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Orbital-Tripsy: Novel Combination of Orbital-Atherectomy and Intravascular-Lithotripsy, in Calcified Coronaries After Failed Intravascular-Lithotripsy.

ABSTRACT: Calcified coronary lesions are notorious for posing technical difficulty during angioplasty. Fortunately, more devices are available to tackle coronary calcifications. However, there remain difficult cases whereby a single modality is insufficient. Here we report the feasibility and success of a case, using Novo combination of Shockwave Lithotripsy after Orbital Atherectomy. (Level of Difficulty: Intermediate.).

SUBMITTER: Chiang CSM

PROVIDER: S-EPMC8305089 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Orbital-Tripsy: Novel Combination of Orbital-Atherectomy and Intravascular-Lithotripsy, in Calcified Coronaries After Failed Intravascular-Lithotripsy.

Chiang Chi Shing Michael CSM Alan Chan Ka Chun KC Lee Michael M Chan Kam Tim KT

JACC. Case reports 20201216 15

Calcified coronary lesions are notorious for posing technical difficulty during angioplasty. Fortunately, more devices are available to tackle coronary calcifications. However, there remain difficult cases whereby a single modality is insufficient. Here we report the feasibility and success of a case, using Novo combination of Shockwave Lithotripsy after Orbital Atherectomy. (<b>Level of Difficulty: Intermediate.</b>). ...[more]

PMID: 34317190

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Safety and procedural outcomes of intravascular lithotripsy in calcified coronaries in Indian patients.

Project description:ObjectiveCalcified coronaries still remain a major challenge for interventional cardiologist. This study aims to evaluate safety and efficacy of intravascular lithotripsy (IVL) in management of coronary artery calcification.MethodsThis was a retrospective single centre study regarding the utility of IVL in management of calcified coronaries. Patients with hemodynamically stable acute coronary syndrome or symptomatic chronic coronary syndrome (CCS) and calcified coronaries on angiography and who underwent IVL were enrolled. Intravascular imaging was performed wherever feasible. The primary endpoint was procedural success. In addition, data regarding procedural complications were collected.ResultsA total of 29 patients underwent IVL with a majority being males and having comorbidities such as hypertension and diabetes. A procedural success rate of 93.1% was achieved with no patient having >50% residual stenosis. IVL catheter was successfully delivered in all patients. The mean catheter diameter was 3.3 ± 0.4 mm and mean number of delivered pulses was 70.3 ± 16.4. The arteries most commonly intervened were the left main coronary and the left anterior descending artery. Intracoronary imaging revealed a significant increase in minimum luminal cross-sectional area (MLA) post IVL (pre-MLA: 5.1 ± 2.5 mm2; post-MLA: 10.7 ± 2.9 mm2; P<0.001). Two patients had in-hospital MACE in form of peri-procedural non Q-wave MI. No patient had arrhythmias, stent thrombosis, coronary perforation, or slow flow/no-reflow. Two patients had a rupture of IVL balloon while four had coronary artery dissection.ConclusionsIVL is a safe and highly effective modality with high procedural success rate in management of calcified coronaries.

| S-EPMC9039684 | biostudies-literature

Intravascular Lithotripsy as a Novel Treatment Method for Calcified Unprotected Left Main Diseases-Comparison to Rotational Atherectomy-Short-Term Outcomes.

Project description:BackgroundThe unprotected calcified Left Main disease represents a high-risk subset for percutaneous coronary intervention (PCI), and it is associated with a higher number of periprocedural complications and an increased rate of in-stent thrombosis and restenosis. Adequate lesion preparation plays a crucial role in achieving a favorable PCI outcome. Rotational Atherectomy (RA) is a well-established plaque-modifying method; nevertheless, the data regarding the effectiveness of RA in LM diseases is scarce. Recently, the novel ShockWave-Intravascular-Lithotripsy(S-IVL) device has been introduced to the PCI armamentarium in order to modify the calcified plaque.MethodsWe performed a retrospective evaluation of 44 consecutive subjects who underwent the LM-PCI, and who were supported by either the RA or S-IVL.ResultsThe Rota group consisted of 29 patients with a mean syntax score of 28.0 ± 7.5. The S-IVL group was composed of 15 subjects with a syntax score of 23.3 ± 13.0 There were no statistical differences regarding MACE between the RA and Shockwave arms of the in-hospital group (10.3% vs. 6.7%), or in the six month (17.2% vs. 13.3%) follow-up group.ConclusionsRA and S-IVL could be safe and effective therapeutic strategies for calcified LM disease. Further studies with a higher number of participants and longer follow-up times are warranted to establish the potential benefits of RA and S-IVL for the management of LM stenosis.

| S-EPMC9330248 | biostudies-literature

Orbital atherectomy of calcified coronary ostial lesions.

Project description:ObjectivesTo evaluate the feasibility and safety of coronary orbital atherectomy (OA) for the treatment of calcified ostial lesions.BackgroundPercutaneous coronary intervention (PCI) is increasingly being completed in complex patients and lesions. OA is effective for severely calcified coronary lesions; however, there is a dearth of evidence on the use of OA in ostial lesions, especially with long-term outcome data.MethodsData were obtained from a retrospective analysis of patients who underwent OA of heavily calcified ostial lesions followed by stent implantation from December 2010 to June 2019 at two high-volume PCI centers. Kaplan-Meier analysis was utilized to assess the primary endpoints of 30-day, 1-year, and 2-year freedom-from (FF) major adverse cardiac events (MACE: death, myocardial infarction, or target vessel revascularization), stroke, and stent thrombosis (ST).ResultsA total of 56 patients underwent OA to treat heavily calcified ostial coronary lesions. The mean age was 72 years with a high prevalence of diabetes (55%) and heart failure (36%), requiring hemodynamic support (14%). There was high FF angiographic complications (93%), and at 30-day, 1-year, and 2-year, a high FF-MACE (96%, 91%, and 88%), stroke (98%, 96%, and 96%), and ST (100%), respectively.ConclusionsThis study represents the largest real-world experience of coronary OA use in heavily calcified ostial lesions with long-term outcomes over 2 years. The main finding in this retrospective analysis is that, despite the complex patients and lesions included in this analysis, OA appears to be a feasible and safe treatment option for calcified coronary ostial lesions.

| S-EPMC9804932 | biostudies-literature

Intravascular Lithotripsy for Calcified Left Main Artery Disease.

Project description:Left main coronary artery disease subtends a large area of potentially jeopardized myocardium. Percutaneous coronary intervention for severe left main coronary artery disease is a reasonable treatment option for select patients. Severe coronary artery calcium of the left main artery increases the complexity of percutaneous coronary intervention and is associated with increased risk of periprocedural complications and worse long-term clinical outcomes. Intravascular lithotripsy (IVL) utilizes sonic pressure waves to modify severe coronary artery calcium and has emerged as a safe and effective alternative to coronary atherectomy. However, left main lesions were excluded from regulatory approval clinical trials of IVL. Herein, we review all available data regarding the use of IVL treatment for severe left main coronary artery disease.

| S-EPMC11308112 | biostudies-literature

Staged strategy of combined rotational atherectomy and intravascular lithotripsy for severely calcified lesions: an evaluation using multimodality intracoronary imaging-a case report.

Project description:BackgroundSeverely calcified lesions are the most significant challenge for percutaneous coronary intervention, exhibiting poor clinical outcomes. Some severely calcified lesions remain untreatable with conventional balloons or even atherectomy devices. Intravascular lithotripsy is a new option for treating severe calcification.Case summaryHerein, we describe a case of ischaemic cardiomyopathy with a thick, circumferential calcified lesion in the proximal and mid-segments of the left anterior descending coronary artery. In the first session, high-pressure balloons, cutting balloons, and rotational atherectomy failed to disrupt the calcification. In the staged additional treatment that was subsequently planned, eight cycles of intravascular lithotripsy created multiple fractures in the deep calcification, resulting in successful stent deployment. The effect of intravascular lithotripsy was observed mainly in calcified areas with lipid components detected using near-infrared spectroscopy-intravascular ultrasound.DiscussionOur report suggests the efficacy of employing a combined strategy of rotational atherectomy with small burrs and intravascular lithotripsy in the treatment of severe calcification with a minimal risk of complications. Our study introduces a novel aspect by utilizing near-infrared spectroscopy-intravascular ultrasound to evaluate calcified lesions before performing intravascular lithotripsy. To our knowledge, there have been no similar reports to date. The effect of intravascular lithotripsy on calcified lesions may be related to the distribution of lipid components and/or heterogeneity within the calcification.

| S-EPMC11443966 | biostudies-literature

Coronary Intravascular Lithotripsy in a Tight Circumferential Calcified Lesion in the Presence of Haematoma Extending into Left Main Coronary Artery After Rotational Atherectomy

Project description:Calcified disease increases procedural challenges and is associated with worse outcomes in percutaneous coronary intervention. Coronary intravascular lithotripsy is a new balloon-based modality for treating calcified disease with deep circumferential calcification. Its main benefit is simplicity and safety compared to atherectomy. However, atherectomy remains the modality of choice in balloon-uncrossable lesions. More than one modality is often needed for treatment of calcified disease. The authors present a case of a balloon-uncrossable calcified ostial left circumflex lesion which was first treated with rotational atherectomy. However, there was haematoma formation in the ostial circumflex extending into left main coronary artery, together with suboptimal preparation of calcified disease. Intravascular coronary lithotripsy was then used to successfully prepare the calcified lesion for stenting without causing extension of the haematoma.

| S-EPMC10437410 | biostudies-literature

Intravascular lithotripsy for heavily calcified subtotal occlusion of right coronary artery.

Project description: Not available

| S-EPMC8084382 | biostudies-literature

Can Most Calcified Coronary Stenosis Be Optimized With Coronary Intravascular Lithotripsy?

Project description:Intravascular lithotripsy can be used as an effective therapy for lesion preparation in severely calcified lesions. The mechanism, as shown by optical coherence tomography, is calcium fractures. The aforementioned modification is performed with minimal risk of perforation, no-reflow and a low incidence of flow-limiting dissection and myocardial infarctions. Other techniques, such as cutting or scoring balloons and rotational atherectomy have also been shown to increase luminal diameter, but other complications, such as distal embolization, induced by these treatment modalities, are a source of concern. This review describes a single-center study of all-comer patients, including those with complex characteristics. This therapy is very effective, with a very low risk of complications. In this article, we characterize the mechanism of action of the intravascular lithotripsy catheter, its optical coherence tomography validation, clinical applications, and comparison with other calcium-modifying technologies, as well as future directions, which can be used to improve the technology.

| S-EPMC10167520 | biostudies-literature

Orbital and Rotational Atherectomy in Calcified Bifurcations: A Walk in the Park?

Project description: Not available

| S-EPMC7489459 | biostudies-literature

Changing paradigm for treatment of heavily calcified coronary artery disease. A complementary role of rotational atherectomy and intravascular lithotripsy with shockwave balloon: a case report.

Project description:BackgroundManagement of heavily calcified coronary arteries is still a major challenge in interventional cardiology. Inadequate stent expansion in calcific lesions is the single most important predictor of stent thrombosis and in-stent restenosis. Rotational atherectomy (RA) is an important tool to modify the calcium burden but is associated with limitations and requires specific skills. Intravascular lithotripsy (IVL) is a novel technique to treat calcified stenotic lesions and has been proposed as an alternative to RA with promising results.Case summaryWe report a case of a patient with severely calcified right coronary artery stenosis successfully treated with combination of RA and IVL.DiscussionIn this case, we demonstrate that the RA and IVL are complementary strategies, not sufficient on their own and not alternative to each other.

| S-EPMC7898579 | biostudies-literature

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