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Atherectomy
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A procedure to open an occluded artery through the removal of atheromatous plaque that has formed from the build-up of cholesterol and other fatty substances within the artery walls. Major arteries, such as the coronary, carotid and vertebral arteries, are the primary targets of atherectomy procedures. Three forms of atherectomy are employed: (1) Conventional Surgery (incision in artery and removal of plaque); (2) Rotational Atherectomy (interventional procedure in which a high-speed rotational burr, inserted via a catheter, pulverizes plaque to particle sizes smaller than red blood cells, which are flushed downstream through the coronary arteries); (3) Directional Coronary Atherectomy (catheter delivers a cutting and retrieval system comprised of a special catheter equipped with a metal housing, small balloon, collection chamber and hollow torque tube that holds a guidewire). PTCA or stenting may be performed after atherectomy.
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Early and Late Clinical Outcomes After Rotational Atherectomy with Stenting Versus Rotational Atherectomy with Balloon Angioplasty for Complex Coronary Lesions
Limited data are available on the effect of rotational atherectomy plus stenting versus rotational atherectomy plus balloon angioplasty for complex coronary lesions. We compared the early and late clinical outcomes between rotational atherectomy plus stenting (158 patients, 171 lesions) and rotational atherectomy plus balloon angioplasty (165 patients, 186 lesions) for complex lesions. Baseline characteristics were similar between the two groups. The procedural success rate was similar between the 2 groups (94% in rotational atherectomy plus stenting versus 96% in rotational atherectomy plus balloon angioplasty; p = 0.54). There were no significant differences in the in-hospital complications between the 2 groups. During mean follow-up of 40.4 ± 20.2 months, fourteen patients died: 6 in rotational atherectomy plus stenting and 8 in rotational atherectomy plus balloon angioplasty. Target lesion revascularization was similar between the 2 groups (20% in rotational atherectomy plus stenting versus 24% in rotational atherectomy plus balloon angioplasty; p = 0.46). Three-year event (death, nonfatal myocardial infarction and target lesion revascularization)-free survival rate was 79 ± 4% in the rotational atherectomy plus stenting group and 75 ± 3% in the rotational atherectomy plus balloon angioplasty group (p = 0.44). In conclusion, rotational atherectomy followed by stenting or balloon angioplasty is associated with favorable long-term outcomes. Compared with rotational atherectomy plus balloon angioplasty, routine stenting after rotational atherectomy does not provide additional benefits in the clinical outcomes in complex coronary lesions.
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The Safety of a Bivalirudin-Based Approach in Patients undergoing Rotational Atherectomy
ABSTRACT: Background. Rotational atherectomy is associated with a high incidence of periprocedural myonecrosis. Glycoprotein (GP) IIb/IIIa inhibitors have been demonstrated to be particularly effective in this population in reducing periprocedural myocardial infarction. While bivalirudin-based therapy has emerged as an attractive alternative to heparin in patients undergoing contemporary percutaneous coronary intervention, it is unclear if such a strategy is safe in patients undergoing rotational atherectomy. Methods. We analyzed all patients undergoing rotational atherectomy at our institution from 2001 to 2004, and compared periprocedural outcome among those treated with a bivalirudin-based regimen compared to those treated with a heparin-based regimen. Results. A total of 253 patients were treated with rotational atherectomy during this period. Bivalirudin-based therapy was used in 56 patients, while the remainder were treated with a heparin-based approach. Patients treated with heparin were significantly more likely to be treated with GP IIb/IIIa inhibitors (91% vs 25%; p = 0.001). There was no difference in the two groups with respect to gender, diabetes, peripheral vascular disease or incidence of renal dysfunction. While there was no statistical difference in the incidence of any myonecrosis (32% versus 34%; p = 0.87), the incidence of creatine kinase-MB was greater than 3 times the upper limit of normal (ULN) (14.1 % versus 5.7%; p = 0.15), or CK-MB >5 times the ULN (7.3% versus 1.9%) was nonsignificantly lower in the group treated with bivalirudin. Conclusions. Bivalirudin-based therapy can be safely used in selected patients undergoing rotational atherectomy. Further studies are warranted to confirm our findings.
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The Renaissance of Directional Coronary Atherectomy: A Second Look From the Inside
The Renaissance of Directional Coronary Atherectomy: A Second Look From the Inside Review: The Renaissance of Directional Coronary Atherectomy: A Second Look From the Inside - Yasuhiro Honda, MD and Peter J. Fitzgerald, MD, PhD The dawn of atherectomy. in 1999.14 In the STent versus directional coronary Atherectomy Randomized Trial (START), a significantly lower restenosis rate was reported for DCA compared to stent (16% vs. 33%; p ...
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Treatment of Stent-Jailed Side Branch Stenoses with Rotational Atherectomy
ABSTRACT: While debulking with rotational atherectomy (RA) prior to balloon angioplasty (BA) improves acute results by reducing elastic recoil, treatment of an ostial side branch lesion that is covered (?jailed?) by a stent represents a particular challenge. We report our experience with RA in conjunction with BA for the treatment of ostial stenosis in jailed side branches. Methods and Results. Thirty-two lesions in side branches jailed by a stent were treated with RA and BA 39 times in 30 patients. The mean age was 65.5 ± 11.5 years; 26.3% were women; 18.4% had diabetes mellitus; and 18.4% had a history of prior bypass surgery. Of the treated side branches, 53.9% were diagonals, 71.8% were jailed by a slotted-tube stent, and 86.5% were previously dilated prior to RA. The burr sizes used to treat the jailed side branch origin ranged from 1.25 to 2.25 mm, with a mean burr size of 1.62 ± 0.31 mm. An average of 1.53 ± 0.72 burrs were used per lesion. Quantitative coronary angiography was performed prior to, and after, intervention. The mean diameter stenosis of the side branch prior to revascularization was 77.8% ± 12.6%; this was reduced to a mean stenosis of 23.0% ± 17.9% following treatment with RA and BA. Angiographic success (residual stenosis < 50% and TIMI 3 flow) in the side branch occurred in 36 of 39 lesions (92.3%). Procedural success (angiographic success in both the side branch and the parent vessel in the absence of death, emergent CABG, urgent TVR, and myocardial infarction (CK-MB >/= 3 times normal) during the index hospitalization) was achieved in 33 of 38 cases (86.8%). One patient suffered a periprocedural myocardial infarction; another patient presented with stent thrombosis in the parent vessel requiring emergency revascularization 36 hours after the index procedure. Clinically-driven revascularization of either the side branch or the side branch or parent was performed in 44.8% and 46.4% of patients, respectively. The estimated freedom from any target lesion revascularization was
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Expanded Applications of Rotational Atherectomy in Contemporary Coronary and Peripheral Interventional Practice
ercutaneous rotational atherectomy is mainly utilized in contemporary interventional practice to alter lesion compliance, facilitating stent delivery and antirestenotic drug delivery at the site of the underlying lesion. This enables a percutaneous revascularization strategy in a group of patients who would otherwise require a surgical revascularization. We identify and present three novel uses for this device in percutaneous coronary and peripheral interventional procedures, which further expands the applications of rotational atherectomy.
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Clinical Outcomes with Drug-Eluting Stents following Atheroablation Therapies
ABSTRACT: Background. Prior studies of atheroablation (directional atherectomy, rotational atherectomy and laser angioplasty) have demonstrated either no advantage or worse outcomes relative to conventional balloon angioplasty. Because these techniques are still required in a minority of patients, we hypothesized that the use of drug-eluting stents (DES) would minimize the rate of major adverse cardiac events (MACE) after atheroablation. Methods. From 2,252 percutaneous coronary intervention procedures, 212 patients were extracted using case control matching and were analyzed to compare the rate of MACE across four groups (DES with atheroablation, bare-metal stent (BMS) with atheroablation, DES without atheroablation, bare-metal stent without atheroablation). A Cox proportional hazards model was constructed to determine predictors of MACE after adjustment for potential confounders. Internal validation was performed with bootstrapping. Results. There were 36 patients, 42 patients, 63 patients and 71 patients in each of the groups, respectively. The incidence of 30-day and 6-month MACE was numerically lowest among patients who received DES after atheroablation, although the differences did not reach statistical significance (30-day MACE: 0% DES with atheroablation, 4.8% BMS with atheroablation, 3.2% DES without atheroablation, 8.5% BMS without atheroablation; 6-month MACE: 2.8% DES with atheroablation, 19.0% BMS with atheroablation, 6.4% DES without atheroablation, 16.9% BMS without atheroablation). After adjustment, the use of atheroablation was not a predictor of MACE. Conclusions. This study suggests that in situations where directional atherectomy, rotational atherectomy or laser angioplasty is required to optimize stenting, the use of DES can minimize MACE associated with atheroablation.
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Clinical Experience with Rotational Atherectomy in Patients with Severe Left Ventricular Dysfunction
ABSTRACT: Objective. To evaluate the safety and efficacy of rotational atherectomy (RA) in patients with severe left ventricular (LV) dysfunction. Background. RA, using a rotating diamond-crystal burr, is most commonly used to open lesions with severe calcification or diffuse disease that may prove difficult to cross or dilate. However, RA generates microparticular debris that may attenuate the coronary microcirculation, inducing transient myocardial stunning and LV dysfunction. In fact, the manufacturer does not support RA use in patients with severe LV dysfunction. Methods. We retrospectively identified patients with a LV ejection fraction < 30% who underwent RA in our institution over a 4-year period. The medical records were reviewed and risk factors for cardiac disease were recorded. The procedural reports and subsequent hospitalization records were reviewed to identify predetermined positive and negative outcomes. Results. Twenty-three patients (17 males) who underwent RA with severe LV dysfunction (mean LVEF 21.3%) were identified. The majority of these patients had multivessel coronary artery disease, hypertension, hyperlipidemia and/or tobacco use. Also, a substantial subset had diabetes, renal insufficiency and/or in-stent restenosis. RA was 100% successful in opening the lesions without any in-hospital procedure-related mortality. Three patients experienced periprocedural myocardial infarctions; 1 patient died from malignancy during hospitalization. There were no major adverse cardiac events at 30 days. Conclusion. The transient effect of RA on ventricular function did not adversely affect short-term outcomes in our study population. These results suggest that RA, when performed by experienced operators, is safe and feasible in patients with severe LV dysfunction.
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A Novel Approach Using Rotational Atherectomy for Protruded Stent Struts Getting in the Way of the Guiding Catheter at the Ostial Left Main Trunk
A Novel Approach Using Rotational Atherectomy for Protruded Stent Struts Getting in the Way of the Guiding Catheter at the Ostial Left Main Trunk CASE REPORTS: A Novel Approach Using Rotational Atherectomy for Protruded Stent Struts Getting in the Way of the Guiding Catheter at the Ostial Left Main Trunk - Shigenori Ito, MD, Tatsuya Ito, MD, Takahiko Suzuki, MD Case Report. The patient declined coronary ...
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Efficacy of Stenting after Rotational Atherectomy for Ostial LAD and Ostial LCX Stenosis in Patients with Diabetes
Objective. The goal of this study was to investigate the efficacy of stenting after rotational atherectomy (rotastent) for ostial LAD and ostial LCX stenosis in patients with diabetes. Background. Previous studies have demonstrated that rotastent for non-aorto ostial stenoses can be performed safely with high clinical success rate. However, in diabetic patients, long-term results of rotastent for ostial stenoses are still unknown. Methods. A series of 70 patients with de novo non-aorto ostial stenosis who underwent successful elective stenting after rotational atherectomy were the subject of this study. Clinical, angiographic, and procedural characteristics, as well as acute and chronic results were obtained for all patients. Results. There were no significant differences between diabetic versus non-diabetic patients in terms of baseline clinical characteristics, lesion characteristics, and procedural factors. The restenosis rate of diabetic patients was significantly higher than that of non-diabetic patients as assessed by the follow-up angiogram (53% versus 28%, respectively; p < 0.05). The rate of lesion progression which meant the development of new left main or non-treated artery-ostial narrowing was significantly higher in diabetic patients at follow-up angiography (23% versus 5%; p < 0.05 compared to non-diabetic patients). By use of multiple regression analysis, diabetes mellitus was identified as an independent predictor of restenosis and lesion progression. Conclusions. These results suggest that diabetic patients are more likely to have not only higher rates of restenosis but also development of new left main narrowing or non-treated artery ostial narrowing compared to non-diabetic patients.
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?Buddy Wire? Technique to Overcome Proximal Coronary Tortuosity During Rotational Atherectomy
We report a case in which rotational atherectomy was planned for the treatment of a severely calcified obstructive lesion in the middle right coronary artery. Severe proximal vessel tortuosity prevented the advancement of the Rotablator burr. We utilized the ?buddy wire? technique, allowing facilitated advancement of the Rotablator and successful atherectomy and stenting. We propose this old technique as an alternative method to allow advancement of the Rotablator burr through tortuous and calcified vessels.
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 Electrophysiologic Perspective on the BIPOLAR RF EPICARDIAL ABLATION Procedure for Atrial Fibrillation
Complimentary Accredited Breakfast Symposium
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Location: The St. Regis San Francisco
125 3rd Street
San Francisco, CA 94103
3rd and Mission Streets
Gallery Ballroom, 2nd floor
This activity is supported by an educational grant from AtriCure, Inc.
This program is not part of the Heart Rhythm 2008 Official Scientific Sessions as planned by the Heart Rhythm Society Scientific Sessions Committee. This event is neither sponsored nor endorsed by the Heart Rhythm Society.
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 Newest Perspectives on Drug-Eluting Stents
Complimentary CME Accredited Dinner Meetings Click Here for More Info.
Miami, FL - Date: Friday, April 4, 2008 6:00pm EST -8:00 pm EST
Birmingham, AL - Date: Friday, May 9, 2008 6:00pm EST -8:00 pm EST
This activity is supported by an educational grant from Abbott Vascular.
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 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE
On Demand Web Archive
Non-Accredited
This activity is supported by an educational grant from Terumo Medical Corporation.
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 Pharmacoinvasive Management of Acute Coronary Syndrome: Incorporating the 2007 ACC/AHA Guidelines
Complimentary Accredited CME Program
This activity is supported by an educational grant from Sanofi-Aventis.
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 Varicose Veins: Causes, Symptoms, Diagnosis and Treatment of Chronic Venous Insufficiency
A Complimentary Accredited ON-DEMAND Webcast
This activity is supported by an educational grant from Diomed, Inc.
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 Create a Successful Vena Cava Filter Practice
Accredited CD
This activity is supported by an educational grant from Cook Incorporated and has been designed for Interventional Cardiologists, Vascular Surgeons, Fellows and Interventional Cardiovascular Nurses and Technologists.
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Webcast and Web Archives |
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 Achieving Optimal Outcomes in Carotid Stenting: Lessons Learned from Recent Clinical Trials
Complimentary Accredited ON DEMAND Webcast
Topics
1. EVA-3S & Space-Bumps in the road
2. CAPTURE 3500-Lesion morphology & Predictors for Stroke
3. CAPTURE II vs. EXACT 1500-Does open or Closed Cell Stent design really matter?
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Neurologists, Interventional Nurses and Technologists with an interest in the diagnosis and treatment of peripheral artery disease. |
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 Anticoagulation Techniques for Peripheral Vascular Interventions
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This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 New Treatment Strategies for the Endovascular Approach to Critical Limb Ischemia: ADVANCEMENTS IN LIMB SALVAGE MEDICINE
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 Reducing the Incidence of CIN during Cardiac Catheterization and PCI
Complimentary Accredited ON DEMAND
Educational Web Archive
This activity has been developed for nurses and technologists. |
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March 2007 Supplement
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On-Demand Webcast
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Archived Webcast
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Release Date: December 8, 2006