Rotational ablation of coronary artery lesions using single, large burrs.

Previous clinical use of the Rotablator in coronary artery disease has involved a sequential increase in burr sizes up to 2 mm in diameter and has often utilized balloon adjunct to achieve an optimal result. We report our experience and describe our technique using a single, large burr (2.25, 2.5, or 2.75 mm diameter) without balloon assistance. The burr size was selected to approximate 70-90 percent of the apparent normal lumen diameter. Thirty-one patients with 36 lesions of complex morphology (eccentric, irregular, calcified, ulcerated, at bends, at bifurcations, completely occluded, as well as balloon failures) were successfully treated with the Rotablator. Results were assessed by computerized quantitative angiography. The percent diameter stenosis (mean +/- SD) for the group was reduced from 69.8 +/- 11.3% to 30.9 +/- 10% (p less than 0.001). The mean absolute diameter stenosis increased from 0.9 +/- 0.3 mm to 2.2 +/- 0.3 mm (p less than 0.001). Angiographically visible dissections were seen in 4 patients and were uncomplicated in 2. One patient had a non-Q-wave myocardial infarction. A fourth patient had a presumed acute occlusion 36 hr after the procedure, necessitating emergency bypass surgery, but without Q waves on the electrocardiogram or wall-motion abnormalities on the echocardiogram. Nitroglycerin was infused through the Rotablator catheter and has considerably lowered the degree and frequency of spasm. No other acute complications occurred. The mean procedure time using a single burr was shorter than when multiple burrs were used: 56.5 vs. 97.3 min, respectively (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

冠状动脉旋磨术及经皮冠状动脉成形术在复杂病变介入治疗中的应用

目的　探讨冠状动脉旋磨术 (Rotational atherectomy)及经皮腔内冠状动脉成形术 (Percutaneous translum i-nal coronary angioplasty PTCA)治疗复杂冠脉病变的临床效果。方法　对 15例患者的 2 0处病变行冠脉旋磨术及经皮腔内冠状动脉成形术 (PTCA)治疗 ,部分病例并在血管内超声指导下进行 ,观察其治疗的即刻成功率及并发症率。结果　 15例施行冠状动脉旋磨术的患者 ,旋磨头均成功地通过了病变 ,平均狭窄程度由 88.30 %± 7.5 4 %降至15 .6 0 %± 10 .75 %。其中 6 0 .0 0 %的病例选择了 1.5 mm的旋磨头 ,13.33%的病例使用了 2个旋磨头。全部病例均联合应用了 PTCA,13例在行旋磨术后置入冠脉内支架 (余下 2例为支架内再狭窄病例 )。 1例患者术中发生较严重的冠状动脉痉挛 ,经冠状动脉内给予硝酸甘油后缓解 ;2处 (10 .0 0 % )病变出现了 B型以上的内膜撕裂 ,出现缓慢血流现象发生率为 3.8%。无急诊冠状动脉搭桥及死亡病例。结论　冠状动脉旋磨术及 PTCA可选择性用于复杂冠状动脉病变 ,尤其是严重钙化病变 ,小血管长节段病变     

冠状动脉旋磨术在复杂病变介入治疗中的应用

目的 :探讨冠状动脉旋磨术 (Rotationalatherectomy)治疗复杂冠脉病变的策略及效果。方法 :对 79例患者的 86处病变行冠脉旋磨治疗 ,观察其治疗的即刻成功率及并发症率。结果 :79例施行冠状动脉旋磨术的患者 ,旋磨头均成功地通过了病变 ,手术成功率为 96 .2 0 % (76 79) ,平均狭窄程度由87 4%± 8.78%降至 14.6 %± 10 .89%。其中 5 9.49%的病例选择了 1.5mm的旋磨头 ,2 7.88%的病例使用了二个旋磨头。全部病例均联合应用了冠脉球囊扩张术 ,12例在行旋磨术后置入冠脉内支架。 6例患者术中发生较严重的冠脉痉挛 ,经冠脉内给予硝酸甘油后缓解 ;9处 (10 .47% )病变出现了B型以上的内膜撕裂 ,出现无血流或缓慢血流现象发生率为 3.8%。 1例患者术后发生急性Q波心肌梗塞 ,无急诊冠脉搭桥及死亡病例。结论 :冠状动脉旋磨术可选择性用于复杂冠状动脉病变 ,尤其是严重钙化病变 ,小血管长节段病变     

Low restenosis rate in lesions of the left anterior descending coronary artery with stenting following directional coronary atherectomy

The present study evaluated acute and late results with stenting following directional coronary atherectomy (DCA) for the lesions in the left anterior descending coronary artery (LAD). Between April 1995 and January 1997, 200 LAD lesions with ≥3 mm reference vessel diameter were treated with coronary stents. The lesions were divided as to whether or not DCA was performed before stenting; 1) stenting alone (n = 163) and 2) debulking and stenting (n = 37). There were no significant differences in the incidences of complications except for non-Q-wave myocardial infarction that was more frequent in patients with debulking and stenting than in those with stenting alone (13.5% vs. 2.4%, P < 0.05). A greater acute lumen gain (2.85 ± 0.66 vs. 2.25 ± 0.60 mm, P < 0.01) and minimal lumen diameter (3.64 ± 0.56 vs. 3.15 ± 0.41 mm, P < 0.01) after stenting were observed in patients with debulking and stenting than in those with stenting alone. At follow-up patients with debulking and stenting continued to have a greater minimal lumen diameter (2.88 ± 0.72 vs. 2.15 ± 0.85 mm, P < 0.01) and had a lower restenosis rate (6.3% vs. 23.1%, P < 0.05) than those with stenting alone. Stenting following DCA appears to be advantageous in the LAD lesions with ≥3 mm reference vessel diameter. Cathet. Cardiovasc. Diagn. 45:131–138, 1998. © 1998 Wiley-Liss, Inc.     

Interventional techniques for the management of coronary artery lesions: An update

Coronary balloon angioplasty has become standard treatment for ischemic coronary artery disease. Major limitations of angioplasty are the inferior results obtained with unfavorable lesions, the occurrence of abrupt occlusion responsible for in-hospital mortality and morbidity, and the high restenosis rate at 6 months. New techniques for stents, laser, and atherectomy have been developed to overcome these limitations. Until now, although the initial results are encouraging, these new techniques have not as yet shown to be clearly superior to balloon angioplasty. However, due to the limitations of balloon angioplasty, further development of new techniques should be stimulated so that nonsurgical treatment of coronary artery disease will become safer, more effective, and applicable to a wider spectrum of coronary artery disease.     

The “furrowing effect”: Guidewire-induced “directional” lesion ablation in rotational atherectomy of angulated coronary artery lesions

We discuss a guidewire induced asymmetric abiative effect in three cases of rotational atherectomy facilitated angioplasty of angulated coronary artery lesions. © 1996 Wiley-Liss, Inc.     

冠状动脉旋磨术在冠心病钙化病变介入治疗中的应用

目的探讨冠状动脉旋磨术治疗冠状动脉钙化病变的安全性及有效性。方法回顾性分析12例行冠状动脉旋磨术结合冠状动脉球囊成形术和支架植入术的冠状动脉粥样硬化性心脏病(冠心病)患者的临床资料,着重分析手术方法、手术成功率、术后随访主要心血管事件(包括心源性死亡、心肌梗死、靶病变血运重建)的发生率。结果 12例患者共有16处钙化病变,有15处钙化病变行冠状动脉旋磨术,管腔狭窄由术前的87%±10%减少至42%±9%,结合冠状动脉球囊成形术,共植入18枚国产药物支架,手术成功率为93.75%(15/16)。1例因血管严重扭曲,球囊扩张后出现冠状动脉夹层,植入支架失败,建议行外科冠状动脉旁路移植术。术中均无主要并发症(包括心源性死亡、Q波心肌梗死、急诊冠状动脉旁路移植术)发生。所有患者随访(8.4±3.6)个月,有2例再发心绞痛,无主要心血管事件(包括心源性死亡、心肌梗死、靶病变血运重建)发生。5例患者复查冠状动脉造影,有1例出现支架内再狭窄30%。结论冠状动脉旋磨术联合球囊扩张和支架植入术治疗冠状动脉钙化病变可取得很高的手术成功率,是治疗钙化病变安全、有效的方法。     

Rotational atherectomy and simultaneous kissing stenting of a bifurcation stenosis of left anterior descending and anomalous right coronary arteries

Intervention to anomalous coronaries can present specific challenges: non-standard guide catheters may be required to provide adequate access and support, the course of the arteries can be tortuous with sharp angulations, and they may subtend a critical area of myocardium. We present the first report of percutaneous coronary intervention to the bifurcation of an anomalous right coronary artery arising from the left anterior descending artery. This lesion contained a high burden of calcification, which required rotational atherectomy of the left anterior descending artery before kissing stenting of the bifurcation.     

Safety and effectiveness of percutaneous coronary intervention using rotational atherectomy and new-generation drug-eluting stents for calcified coronary artery lesions in patients with chronic kidney disease

AimCoronary artery calcification is an important factor influencing revascularisation outcomes in patients with chronic kidney disease (CKD). Lesion preparation using rotational atherectomy (RA) may help adequately modify calcified plaques and facilitate the achievement of optimal clinical outcomes in these patients. In this study, we assessed the safety and effectiveness of percutaneous coronary intervention (PCI) using RA followed by new-generation drug-eluting stent (DES) implantation in patients with CKD and calcified coronary artery disease (CAD).Methods and resultsFrom November 2014 to October 2019, a total of 203 patients with calcified CAD who underwent RA followed by second- or third-generation DES implantation at our centre were included in the study. Mild, moderate, and severe CKD was present in 38%, 55.5%, and 6.5% of the patients, respectively. Diffused coronary calcifications were present in 85%. Procedural success was 97.5% with minimal periprocedural complications. In-stent restenosis occurred in one patient (0.5%); major adverse cardiovascular and cerebrovascular events were reported in 22 patients (10.8%); cardiac death occurred in eight patients during follow-up.ConclusionPercutaneous coronary intervention using RA followed by second- or third-generation DES implantation is feasible and safe with high procedural success and low in-stent restenosis in CKD patients with calcified coronary lesions.     

Rotational ablation and stent placement for severe calcific coronary artery stenosis after Kawasaki disease.

We report on a 5-year-old child who had an episode of Kawasaki disease with giant coronary artery aneurysms at the age of 4 months. Surveillance coronary angiography showed severe calcific stenosis in the proximal left anterior descending artery. Balloon angioplasty failed to resolve the obstruction. Rotational ablation was therefore performed. Surveillance angiogram performed 6 months after rotational ablation showed critical restenosis. Rotational ablation was therefore repeated, followed by stent placement. To the best of our knowledge, this is the youngest child who has undergone coronary stenting after Kawasaki disease.     

Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention

To test the feasibility of using guiding catheters equal to or greater than 7 Fr in transradial coronary intervention (TRI), we measured the inner diameter of the radial artery (RA) and its flow using two-dimensional ultrasound and Doppler examinations before and after TRI in 250 Japanese patients. The incidence of severe flow reduction of the RA after TRI was 6.8% on average (7.2%, 4.7%, and 8.3% in patients with 6, 7, and 8 Fr sheaths used, respectively), which increased from 4.0% to 13.0% (P = 0.0113) if the ratio of the RA inner diameter/sheath outer diameter was less than 1.0. The frequency of this ratio (≥ 1.0) for 7 and 8 Fr sheaths was 71.5% and 44.9% in male patients and 40.3 and 24.0% in female patients, respectively. We conclude that the use of guiding catheters equal to or greater than 7 Fr in the radial artery is feasible in selected patients. Cathet. Cardiovasc. Intervent. 46:173–178, 1999. © 1999 Wiley-Liss, Inc.     

Rotablation in the treatment of high-risk patients with heavily calcified left-main coronary lesions

Objective Heavily calcified left-main coronary diseases (LMCA) remain a formidable challenge for percutaneous interventions (PCI). This study was to investigate the safety and efficacy of using rotational atherectomy (RA) in treating such lesions in actual practice. Methods From February 2004 to March 2012, all consecutive patients who received RA for heavily-calcified LMCA lesions in our cath lab were enrolled. The relevant clinical and angiographic characteristics at the time of index PCI, as well as the clinical follow-up outcomes, were retrieved and analyzed. Results A total of 34 consecutive patients were recruited with a mean age 77.2 ± 10.2 years. There were 82.4% presented with acute coronary syndrome and 11.8% with cardiogenic shock. Chronic renal disease and diabetes were seen in 64.7% and 52.9%, respectively. Triple-vessel coronary disease was found in 76.5% of them. The mean SYNTAX score was 50 ± 15 and EuroSCORE II scale 5.6 ± 4.8. The angiographic success rate was 100% with a procedural success rate of 91.2%. The mean number of burrs per patient was 1.7 ± 0.5. Crossing-over stenting was used in 64.7%. Most stents were drug-eluting (67.6%). Intra-aortic ballon pump was used in 20.6% of the procedures. Three patients died during hospitalization, all due to presenting cardiogenic shock. No major complication occurred. Among 31 hospital survivors, the major adverse cardiac events (MACE) rate was 16.1%, all due to target lesion revascularization or target vessel revascularization. Conclusions In high-surgical-risk elderly patients, plaque modification with RA in PCI of heavily-calcified LMCA could be safely accomplished with a minimal complication rate and low out-of-hospital MACE.     

Rotational coronary atherectomy with adjunctive balloon angioplasty for the treatment of ostial lesions

Conventional balloon angioplasty (PTCA) of ostial lesions (OL) is associated with suboptimal results and a higher complication rate. Partial plaque ablation with rotational atherectomy (RA) before PTCA might improve results. This approach was used in 63 patients (pts) (mean age 64±10 yrs; 44 men, 19 women) with 69 OL. There were 15 aorto-OL and 54 branch-OL. Calcification was more frequent in aorto-OL than in branch-OL (67% vs. 35%, P< 0.05). Mean burr size was 1.8±0.3 mm. Burr-artery ratio was 0.74±0.10. Adjunctive PTCA was systematically performed. Procedural success was achieved in 58 pts (92%): 14 aorto-OL (93%) and 50 branch-OL (93%) were successfully treated; major complications occurred in 1 (7%) aorto-OL and 1 (2%) branch-OL. Uncomplicated failure occurred in three cases. Minimal lumen diameter (MLD) increased from 0.69±0.31 mm before RA to 1.43±0.28 mm after RA (P<0.001) and 2.16±0.29 mm after PTCA (P<0.001). Diameter stenosis (DS) decreased from 75±13% before RA to 32±12% after RA (P<0.001) and 14±10% after PTCA (P<0.001). All successfully treated pts underwent repeat angiography 24 h later and exercise testing or repeat cardiac catheterization >6 mo later. At 24 h repeat angiography, DS was 17±15% (P=NS vs. after PTCA); no lesion had a DS ≥ 50%. Follow-up coronary angiography was performed in 30 pts (52%) who had abnormal stress testing: 13 pts (43%) showed angiographic restenosis in at least one successfully treated OL. In conclusion, RA with adjunctive PTCA is a safe and effective treatment of OL. It is associated with higher success and lower major complications rates when compared with conventional PTCA. Restenosis remains a major limitation of all percutaneous approaches. © Wiley-Liss, Inc.     

冠状动脉严重钙化病变旋磨术后植入药物洗脱长支架的长期临床疗效观察

目的 探讨冠状动脉（简称“冠脉”）旋磨术联合药物洗脱长支架用于治疗严重冠脉钙化病变的安全性及有效性。方法 入选2010年1月至12月因严重冠脉钙化而行冠脉旋磨术联合药物洗脱长支架植入治疗的患者。观察患者的手术成功率,围术期并发症及术后主要心血管事件（包括心源性死亡、心肌梗死、靶病变血运重建）的发生率。结果 共21例严重冠脉钙化病变患者接受了冠脉旋磨术联合药物洗脱长支架植入治疗,年龄（65.2±6.9）岁。合并高血压病16例（76.2%）,糖尿病7例（33.3%）,肾功能不全1例（4.8%）。旋磨部位共植入35枚国产药物支架（1.75枚/部位）,最短支架长度为28mm,病变部位平均支架总长度为48（29～66）mm,仅1例因旋磨头未能通过病变而放弃,手术成功率为95.2%（20/21）。术中1例出现冠脉痉挛,1例出现胸痛伴心率减慢;术后1例出现消化道出血。住院期间无心血管事件发生,平均随访26个月,仅1例（4.8%）患者于术后第2个月发生急性心肌梗死,余患者病情稳定。结论 冠脉旋磨术联合药物洗脱长支架植入术治疗严重冠脉钙化病变可取得很高的手术成功率,是治疗钙化病变安全、有效的方法。     

Salvage from cardiogenic shock by atherectomy after failed emergency coronary artery angioplasty

In this case report of a patient undergoing angioplasty for cardiogenic shock during acute myocardial infarction, recurrent occlusion resulted in recurrence of shock. Atherectomy reestablished lasting patency and reversed the patient's hemodynamic collapse. Atherectomy deserves further investigation as a means to salvage vessel patency during unsuccessful coronary angioplasty.     

Directional coronary atherectomy for failed angioplasty due to occlusive coronary dissection

We describe a case in which coronary balloon angioplasty failed to improve sequential lesions and resulted in a long area of dissection between the stenoses. Directional coronary atherectomy of the occlusive dissection produced excellent angiographic improvement to achieve a successful result and avoid the need for urgent coronary bypass surgery. Directional coronary atherectomy represents a potentially useful treatment for PTCA-induced coronary dissection.     

冠状动脉内旋磨与球囊扩张术联合应用治疗冠状动脉复杂血管病变

目的　评价经皮冠脉腔内旋磨术与囊扩张术联合应用治疗复杂冠脉病变的疗效。方法　14例 16处血管病变 ,分别先后应用冠脉内旋磨与球囊扩张两种方法。结果　 11处病变直接行PTCRA ,于旋磨后发现管腔径偏小或内膜撕裂再行PTCA ,而 5处为PTCA失败后再行PTCRA。14例 (10 0 % )达成功标准。结论　PTCRA与PTCA联合应用治疗冠心病复杂血管病变可提高治疗成功率。     

旋磨与球囊预扩张治疗冠状动脉重度钙化病变的疗效分析

目的研究旋磨与球囊预扩张后植入药物支架对治疗冠状动脉钙化病变的疗效。方法选取接受PCI治疗的冠状动脉重度钙化患者,按随机数字表法分为行旋磨术后支架植入(旋磨组,32例)和球囊预扩张支架植入(对照组,40例),对其进行前瞻性随机对照研究,比较两组治疗特征、围手术期并发症,分析6个月内主要不良心脑血管事件(MACCE)的危险因素。结果旋磨组平均支架直径显著大于对照组[3.25(3.00,3.50)mm比3.00(2.81,3.25)mm,P=0.002]。旋磨组球囊预扩张次数、预扩张最大压力、球囊后扩张次数和后扩张最大压力均显著低于对照组,差异均有统计学意义(P<0.05)。旋磨组术后管腔直径大于对照组[(3.34±0.28)mm比(3.15±0.27)mm,P=0.005]。旋磨组手术即刻成功率(96.9%)大于对照组(92.5%),总MACCE发生率(9.4%)低于对照组(22.5%),但差异无统计学意义(P>0.05)。PCI手术史[危险比(RR)为1.155(95%CI 0.030~0.691,P=0.015)]及球囊预扩张最大压力[危险比(RR)为2.326(95%CI 0.721~0.988,P=0.035)]是6个月内MACCE发生的独立危险因素。结论SYNTAX评分为23~32分的冠状动脉重度钙化病变,旋磨术有提高手术即刻成功率、降低短期不良事件的趋势,PCI手术史、球囊预扩张最大压力是6个月内MACCE发生的独立危险因素。     

New devices enhance hospital results of coronary angioplasty

After rigorous screening by means of registries and controlled trials, various atherectomy devices, excimer laser catheters, and endoluminal stents were approved for general clinical use. Few data are available describing their safety and effectiveness after approval. This analysis was undertaken to assess the impact on patient outcomes of the unrestricted clinical application of new transcatheter devices for coronary angioplasty. Thirty-six cardiologists performed 3,113 transcatheter procedures during 1995. Each chose the transcatheter modality best suited to the clinical and angiographic features of the patient. Baseline clinical and angiographic data and initial outcome were recorded by cardiac catheterization laboratory personnel. In-hospital events were obtained by independent chart review. Balloon angioplasty alone was employed in 1,089 (35.0%) patients. A stent was deployed after balloon angioplasty in 1,029 (33.1%) patients. An atherectomy or laser device was used without stent support in 631 (20.3%) patients, and stent support was added in an additional 364 (11.7%) patients. In all three new device categories the angiographic success (final luminal narrowing <50%) rate was better than in balloon angioplasty for type-C lesions and for chronic occlusions. The frequency of adverse events in the aggregate was not increased with device use, but the frequency of coronary rtery bypass surgery was reduced with stent use. The frequency of non-Q-wave myocardial infarction was greater with devices than with balloon angioplasty alone. After adjustment for the differences in baseline clinical and angiographic variables by means of multivariate analysis, each of the three new device categories was independently associated with an increased chance of angiographic and procedural success compared to balloon angioplasty. The availability of new transcatheter devices for clinical practice enhances patient outcomes during hospitalization for the procedure. Cathet. Cardiovasc. Diagn. 43:1–6, 1998. © 1998 Wiley-Liss, Inc.