been adequately described.MethodsData of 218 consecutive patients who underwent RA were evaluated in a prospective register. Primary endpoints were the angiographic success and long‐term mortality. Secondary endpoints were procedural success, consumption of the angioplasty equipment, and periprocedural major adverse cardiac events. The impact of the relevant angiographic and clinical characteristics on long‐term mortality was analyzed using uni‐ and multivariate Cox regression analysis.ResultsMean age of the patients was 70 ± 8.2 years, diabetes was present in 44%, and chronic renal failure in 29%. Prior myocardial infarction and three‐vessel disease amounted to 42.2% and 32.6%, respectively. Altogether, 52.8% of patients underwent RA after a failed, non‐RA intervention attempt, and 30.7% of cases presented as acute coronary syndromes. Angiographic success was 100%, and all patients received stents after RA. Periprocedural major adverse cardiac events occurred in five (2.3%) patients. Postprocedural death was investigated, with a mean follow‐up of 36 months. Mortality amounted to 37.2%. Multivariate analysis revealed that left ventricular ejection fraction < 50%, glomerular filtration rate < 60 ml/min, cardiogenic shock, and diabetes were the only independent mortality predictors.ConclusionsWe have found that RA and stenting is feasible and viable in an elderly high‐risk population, with exceptional procedural success and acceptable long‐term results. © 2015 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Clinical predictors of mortality following rotational atherectomy and stent implantation in high‐risk patients: A single center experience

Édes

Ruzsa

Szabó

et al. 2015

Cathet Cardio Intervent

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“…1,9) Balloon failure-to-cross after successful guidewire crossing is the second most common cause for CTO PCI failure, occurring in up to 7% of cases. 10) ELCA has been demonstrated to be both a valid alternative and an adjunctive therapy to RA in severely calcified lesions and CTOs, in cases of failureto-cross/expand. 9) There are several alternatives available to the interventionalist who is faced with such a scenario.…”

Section: Discussionmentioning

confidence: 99%

“…Exchange of the guidewire for a RotaWire TM (Boston Scientific Corp.) is then performed, thus allowing RA. 10) Alternatively, the Tornus ® penetration catheter could be used to create a channel through the lesion, thus allowing balloon passage. 15) There exists only scant literature on a direct comparison between RA and the Tornus ® system.…”

Section: Discussionmentioning

confidence: 99%

Laser Atherectomy for Balloon Failure in Chronic Total Occlusion

Azzalini

2014

Int. Heart J.

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SummaryExcimer laser coronary atherectomy (ELCA) is based on ultraviolet energy and is capable of disintegrating atheroma, without burning or grossly fragmenting it. ELCA has proven effective in the percutaneous treatment of a variety of complex lesions, including chronic total occlusions (CTO) and severely calcified lesions, in case of balloon failure-tocross or failure-to-expand. Here we present a case of a successful CTO recanalization with ELCA after balloon failure, review the literature on this topic, and present an algorithm outlining the management of this challenging clinical scenario. (Int Heart J 2014; 55: 546-549) Key words: Laser-assisted angioplasty, Coronary occlusion, Percutaneous coronary intervention E xcimer laser coronary atherectomy (ELCA) has been proven to be effective for the percutaneous treatment of a variety of complex lesions, including chronic total occlusions (CTO) and severely calcified lesions when conventional ballooning techniques have failed, stent restenosis, saphenous vein graft debulking, and thrombus vaporization in acute coronary syndromes. 1)ELCA has been shown to be both safe and effective for plaque modification in severely calcified plaques and CTO, in which balloons have failed to cross or expand the lesion. 2,3)However, when tested against balloon angioplasty, stenting and rotational atherectomy (RA), ELCA failed to show superiority for efficacy and safety. 4,5) Subsequently, especially after the introduction of drug-eluting stents (DES), use of ELCA has become quite limited. Nevertheless, in well-defined clinical settings ELCA still represents a valid -and sometimes the only -alternative. Here, we present the case of a successful CTO recanalization with ELCA, after failure to cross with multiple coronary devices. Case ReportA 34-year-old man presented to a referring hospital's emergency room with multiple episodes of prolonged chest pain at rest. His prior medical history included heterozygosis for Factor V Leiden mutation with documented pulmonary embolism 4 years earlier. He also had an important family history of premature coronary artery disease (CAD). After screening tests ruled out pulmonary embolism and despite a lack of dynamic EKG changes, a diagnosis of non-ST elevation myocardial infarction motivated the decision to refer the patient for cardiac catheterization. Prior to transfer to our institution, aspirin and clopidogrel were preloaded. Coronary angiography showed left dominance and two-vessel disease ( Figure 1): a thrombotic, 85%, type B2, bifurcation lesion in the proximal circumflex (Medina 1, 0, 1), followed by a 60%, diffuse, type C lesion in the mid circumflex; and a CTO of the mid left anterior descending (LAD) artery, which received Werner collateral connections grade 2 from the right coronary artery (RCA) and circumflex artery, through septal and epicardial vessels. Thrombectomy in the circumflex was performed. Balloon dilatation was followed by the implantation of two Integrity TM (Medtronic Inc., Minneapolis, MN) bare-metal stents (a 3.0 ...

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“…Interventionalists often colloquially refer to this situation as "the wire has crossed but nothing will go. " Balloon failure-to-cross after successful guidewire crossing is the second most common cause for CTO failure in percutanous coronary interventions, occurring in up to 7% of cases [1].…”

Section: Textmentioning

confidence: 99%

“…Maple Grove, MN) can be very effective (i.e. calcified lesions) but technically and time demanding and is frequently not applicable due to non-successful wire passage in cases where only a hydrophiliccoated polymer guidewire permit passage of the complex atherosclerotic lesion [1]. Alternatively, the Tornus penetration catheter (Tornus™, Asahi-Intecc, Aichi, Japan) could be used in balloon-uncrossable lesions to create a channel, thus allowing balloon passage like Excimer Laser Coronary Angioplasty (ELCA) represent an interesting alternative to create a pilot hole [5,6].…”

Section: Textmentioning

confidence: 99%

Metallic-Tip-Facilitated Recanalization Angioplasty-An Innovative, Easily Applicable, Effective and Safe Therapeutic Option for Balloon-Uncrossable Lesions

Dahm¹

2019

Journal of Cardiology and Vascular Medicine

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Rotational atherectomy in resistant chronic total occlusions

Abstract: The inability to cross a CTO with a balloon catheter occurs in approximately 7% of all CTOs that are successfully crossed with a guidewire. Rotational atherectomy is a safe and effective technique to overcome this frustrating situation.

Cited by 73 publications

References 30 publications

Clinical predictors of mortality following rotational atherectomy and stent implantation in high‐risk patients: A single center experience

Clinical predictors of mortality following rotational atherectomy and stent implantation in high‐risk patients: A single center experience

Laser Atherectomy for Balloon Failure in Chronic Total Occlusion

Metallic-Tip-Facilitated Recanalization Angioplasty-An Innovative, Easily Applicable, Effective and Safe Therapeutic Option for Balloon-Uncrossable Lesions

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