open access

Vol 26, No 5 (2019)
Review articles — Interventional cardiology
Published online: 2019-09-25
Get Citation

Calcific lesion preparation for coronary bifurcation stenting

Matteo Perfetti, Fabio Fulgenzi, Francesco Radico, Alessandro Toro, Antonio Procopio, Nicola Maddestra, Marco Zimarino
DOI: 10.5603/CJ.a2019.0094
·
Pubmed: 31565792
·
Cardiol J 2019;26(5):429-437.

open access

Vol 26, No 5 (2019)
Review articles — Interventional cardiology
Published online: 2019-09-25

Abstract

Bifurcating coronary lesions are a very common challenge in interventional cardiology because of the
technical complexity in their treatment, the risk of side branch occlusion and an overall worse outcome
when compared to non-bifurcating lesions.


The presence of calcifications represents further complexity due to the difficulty in device delivery and
stent expansion as well as enhanced risk of side branch occlusion.


Rotational and orbital atherectomy, scoring and cutting balloons, coronary lithoplasty are available tools
which have been introduced over the last three decades to overcome such issue. Nevertheless, their application in different contexts of bifurcations presents specific caveats and the studies directed at comparing such techniques have never been expressly oriented in the subset of the bifurcating lesion.


In this paper, we review these devices and their usefulness in bifurcations by analyzing consistent data
from clinical trials, and we propose a practical algorithm for the treatment of severely calcified bifurcating
lesions according to their anatomical features.

Abstract

Bifurcating coronary lesions are a very common challenge in interventional cardiology because of the
technical complexity in their treatment, the risk of side branch occlusion and an overall worse outcome
when compared to non-bifurcating lesions.


The presence of calcifications represents further complexity due to the difficulty in device delivery and
stent expansion as well as enhanced risk of side branch occlusion.


Rotational and orbital atherectomy, scoring and cutting balloons, coronary lithoplasty are available tools
which have been introduced over the last three decades to overcome such issue. Nevertheless, their application in different contexts of bifurcations presents specific caveats and the studies directed at comparing such techniques have never been expressly oriented in the subset of the bifurcating lesion.


In this paper, we review these devices and their usefulness in bifurcations by analyzing consistent data
from clinical trials, and we propose a practical algorithm for the treatment of severely calcified bifurcating
lesions according to their anatomical features.

Get Citation

Keywords

bifurcation; calcified lesion; plaque modification; rotational atherectomy; coronary lithoplasty

About this article
Title

Calcific lesion preparation for coronary bifurcation stenting

Journal

Cardiology Journal

Issue

Vol 26, No 5 (2019)

Pages

429-437

Published online

2019-09-25

DOI

10.5603/CJ.a2019.0094

Pubmed

31565792

Bibliographic record

Cardiol J 2019;26(5):429-437.

Keywords

bifurcation
calcified lesion
plaque modification
rotational atherectomy
coronary lithoplasty

Authors

Matteo Perfetti
Fabio Fulgenzi
Francesco Radico
Alessandro Toro
Antonio Procopio
Nicola Maddestra
Marco Zimarino

References (38)
  1. Grundeken MJ, Wykrzykowska JJ, Ishibashi Y, et al. First generation versus second generation drug-eluting stents for the treatment of bifurcations: 5-year follow-up of the LEADERS all-comers randomized trial. Catheter Cardiovasc Interv. 2016; 87(7): E248–E260.
  2. Lassen JF, Burzotta F, Banning AP, et al. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. EuroIntervention. 2018; 13(13): 1540–1553.
  3. Zimarino M, Curzen N, Cicchitti V, et al. The adequacy of myocardial revascularization in patients with multivessel coronary artery disease. Int J Cardiol. 2013; 168(3): 1748–1757.
  4. Fujino Y, Attizzani GF, Tahara S, et al. Impact of main-branch calcified plaque on side-branch stenosis in bifurcation stenting: an optical coherence tomography study. Int J Cardiol. 2014; 176(3): 1056–1060.
  5. Kim HY, Doh JH, Lim HS, et al. Identification of coronary artery side branch supplying myocardial mass that may benefit from revascularization. JACC Cardiovasc Interv. 2017; 10(6): 571–581.
  6. Louvard Y, Medina A, Stankovic G. Definition and classification of bifurcation lesions and treatments. EuroIntervention. 2010; 6 Suppl J: J31–J35.
  7. Zimarino M, Briguori C, Amat-Santos IJ, et al. Mid-term outcomes after percutaneous interventions in coronary bifurcations. Int J Cardiol. 2019; 283: 78–83.
  8. Mintz GS, Lefèvre T, Lassen JF, et al. Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club. EuroIntervention. 2018; 14(4): e467–e474.
  9. Neumann F, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Kardiol Pol. 2018: 1585–1664.
  10. Madhavan MV, Tarigopula M, Mintz GS, et al. Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol. 2014; 63(17): 1703–1714.
  11. Bourantas CV, Zhang YJ, Garg S, et al. Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart. 2014; 100(15): 1158–1164.
  12. Latib A, Takagi K, Chizzola G, et al. Excimer Laser LEsion modification to expand non-dilatable stents: the ELLEMENT registry. Cardiovasc Revasc Med. 2014; 15(1): 8–12.
  13. Pescetelli I, Zimarino M, Ghirarduzzi A, et al. Localizing factors in atherosclerosis. J Cardiovasc Med (Hagerstown). 2015; 16(12): 824–830.
  14. Barath P, Fishbein MC, Vari S, et al. Cutting balloon: a novel approach to percutaneous angioplasty. Am J Cardiol. 1991; 68(11): 1249–1252.
  15. Mauri L, Bonan R, Weiner BH, et al. Cutting balloon angioplasty for the prevention of restenosis: results of the cutting balloon global randomized trial. Am J Cardiol. 2002; 90(10): 1079–1083.
  16. Dahm JB, Dörr M, Scholz E, et al. Cutting-balloon angioplasty effectively facilitates the interventional procedure and leads to a low rate of recurrent stenosis in ostial bifurcation coronary lesions: A subgroup analysis of the NICECUT multicenter registry. Int J Cardiol. 2008; 124(3): 345–350.
  17. Hussain F, Kashour T, Rajaram M. Ostial RCA intervention: guiding catheter challenges and use of a buddy wire to perform focused-force angioplasty on a severely calcific ostial right coronary lesion. J Invasive Cardiol. 2006; 18(12): E298–E301.
  18. Jujo K, Saito K, Ishida I, et al. Intimal disruption affects drug-eluting cobalt-chromium stent expansion: A randomized trial comparing scoring and conventional balloon predilation. Int J Cardiol. 2016; 221: 23–31.
  19. Otsuka Y, Koyama T, Imoto Y, et al. Prolonged inflation technique using a scoring balloon for severe calcified lesion. Int Heart J. 2017; 58(6): 982–987.
  20. Weisz G, Metzger DC, Liberman HA, et al. A provisional strategy for treating true bifurcation lesions employing a scoring balloon for the side branch: final results of the AGILITY trial. Catheter Cardiovasc Interv. 2013; 82(3): 352–359.
  21. Ritchie JL, Hansen DD, Intlekofer MJ, et al. Rotational approaches to atherectomy and thrombectomy. Z Kardiol. 1987; 76 Suppl 6: 59–65.
  22. Zimarino M, Corcos T, Favereau X, et al. Rotational coronary atherectomy with adjunctive balloon angioplasty for the treatment of ostial lesions. Cathet Cardiovasc Diagn. 1994; 33(1): 22–27.
  23. Cavusoglu E, Kini AS, Marmur JD, et al. Current status of rotational atherectomy. Catheter Cardiovasc Interv. 2004; 62(4): 485–498.
  24. Cohen BM, Weber VJ, Blum RR, et al. Cocktail attenuation of rotational ablation flow effects (CARAFE) study: pilot. Cathet Cardiovasc Diagn. 1996; Suppl 3: 69–72.
  25. Barbato E, Carrié D, Dardas P, et al. European expert consensus on rotational atherectomy. EuroIntervention. 2015; 11(1): 30–36.
  26. Ando G, Cortese B, Russo F, et al. Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX. J Am Coll Cardiol. 2017.
  27. Kini AS, Vengrenyuk Y, Pena J, et al. Optical coherence tomography assessment of the mechanistic effects of rotational and orbital atherectomy in severely calcified coronary lesions. Catheter Cardiovasc Interv. 2015; 86(6): 1024–1032.
  28. Chambers JW, Feldman RL, Himmelstein SI, et al. Pivotal trial to evaluate the safety and efficacy of the orbital atherectomy system in treating de novo, severely calcified coronary lesions (ORBIT II). JACC Cardiovasc Interv. 2014; 7(5): 510–518.
  29. Bhatt P, Parikh P, Patel A, et al. Long-term safety and performance of the orbital atherectomy system for treating calcified coronary artery lesions: 5-Year follow-up in the ORBIT I trial. Cardiovasc Revasc Med. 2015; 16(4): 213–216.
  30. Abdel-Wahab M, Toelg R, Byrne RA, et al. High-Speed rotational atherectomy versus modified balloons prior to drug-eluting stent implantation in severely calcified coronary lesions. Circ Cardiovasc Interv. 2018; 11(10): e007415.
  31. Iannaccone M, Colangelo S, Di Mario C, et al. Double wire rotational atherectomy technique in a heavily calcified coronary bifurcation. EuroIntervention. 2018; 14(2): 204–205.
  32. Ito H, Piel S, Das P, et al. Long-term outcomes of plaque debulking with rotational atherectomy in side-branch ostial lesions to treat bifurcation coronary disease. J Invasive Cardiol. 2009; 21(11): 598–601.
  33. Iannaccone M, Barbero U, D'ascenzo F, et al. Rotational atherectomy in very long lesions: Results for the ROTATE registry. Catheter Cardiovasc Interv. 2016; 88(6): E164–E172.
  34. Chambers JW, Warner C, Cortez J, et al. Outcomes after atherectomy treatment of severely calcified coronary bifurcation lesions: a single center experience. Cardiovasc Revasc Med. 2019; 20(7): 569–572.
  35. Tovar Forero MN, Wilschut J, Van Mieghem NM, et al. Coronary lithoplasty: a novel treatment for stent underexpansion. Eur Heart J. 2019; 40(2): 221.
  36. Ali ZA, Brinton TJ, Hill JM, et al. Optical coherence tomography characterization of coronary lithoplasty for treatment of calcified lesions: first description. JACC Cardiovasc Imaging. 2017; 10(8): 897–906.
  37. Ali Z, Nef H, Escaned J, et al. Safety and effectiveness of coronary intravascular lithotripsy for treatment of severely calcified coronary stenoses. The Disrupt CAD II Study. Circulation: Cardiovascular Interventions. 2019; 12(10).
  38. Zimarino M, Corcos T, Bramucci E, et al. Rotational atherectomy: a "survivor" in the drug-eluting stent era. Cardiovasc Revasc Med. 2012; 13(3): 185–192.

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