scholarly journals Plakkmodifikáció a 21. században – az első magyar tapasztalatok az intravascularis lithoplasticával

2021 ◽  
Vol 162 (2) ◽  
pp. 69-73
Author(s):  
Balázs Tamás Németh ◽  
István Ferenc Édes ◽  
Bálint Szilveszter ◽  
Fanni Nowotta ◽  
Dávid Becker ◽  
...  
Keyword(s):  
Balloon Dilation ◽  
Calcium Content ◽  
Vessel Diameter ◽  
Percutaneous Intervention ◽  
Stent Deployment ◽  
Ultra High Pressure ◽  
Leading Role ◽  
Coronary Lesions ◽  
Angiographic Result ◽  
Calcified Coronary Lesions

Összefoglaló. A nagy mésztartalmú plakkok által okozott szűkületek percutan intervenciója az esetek egy részében a jelenleg széles körben elérhető megoldások alkalmazásával technikailag nem kivitelezhető. A procedurális sikertelenség vezető oka a meszes laesiók kalciumtartalom miatti fokozott ellenállása a ballonos dilatációkkal szemben, mely lehetetlenné teszi a szükséges sztentek levezetését is. Az ilyen laesiók mésztartalmának csökkentését célzó hagyományos plakkmodifikációs eljárások – mint a rotablatio, a vágó- és ultranagy nyomású ballonok – sem jelentenek megoldást minden esetben, különösen az érfal átmérőjének legalább 50%-át elérő, akár körkörösen jelen lévő meszesedés fennállása esetén. A közelmúltban éppen ezen laesiók mésztartalmának feltördelésére, így a sztentek deponálásának elősegítésére kifejlesztett módszert a szakirodalom intravascularis lithoplastica néven említi. A jelen közleményben a Klinikánkon eddig 4 beteg rendkívül meszes laesióinak jó angiológiai eredményű ellátása során az eszközzel szerzett tapasztalatokat foglaljuk össze. A végeredményt tekintve az intravascularis lithoplastica ígéretes új intervenciós lehetőség a masszívan meszes coronarialaesiók ellátására. Orv Hetil. 2021; 162(2): 69–73. Summary. Percutaneous intervention of stenoses caused by highly calcified plaques utilizing the currently widely available methods is not possible due to technical difficulties in several cases. Increased resistance of calcified plaques against balloon dilation due to their calcium content plays a leading role in procedural failure, as stent crossing becomes impossible as well. Classical methods of plaque modification for debulking the calcification of such lesions – such as rotablation, cutting and ultra-high pressure non-compliant balloons – do not resolve this issue, especially when calcification exceeds 50% of the vessel diameter. A new method, referred to as intravascular lithoplasty in the literature, has recently been developed to break the calcium and thus promote stent deployment in such lesions. In our current work, we summarize the experience gathered with this method during the treatment of extremely calcified lesions of 4 patients with good angiographic result. As a conclusion, intravascular lithoplasty is a promising new interventional method in the treatment of massively calcified coronary lesions. Orv Hetil. 2021; 162(2): 69–73.

Abstract 20162: Comparision of Procedural and 30 Day Outcomes of Roataional vs Orbital Atherectomy in Severely Calcified Coronary Lesions

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Anitha Rajamanickam ◽  
Usman Baber ◽  
Melissa Aquino ◽  
Swathi Roy ◽  
Annapoorna Kini ◽  
...  
Keyword(s):  
Learning Curve ◽  
Clinical Success ◽  
Percutaneous Treatment ◽  
Side Branch ◽  
Stent Deployment ◽  
Novel Approach ◽  
Orbital Atherectomy ◽  
Coronary Lesions ◽  
Procedural Success ◽  
Calcified Coronary Lesions

Introduction: The percutaneous treatment of heavily calcified coronary lesions remains suboptimal and often requires debulking with Rotational Atherectomy (RA) which is often underutilized due to a steep learning curve. Although a novel approach using Orbital Atherectomy (OA) has been introduced, which has an easier set-up and easier learning curve, a comparative assessment of both techniques in real world cohort has not been performed METHODS: Retrospective analysis of our prospectively collected database between October 2013 to May 2014 for patients undergoing atherectomy in heavily calcified lesions at our center retrieved 105 OA and 196 RA procedures RESULTS: There were no significant differences in patient demographics.The maximal stent diameter was significantly larger in OA vs RA (3.41 mm 2 vs 3.28 mm 2 , p=0.02).There was a trend towards RA showing better Procedural success defined as successful stent deployment with TIMI 3 flow ( 95.9% vs 90.5%, p = 0.06) and Clinical Success which is procedural success without death, stroke or CABG ( 95.9% vs 90.5%, p = 0.06). Two cases of failed initial OA underwent successful RA. Procedural complications (≥ grade 3 dissection, side branch closure, perforation, slow flow/no flow or vessel closure), In-hospital MACE (a composite of death, stroke, CABG or CKMB>5X), 30 day readmission rates and 30 day MACE were not statistically significant[See Table 1 and Figure 1]. CONCLUSION: OA demonstrated a similar safety and efficacy profile to RA with a trend towards lower procedural success but comparable complications and 30 day outcomes, suggesting OA may serve as an alternative to RA in PCI of heavily calcified lesions.

Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

2016 ◽  
Vol 11 (1) ◽  
pp. 33
Author(s):  
Yohei Sotomi ◽  
◽  
◽  
◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Rotational Atherectomy ◽  
Percutaneous Coronary ◽  
Orbital Atherectomy ◽  
Long Term Follow Up ◽  
Coronary Lesions ◽  
Calcified Coronary Lesions

Despite advances in technology, percutaneous coronary intervention (PCI) of severely calcified coronary lesions remains challenging. Rotational atherectomy is one of the current therapeutic options to manage calcified lesions, but has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with other PCI techniques due to unfavourable clinical outcome in long-term follow-up. However the results of orbital atherectomy presented in the ORBIT I and ORBIT II trials were encouraging. In addition to these encouraging data, necessity for sufficient lesion preparation before implantation of bioresorbable scaffolds lead to resurgence in the use of atherectomy. This article summarises currently available publications on orbital atherectomy (Cardiovascular Systems Inc.) and compares them with rotational atherectomy.

Planned versus provisional rotational atherectomy for severe calcified coronary lesions: Insights From the ROTATE multi-center registry

2016 ◽  
Vol 88 (6) ◽  
pp. 881-889 ◽  
Author(s):  
Hiroyoshi Kawamoto ◽  
Azeem Latib ◽  
Neil Ruparelia ◽  
Giacomo G. Boccuzzi ◽  
Mauro Pennacchi ◽  
...  
Keyword(s):  
Rotational Atherectomy ◽  
Coronary Lesions ◽  
Calcified Coronary Lesions

Abstract 5992: Comparison of 4 Years Efficacy and Durability of Sirolimus-Eluting Stent and Paclitaxel- Eluting Stent Deployment in Patients with Very Long Coronary Lesions: Multicenter Registry in Asia

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sunao Nakamura ◽  
Hisao Ogawa ◽  
Jang-Ho Bae ◽  
Yeo Hans Cahyadi ◽  
Wasan Udayachalerm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Late Stent Thrombosis ◽  
Cardiac Events ◽  
Stent Deployment ◽  
Very Late Stent Thrombosis ◽  
Coronary Lesion ◽  
Coronary Lesions ◽  
Sirolimus Eluting Stent

Aim : The aim of this study is to compare the 4 years safety and durability of Sirolimus-eluting stent (SES) and Paclitaxel-eluting stent (PES) deployment on the outcome of patients with very long coronary lesions (VLL). Methods : A prospective analysis of 656 patients 730 lesions (male 70.4%, mean age 66.9 yrs) with very long coronary lesion (≥40mm) (368 SES and 288 PES) in five high volume Asian centers after successful stenting in VLL was performed. Lesion locations of VLL were LAD 48.2% (SES 50.2%, PES 45.7%), LCX 18.5%, RCA 33.3%. Complete clinical follow-up to 4 years is being analyzed for all patients. Results : The baseline clinical characteristics between 2 groups were similar. At 4 years overall cardiac events of SES (16.3%) were lower than PES (24.0%) (p=0.03). See table for clinical results. Conclusion : The use of SES and PES in patients with very long coronary lesion was safe and feasible with low acute complication and low incidence of restenosis. SES showed lesser incidence of cardiac events (death, myocardial infarction, CABG and PCI) at 4 years clinical follow-up. SAT (sub acute stent thrombosis), LAST (late stent thrombosis: ~1year), VLAST (very late stent thrombosis: 1year~ 4years) MACE (death, myocardial infarction, CABG and PCI).

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