1. Synergistic Coronary Artery Calcium Modification With Combined Atherectomy and Intravascular Lithotripsy.
- Author
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Wong B, Kam KK, So CY, Tam GM, Chi WK, Chui KL, Wu EB, Chan JY, and Yan BP
- Subjects
- Male, Humans, Middle Aged, Aged, Female, Calcium, Retrospective Studies, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Treatment Outcome, Atherectomy, Coronary Angiography methods, Percutaneous Coronary Intervention methods, Atherectomy, Coronary methods, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Myocardial Infarction etiology, Lithotripsy, Vascular Calcification diagnosis, Vascular Calcification surgery
- Abstract
Background: Severe coronary artery calcification (CAC) remains challenging during percutaneous coronary intervention (PCI) and often requires 1 or more advanced calcium modification tools., Objectives: We describe the combination use of rotational (RA) or orbital atherectomy (OA), with intravascular lithotripsy (IVL), termed rotatripsy and orbital-tripsy, respectively, for modifying CAC prior to stent implantation during PCI., Methods: We performed a retrospective analysis of patients treated with rotatripsy or orbital-tripsy at our center between July 2019 and March 2022. The primary efficacy endpoint was procedural success (successful stent implantation, <30% residual stenosis visually, Thrombolysis in Myocardial Infarction 3 flow; absence of types C to F dissection/perforation or loss of side branch ≥2.0mm visually) without in-hospital major adverse cardiovascular event (MACE, defined as cardiovascular death, myocardial infarction [MI], target-vessel revascularization)., Results: A total of 25 patients (14 rotatripsy and 11 orbital-tripsy) were included in our study. The mean age was 72.2 ± 7.6 years and 76% were men. PCI was guided by intravascular imaging in 24 patients (96%). All cases were treated with either RA or OA before utilization of IVL. Procedural success was achieved in 22 cases (88%) with 1 sidebranch loss without periprocedural MI (4%) and 2 in-patient deaths (8%) unrelated to the procedure (1 intracerebral hemorrhage and 1 cardiac arrest)., Conclusion: We describe efficacious use of both rotatripsy and orbital-tripsy to modify severe CAC during PCI in a real-world setting. Intravascular imaging can guide appropriate use of these devices to complement each other to modify severe CAC to achieve optimal outcomes.
- Published
- 2023
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