scholarly journals Case Report: Role of Rotational Atherectomy in Complex PCI

2021 ◽  
Vol 2 (3) ◽  
pp. 35-40
Author(s):  
Seprian Widasmara ◽  
Mohammad Saifur Rohman ◽  
Heny Martini ◽  
Indra Prasetya
Keyword(s):  
High Speed ◽  
Coronary Calcification ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Rotational Atherectomy ◽  
Complication Rates ◽  
X Rays ◽  
Laboratory Findings ◽  
History Of

Background : One in three patients undergoing percutaneous coronary intervention (PCI) exhibits moderate or severe coronary artery calcification. Coronary calcification remains a major independent predictor of PCI failure and adverse outcomes. PCI of calcified coronary lesions remains challenging, despite significant improvements in the available tools and techniques. Rotational Atherectomy (RA) is a critical component to improve PCI success in these situations by producing lumen enlargement by physical removal of plaque and reduction in plaque rigidity, thus facilitating dilation Case Illustration: A 73-year-old man with exertional angina was referred to our hospital, with a history of hypertension, diabetes mellitus, ex-smoker and dyslipidemia. Physical exam, electrocardiogram, chest x-rays, and laboratory findings were unremarkable, but transthoracic echocardiogram revealed anterior wall hypokinesis. History of cardiac catheterization outside of our center with angiographic result of left anterior descending (LAD) lesion, highly calcified, non-dilatable on first several POBA attempts. Coronary angiography at our center, revealed diffuse calcification from proximal to distal of the LAD artery with about 90% maximum stenosis in mid LAD. RA (Rotablator, Boston) was then performed with A 1.50 mm burr gradually advanced at 150,000 rpm to passed the lesion. After deployments of stents, final angiogram showed well positioned stents with good distal run-off flow. The patient was uneventful during the procedure and was discharged following day. Discussion: In experienced hands, RA is as safe as standard PCI. RA is as a tool to make PCI possible in complex lesions with moderate or severe calcification when clinical variables make PCI appropriate. Rotablator is a catheter-based interventional cardiology procedure using a high-speed rotational device designed to ablate atherosclerotic plaque and restore luminal patency. This help to facilitate stent delivery, avoiding the barotrauma caused by repeated high-pressure balloon inflations that can lead to vessel dissection or perforation. Atherectomy can be performed safely with optimal burr selection and proper ablation techniques, and as a result, complication rates have been significantly minimized, with few changes in the acute complications reported in contemporary studies.

P3140Burden and the clinical significance of the retained cardiac implantable electronic device components after heart transplantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Simsek ◽  
F Tamnik ◽  
E Demir ◽  
S Nalbantgil
Keyword(s):  
Cardiac Surgery ◽  
Heart Transplantation ◽  
Clinical Significance ◽  
Statistical Significance ◽  
Vena Cava ◽  
Adverse Outcomes ◽  
X Rays ◽  
Assist Device ◽  
History Of ◽  
Clinical Records

Abstract Background Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. Frequency and clinical significance of retained CIED components after HT is not well studied. Methods Adult heart failure patients whom had heart transplantation in our institution from date June 2000 to December 2018 were retrospectively evaluated. Pre-post operative chest x-rays and recorded fluoroscopy images of the previous coronary angiograms or endomyocardial biopsies were reviewed by a single observer for retained CIED components. All patients clinical records were also reviewed for adverse outcomes of retained components such as deep venous thrombosis of upper extremity, infection and mortality. Results A total of 226 patients had bicaval orthotopic heart transplantation during study time. 73 (32%) of the patients had CIED before transplantation and 24 (32.8%) of the patients had retained lead components after HT. (Table 1) All of the components were part of a superior vena cava coil of the right ventricular ICD lead. Mean follow up time was 46.6±49.8 months and only 1 (1.3%) adverse event (right subclavian DVT) occurred in a patient with retained lead. There were not any statistical significance for mortality and infection between patients with and without lead fragments. Patients were also compared for history of any cardiac surgery before HT, especially ventricular assist device procedures and no differences were observed between groups. For history of any cardiac surgery p=0.748, for assist device surgery, p=0.269). Patient's medical records reviewed for a history of magnetic resonance imaging (MRI). Two patients with retained lead fragments had non-thorocic (abdominal and cranial) MRI and any clinical pathology did not observed after MRI. Table 1 All Patients With Retained CIED comp. Without Retained CIED comp. p (n=226) (n=24) (n=49) Age ± sd 42.91±12.2 44.88±12.6 41.59±13 0.290 Ischemic etiology 65 (28.8%) 8 (33.3%) 13 (26.5%) 0.546 CIED type   CRT-D 5 (20.8%) 5 (%10.2) 0.215   DR-ICD 5 (20.8%) 8 (16.3%) 0.636   VR-ICD 14 (58.3%) 35 (71.4%) 0.263 Dual coil ICD lead 24 (100%) 48 (97%) 1 Mortality (%) 96 (42.5) 7 (37%) 20 (40.8%) 0.463 Conclusion Retained CIED components were seen 32.8% of the HT patients with CIED prior to transplantation. According to our data retained leads are not associated with severe adverse clinical outcomes. Also non cardiac MRI could be safe in patients with retained lead fragments.

scholarly journals Impact of Body Mass Index on Short-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Newfoundland and Labrador, Canada

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Anne B. Gregory ◽  
Kendra K. Lester ◽  
Deborah M. Gregory ◽  
Laurie K. Twells ◽  
William K. Midodzi ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Newfoundland And Labrador ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Overweight And Obesity ◽  
Adverse Outcomes ◽  
Obese Patients ◽  
Short Term ◽  
Percutaneous Coronary ◽  
History Of

Background and Aim. Obesity (BMI ≥ 30 kg/m2) is associated with advanced cardiovascular disease requiring procedures such as percutaneous coronary intervention (PCI). Studies report better outcomes in obese patients having these procedures but results are conflicting or inconsistent. Newfoundland and Labrador (NL) has the highest rate of obesity in Canada. The aim of the study was to examine the relationship between BMI and vascular and nonvascular complications in patients undergoing PCI in NL.Methods. We studied 6473 patients identified in the APPROACH-NL database who underwent PCI from May 2006 to December 2013. BMI categories included normal, 18.5 ≤ BMI < 25.0 (n=1073); overweight, 25.0 ≤ BMI < 30 (n=2608); and obese, BMI ≥ 30.0 (n=2792).Results. Patients with obesity were younger and had a higher incidence of diabetes, hypertension, and family history of cardiac disease. Obese patients experienced less vascular complications (normal, overweight, and obese: 8.2%, 7.2%, and 5.3%,p=0.001). No significant differences were observed for in-lab (4.0%, 3.3%, and 3.1%,p=0.386) or postprocedural (1.0%, 0.8%, and 0.9%,p=0.725) nonvascular complications. After adjusting for covariates, BMI was not a significant factor associated with adverse outcomes.Conclusion. Overweight and obesity were not independent correlates of short-term vascular and nonvascular complications among patients undergoing PCI.

The changing role of high speed rotational atherectomy in the present and future practice of coronary intervention

1996 ◽  
pp. 1-13
Author(s):  
Simon H. Stertzer ◽  
Eugene V. Pomerantsev ◽  
Jonas A. Metz ◽  
Peter J. Fitzgerald ◽  
Paul G. Yock
Keyword(s):  
High Speed ◽  
Coronary Intervention ◽  
Rotational Atherectomy ◽  
Changing Role ◽  
Future Practice

scholarly journals Pulmonary TB in Pregnancy

2021 ◽  
Vol 5 (2) ◽  
pp. 301-308
Author(s):  
Nurmala Sari Dewi ◽  
Efriza Naldi
Keyword(s):  
High Protein Diet ◽  
Pregnant Patient ◽  
Serum Levels ◽  
X Rays ◽  
Laboratory Findings ◽  
Pulmonary Tb ◽  
Tb Treatment ◽  
History Of ◽  
Treatment Category ◽  
In Pregnancy

Objective : To report a case of pulmonary TB in pregnancyMethod : A case reportCase : Presented a case of cpulmonar TB in pregnancy on 33-year-old patient. This is fifth pregnancy with twice history of abortion, malnutrition and pulmonary TB (in treatment). The result of chest x-rays was pulmonary TB. The patient was on treatment for anti-tuberculosis drugs for second month. Patient had BMI was 16,88 kg/m2 which is underweight category. There were bronchovesicular and ronchi from both side of lung from auscultation examination. From laboratory findings there was decrease of albumin serum levels to 2,1 gr%. From ultrasound got impression 16-17 weeks of pregnancy. Patient got anti tuberculosis drugs treatment category I incentive phase (2HRZE). During hospitalization treatment, patient was given some nutrition consultation and high calories and high protein diet and also extra 3 egg whites per day. Total calories are 2250 kcal. Patient also got 1 infuse bottle of albumin and albumin supplementation.Discussion : The incidence of TB in pregnancy was 1/10,000 pregnancies. Provision of an appropriate and adequate chemotherapy regimen will improve the quality of life of the mother, reduce the side effects of anti-tuberculosis drugs (OAT) on the fetus and prevent infection in newborns. Patient got anti tuberculosis drugs treatment category I incentive phase (2HRZE) which is no difference theraphy with no-pregnant patient. Patient was not given pyridoxine as adjuvant drugs along with the anti- tuberculosis drugs. Pyridoxine supplementation must be given with the dose of 50 mg/day and is suggested for every pregnant woman who consumes isoniazid because the deficiency often happens in pregnancy than general population.Conclusion The diagnosis of this patient was correct based on anamnesis, physical examination, and supporting test . Active TB treatment in pregnancy doesn’t have any difference with non-pregnant. The management of this patient is not correct because the patient didn’t get pyridoxine supplementation, didn’t undergo sputum test in second month, and wasn’t done culture M. Tuberculosis as a gold standard.Keywords: tuberculosis, pulmonary TB, pregnancy, anti tuberculosis drugs, pyridoxine

scholarly journals When Rotational Atherectomy is not Enough

2020 ◽  
Author(s):  
Negar Atefi ◽  
Basem Elbarouni ◽  
Amir Ravandi ◽  
David Allen
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Calcification ◽  
Coronary Intervention ◽  
Coronary Calcium ◽  
Rotational Atherectomy ◽  
Stent Expansion ◽  
Percutaneous Coronary ◽  
Poor Outcomes

Severe coronary calcification predicts stent under-expansion, malapposition, and poor outcomes in percutaneous coronary intervention. Rotational atherectomy permits debulking of coronary calcium allowing for stent expansion. More recently, intravascular lithotripsy has been used to fracture calcium and aid revascularization. Here we report two cases where both strategies were required for revascularization.

High-Speed Rotational Atherectomy of Human Coronary Stenoses: Acute and One-Year Outcomes From the New Approaches to Coronary Intervention (NACI) Registry

1997 ◽  
Vol 80 (10) ◽  
pp. 60K-67K ◽  
Author(s):  
David L Brown ◽  
Charles J George ◽  
Ann R Steenkiste ◽  
Michael J Cowley ◽  
Martin B Leon ◽  
...  
Keyword(s):  
High Speed ◽  
Coronary Intervention ◽  
Rotational Atherectomy ◽  
New Approaches ◽  
Coronary Stenoses ◽  
One Year

scholarly journals A Personalized Approach to Percutaneous Coronary Interventions in the Left Main Coronary Artery—Is the Female Gender Associated with Worse Outcomes?

2021 ◽  
Vol 11 (6) ◽  
pp. 581
Author(s):  
Marta Kałużna-Oleksy ◽  
Wojciech Jan Skorupski ◽  
Marek Grygier ◽  
Aleksander Araszkiewicz ◽  
Włodzimierz Skorupski ◽  
...  
Keyword(s):  
Real Life ◽  
Female Gender ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Complication Rates ◽  
Left Main ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Personalized Approach

There is still controversy whether the female gender is associated with worse outcomes after the percutaneous coronary intervention within the left main (LM PCI). This study aimed to examine gender-based differences in real-life LM PCI patients and present a gender-personalized LM PCI approach. Consecutively, 613 patients underwent LM PCI in our department from January 2015 to June 2019. Five hundred and thirty-three patients, with at least a one-year follow-up, were included in the study. There were 130 (24.4%) women and 403 (75.6%) men. Compared with men, women were older (70.0 ± 9.4 vs. 67.7 ± 9.2; p = 0.006) and had higher diabetes, hypertension, and chronic kidney disease rates. Left ventricle ejection fraction was higher in women (53.5 ± 9.4 vs. 49.5 ± 11.2; p = 0.001). Euroscore II and SYNTAX scores did not differ between the genders. However, we observed a trend towards more frequent use of complex PCI techniques in women (26.2% vs. 19.4%; p = 0.098). The overall periprocedural complication rates (10.0% vs. 7.7%; p = 0.406) and the periprocedural myocardial infarction rates did not differ. Contrast-induced nephropathy was more frequent in women (6.9% vs. 3.0%; p = 0.044). Long-term all-cause mortality did not differ (20% vs. 22.5%; p = 0.069). Both genders presented similar rates of periprocedural complications, and no significant differences in long-term all-cause mortality were revealed. Our results suggest that the female gender in LM PCI is not a predictor of adverse outcomes. Further studies are required to determine the optimal revascularization strategy in women.

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