Severely calcified coronary stenosis poses a significant challenge for coronary angioplasty procedures. Modifying plaque before stenting is crucial to a successful intervention, since it will prevent the sub expansion associated to worse clinical outcomes at followup. The tools employed to assess complex lesions include specialized balloons such as cutting, scoring, or high pressure balloons, as...
Approximately 30% of patients undergoing percutaneous coronary intervention (PCI) present moderate to severe calcified lesions, which presents a significant challenge involving a high incidence of major adverse cardiovascular events (MACE). Rotational atherectomy (RA) is used to modify these calcified lesions and facilitate balloon angioplasty followed by stent implantation. The combination of RA with other plaque...
Severely calcified lesions currently pose a significant challenge, as they require adequate preparation through non-compliant balloons or cutting balloons to achieve effective stent expansion. Another option is the use of orbital or rotational atherectomy (RA), but this carries the risk of complications such as slow/no reflow, perforations, dissections, peri-procedural infarction, or guidewire rupture. Despite the...
At present, severe calcified coronary stenosis poses a significant challenge for PCI. A successful intervention will require plaque modification prior stenting, seeing as sub-expansion has been associated with worse clinical outcomes at followup. The tools normally used to treat these complex lesions include specialized balloons such as cutting, scoring, and high pressure balloons, as well...
Compared against conventional predilation with balloon, rotational atherectomy is associated with higher procedural success rate in severely classified lesions. Balloons capable of modifying plaque such as the Flextome Cutting Balloon or the AngioSculpt Scoring Balloon -among others- could reach similar results to that of rotational atherectomy, though this has not been tested so far. 200...
Rotational atherectomy is a very important tool in the treatment of heavily calcified and non-dilatable lesions. Historically, transfemoral access has been the gold standard due to a perceived need for large-bore guidewire catheters in order to use spheroids for proper debulking. Nowadays, rotational atherectomy has evolved towards a technique that aims to modify plaque for...
Courtesy of Dr. José Álvarez ‘Slow flow’ may complicate a rotational atherectomy procedure, especially when done on severely and extensively calcified lesions and small caliber vessels. Although its incidence is between 3% and 27%, its cause remains unclear, and it is thought that platelet antiaggregation induced by burr rotation speed may be behind it. ...
Original title: 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. Reference: Mohamed Abdel-Wahab et al. J Am Coll Cardiol Intv 2013; article in press Heavily calcified lesions are difficult and may prevent the appropriate expansion of a...
The objective of the study was to test the use of a new atherectomy device to prepare severely calcified lesions. It was an observational, prospective, multicenter study that included 443 patients from 49 sites with a 30-day follow-up. The lesion was classified as severely calcified, as fluoroscopy showed the presence of calcium on both sides...
Original title: Pivotal Trial to Evaluate the Safety and Efficacy of the Orbital Atherectomy System in Treating de Novo, Severely Calcified Coronary Lesions (ORBIT II) Reference: Jeffrey Chambers, et al. JACC Intervention 2014;7:510-8 Severely calcified coronary lesions, traditionally associated to difficult or impossible stent implantation, asymmetric stent expansion, higher post procedural events rate, more restenosis, more lesion revascularization,...