Usefulness of Rotational Atherectomy in Preventing Polymer Damage of Everolimus-Eluting Stent in Calcified Coronary Artery

Kuriyama, Nehiro; Kobayashi, Yoshio; Yamaguchi, Masashi; Shibata, Yoshisato

doi:10.1016/j.jcin.2010.11.017

Cited by 75 publications

(51 citation statements)

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“…1e3,5,6 Coronary calcification often leads to difficulty in delivering coronary devices, may damage the drug polymer and stent platform, 13 and limit full stent expansion, resulting in suboptimal procedural results and an increased risk of subsequent ischemic adverse events. Appropriate lesion preparation remains crucial to ensure optimal angiographic and clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Orbital Atherectomy for Treating De Novo Severely Calcified Coronary Narrowing (1-Year Results from the Pivotal ORBIT II Trial)

Généreux

Lee

Kim

et al. 2015

The American Journal of Cardiology

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Percutaneous coronary intervention of severely calcified lesions has historically been associated with major adverse cardiac event (MACE) rates as high as 30%. In the ORBIT II (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) trial, treatment of de novo severely calcified lesions with the Diamondback 360° Coronary Orbital Atherectomy System (OAS) resulted in low rates of procedural and 30-day adverse ischemic events. The long-term results from this trial have not been reported. We sought to determine the 1-year outcomes after orbital atherectomy of severely calcified coronary lesions. ORBIT II was a single-arm trial enrolling 443 subjects at 49 US sites with severely calcified lesions usually excluded from randomized trials. OAS utilizes a centrifugal differential sanding mechanism of action for plaque modification prior to stent implantation. After OAS drug-eluting stents were implanted in 88.2% of the patients. The primary safety end point was 30-day MACE, the composite of cardiac death, myocardial infarction, or target vessel revascularization [TVR]. The present analysis reports the 1-year follow-up results from ORBIT II. One-year data were available in 433 of 443 patients (97.7%), with median follow-up time of 16.7 months. The 1-year MACE rate was 16.4%, including cardiac death (3.0%), myocardial infarction (9.7%), and target vessel revascularization (5.9%). The 1-year target lesion revascularization rate was 4.7%, and stent thrombosis occurred in 1 patient (0.2%). Independent predictors of 1-year MACE and target vessel revascularization were diameter stenosis at baseline and the use of bare-metal stents. In patients with severely calcified lesions who underwent percutaneous coronary intervention, the use of OAS was associated with low rates of 1-year adverse ischemic events compared with historical controls. This finding has important clinical implications for the selection of optimum treatment strategies for patients with severely calcified lesions.

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Section: Discussionmentioning

confidence: 99%

Orbital Atherectomy for Treating De Novo Severely Calcified Coronary Narrowing (1-Year Results from the Pivotal ORBIT II Trial)

Généreux

Lee

Kim

et al. 2015

The American Journal of Cardiology

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“…22) DES might play a role of reducing the neointimal response to the injury through atherectomy. It is also speculated that lesion modification by RA could yield smooth stent delivery, prevent damage to the polymer coating, 23) and provide optimal stent expansion, all of which could help DES be effective for even calcified coronary lesions. Study limitations: Our study was a single-center retrospective observational study with a relatively small number of subjects, which suggests a potential risk for bias and beta error.…”

Section: A C D Bmentioning

confidence: 99%

Comparison of Long-Term Clinical Outcomes Between Sirolimus-Eluting Stents and Paclitaxel-Eluting Stents Following Rotational Atherectomy

et al. 2012

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SummaryRotational atherectomy (RA) can facilitate smooth stent delivery and stent expansion through lesion modification for a calcified coronary lesion. Several studies reported that sirolimus-eluting stent (SES) implantation following RA showed a lower rate of revascularization compared with bare-metal stents (BMS). However, there are limited data that compared the clinical outcomes between SES and paclitaxel-eluting stents (PES) after RA. We compared the long-term clinical outcomes of SES and PES following RA. Two hundred and thirty-three consecutive patients (SES n = 179, PES n = 54) who were treated with SES or PES following RA between 10 th September 2004 and 13 th April 2010 were investigated. Follow-up data for clinical outcomes were obtained in 91.4% of all subjects. The median follow-up period was 630 days (interquartile range, 300 to 1170 days) in the SES group, and 625 days (interquartile range, 285 to 900 days) in the PES group. Clinical outcomes including target lesion revascularization (TLR) (SES 4.9% versus PES 9.8%, P = 0.31), target vessel revascularization (TVR) (SES 6.8% versus PES 11.8%, P = 0.25), and major adverse cardiac events (MACE) (SES 14.8% versus PES 13.7%, P = 0.8) were not statistically different between the groups. The unadjusted cumulative event rates estimated by the Kaplan-Meier method and the log-rank test showed no significant differences between the two groups for time to event for TLR, cardiovascular death, all-cause death, or MACE. In conclusion, there was no significant difference in the long-term clinical outcomes between SES and PES following RA. (Int Heart J 2012; 53: 149-153) Key words: Sirolimus-eluting stents, Paclitaxel-eluting stents, Rotational atherectomy, Calcified coronary lesion C alcified coronary lesions and diffuse long lesions are still one of the challenging coronary artery lesion subsets, despite the advances in percutaneous coronary artery intervention (PCI) devices and techniques.1-3) Rotational atherectomy (RA) has emerged to be a representative device for such complex lesions. RA can facilitate smooth stent delivery and stent expansion through lesion modification. [4][5][6] However, the clinical outcomes after implanting a baremetal stent (BMS) following RA have not been satisfactory. [7][8][9] Drug-eluting stents (DES) have dramatically reduced the rate of revascularization compared with BMS. [10][11][12][13] With regard to calcified lesions, several studies reported that sirolimus-eluting stent (SES) implantation following RA had a lower rate of revascularization than BMS. 14,15) Other studies demonstrated that long-term clinical outcomes of DES implantation after RA were feasible. 16,17) In these studies, multiple types of DES including SES and paclitaxel-eluting stents (PES) were implanted. However, data that compared the clinical outcomes between SES and PES after RA are limited. Therefore, we compared the long-term clinical outcomes of SES and PES following RA.

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“…Obstructive severe calcifications in segments proximal to the target lesion impairs device delivery, therefore increasing the risk of procedure failure [18]. PCI in HCCL is also especially challenging to DES because calcium may damage the polymer or drug coating leading to inadequate drug delivery and device ineffectiveness [19]. All the factors mentioned above may be responsible for higher rates of recurrent ACS in patients with severe TLC.…”

Section: Discussionmentioning

confidence: 99%

Patients with acute myocardial infarction and severe target lesion calcifications undergoing percutaneous coronary intervention have poor long-term prognosis

Zimoch

Kübler²,

Kosowski³

et al. 2017

Kardiol Pol

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A b s t r a c t Background:To assess the influence of severe target lesion calcification (TLC) on the outcomes of patients undergoing percutaneous coronary interventions (PCI) due to acute myocardial infarction (AMI).Aim: Contemporary data concerning coronary artery calcifications (CAC) are based on pooled analyses from randomised trials with short follow-up. We still lack the knowledge on how CAC in target lesions affect long-term prognosis of patients with AMI in everyday practice. Methods:We evaluated clinical and laboratory data of 206 consecutive patients who underwent coronary angiography and PCI due to AMI. Primary endpoints were all-cause death and recurrent hospitalisations due to acute coronary syndrome (ACS). Results:Severe TLC lesions were present in 17% of patients. These patients were older (71 vs. 65 years, p = 0.02) and more often diagnosed with non-ST segment elevation myocardial infarction (77% vs. 58%, p = 0.03). Patients with severe TLC had lower rates of PCI success (80% vs. 97%, p < 0.0001) and less often achieved full revascularisation during index procedure (14% vs. 41%, p = 0.003). During 30 months follow-up patients with severe TLC more often suffered from another ACS (37% vs. 13%, p = 0.0005) and had higher all-cause mortality (31% vs. 16%, p = 0.04). Multivariate Cox regression model showed severe TLC to be an independent predictor of another ACS (HR 2.8; 95% CI 1.4-5.6; p = 0.004). Conclusions:Severe TLC are not uncommon in patients with ACS. The presence of severe TLC is a prognostic factor of another ACS in AMI patients undergoing PCI.

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Usefulness of Rotational Atherectomy in Preventing Polymer Damage of Everolimus-Eluting Stent in Calcified Coronary Artery

Cited by 75 publications

References 0 publications

Orbital Atherectomy for Treating De Novo Severely Calcified Coronary Narrowing (1-Year Results from the Pivotal ORBIT II Trial)

Orbital Atherectomy for Treating De Novo Severely Calcified Coronary Narrowing (1-Year Results from the Pivotal ORBIT II Trial)

Comparison of Long-Term Clinical Outcomes Between Sirolimus-Eluting Stents and Paclitaxel-Eluting Stents Following Rotational Atherectomy

Patients with acute myocardial infarction and severe target lesion calcifications undergoing percutaneous coronary intervention have poor long-term prognosis

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