Coronary Rotational Atherectomy Research Articles

Feasibility of Novel Grinding Device With Forward-Looking Intravascular Ultrasound Transducer in Coronary Rotational Atherectomy

Feasibility of Novel Grinding Device With Forward-Looking Intravascular Ultrasound Transducer in Coronary Rotational Atherectomy

TCT-319 Coronary Rotational Atherectomy Elective vs. Bailout in Patients With Severely Calcified Lesions and Chronic Renal Failure Trial

TCT-319 Coronary Rotational Atherectomy Elective vs. Bailout in Patients With Severely Calcified Lesions and Chronic Renal Failure Trial

Numerical Analysis of Stress Force on Vessel Walls in Atherosclerotic Plaque Removal through Coronary Rotational Atherectomy.

Coronary rotational atherectomy is an effective technique for treating cardiovascular disease by removing calcified tissue using small rotary grinding tools. However, it is difficult to analyze the stress force on vessel walls using experiments directly. Using computational fluid dynamics is a better way to study the stress force characteristics of the burr grinding procedure from a fluid dynamics perspective. For this purpose, physical and simulation models of atherosclerotic plaque removal were constructed in this study. The simulation results show that smaller ratios between the burr and arterial diameter (B/A = 0.5) result in a more stable flow field domain. Additionally, the pressure and stress force generated by the 4.5 mm diameter grinding tool reach 92.77 kPa and 10.36 kPa, surpassing those of the 2.5 mm and 3.5 mm grinding tools. The study has demonstrated the use of computational fluid dynamics to investigate wall shear stress characteristics in medical procedures, providing valuable guidance for optimizing the procedure and minimizing complications.

Sheathless radial approach in contemporary coronary rotational atherectomy: data from two high-volume centers

Aim: To analyze the feasibility and procedural outcome of percutaneous coronary intervention (PCI) using rotational atherectomy (RA), performed via transradial sheathless guiding catheter, as compared to a standard radial and femoral vascular approach. Methods: All consecutive patients undergoing RA at two high-volume PCI centers from May 2011 to May 2023 were included. Comparisons were made between the two transradial approaches and between the three types of vascular access. Results: Two hundred twenty-three patients were enrolled. Baseline characteristics were similar, with the exception of gender. We observed, in percentages, fewer cases of failure for sheathless than standard transradial attempts (7.5% vs. 11.5%, respectively), whereas all trans-femoral attempts were successful. Transfemoral procedures were longer and more frequently performed under mechanical circulatory support. There was no difference in procedural success between the three vascular approaches. A trend towards a higher rate of vascular and bleeding complications was found in the femoral group. Conclusion: Sheathless transradial vascular access is a viable option when performing RA during complex PCI procedures, tending to result in fewer failures than the standard transradial approach and reduced bleeding and vascular complications compared to the femoral method.

Coronary rotational atherectomy in patients with severe aortic stenosis

Abstract Introduction Rotational atherectomy (RA) has been shown to be safe and effective in patients with severe calcified coronary arteries lesions. However, clinical data on the use of RA in patients with concomitant severe aortic stenosis (AS patients) are lacking. Escalation to RA for coronary lesion preparation in patients undergoing transcatheter aortic valve implantation (TAVI) is still controversial, given their impaired haemodynamic status and possible higher risk of complications. We reported the clinical outcomes of AS patients undergoing RA and TAVI from a prospective clinical registry and compared their outcome with patients undergoing RA with no severe aortic valve stenosis (non-AS patients). Methods We retrieved data of all consecutively enrolled patients in a single centre registry from January 2016 up to October 2021. All AS patients who underwent RA prior to TAVI within a six-month period were included for our analysis. We compared the AS patients with all patients without severe aortic stenosis (non-AS patients) who underwent RA during the same period. Data were analysed to assess rates of in-hospital major adverse cardiovascular event (MACE) in AS vs non-AS patients. MACE was defined as composite of cardiac death, myocardial infarction, and target lesion revascularisation. Procedural characteristics as well as in-hospital outcomes and complications were also examined to detect differences between both patient groups. We then performed univariate and multivariate analyses using binary logistic regression with the presence of severe aortic stenosis as a dependent variable for MACE. Results A total of 472 patients underwent RA. Of those, 38 (8.05%) had severe AS and received TAVI within six months after index RA. Compared with the AS-patients, more non-AS patients presented with acute coronary syndrome (2.6% vs 19.8 %; p<0.009). Left main coronary artery intervention was documented in 36.8% of the AS-patients and in 25.1% of the non-AS patients. Mechanical circulatory support during the procedures was low (10 %) in both groups and was used only in two patients from the AS group. The procedural success was 97% and did not differ between both patients’ groups. There was no difference of in-hospital MACE between the AS and non-AS patients (7.9% vs 8.8%; p=0.418). Procedural rates of complications related to RA such as slow flow, coronary dissection, coronary perforation, or trapped burr did not differ between both patient groups. Adverse outcomes of RA were not affected by the presence of severe AS in the univariate analysis (OR 1.12; 95% CI [0.33-3.91]; p=0.857). Conclusion RA in patients with severe AS undergoing TAVI is feasible, and in-hospital adverse events were comparable to non-AS patients. Adequate lesion preparation of calcified coronary arteries should be implemented regardless of the presence of severe AS.

Experimental Investigation of the Calcified Plaque Material Removal Rate in Coronary Rotational Atherectomy

Abstract Rotational atherectomy (RA) is a minimally invasive procedure to remove the calcified atherosclerotic plaque from arteries to restore blood flow. It uses a high-speed, metal-bonded diamond abrasive grinding wheel to pulverize the calcified plaque into absorbable debris via a catheter through the artery. Although RA has been clinically used for over two decades, procedural complications persist and there remains a lack of consensus on the optimal device parameters. This study aims to investigate the material removal rate (MRR) in coronary RA with respect to grinding wheel sizes and rotational speeds based on a tissue-mimicking phantom. Three grinding wheel sizes, 1.25, 1.5, and 1.75 mm in diameter, and three rotational speeds, 1,20,000, 1,50,000, and 1,80,000 rpm, were investigated. The RA MRR was presented as the luminal area gain and measured by microscopy and image processing. The results show the increase in the grinding wheel size or rotational speed leads to a higher MRR and luminal gain in RA. With a 1.75 mm diameter grinding wheel rotating at 1,80,000 rpm in a 2 mm initial diameter lumen, the max MRR and the luminal gain are 2.49 mm2/three passes and 5.09 mm2, respectively. The MRR decreases as the number of grinding passes increases during RA with the same grinding wheel rotating at a constant speed. This study provides a thorough understanding of the wheel size and speed effects on coronary RA MRR for potential improvements in RA devices and clinical operational guidelines.

Feasibility Analysis of Novel Grinding Device With PVDF Sensor in Coronary Rotational Atherectomy

Feasibility Analysis of Novel Grinding Device With PVDF Sensor in Coronary Rotational Atherectomy

Feasibility Analysis of Planned Coronary Rotational Atherectomy Guided by Coronary Angiography for Severe Calcified Coronary Lesions in Grass-Roots Hospitals

Objective: To investigate the feasibility of planned percutaneous coronary Rotational Atherectomy (RA) under the guidance of coronary angiography in the treatment of severe coronary calcification in grass-roots hospitals.

Neutrophil and lymphocyte count as predictors of the location of calcific coronary lesions in patients treated with rotational atherectomy.

The role of immune system activation in development and progression of atherosclerotic plaques has been postulated. Previous studies on inflammation have focused on the severity of coronary disease, the risk of acute coronary syndrome, and the prediction of outcomes based on hematological indices obtained from whole blood count analysis. To analyze simple data of the whole blood count in relation to the location of calcified atherosclerotic lesions in patients treated with coronary rotational atherectomy (RA). Eighty-one patients (57 (70%) males, mean (SD) age of 70.4 ±8 years) who underwent RA were enrolled in the study. The study group was divided into two subgroups depending on the proximal (group 1) and non-proximal (group 2) location of the culprit lesions in coronary arteries. The angiographic results were compared with demographic and clinical data and whole blood count analysis. The multivariable analysis revealed the predictive value of low neutrophil (OR = 0.75, 95% CI: 0.58-0.97, p = 0.030) and lymphocyte counts (OR = 0.27, 95% CI: 0.11-0.68, p = 0.005) for the proximal location of the culprit lesions. In the ROC analysis, combined neutrophil and lymphocyte counts showed the best prediction of proximal location, with the area under the curve of 0.747 (p < 0.001), yielding a sensitivity of 79.07% and specificity of 73.68%. The lower neutrophil and lymphocyte counts in peripheral blood count analysis may be more representative of proximal calcified coronary lesions. The relationship between neutrophil and lymphocyte blood count and calcific atherosclerotic plaque location can indicate the inflammatory background of epicardial atheroma formation and distribution.

Long-term Clinical Outcomes of Coronary Rotational Atherectomy for Specific Indications

Objective: This study compared the long-term outcomes between rotational atherectomy (RA) for specific indications and on-label use of RA for severely calcified coronary lesions. Methods: Data for patients who underwent RA between 2015 and 2020 in a single-center registry were analyzed. The specific indication group included patients with ostial lesions, unprotected left main coronary artery stenosis, chronic total occlusions, stent ablation, angulated lesions, and cardiac dysfunction, whereas patients with none of the above-mentioned characteristics were included in the on-label group. The primary endpoint was compared between groups. Results: A total of 176 patients in the on-label group and 125 patients in the specific indication group were included. Patient clinical characteristics were comparable between groups. The incidence of complications during the procedure was higher in the specific indication group than in the on-label group (20.0% vs. 10.8%, P=0.018). No significant difference was observed in in-hospital MACCE between groups (12.5% vs 9.7%, P=0.392). During 35 (10–57) months of follow-up, MACCE occurred in 46 patients (15.3%). The incidence of MACCE was much higher in the specific indication group than the on-label group (25.6% vs 13.6%, P=0.034). Conclusions: RA for specific indications, compared with on-label use, had a higher incidence of complications during the procedure and poorer long-term clinical outcomes.

457 CORONARY ROTATIONAL ATHERECTOMY AFTER TAVI: A PROCEDURAL CHALLENGE

Abstract Background Selective cannulation must be ensured especially in patient with coronary artery disease (CAD). Commissural alignment in self-expanding transcatheter heart valve (THV) is fundamental to facilitate subsequent coronary reaccess. Clinical Scenario A man of 84 years old, suffering from hypertension, dyslipidemia, diabetes mellitus, third stage of chronic kidney disease and obesity was admitted in our hospital for treatment. He had angina and dyspnea with a third NYHA class. The echocardiogram showed severer aortic stenosis with mean gradient of 48 mmHg and aortic valve area of 0.6cmq with preserved ejection fraction. He was eligible for transfemoral transcatheter aortic valve implantation (TAVI) and he had intermediate risk score. The preprocedural coronary angiogram revealed subocclusive and severe calcified lesion on mid circumflex artery. Methods The Acurate NEO 2 size L THV was chosen and was planned to implant the bioprosthesis with commissural orientation correlated to the native commeasures, selecting at the CT scan the projection of cusp overlap (right and left coronary cusp on the right of the screen). The delivery catheter was inserted into the introducer sheath with its flush port facing the six o’clock position and the after crossing the aortic arch and native annulus, the handle of the delivery catheter was torqued clockwise until 1 of the Acurate NEO 2 commissural posts faced the commissural of the aortic root. The final angiogram showed optimal position and orientation of the THV without paravalvular leak. The patient was discharged the next day with a mean gradient of 9mmHg. One month after TAVI, elective PCI was performed. We’ve prepared the lesion with rotational atherectomy, due to severe calcification. Three forward advancements of rotating abrasive burr was performed and subsequently one DES was implanted. The angiogram check showed excellent result with TIMI 3 flow. Conclusion The Acurate Neo 2 supra-annular valve platform provides a successful coronary cannulation. Coronary rotational atherectomy for severe calcified lesions after TAVI with Acurate Neo 2 is a feasible strategy

Evolution of novel grinding tool in removing coronary artery calcification tissue process.

Coronary rotational atherectomy (CRA) means of use a tiny grinding tool to rotate at high speed in the blood vessels, so as to remove calcified tissue, effectively enlarge the inner diameter of the vessels, which is an important tool for the treatment of cardiovascular calcified blockage. However, excessive grinding force, temperature and debris size can lead to serious surgical complications and endanger the patient life during CRA. This study introduces the design, fabrication and performance verification process of a novel grinding tool, and investigates the influence of tool geometrical parameters and grinding parameters The experimental results showed that: the novel grinding tool can effectively remove the simulated calcified tissue by grinding. The geometrical size of tools plays an important effect on the grinding properties, which can result in increasing grinding force, temperature and debris size with the increase of tool diameters. In addition, with the increase of rotational speed, the grinding force and temperature increase gradually, while the debris size decreases as the rotational speed increases. The increasing inner diameter of bone can also lead to a decrease in grinding force and temperature slightly. All the obtained results can give effective guidance for clinical operations.

Rotational atherectomy via the transradial access: success rates, procedural parameters and complications

Radial access is recommended for percutaneous coronary intervention (PCI), but rotational atherectomy remains frequently performed via femoral access. Analyzing the procedural parameters, success rate and complications of rotational atherectomy, performed via radial in comparison to femoral access. We retrospectively analyzed 427 consecutive patients undergoing rotational atherectomy. Procedural parameters and outcome were determined in 171 patients, scheduled for radial and compared to 256 patients with femoral access use. In the radial access group (74 ± 9 years, 84% male), the LAD was most frequently treated (49%). Sheath size was 7F in 59% and 6F in 41%, burr size was 1.5 mm in 46% and 1.25 mm in 14% of patients. A temporary pacemaker was inserted in 14%. Procedural success rate stood at 97%. Access site complications occurred in 4% of patients, which was significantly less frequent than in in 256 patients treated via femoral access (13% p = 0.003). Compared to radial access, femoral access was associated with the use of larger sheaths (p < 0.001), more frequent treatment of non-LAD vessels (58.2% vs. 44.4%, p = 0.013) and a higher rate of temporary pacemaker use (27%; p = 0.001). No differences could be seen in procedural success (p = 0.83) and burr size (p = 0.51). Femoral access (OR 3.33; 95% CI 1.40–7.93), and female sex (OR3.40 95% CI 1.69–6.63) were independent predictors for access site complications. For coronary rotational atherectomy, radial access has a high success rate with overall use of smaller sheaths, but of equally sized burrs as well as a significant lower rate of access site-related complications than femoral access.

The Use of Rotational Atherectomy in a Non-Surgical Centre in Far North Queensland: Evaluating Safety Outcomes

Percutaneous transluminal coronary rotational atherectomy (PTCRA) is a complex and higher-risk coronary intervention, although it is an established additional tool commonly utilised in non-surgical centres. We evaluated the outcomes of PTCRA in a single non-surgical centre in Far North Queensland.

Long-term results of percutaneous transluminal coronary rotational atherectomy for localised stenosis caused by Kawasaki disease.

Thirteen boys and one girl, 5-30 years (median 13 years), underwent percutaneous transluminal coronary rotational atherectomy. The interval from the onset of Kawasaki disease to PTCRA ranged from 5 to 29 years (median 12 years). The follow-up period was 1-22 years (median 13 years). The target vessels were the right coronary artery (7), left anterior descending artery (3), left circumflex (2), and left main trunk (2). The maximum burr size used was 1.75mm in four, 2.00mm in four, and 2.15mm in six. The immediate results of rotational atherectomy were successful in all patients, and the mean stenosis degree improved from 86±15% (mean ± standard deviation) to 37±14% (p < 0.001). Cardiac events in the late period were found in four patients (29%). Acute myocardial infarction occurred in two, and syncope and ventricular fibrillation in one each. The cardiac event-free rate at 10 and 20 years was 79% (95% confidence interval 50-92) and 39% (6-87), respectively, (n = 14). The overall 20-year patency rate was 54% (95% CI 28-78). That in patients more than 10 years old was 77% (95% CI 42-94, n = 10). PTCRA alone is suitable for severe localised stenosis with calcification caused by KD in young adults except for small children. Re-stenosis within the first year after PTCRA often develops because of reactive intimal thickening after the procedure. If a target vessel is a patent 1 year after the procedure, long-term patency may be expected in patients more than 10 years old.

Effect of Sex on Outcomes of Coronary Rotational Atherectomy Percutaneous Coronary Intervention (From the European Multicenter Euro4C Registry)

Data regarding the potential influence of gender on outcomes of rotational atherectomy (RA) percutaneous coronary intervention (PCI) are scarce and conflicting. Using the Euro4C registry, an international prospective multicentric registry of RA PCI, we evaluated the influence of gender on clinical outcomes of RA PCI. Between October 2016 and July 2018, 966 patients were included. In them, 267 (27.6%) were females. Female patients were older than males (77.7 years old ± 9.8 vs 73.3 ± 9.5 years old respectively, p < 0.001) had a poorer renal function (43,1% of females had a GFR < 60 ml/min:1.73m² vs 30.4% of males, p < 0.001) and were more frequently admitted for an acute coronary syndrome (32.2% vs 22.3% p = 0.002). During RA procedure, women were less likely to be treated by radial approach (65.0% vs 74.4%, p = 0.004). In-hospital major adverse cardiac event rate-defined as cardiovascular death, myocardial infarction, stroke/transient ischemic attack, target lesion revascularization, and coronary artery bypass grafting surgery-was higher in the female group (7.1% vs 3.7%, p = 0.043). However, coronary perforation, dissection, slow/low flow and tamponade did not significantly differ in gender, neither did cardiovascular medications at discharge. At 1 year follow-up, rate of major adverse cardiac event was 18.4% in the female group vs 11.2% in the male group (adjusted Hazard Ratio 1.82 [1.24 to 2.67], p = 0.002). No significant bleeding differences were observed in gender, neither in hospital, nor during follow-up. In conclusion women had worse clinical outcomes following RA PCI during hospitalization and at 1 year follow-up than did men.

Rotational Artherectomy via Distal Radial Artery Access

We present the case of a 59-year-old man who had coronary rotational atherectomy and insertion of a drug-eluting stent via distal right radial artery access (DRA), as opposed to the more traditional proximal radial artery approach.

The association of procedural variables and lipid parameters with coronary rotational atherectomy outcomes.

The aim of our study is to evaluate the association of rotational atherectomy (RA) operation procedural indices and baseline lipid parameters with the prognosis of the patients with severe coronary calcification who underwent RA. Our study population consists of 287 patients treated with RA in Fuwai Hospital from January 2013 to December 2019. We analyzed the patients' rotation procedural indices including the number of burrs, the size of burrs, approach site, the size of guiding catheter, along with the baseline level of lipoprotein(a) (Lp(a)), low-density lipoprotein-cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP) to examine the association of these measurements with the prognosis of these patients using Cox regression analysis and Kaplan-Meier survival analysis. We find that during the follow-up period of 56.7 months with the median, the use of single burr in the patients who underwent RA was significantly associated with the occurrence of cumulative major adverse cardiac events (MACE) when compared with using non-single burrs [Hazard Ratio (HR) 0.43, 95% confidence interval (95% CI) 0.24-0.77, p = 0.004] from univariate Cox regression analysis; (HR 0.36, 95% CI 0.20-0.66, p = 0.001) from multivariate Cox regression analysis In addition, we find a higher event-free survival rate in the single-burr group after Kaplan-Meier survival analysis (Log rank p = 0.0033). However, there was no significant association of the size of burrs with the occurrence of MACE (HR 0.90, 95% CI 0.47-1.73, p = 0.76). Similarly, we find no significant associations between the approach site and the occurrence of MACE (HR 0.79, 95% CI 0.24-2.53, p = 0.69), the baseline Lp(a) (HR 1.07, 95% CI 0.76-1.49, p = 0.71), the level of LDL-C (HR 0.83, 95% CI 0.55-1.26, p = 0.38) or hs-CRP (HR 0.85, 95% CI 0.45-1.58, p = 0.60). We find that the patients who receive RA with a single burr have better outcomes than those who receive RA with non-single burrs. Moreover,we find that the number of burrs used in RA instead of the size of burrs, approach site, the size of guiding catheter, or baseline levels of Lp(a), LDL-C or hs-CRP had significant association with the prognosis of RA patients.

Short-and-Long-Term Outcomes after Coronary Rotational Atherectomy in Patients Treated with Trans-Catheter Aortic Valve Implantation.

Background. Coronary artery disease (CAD) is a common finding among patients undergoing trans-catheter aortic valve implantation (TAVI), who often present severely calcified coronary lesions. Evidence is scarce about the use of rotational atherectomy (RA) in this setting, in particular regarding long-term outcome. Methods. RA was performed on severely calcified coronary lesions concomitant with TAVI in a consecutive series of patients treated between 2010 and 2020. Immediate and long-term clinical outcomes are reported. Results. A concomitant CAD (coronary stenosis visually > 50%) was observed in 402/845 (47.6%) consecutive patients undergoing TAVI at the University Hospital of Verona. Angioplasty was performed in 104 patients (12.3%). Among these, 19 patients (18.3%, 20 coronary arteries), were treated with RA after TAVI: 10 after implantation of a balloon-expandable trans-catheter valve and 9 after a self-expandable valve. All procedures were successful. Hypotension occurred in 3 patients (15.8%), with rapid recovery after the procedure; CI-AKI (contrast-induced acute kidney injury) in 3 patients (15.8%), of which two recovered within discharge. At a median follow-up of 21.5 months (Q1–3: 6–36) event free survival was 83.3%. Only one patient suffered a target vessel failure >2 years after RA. Neither stroke nor peri-procedural infarctions were detected. Conclusions. RA concomitant with TAVI was feasible and safe in patients treated with implantation of either self-expandable, or balloon-expandable trans-catheter aortic valves. Long-term clinical events related to the coronary procedure were extremely infrequent and the survival rate at median follow-up of 21.5 months was 83.3%.

Short-term and long-term outcomes of bailout versus planned coronaryrotational atherectomy.

The goal of this study was to compare in-hospital and long-term events between bailout rotational atherectomy (RA) and planned RA. In this retrospective study, All patients who underwent percutaneous coronary intervention (PCI) using RA at Nanjing Drum Tower Hospital from November 2011 to December 2018 were enrolled in this study. Planned RA was defined as RA performed immediately before balloon pre-dilation, while bailout RA was defined as RA after failure to expand the balloon or perform any other procedure. In-hospital and long-term major adverse cardiac events (MACE, defined as cardiac mortality, myocardial infarction (MI), target vessel revascularization (TVR) and stroke) were compared between the two groups. After statistical analysis, a total of 211 patients underwent PCI with RA during the study period: 153 in the planned RA group, and 58 in the bailout group. The incidence of coronary dissection was significantly higher in the bailout RA group than in the planned RA group (22.4% vs. 6.5%, P = 0.001). However, no significant difference in in-hospital MACE was found between the two groups (12.1% vs. 13.7%, P = 0.752). There was no difference in all-cause mortality (9.1% vs. 12.5%, P = 0.504) or long-term MACE (13.8% vs. 17.1%, P = 0.560) between the groups. Bailout RA was associated with a significantly longer procedural time (139.86 ± 56.24 min vs. 105.56 ± 36.71 min, P < 0.001) than planned RA. Therefore, compared with bailout RA, planned RA is associated with shorter procedural time and reduced incidence of coronary dissection, with no difference in MACE or mortality.