Short- and Mid-Term Prognosis of Patients Undergoing Rotational Atherectomy in Aortoostial Coronary Lesions in Left Main or Right Coronary Arteries

Objective. To determine short-term and mid-term prognosis in patients with calcified ostial coronary lesions who underwent rotational atherectomy (RA). Background. RA was developed to facilitate stenting in complex lesions. Treatment of calcified aortoostial coronary lesions with RA appears to have poorer procedure outcomes than nonostial lesions; yet the literature on this topic is scarce. Methods. Of 498 consecutive patients who underwent RA, a total of 80 (16.1%) presented with aortoostial lesions. A comparative, monocentric study was performed between patients with aortoostial and nonaortoostial stenosis, in a retrospective registry. The primary endpoint was the procedural success rate. Secondary endpoints were the rates of major adverse cardiac and cardiovascular events (MACE) at 30 days and 24 months. Results. The procedural success rate was high and similar in patients with and without ostial lesions (96.3% vs 94.7%, p=0.78), as was the rate of angiographic complications (7.5% vs 8.4%, p=0.80). However, the 30-day mortality rate was significantly higher in the aortoostial group (11.3% vs 4.8%, p=0.04), as was the 24-month rate of MACE (43.8% vs 31.8%, p=0.04). The aortoostial location of the lesion was an independent factor associated with the occurrence of cardiovascular events at 24 months (HR = 1.52, 95% CI, 1.03-2.26, p=0.035). Conclusion. Procedural success and complication rates were similar in patients with and without aortoostial lesions. Despite a poor short- and mid-term prognosis, rotational atherectomy appears to be a feasible and safe treatment option for calcified aortoostial coronary lesions.

Download Full-text

P975Safety and clinical outcomes of rotational atherectomy: an eleven-year centre experience

European Heart Journal ◽

10.1093/eurheartj/ehz747.0569 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A R Pereira ◽

R Cale ◽

P Santos ◽

A R Almeida ◽

A Marques ◽

...

Keyword(s):

Success Rate ◽

Clinical Outcomes ◽

Rotational Atherectomy ◽

Safe Procedure ◽

Access Site ◽

Significant Difference ◽

Coronary Lesions ◽

Procedural Success ◽

Calcified Coronary Lesions

Abstract Introduction Rotational atherectomy (RA) is an adjunctive tool for the management of heavily calcified coronary lesions during percutaneous coronary intervention (PCI), but the clinical outcomes remain unclear. Access site choice is also poorly defined and there is growing evidence that transradial approach (TRA) is associated with lower complications and lower mortality. Objectives To assess the safety and long-term outcomes of RA for calcified coronary lesions and to investigate the influence of vascular access site in the efficacy and safety of the procedure. Methods Retrospective single-centre study that included consecutive PCI with RA performed from January 2006 to December 2017. Endpoint was a composite of major adverse cardiac events (MACE), defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke and target vessel revascularization, at 1- and 5-year. Results 246 procedures were included in a total of 236 patients (pts): mean age 70.1±9.7 years, 73.6% male; 36.2% had previous PCI, 12.2% vascular peripheral disease (VPD), 24% reduced left ventricle ejection fraction (LVEF) and 6.9% were under hemodialysis. PCI with RA was mostly performed due to stable angina (48.9%) and via TRA (55.3%), with a total of 371 treated segments and a median number of 1 vessel treated per intervention. The left anterior descending artery was the most frequently treated artery (67.5%). Single burr was used in 76% of cases (mean number of burrs 1.23; mean burr size 1.5 mm). Procedural success rate was 94.7%. Complications were recorded in 9.3%, with no procedure related death. Clinical follow-up was complete in 98.8% of pts at 1-year and 81.3% at 5-year (mean time 62.3±41.8 months). Survival free of MACE at 1- and 5-year were 83.7% and 73.2%, respectively. Multivariate Cox regression identified 6 independent predictors (only 1 protector) for 1-year MACE (Fig. A) and 6 independent predictors (all of increased risk) for 5-year MACE (Fig. B). TRA was protector of 1-year MACE and Kaplan-Meier curves showed benefit for both 1- and 5-year MACE occurrence (Fig. C and D), without significant difference in procedural success (p=0.92) and complications (p=0.45) rate comparing to transfemoral approach. Conclusions RA followed by stenting was a safe procedure with a high immediate success rate but an increased number of long-term cardiovascular events. Some clinical conditions, such as previous PCI, VPD and reduced LVEF, seems to adversely influence the long-term outcome while TRA appears to be protective.

Download Full-text

Comparison of Bailout and Planned Rotational Atherectomy for Severe Coronary Calcified Lesions

10.21203/rs.3.rs-19577/v2 ◽

2020 ◽

Author(s):

Cheng-fu CAO ◽

Yu-liang MA ◽

Qi LI ◽

Jian LIU ◽

Hong ZHAO ◽

...

Keyword(s):

Success Rate ◽

Clinical Characteristics ◽

Operation Time ◽

Rotational Atherectomy ◽

Single Center ◽

Lower Complication ◽

Severe Coronary Artery ◽

Coronary Lesions ◽

Procedural Success ◽

Calcified Coronary Lesions

Abstract Objective : To compare outcomes of bailout and planned rotational atherectomy (RA) in the treatment of severe calcified coronary lesions. Methods: Data of patients treated with RA from 2017 to 2018 at a single-center registry were retrospectively analyzed. All patients were divided into planned RA and bailout RA groups, data between two groups were compared. Results: A total of 190 patients were included in this study, 138 patients received planned RA and 52 patients received bailout RA. Baseline clinical characteristics had no significant differences between groups. The number of implanted stents and total stents length were similar. But the number of balloon (1.6±0.8 vs. 2.7±1.3, P <0.001), operation time (83.5±26.2 vs. 100.8±36.4min, P =0.007), fluoroscopy volume (941±482 vs. 1227±872mGy, P =0.012] and contrast amount （237±62 vs. 275±90ml, P =0.003）were all lower in planned RA group. Planned RA had a higher procedural success rate (99.3% vs. 92.3%, P =0.007) and a lower complication incidence (4.3% vs. 17.3%, P =0.009). But the cumulative 3-year incidences of MACE events (9.2% and 16.6%, log rank p 0.24) had no difference between groups. Conclusion: For severe coronary artery calcification, although planned RA did not reduce MACE compared with bailout RA, but it can improve the immediate procedural success rate, reduce the incidence of complications, the operation time and the volume of contrast.

Download Full-text

Comparison of Bailout and Planned Rotational Atherectomy for Severe Coronary Calcified Lesions

10.21203/rs.3.rs-19577/v3 ◽

2020 ◽

Author(s):

Cheng-fu CAO ◽

Yu-liang MA ◽

Qi LI ◽

Jian LIU ◽

Hong ZHAO ◽

...

Keyword(s):

Success Rate ◽

Rotational Atherectomy ◽

Procedure Time ◽

Lower Complication ◽

Severe Coronary Artery ◽

Coronary Lesions ◽

Procedural Success ◽

Long Term Prognosis ◽

Calcified Coronary Lesions

Abstract Background: To compare outcomes of bailout and planned rotational atherectomy (RA) in the treatment of severe calcified coronary lesions.Methods: Data of patients treated with RA from 2017 to 2018 at a single-center registry were retrospectively analyzed. All patients were divided into planned RA and bailout RA groups, data between two groups were compared.Results: A total of 190 patients were included in this study, 138 patients received planned RA and 52 patients received bailout RA. Baseline clinical characteristics had no significant differences between groups. The number of implanted stents and total stents length were similar. But the number of balloon (1.6±0.8 vs. 2.7±1.3, P<0.001), procedure time (83.5±26.2 vs. 100.8±36.4min, P=0.007), fluoroscopy volume (941±482 vs. 1227±872mGy, P=0.012] and contrast amount （237±62 vs. 275±90ml, P=0.003）were all lower in planned RA group. Planned RA had a higher procedural success rate (99.3% vs. 92.3%, P=0.007) and a lower complication incidence (4.3% vs. 17.3%, P=0.009). But the primary outcomes at 3 years (9.2% and 16.6%, log rank p=0.24) had no difference between groups.Conclusions: For severe coronary artery calcification, although planned RA did not improved the long term prognosis compared with bailout RA, but it can improve the immediate procedural success rate, reduce the incidence of complications, the procedure time and the volume of contrast.

Download Full-text

Comparison of Bailout and Planned Rotational Atherectomy for Severe Coronary Calcified Lesions

10.21203/rs.3.rs-19577/v1 ◽

2020 ◽

Author(s):

Cheng-fu CAO ◽

Yu-liang MA ◽

Qi LI ◽

Jian LIU ◽

Hong ZHAO ◽

...

Keyword(s):

Success Rate ◽

Clinical Characteristics ◽

Operation Time ◽

Rotational Atherectomy ◽

Single Center ◽

Lower Complication ◽

Severe Coronary Artery ◽

Coronary Lesions ◽

Procedural Success ◽

Calcified Coronary Lesions

Download Full-text

Risk-Stratified Cardiovascular Screening Including Angiographic and Procedural Outcomes of Percutaneous Coronary Interventions in Renal Transplant Candidates

Journal of Transplantation ◽

10.1155/2014/854397 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Julian König ◽

Martin Möckel ◽

Eda Mueller ◽

Wolfgang Bocksch ◽

Seema Baid-Agrawal ◽

...

Keyword(s):

High Risk ◽

Success Rate ◽

Percutaneous Coronary Interventions ◽

Improve Outcome ◽

Cardiac Screening ◽

Percutaneous Coronary ◽

Risk Patients ◽

Coronary Lesions ◽

Transplant Candidates ◽

Procedural Success

Background. Benefits of cardiac screening in kidney transplant candidates (KTC) will be dependent on the availability of effective interventions. We retrospectively evaluated characteristics and outcome of percutaneous coronary interventions (PCI) in KTC selected for revascularization by a cardiac screening approach.Methods. In 267 patients evaluated 2003 to 2006, screening tests performed were reviewed and PCI characteristics correlated with major adverse cardiovascular events (MACE) during a follow-up of 55 months.Results. Stress tests in 154 patients showed ischemia in 28 patients (89% high risk). Of 58 patients with coronary angiography, 38 had significant stenoses and 18 cardiac interventions (6.7% of all). 29 coronary lesions in 17/18 patients were treated by PCI. Angiographic success rate was 93.1%, but procedural success rate was only 86.2%. Long lesions (P=0.029) and diffuse disease (P=0.043) were associated with MACE. In high risk patients, cardiac screening did not improve outcome as 21.7% of patients with versus 15.5% of patients without properly performed cardiac screening had MACE (P=0.319).Conclusion. The moderate procedural success of PCI and poor outcome in long and diffuse coronary lesions underscore the need to define appropriate revascularization strategies in KTC, which will be a prerequisite for cardiac screening to improve outcome in these high-risk patients.

Download Full-text

A Tale of Two (Anal Fistula) Plugs: Is there a Difference in Short-Term Outcomes?

The American Surgeon ◽

10.1177/000313481007601030 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1150-1153 ◽

Cited By ~ 18

Author(s):

Brian Buchberg ◽

Hossein Masoomi ◽

John Choi ◽

Herlinda Bergman ◽

Steven Mills ◽

...

Keyword(s):

Success Rate ◽

Anal Fistula ◽

Retrospective Chart Review ◽

Minimal Risk ◽

Anal Fistulas ◽

Short Term ◽

Fistula Plug ◽

Anal Fistula Plug ◽

Procedural Success ◽

Complex Anal Fistulas

Treatment of complex anal fistulas presents an ongoing challenge to colorectal surgeons. The anal fistula plug is an attractive definitive option due to its minimal risk of incontinence, simple design, and easy application. Our objective was to compare the Cook Surgisis® AFP™ plug and the newer Gore Bio-A® plug in the management of complex anal fistulas. A retrospective chart review of patients treated with Cook and Gore fistula plugs between August 2007 and December 2009 was performed. Success was defined as closure of all external openings and absence of drainage and abscess formation. Twelve Cook patients underwent 16 plug insertions and 10 Gore patients underwent 11 plug insertions. The overall procedural success rate in the Gore group was 54.5 per cent (6 of 11) versus 12.5 per cent (2 of 16) in the Cook group. The reasons for failure were unknown in the majority of patients and plug dislodgement in two patients. Our short-term results with the Gore fistula plug suggest a higher procedural success rate in comparison to the Cook plug. Patients should be cautioned regarding potentially high failure rates; however, longer follow-up and a larger patient population are needed to confirm significant differences in fistula plug efficacy.

Download Full-text

Experience with CAPD in Diabetic Patients in Toronto

Peritoneal Dialysis International ◽

10.1177/089686088100201s02 ◽

1981 ◽

Vol 2 (1_suppl) ◽

pp. 12-14 ◽

Cited By ~ 7

Author(s):

Clair Williams ◽

Dale Belvedere ◽

Daniel Cattran ◽

Sheila Clayton ◽

Edward Cole ◽

...

Keyword(s):

Success Rate ◽

Cause Of Death ◽

Cardiovascular Events ◽

Survival Rates ◽

First Year ◽

Diabetic Patients ◽

Dialysis Modality ◽

Short Term ◽

The Mean

During the first four years of the CAPD programs in Toronto, 409 patients completed CAPD training; of these 64 (15.7%) were diahetics. The mean age of the diabetics was 46.7 and of the non-diabetics 51.4 years. One and two-year survival rates were not significantly different between the two groups (93%-82% for the non-diabetics and 90%-72% for the diabetics}. The main cause of death was cardiovascular events, in both groups. During the first year on CAPD, diabetics were transplanted at a higher rate than non-diabetics (20% vs. 9%). The overall technique success rate, the rate of transfer to an alternative dialysis modality and the incidence of peritonitis were similar in the two groups. At least in the short -term, diabetics do well on CAPD. It is suggested that CAPD may be the dialysis modality of choice in diabetics with ESRD.

Download Full-text

Successful rotational atherectomy of left main stem with double kiss crush stenting using double guiding catheter: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab481 ◽

2021 ◽

Author(s):

Ghaith M Maqableh ◽

Mohammed Osheiba ◽

Anthony Mechery ◽

Sohail Q Khan

Keyword(s):

Chest Pain ◽

Artery Bypass ◽

Hemodynamic Instability ◽

Main Stem ◽

Rotational Atherectomy ◽

Complication Rates ◽

Left Main ◽

Left Main Stem ◽

Catheter Technique ◽

Guide Catheter

Abstract Background Coronary artery bypass grafting (CABG) is the preferred revascularization procedure for patients with multivessel disease, and those with complex left main disease, as it is associated with a survival advantage in this group of patients. Sometimes however surgical management is not the treatment of choice due to many factors including; ongoing chest pain, hemodynamic instability or patient preference. In these situations, PCI offers an alternative revascularization strategy. In this case study, we present a successful PCI with rotational atherectomy (RA) for distal LMS, LAD and CX using a double guide catheter technique in a patient with severe calcific disease. Case Summery A 63-year-old female was diagnosed with a non-ST elevation myocardial infarction (NSTEMI). Coronary angiography showed significant distal left main stem disease with a severe proximal/ostial calcified lesion of the LAD and a possible thrombotic lesion at the ostium of the CX. She had ongoing hemodynamic instability with chest pain however could not be offered immediate surgical revascularization. We therefore elected to proceed to complex bifurcation LMS coronary intervention using RA under IVUS guidance achieving an excellent final result with TIMI III flow. Discussion This case demonstrates that rotational atherectomy (RA) using the double catheter technique (also known as Ping-Pong) can be safely performed with minimal complication rates and with very favorable angiographic and IVUS results. The clinical outcome was excellent with early discharge.

Download Full-text

Endovascular neurointervention success and complication rates in the first year of independent practice in a suburban hospital setup

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.127864 ◽

2014 ◽

Vol 5 (01) ◽

pp. 11-17 ◽

Cited By ~ 2

Author(s):

Subhash Kumar

Keyword(s):

Patient Outcome ◽

Success Rate ◽

Clinical Skills ◽

Deep Understanding ◽

Interventional Neuroradiology ◽

First Year ◽

Complication Rates ◽

Modified Rankin Scale ◽

Therapeutic Procedures ◽

Procedural Success

ABSTRACT Context: Endovascular neurointervention (interventional neuroradiology) is a highly demanding science requiring deep understanding of disease, anatomy, clinical skills and manual dexterity, consequently with a long learning curve and thus posing significant challenges to a physician entering new into the competitive arena. Aim: To evaluate the procedural success, complications and outcome in the first year of independent endovascular neurointervention practice in a suburban hospital. Materials and Methods: Retrospective analysis of prospectively maintained data of all diagnostic and therapeutic neurointerventional cases performed by the author between the period of January 02, 2012 and December 31, 2012. Results: A total of 61 procedures were performed. The performance success rate of the diagnostic procedures was 100% (38/38) and that of therapeutic procedures was 82.6% (19/23). The periprocedural complication rates were nil and 13%, respectively, for diagnostic and therapeutic procedures. The 3-month patient outcome for therapeutic procedures was good outcome (Modified Rankin Scale <2) in 87% cases (20/23), and poor outcome in 13% (2 dead and 1 debilitated with Modified Rankin Scale of 3). Conclusion: For a well-trained endovascular neurointerventionalist, the first year of practice had high procedural success rate and acceptable complication with patient outcome rates comparable to the existing literature.

Download Full-text

“Shelf” Technique Using a Novel Braided Self-Expandable Stent for the Treatment of Wide-Necked Bifurcation Aneurysms

Clinical Neuroradiology ◽

10.1007/s00062-021-01032-2 ◽

2021 ◽

Author(s):

Volker Maus ◽

Werner Weber ◽

Sebastian Fischer

Keyword(s):

The Novel ◽

Inclusion Criteria ◽

Endovascular Techniques ◽

Short Term ◽

Aneurysm Neck ◽

Ischemic Complications ◽

Secondary Endpoints ◽

Aneurysm Occlusion ◽

Safe Treatment Option

Abstract Background Different endovascular techniques exist for treatment of cerebral wide-necked bifurcation aneurysms (WNBA). We present the “shelf” technique with the novel woven LVIS EVO stent, which enables forming a buttress at the level of the aneurysm neck to prevent coil prolapse and additional stenting. Methods Single-center retrospective analysis of patients treated with the “shelf” technique by using LVIS EVO stent in incidental WNBAs between January 2020 and March 2021. Inclusion criteria were saccular aneurysms with neck width ≥4 mm or a dome/neck ratio ≤2. Primary endpoint was a favorable navigation to the target vessel and successful deployment of the LVIS EVO stent with forming a buttress that enables aneurysm occlusion by subsequent coiling. Secondary endpoints were aneurysm occlusion on follow-up, procedure-related complications and clinical outcome. Results A total of 15 patients were included. The primary end point was reached in 100% of cases. A complete aneurysm occlusion at the end of the procedure was achieved in 14/15 patients (93%). No intraprocedural complications occurred. All patients except one were discharged with an modified Rankin Scale (mRS) of 0. Procedure-related morbidity was 7%. Median follow-up imaging was 115 days (7–419 days) and available for 11/15 (73%) of the patients. Of those, 10 (91%) individuals had a complete aneurysm occlusion and 1 showed a residual neck. In all patients, the covered branch was patent and no ischemic complications occurred during follow-up. Conclusion This study demonstrates the “shelf” technique with LVIS EVO stents as a feasible and safe treatment option for WNBAs with very good short-term occlusion rates.

Download Full-text