Stent-Less Percutaneous Coronary Intervention of Calcified Nodule Causing Non-ST-Elevation Myocardial Infarction　― Serial Optical Coherence Tomography Follow-up After Rotational Atherectomy Followed by Drug-Coated Balloon Angioplasty―

Ishida, Masaru; Ishisone, Takenori; Kimura, Takeshi; Morino, Yoshihiro

doi:10.1253/circj.cj-21-0628

Cited by 6 publications

(2 citation statements)

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“…However, our group previously showed that CN treated with RA had comparable clinical outcomes when compared to CN treated without RA 18) , suggesting the limited efficacy of atherectomy devices for CN. There are a few reports showing the optional strategy of drug-coated balloon following debulking devices or excimer laser catheter ablation, although the effect of drugs on calcification is limited considering a functional mechanism of drug 33,35) . Since there is no gold standard strategy for CN, interventional strategy for CN should be carefully considered in individual cases.…”

Section: Clinical Implications From the New Insightmentioning

confidence: 99%

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

Jinnouchi

Sakakura

Taniguchi

et al. 2023

JAT

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Aims: Calcified nodule (CN) has been known as the advanced stage of coronary calcification. However, clinical outcomes following percutaneous coronary intervention (PCI) to CN remain unknown. This study aimed to compare clinical outcomes, including target lesion revascularization (TLR), between calcified coronary lesions with and without CN. Methods: Two hundred forty-nine lesions undergoing intravascular ultrasound-guided PCI with rotational atherectomy (RA) were enrolled and divided into the CN group (n=100) and the non-CN group (n=149) according to the presence of CN. The cumulative incidence of clinically driven TLR (CD-TLR) and the reasons for CD-TLR were compared between the CN and non-CN groups.Results: The incidence of CD-TLR was significantly higher in the CN group than in the non-CN group. In the landmark analysis at 1 year, the CN group showed a significantly higher incidence of CD-TLR within 1 year. However, the incidence of CD-TLR beyond 1 year was numerically lower in the CN group than in the non-CN group. In the multivariate Cox hazard model, CN was significantly associated with CD-TLR. In the CN group, in-stent CN was the major reason for CD-TLR (52%) and was observed mainly within 1 year (90%). Conclusions:In the heavily calcified lesions requiring RA, CN was the factor associated with the higher rate of CD-TLR especially within 1 year. The timing of CD-TLR in lesions with CN may indicate that the process of CN protruding through the struts was progressed monthly.

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Section: Clinical Implications From the New Insightmentioning

confidence: 99%

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

Jinnouchi

Sakakura

Taniguchi

et al. 2023

JAT

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“…Recent studies indicated that stentless PCI could be a potential therapeutic option for CNs when achieving an adequate luminal area without major dissection. [23][24][25] Therefore, for CN lesions with maximum CN angles >182°, close follow-up and aggressive medical therapy may be required, and stentless PCI or bypass surgery may be a treatment option. This study had several limitations.…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Calcified Nodules in Patients with Severely Calcified Lesions Treated by Rotational Atherectomy: A Serial Optical Coherence Tomography Study

Narui,

Yamamoto,

Mori

et al. 2024

Preprint

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Background: Percutaneous coronary intervention (PCI) for lesions with calcified nodules (CNs) is associated with worse outcomes than PCI for other calcified lesions. We aimed to clarify the relationship between CNs at index PCI, optical coherence tomography (OCT) findings at 8-month follow-up, and clinical outcomes using serial OCT. Methods This retrospective observational study utilized data from a prospective, single-center registry. We conducted consecutive PCI for calcified lesions requiring rotational atherectomy (RA) with OCT guidance. We categorized 51 patients (54 lesions) into those with (16 patients [16 lesions]) and without CNs (35 patients [38 lesions]). Results: Post-PCI, stent expansion was comparable between the two groups, and CN-like protrusion was observed in 75% of patients in the CN group. Follow-up OCT at 8 months revealed in-stent CNs in 54% of treated CN lesions with CN-like protrusion, whereas non-CN lesions lacked in-stent CNs. The CN group exhibited greater maximum neointimal tissue (NIT) thickness than the non-CN group (p<0.001). Multivariate linear regression analysis demonstrated that CN was associated with maximum NIT (p=0.02). Consequently, the CN group exhibited a higher clinically-driven target lesion revascularization (TLR) rate than the non-CN group at 1 (p=0.009) and 5 years (p=0.02). TLR primarily occurred in lesions with maximum CN angles >180°. Conclusions: Following RA treatment with acceptable stent expansion, the presence of CNs before PCI correlated with greater neointimal tissue formation with in-stent CNs, resulting in a higher TLR rate, especially in lesions with maximum CN angles exceeding 180°.

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Incidence and prognostic impact of the calcified nodule in coronary artery disease patients with end-stage renal disease on dialysis

et al. 2022

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Stent-Less Percutaneous Coronary Intervention of Calcified Nodule Causing Non-ST-Elevation Myocardial Infarction　― Serial Optical Coherence Tomography Follow-up After Rotational Atherectomy Followed by Drug-Coated Balloon Angioplasty―

Cited by 6 publications

References 1 publication

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

Clinical Impact of Calcified Nodules in Patients with Severely Calcified Lesions Treated by Rotational Atherectomy: A Serial Optical Coherence Tomography Study

Incidence and prognostic impact of the calcified nodule in coronary artery disease patients with end-stage renal disease on dialysis

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Stent-Less Percutaneous Coronary Intervention of Calcified Nodule Causing Non-ST-Elevation Myocardial Infarction ― Serial Optical Coherence Tomography Follow-up After Rotational Atherectomy Followed by Drug-Coated Balloon Angioplasty―

Cited by 6 publications

References 1 publication

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

Clinical Impact of Calcified Nodules in Patients with Severely Calcified Lesions Treated by Rotational Atherectomy: A Serial Optical Coherence Tomography Study

Incidence and prognostic impact of the calcified nodule in coronary artery disease patients with end-stage renal disease on dialysis

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Stent-Less Percutaneous Coronary Intervention of Calcified Nodule Causing Non-ST-Elevation Myocardial Infarction　― Serial Optical Coherence Tomography Follow-up After Rotational Atherectomy Followed by Drug-Coated Balloon Angioplasty―