Aggressive Plaque Modification with Rotational Atherectomy and Cutting Balloon for Optimal Stent Expansion in Calcified Lesions

Overview

Journal J Geriatr Cardiol

Specialty Geriatrics

Date 2017 Mar 22

PMID 28321242

Citations 8

Authors

Zhe Tang

Jing Bai

Shao-Ping Su

Pui-Wai Lee

Liang Peng

Tao Zhang

Ting Sun

Jing-Guo Nong

Tian-De Li

Yu Wang

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the factors affecting optimal stent expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy (RA) and a cutting balloon (CB).

Methods: From January 2014 to May 2015, 92 patients with moderate to severe coronary calcified lesions underwent rotational atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital (Beijing, China) were included in this study. They were divided into a rotational artherectomy combined with cutting balloon (RACB) group (46 patients treated with RA followed by CB angioplasty) and an RA group (46 patients treated with RA followed by plain balloon angioplasty). Another 40 patients with similar severity of their calcified lesions treated with plain old balloon angioplasty (POBA) were demographically matched to the other groups and defined as the POBA group. All patients received a drug-eluting stent after plaque preparation. Lumen diameter and lumen diameter stenosis (LDS) were measured by quantitative coronary angiography at baseline, after RA, after dilatation, and after stenting. Optimal stent expansion was defined as the final LDS < 10%.

Results: The initial and post-RA LDS values were similar among the three groups. However, after dilatation, the LDS significantly decreased in the RACB group (from 54.5% ± 8.9% to 36.1% ± 7.1%) but only moderately decreased (from 55.7% ± 7.8% to 46.9% ± 9.4%) in the RA group (time × group, < 0.001). After stenting, there was a higher rate of optimal stent expansion in the RACB group (71.7% in the RACB group, 54.5% in the RA group, and 15% in the POBA group, < 0.001), and the final LDS was significantly diminished in the RACB group compared to the other two groups (6.0% ± 2.3%, 10.8% ± 3.3%, 12.7% ± 2.1%, < 0.001). Moreover, an LDS ≤ 40% after plaque preparation (OR = 2.994, 95% CI: 1.297-6.911) was associated with optimal stent expansion, which also had a positive correlation with the appearance of a calcified ring split ( = 0.581, < 0.001).

Conclusions: Aggressive plaque modification with RA and CB achieve more optimal stent expansion. An LDS ≤ 40% after plaque modification was a predictive factor for optimal stent expansion in calcified lesions. This parameter was also associated with the presence of calcified ring split.

Citing Articles

Rotational atherectomy with cutting balloon before stenting in severely calcified coronary lesions: a meta-analysis.

Altobaishat O, Abouzid M, Tanashat M, Amin A, Turkmani M, Abuelazm M Future Cardiol. 2024; 20(15-16):859-870.

PMID: 39668109 PMC: 11731055. DOI: 10.1080/14796678.2024.2440220.

Modified Balloon Use After Rotational Atherectomy Reduces Major Adverse Cardiovascular Event Rates in Severely Calcified Coronary Lesions: A Systematic Review and Meta-Analysis.

Ehrenberger R, Masszi R, Zsigmond E, Do To U, Turan C, Walter A J Clin Med. 2024; 13(22).

PMID: 39597996 PMC: 11594699. DOI: 10.3390/jcm13226853.

Lifetime management of severely calcified coronary lesions: the treatment algorithm focused on the shape of calcification.

Sakakura K, Jinnouchi H, Taniguchi Y, Yamamoto K, Fujita H Cardiovasc Interv Ther. 2023; 38(4):375-380.

PMID: 37542662 DOI: 10.1007/s12928-023-00950-x.

A novel optical coherence tomography‑based calcium scoring system can predict the stent expansion of moderate and severe calcified lesions.

Hou C, Yang L, Xue Z, Lin H, Ma Y, Li Q Exp Ther Med. 2022; 24(6):731.

PMID: 36382098 PMC: 9641159. DOI: 10.3892/etm.2022.11667.

Guidezilla™ guide extension catheter I for transradial coronary intervention.

Lei X, Liang Q, Fang Y, Xiao Y, Wang D, Dong M Front Cardiovasc Med. 2022; 9:931373.

PMID: 36061563 PMC: 9428470. DOI: 10.3389/fcvm.2022.931373.

References

Whitlow P, Bass T, Kipperman R, Sharaf B, Ho K, Cutlip D . Results of the study to determine rotablator and transluminal angioplasty strategy (STRATAS). Am J Cardiol. 2001; 87(6):699-705. DOI: 10.1016/s0002-9149(00)01486-7. View

Haldis T, Fenster B, Gavlick K, Singh K, Iliadis E, Blankenship J . The angiographic step-up and step-down: a surrogate for optimal stent expansion by intravascular ultrasound. J Invasive Cardiol. 2007; 19(3):101-5. View

Kang J, Cho Y, Kim S, Park J, Yoon Y, Oh I . Intravascular Ultrasound and Angiographic Predictors of In-Stent Restenosis of Chronic Total Occlusion Lesions. PLoS One. 2015; 10(10):e0140421. PMC: 4605613. DOI: 10.1371/journal.pone.0140421. View

Sonoda S, Morino Y, Ako J, Terashima M, Hassan A, Bonneau H . Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the sirius trial. J Am Coll Cardiol. 2004; 43(11):1959-63. DOI: 10.1016/j.jacc.2004.01.044. View

Harold J, Bass T, Bashore T, Brindiss R, Brush Jr J, Burke J . ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures: a Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical.... Catheter Cardiovasc Interv. 2013; 82(2):E69-111. DOI: 10.1002/ccd.24985. View

Taherioun M, Namazi M, Safi M, Saadat H, Vakili H, Alipour-Parsa S . Stent underexpansion in angiographic guided percutaneous coronary intervention, despite adjunctive balloon post-dilatation, in drug eluting stent era. ARYA Atheroscler. 2014; 10(1):13-7. PMC: 4063511. View

de Waha S, Allali A, Buttner H, Toelg R, Geist V, Neumann F . Rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: Two-year clinical outcome of the randomized ROTAXUS trial. Catheter Cardiovasc Interv. 2015; 87(4):691-700. DOI: 10.1002/ccd.26290. View

Yin W, Tseng C, Tsao T, Jen H, Huang W, Huang C . Transradial versus transfemoral rotablation for heavily calcified coronary lesions in contemporary drug-eluting stent era. J Geriatr Cardiol. 2015; 12(5):489-96. PMC: 4605943. DOI: 10.11909/j.issn.1671-5411.2015.05.004. View

Bangalore S, Vlachos H, Selzer F, Wilensky R, Kip K, Williams D . Percutaneous coronary intervention of moderate to severe calcified coronary lesions: insights from the National Heart, Lung, and Blood Institute Dynamic Registry. Catheter Cardiovasc Interv. 2010; 77(1):22-8. PMC: 2939153. DOI: 10.1002/ccd.22613. View

10.

Okura H, Hayase M, Shimodozono S, Kobayashi T, Sano K, Matsushita T . Mechanisms of acute lumen gain following cutting balloon angioplasty in calcified and noncalcified lesions: an intravascular ultrasound study. Catheter Cardiovasc Interv. 2002; 57(4):429-36. DOI: 10.1002/ccd.10344. View

11.

Reiber J, Tu S, Tuinenburg J, Koning G, Janssen J, Dijkstra J . QCA, IVUS and OCT in interventional cardiology in 2011. Cardiovasc Diagn Ther. 2013; 1(1):57-70. PMC: 3839131. DOI: 10.3978/j.issn.2223-3652.2011.09.03. View

12.

Barbato E, Carrie D, Dardas P, Fajadet J, Gaul G, Haude M . European expert consensus on rotational atherectomy. EuroIntervention. 2015; 11(1):30-6. DOI: 10.4244/EIJV11I1A6. View

13.

Levine G, Bates E, Blankenship J, Bailey S, Bittl J, Cercek B . 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and.... J Am Coll Cardiol. 2011; 58(24):e44-122. DOI: 10.1016/j.jacc.2011.08.007. View

14.

Clavijo L, Steinberg D, Torguson R, Kuchulakanti P, Chu W, Fournadjiev J . Sirolimus-eluting stents and calcified coronary lesions: clinical outcomes of patients treated with and without rotational atherectomy. Catheter Cardiovasc Interv. 2006; 68(6):873-8. DOI: 10.1002/ccd.20615. View

15.

Mosseri M, Satler L, Pichard A, Waksman R . Impact of vessel calcification on outcomes after coronary stenting. Cardiovasc Revasc Med. 2005; 6(4):147-53. DOI: 10.1016/j.carrev.2005.08.008. View

16.

ONeill W, Kleiman N, Moses J, Henriques J, Dixon S, Massaro J . A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012; 126(14):1717-27. DOI: 10.1161/CIRCULATIONAHA.112.098194. View

17.

Abdel-Wahab M, Richardt G, Buttner H, Toelg R, Geist V, Meinertz T . High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: the randomized ROTAXUS (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease) trial. JACC Cardiovasc Interv. 2012; 6(1):10-9. DOI: 10.1016/j.jcin.2012.07.017. View

18.

Furuichi S, Tobaru T, Asano R, Watanabe Y, Takamisawa I, Seki A . Rotational atherectomy followed by cutting-balloon plaque modification for drug-eluting stent implantation in calcified coronary lesions. J Invasive Cardiol. 2012; 24(5):191-5. View

19.

Safian R, Feldman T, Muller D, Mason D, Schreiber T, Haik B . Coronary angioplasty and Rotablator atherectomy trial (CARAT): immediate and late results of a prospective multicenter randomized trial. Catheter Cardiovasc Interv. 2001; 53(2):213-20. DOI: 10.1002/ccd.1151. View

20.

Tanigawa J, Barlis P, Di Mario C . Heavily calcified coronary lesions preclude strut apposition despite high pressure balloon dilatation and rotational atherectomy: in-vivo demonstration with optical coherence tomography. Circ J. 2007; 72(1):157-60. DOI: 10.1253/circj.72.157. View