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Colegio de Medicina Interna de México.

2021, Number 1

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Med Int Mex 2021; 37 (1)

Rotational atherectomy in the treatment of high-risk calcified coronary lesions and the applicability of proximal and distal transradial access

Alcántara-Meléndez MA, Escutia-Cuevas HH, Rivas-Gálvez RE, Jiménez-Valverde AS, Rentería-Valencia ÁD, Flores-Morgado A, Espinoza-Rueda MA

Language: Spanish
References: 15
Page: 9-15
PDF size: 365.08 Kb.


ABSTRACT

Background: Rotational atherectomy is a technique used in complex highly calcified lesions and under-expanded stents.
Objective: To communicate the initial experience of rotational atherectomy by transradial access, rotastent and by distal transradial access.
Materials and Methods: Prospective and descriptive analysis done from November 2017 to March 2018. Patients undergoing percutaneous coronary intervention (PCI) were included, with single or multiple lesions with severe calcification, with other unsuccessful modification strategies, where rotational atherectomy was performed. Clinical follow-up was done 1, 6 and 12 months after procedure.
Results: Twenty-two patients were included with mean age of 66.5 years, 86.4% men; 68.2% of the patients presented with chronic stable angina; 50% of the cases were done by transradial access and one by distal radial; the treated vessels were: anterior descendant (40.9%), right coronary (45.4%) and circumflex (18.2%). In three cases rotational ablation of under-expanded stents was performed. Complications: one patient died due to a non-cardiac cause, a significant femoral hematoma, two cases of re-PCI due to restenosis, one patient required urgent surgical revascularization.
Conclusions: Rotational atherectomy by femoral access, proximal transradial and distal transradial in highly calcified lesions and underexpant stents has shown safety and encouraging results in the short and medium term.


REFERENCES

  1. Matthew I, Annapoorna S, Samin K. Current status of rotational atherectomy. JACC Cardiovasc Interv 2014; 7 (4): 345-53. doi. 10.1016/j.jcin.2013.12.196.

  2. Barbato E, Carrier D, Dardas P. European expert consensus on rotational atherectomy. EuroIntervention 2015; 11: 30- 6. doi. 10.4244/EIJV11I1A6.

  3. Zimarino M, Corcos T, Bramucci E. Rotational atherectomy: A “survivor” in the drug-eluting stent era. Cardiovas Revasc Med 2012; 13: 185-92. doi. 10.1016/j.carrev.2012.03.002.

  4. Iannaccone M, Piazza F, Boccuzzi GG, D’Ascenzo F, et al. rotational atherectomy in acute coronary syndrome: early and midterm outcomes from a multicentre registry. EuroIntervention 2016; 12 (12): 1457-64. doi. 10.4244/ EIJ-D-15-00485.

  5. Brinkmann C, Eitan A, Schwencke C, Mathey DG, et al. Rotational atherectomy in CTO lesions: Too risk? Outcome of rotational atherectomy in CTO-lesions compared to non- CTO-lesions. Eurointervention 2018; pii: EIJ-D-18-00393. doi. 10.4244/EIJ-D-18-00393.

  6. Tomey MI, Sharma SK. Interventional options for coronary artery calcification. Curr Cardiol Rep 2016; 18: 12. doi. 10.1007/s11886-015-0691-8.

  7. Sénior J, Tamayo N, Rodríguez A, Fernández A. Aterectomía rotacional para manejo de expansión inadecuada de stent (stentablacion). Rev Colomb Cardiol 2017; 24 (6):625. doi. 10.1016/j.rccar.2016.08.010.

  8. Melo PH, Falcão BA, Bezerra CG, Pinton FA, et al. Rotational atherectomy in arteries with extreme calcification or previous failed dilation: technical aspects and late outcomes after percutaneous coronary intervention. Rev Bras Cardiol Invasiva 2015; 23 (1): 38-41. doi. 10.1016/j. rbci.2015.01.003.

  9. Villavicencio R, , Uribe J, Barragán O, Lupi E. Aterectomía rotacional con implante de stent liberador de fármaco. An Med Asoc Med Hosp ABC 2015; 60 (3): 221-7.

  10. Clavellina JM, Varela M. Aterectomía coronaria por rotaablación en un caso de alto riesgo. An Med Asoc Med Hosp ABC 2000; 45 (1): 41-4.

  11. Dill T, Dietz U, Hamm CW, Küchler R, et al. A randomized comparison of balloon angioplasty versus rotational atherectomy in complex coronary lesions (COBRA study). Eur Heart J 2000; 21: 1759-66. doi. 10.1053/euhj.2000.2242.

  12. Mangiacapra F, Heyndrick GR, Puymiar E, Peace AJ, et al. Comparison of drug-eluting versus bare-metal stents after rotational atherectomy for the treatment of calcified coronary lesions. Int J Cardiol 2012; 154 (3): 373-6. doi. 10.1111/j.1540-8183.2007.00243.

  13. Khan A, Panchal H, Zaidi S, Papireddy M, et al. Safety and efficacy of radial versus femoral access for rotational atherectomy: A systematic review and meta-analysis. Cardiovascular Revascularization Medicine 2018. doi. 10.1016/j. carrev.2018.06.006.

  14. Mamas MA, Fath-Ordoubadi F, Fraser DG. Atraumatic complex transradial intervention using large bore sheathless guide catheter. Catheter Cardiovasc Interv 2008; 72 (3): 357-364. doi. 10.1002/ccd.21637.

  15. Whiteside HL, Nagabandi A, Kapoor D. Safety and efficacy of stentablation with rotational atherectomy for the management of underexpanded and undilatable coronary stents. Cardiovasc Revasc Med 2019. doi. 10.1016/j. carrev.2019.01.013.




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