scholarly journals Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Yen-Hsiang Wang ◽  
Wei-Jhong Chen ◽  
Yu-Wei Chen ◽  
Chih-Hung Lai ◽  
Chieh-Shou Su ◽  
...  
Keyword(s):  
Real World ◽  
Vessel Wall ◽  
Clinical Information ◽  
Rotational Atherectomy ◽  
Diagonal Branch ◽  
Poor Outcome ◽  
The Wire ◽  
Noncalcified Plaque

Objective. Heavy calcifications remain formidable challenges to PCI, even for well-experienced operators. However, rotational atherectomy (RA)-induced coronary perforations (CPs) still could not be obviated. This study was to explore incidence and mechanisms of RA-induced CP in real-world practice. Knowing why CPs occur in RA should help operators avert such mishaps. Method. Patients who received coronary RA from April 2010 to December 2019 with keywords related to perforations were retrieved from database. The procedure details, angiography, and clinical information were reviewed in detail. Results. A total of 479 RAs were performed with 11 perforations in 10 procedures among 9 patients documented. The incidence of RA-induced CP was 2.1%. The RA vessels were distributed in different territories, including first diagonal branch. Most CPs could be treated conservatively, but prolonged profound shock predisposed to poor outcome. CPs caused by rotawire tip occurred in 18.2% of cases, inappropriately sized burrs in 18.2% of cases, and rotawire damage with subsequent transection and perforation in another 18.2% of cases. A total of 5 (45.5%) perforations were caused by unintended and unnoticed bias cutting into noncalcified plaques (4, 36.4%) or through calcified vessel wall (1, 9.1%). The mechanisms for certain CPs were unique and illustrated in diagrams. Conclusion. CPs due to RA occur in certain percentage of patients. The mechanisms for CPs are diverse. Wire damage with subsequent transection could occur due to inappropriately repetitive burr stress on the wire body. A significant portion was due to unintended and unnoticed bias cutting into noncalcified plaque or through calcified vessel wall.

Coronary Intravascular Lithotripsy Versus Rotational Atherectomy in an Asian Population: Clinical Outcomes in Real-World Patients

2022 ◽  
Vol 52 ◽  
Author(s):  
Jie Jun Wong ◽  
Sridharan Umapathy ◽  
Yann Shan Keh ◽  
Yee How Lau ◽  
Jonathan Yap ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Real World ◽  
Asian Population ◽  
Rotational Atherectomy

P5753Jailed pressure wire to assess the side branch result for bifurcation lesions treated by provisional stenting strategy: iFR as a new index

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Romero ◽  
F Hidalgo ◽  
S Ojeda ◽  
J Segura ◽  
J Suarez De Lezo ◽  
...  
Keyword(s):  
Side Branch ◽  
Diagonal Branch ◽  
Coronary Syndrome ◽  
Bifurcation Lesion ◽  
Pressure Wire ◽  
Bifurcation Lesions ◽  
Microscopic Damage ◽  
The Wire ◽  
Provisional Stenting

Abstract Purpose To analyze the feasibility and efficacy of the jailed pressure wire technique for bifurcation lesions treated by provisional stenting strategy and to assess the physiological side branch (SB) result using instantaneous wave free ratio (iFR). Methods Between June 2017 and December 2018, 50 patients who presented a bifurcation lesion considered appropriate for provisional stenting strategy were included in the study. Pressure wire was passed to side branch before treatment. Main vessel (MV) and side branch (SB) was predilated at the operator criteria. iFR determination was obtained in the SB baseline and after MV stenting (leaving the pressure wire jailed). Afterwards, the wire was removed to MV ostium to discard the possibility of drift. SB postdilation was performed if SB iFR was less than 0,89 (according to vessel thresholds established in clinical trials), evaluating the result by a new iFR determination. Results The mean age was 64±10 years. Sixteen patients (32%) had diabetes. Clinical presentation was stable angina in 26 patients (52%), non-STEMI in 19 patients (38%) and STEMI (non culprit lesion) in 5 patients (10%). The most frequent bifurcation type according to Medina classifications was 1,1,0 (21 patients, 42%). Seventeen patients (34%) had a true bifurcation lesion. The MV and SB reference diameter was 3,0±0,5 mm and 2,25±0,5 mm respectively. Most of the bifurcations were located at the left anterior descending artery/diagonal branch (27 bifurcations, 54%). Ten patients (20%) presented a distal left main bifurcation. Baseline SB iFR was 0,78±0,2. Under continuous SB iFR monitoring MV stenting was performed by trapping the pressure wire. After MV stenting, the SB iFR changed to 0,90±0,1. We confirmed the presence of drift in 5 patients (10%). In these cases, recalibration of the wire and SB rewiring was performed in 4 cases. In the remaining patient, rewiring was not possible even using specific coronary wires. According to SB IFR, postdilation was necessary in 14 patients (28%). Final SB iFR was 0,94±0,03. A second stent was not necessary in any patient because final SB iFR was higher than 0.89 in all cases. We observed discordance between angiographic and physiological result in 17 cases (34%). All the wires could be removed. Forty wires (80%) were microscopically analyzed. Some grade of microscopic damage was found in 32 wires (80%), all of them distal to the pressure sensor. However, only one of these wires (2%) presented severe damage, and no case of fracture was observed. After a mean follow up time of 10±6 months only one patient (2%) presented a major cardiac adverse event (acute coronary syndrome due to voluntary cessation of dual antiplatelet therapy). Conclusions The use of jailed pressure wire to monitor SB results for bifurcations treated by provisional stenting seems to be safe. The iFR index seems to provide new physiological information about the significance of the SB stenosis.

ENETS single center of excellence experience with the NETest: A real-world assessment of 565 patients.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 605-605
Author(s):  
Anna Malczewska ◽  
Mateusz Rydel ◽  
Amanda Robek ◽  
Katarzyna Kusnierz ◽  
Izabela Les-Zielinska ◽  
...  
Keyword(s):  
Real World ◽  
Clinical Status ◽  
Unmet Need ◽  
Clinical Information ◽  
Disease Status ◽  
Diagnostic Sensitivity ◽  
Lung Cancers ◽  
Center Of Excellence ◽  
Mcnemar’S Test ◽  
Mcnemar's Test

605 Background: There is a substantial clinical unmet need for an accurate and effective blood biomarker of NET disease. We therefore evaluated under real-world conditions the clinical utility of the NETest in a NET Center of Excellence and compare it with the biomarker CgA. Methods: Cohorts: GEP-NET (253), BP-NET (49), colon cancer (37), lung cancers (80), benign lung disease (59) and controls (86). GEP-NETs: 164 (65%) had image-detectable disease or were resection-margin (R1) positive. Grading included G1 [106], G2 [49] and G3 [9]. BP-NETs, 28 of 49 (57%) had evidence of disease. Grading was TC [14], AC [14]. Disease status (stable [SD] or progressive [PD]) determined by RECIST 1.1. Blood sampling: NETest ( n= 565) and NETest/CgA matched samples (135). NETest (PCR) (0-100 score) with positive > 20; progressive > 40. CgA (ELISA). All samples deidentified, and measurement/ analyses blinded. Statistics: Mann-Whitney U-test, McNemar’s test and AUROC. Results: GEPNET: NETest was significantly higher (34.4±1.8, p< 0.0001) in NET disease versus no NET disease (10.5±1, p< 0.0001), non-NET disease (18±4, p= 0.0004) or controls (7±0.5, p< 0.0001). Diagnostic sensitivity was 89%, and specificity 94%. NETest levels were not related to grade (G1: 32±2 vs. G2: 38±3, p= 0.09). BPNET: NETest was significantly higher (30±1.3) vs no NET disease (24.1±1.3, p= 0.0049). Diagnostic sensitivity 100%. Levels were elevated vs controls ( p< 0.0001) and non-NET disease (20±2, p= 0.0001). NETest levels were not related to grade (TC 30±2 vs. AC: 30±2, p= NS). Levels were elevated in PD (55±5.5) vs SD (33.6±2, p= 0.0005). AUCs for detecting disease ranged between 0.89 (GEP-NET) to 1.0 (BE-NET) ( p< 0.0001). Matched GEP-NETS (135): NETest was significantly more accurate for detecting NETS (99%) than CgA (53%, McNemar’s test Chi2= 87, p= 0.0001). sensitivity (99%) and specificity (96%) were better than CgA (37% and 96% respectively). Conclusions: The NETest is an accurate diagnostic test for both GEP- and BP-NEN. It defines clinical status (stable or progressive disease). NETest is significantly more accurate than CgA. The multianalyte genomic blood assessment of NET disease provided clinical information of utility in management.

OP08 Using Real World Data To Support National Postmarketing Surveillance

2018 ◽  
Vol 34 (S1) ◽  
pp. 3-3
Author(s):  
Yeqin Zuo ◽  
Bernie Mullen ◽  
Rachel Hayhurst ◽  
Karen Kaye ◽  
Renee Granger ◽  
...  
Keyword(s):  
Primary Care ◽  
Real World ◽  
National Level ◽  
Clinical Information ◽  
Health Priorities ◽  
Care Practice ◽  
Postmarketing Surveillance ◽  
Care Practices ◽  
Primary Care Practices ◽  
Tract Infections

Introduction:While medicines and medical tests are developed in a controlled clinical trial environment, postmarketing surveillance in the real world can be challenging. MedicineInsight—a database of longitudinal patient-level clinical information from primary care practices in Australia—is a novel program that collects primary care data to improve postmarketing surveillance at a national level.Methods:MedicineInsight collects de-identified clinical information from primary care practice information systems using data extraction tools. MedicineInsight currently includes 3.6 million regular patients of 3,300 family physicians (general practitioners) from 650 primary care practices across Australia. MedicineInsight data include longitudinal clinical information on diagnosis and medicines (dose, strength, route of administration, medication switches over time, adverse events, and allergies), and pathology testing data. A series of observational studies was developed for postmarketing surveillance of management of a range of health priorities including type 2 diabetes mellitus (T2DM), chronic obstructive pulmonary disease (COPD), depression, and antibiotics use.Results:Forty-four percent of patients with T2DM in the MedicineInsight database did not have a recorded hemoglobin A1c result and thirty-one percent did not have a recorded blood pressure reading in the previous 6 months. While guidelines recommend a stepwise approach to the initiation of COPD therapy, forty-nine percent of patients with COPD (with or without asthma) were prescribed dual therapy at initiation and a small number (4.5 percent) were prescribed triple therapy. Between 2011 and 2015, the annual rate of antidepressant prescribing per 1,000 family physician encounters increased by eight percent. High volumes of antibiotics were prescribed for respiratory tract infections in Australian primary care, notwithstanding guideline recommendations that antibiotics are not recommended in most cases.Conclusions:Large scale, real-world clinical data from primary care practices can play an important role in postmarketing surveillance at a national level.

Optimal teicoplanin dosing regimen in neonates and children developed by leveraging real-world clinical information

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Takaaki Yamada ◽  
Chie Emoto ◽  
Tsuyoshi Fukuda ◽  
Yoshitomo Motomura ◽  
Hirosuke Inoue ◽  
...  
Keyword(s):  
Real World ◽  
Clinical Information ◽  
Dosing Regimen

Evaluation of treatment patterns and outcomes in patients diagnosed with genitourinary (GU) cancers with linked claims plus prior authorization data.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 284-284
Author(s):  
Lincy S. Lal ◽  
Caitlin Elliott ◽  
Stephanie Korrer ◽  
Stacey DaCosta Byfield ◽  
Benjamin Chastek ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Median Duration ◽  
Real World ◽  
Claims Data ◽  
Clinical Information ◽  
Treatment Patterns ◽  
Cancer Type ◽  
Research Database ◽  
Prior Authorization ◽  
Line Of Therapy

284 Background: Integration of clinical and claims data allows for the examination of outcomes and characteristics which is essential for real world evidence generation and clinical decision making. We describe utilization of clinical data collected from an oncology Prior Authorization (PA) program integrated with claims data to evaluate treatment patterns, resource utilization, and total costs of care during therapy for patients with newly diagnosed metastatic and non-metastatic renal (R), bladder (B), and testicular (T) cancers. Methods: Commercially insured patients with a GU cancer diagnosis, from 2/2016 to 12/2019 with both clinical information from a PA tool (based on NCCN guidelines) and claims from the Optum Research Database were identified. Demographics, clinical information (metastatic status and line of therapy), treatment duration, resource utilization, and all-cause costs were collected, and uploaded to a dynamic web-based Tableau dashboard. Analysis was conducted for non-metastatic and metastatic settings based on the first observed treatment episode. Drug additions or switches incremented line of therapy; single drug discontinuations did not. All cost data were adjusted to 2019 values. Results: A total of 3,736 patients were included; 13% were censored (i.e. on treatment at the end of the study period). 916 patients (25%) were metastatic and 2,820 (75%) were in their adjuvant/neoadjuvant (A/N) line. 60% of the population was ≥55 years old and 85% were male. The top regimen in A/N line for each cancer type were: nivolumab (R), BCG(B), bleomycin + carboplatin/cisplatin+ etoposide (T). The top regimen in metastatic cancer were: nivolumab (R), carboplatin/cisplatin + gemcitabine (B), bleomycin + carboplatin/cisplatin + etoposide (T). The median duration of A/N line ranged from 50(B) to 119(R) days while the median duration for metastatic line range from 71(T) to 82(R) days. The highest rate of inpatient admissions was observed in patients with R (31%). Of the three cancers, R was the most expensive in the A/N and metastatic settings with mean (standard deviation) costs of $192,308 ($269,358) and $136,293 ($146,632), respectively. Conclusions: Combination of clinical and claims data provide valuable information on real world outcomes in routine clinical care and may support treatment selection decisions at the point of care.

When Calcium Gets Tough, the Tough Cardiologist Starts to Play …

Cardiology ◽  
2018 ◽  
Vol 141 (3) ◽  
pp. 167-171 ◽  
Author(s):  
Eliezer Joseph Tassone ◽  
Cesare Tripolino ◽  
Gaetano Morabito ◽  
Placido Grillo ◽  
Bindo Missiroli
Keyword(s):  
Coronary Angiography ◽  
Coronary Calcification ◽  
Rotational Atherectomy ◽  
Sound Waves ◽  
Diagonal Branch ◽  
Coronary Syndrome ◽  
First Case ◽  
Coronary Lesions ◽  
Angioplasty And Stenting ◽  
Calcified Coronary Lesions

Coronary calcification is a hard challenge for the interventional cardiologist, as it is associated with incomplete stent expansion and frequently stent failure. In recent years, innovative techniques, such as rotational atherectomy, have been developed to treat coronary calcification. However, these are burdened with an increased procedural risk. We report the case of a 60-year-old Caucasian man treated 1 month before at another center with primary coronary angioplasty and stenting of the ramus intermedius for coronary syndrome. Coronary angiography showed a critical stenosis of the left main coronary artery as well as critical calcified stenosis of the left anterior descending artery and the diagonal branch. Coronary calcification was treated with rotational atherectomy that preceded the angioplasty and stenting. Because of persistence of the symptomatology, coronary angiography was repeated 1 month later and showed a critical calcified restenosis of the ramus intermedius at the site of the previous stenting. Considering the high risk of traditional atherectomy, we performed lithotripsy-enhanced disruption of calcium beyond the stents with the Shockwave Coronary Lithoplasty System. The Shockwave Coronary Lithoplasty System has been introduced recently in order to treat calcified coronary lesions with greater safety. The procedure allows most calcified coronary lesions to be treated with simplicity and safety. This system employs sound waves, similar to those used for treating kidney stones, to crush the calcified lesions. We present the first case described to date in whom this technique was successfully used to treat calcified restenosis in a previous stent.

The Duty of Diplomatic Dissent

2006 ◽  
Vol 1 (3) ◽  
pp. 295-301
Author(s):  
John Brady Kiesling
Keyword(s):  
Foreign Policy ◽  
Real World ◽  
Iraq War ◽  
Political Process ◽  
State Department ◽  
Policy Impact ◽  
The Political ◽  
Poor Outcome ◽  
The Poor ◽  
The Us

AbstractThe poor outcome of the Iraq War has highlighted the usefulness of 'reality-based' foreign policy. Yet the personal and professional consequences of dissent remain high in the US (and every other) diplomatic service. The Dissent Channel, currently underutilized, was designed to protect both the US State Department and its employees from bureaucratic retaliation for unwelcome real-world expertise. It should be reinvigorated. However, the unimpressive policy impact of dissent, whether through institutional channels or public resignations, makes it clear that effective dissent requires mobilizing the domestic political process as a force multiplier. Good dissent raises the political price of foreign policy blunders, and only through turning a bureaucratic system painfully against itself can blunders actually be prevented.

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