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Dong Hyun In,Nae Hee Lee,Yoon Haeng Cho,Jon Suh,Hye Sun Seo,Hyung Oh Choi 순천향대학교 순천향의학연구소 2015 Journal of Soonchunhyang Medical Science Vol.21 No.1
Among the various kinds of percutaneous coronary intervention techniques for balloon non-crossable severe calcified coronary stenosis, rotational atherectomy (RA) is known to be a therapy of choice. We describe a case in which a 1.25 mm RA burr non-crossable heavily calcified stenosis was successfully treated by the RA through ‘6 in 8 child-mother’ guiding technique.
Khung Keong Yeo,Jie Jun Wong,Sridharan Umapathy,Yann Shan Keh,Yee How Lau,Jonathan Yap,Muhammad Idu,Chee Yang Chin,Jiang Ming Fam,Boon Wah Liew,Chee Tang Chin,Philip En Hou Wong,Tian Hai Koh 대한심장학회 2022 Korean Circulation Journal Vol.52 No.4
Background and Objectives: We compared real-world clinical outcomes of patients receiving intravascular lithotripsy (IVL) versus rotational atherectomy (RA) for heavily calcified coronary lesions. Methods: Fifty-three patients who received IVL from January 2017 to July 2020 were retrospectively compared to 271 patients who received RA from January 2017 to December 2018. Primary endpoints were in-hospital and 30-day major adverse cardiovascular events (MACE). Results: IVL patients had a higher prevalence of acute coronary syndrome (56.6% vs 24.4, p<0.001), multivessel disease (96.2% vs 73.3%, p<0.001) and emergency procedures (17.0% vs 2.2%, p<0.001) compared to RA. In-hospital MACE (11.3% vs 5.9%, p=0.152), MI (7.5% vs 3.3%, p=0.152), and mortality (5.7% vs 3.0%, p=0.319) were not statistically significant. 30-day MACE was higher in the IVL cohort vs RA (17.0% vs 7.4%, p=0.035). Propensity score adjusted regression using IVL was also performed on in-hospital MACE (odds ratio [OR], 1.677; 95% confidence interval [CI], 0.588–4.779) and 30-day MACE (OR, 1.910; 95% CI, 0.774–4.718). Conclusions: These findings represent our initial IVL experience in a high-risk, real-world cohort. Although the event rate in the IVL arm was numerically higher compared to RA, the small numbers and retrospective nature of this study preclude definitive conclusions. These clinical outcomes are likely to improve with greater experience and better case selection, allowing IVL to effectively treat complex calcified coronary lesions.
경피적 관동맥 죽상반절제술로 얻어진 죽상반의 조직 소견
김주영(Ju Young Kim),박성욱(Seong Wook Park),박승정(Seung Jung Park),송재관(Jae Kwan Song),김재중(Jae Joong Kim),최기영(Gi Young Choi),이종구(Jong Koo Lee) 대한내과학회 1994 대한내과학회지 Vol.47 No.3
Background: Percutaneous Directional Coronary Atherectomy (DCA) is a second-generation, catheter- based technique for the treatment of coronary artery disease that provide a unique oppertunity to study tissue obtained from coronary artery stenosis, The purpose of this study is to evaluate the histologic features in specimens from primary and restenotic lesions obtained by DCA and to relate this findings to clinical features, Methods: The study population consisted of 19 consecutive patients who underwent DCA at Asan Medical Center between October 1991 and August 1992 and who had tissue submitted for pathologic evaluation. We tried DCA in the 20 lesions of 19 patients (mean age, 56 years, M/F, 15/4) with coronary artery lesions that were primary lesions in 15, restenosis after PTCA in 3, and restenosis after stent implantation in 2. The target vessel of DCA was right coronary artery in 8 and left anterior descending artery in 12. The tissue fragments obtained were stained with hemaxtoxyline-eosin and Masson's trichrome. Results: Primary success of the DCA was achieved in 18 of 20 lesions (90%). Athrosclerotic plaque was seen in 17 of 18 lesions. The intimal hyperplasia was seen in 13 of 18 lesions. The intimal hyperplasia in primary (71%) and restnotic lesions (75%) was histologically identical under light microscopic examination. Conelusion: Intimal hyperplasia is a sensitive, but not spectific, marker for restenosis. Intimal hyperplasia seen in primary lesions may represent a new mechanism by which lesion progression may occur in patients with unstable angina, possibly as a consequence of platelet or smooth muscle cell secretion of mitogenic factor in respone to spontaneaus plaque ulceration or rapture
Mengmeng Yu,Yuehua Li,Wenbin Li,Zhigang Lu,Meng Wei,Jiayin Zhang 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.5
Objective: To assess the feasibility of calcification characterization by coronary computed tomography angiography (CCTA) to predict the use of rotational atherectomy (RA) for coronary intervention of lesions with moderate to severe calcification. Materials and Methods: Patients with calcified lesions treated by percutaneous coronary intervention (PCI) who underwent both CCTA and invasive coronary angiography were retrospectively included in this study. Calcification remodeling index was calculated as the ratio of the smallest vessel cross-sectional area of the lesion to the proximal reference luminal area. Other parameters such as calcium volume, regional Agatston score, calcification length, and involved calcium arc quadrant were also recorded. Results: A total of 223 patients with 241 calcified lesions were finally included. Lesions with RA tended to have larger calcium volume, higher regional Agatston score, more involved calcium arc quadrants, and significantly smaller calcification remodeling index than lesions without RA. Receiver operating characteristic curve analysis revealed that the best cutoff value of calcification remodeling index was 0.84 (area under curve = 0.847, p < 0.001). Calcification remodeling index ≤ 0.84 was the strongest independent predictor (odds ratio: 251.47, p < 0.001) for using RA. Conclusion: Calcification remodeling index was significantly correlated with the incidence of using RA to aid PCI. Calcification remodeling index ≤ 0.84 was the strongest independent predictor for using RA prior to stent implantation.
Contemporary Interventional Approach to Calcified Coronary Artery Disease
Jonathan Gabriel Sung,Sidney TH Lo,Ho Lam 대한심장학회 2023 Korean Circulation Journal Vol.53 No.1
Calcific coronary artery disease is an increasingly prevalent entity in the catheterization laboratory which has implications for stenting and expected outcomes. With new interventional techniques and equipment, strategies to favorably modify coronary calcium prior to stenting continue to evolve. This paper sought to review the latest advances in the management of severe coronary artery calcification in the catheterization laboratory and discuss contemporary percutaneous interventional approaches.
시술 전 아미노필린 투여가 회전형 죽상반절제술시 서맥성 부정맥의 발생과 혈역학 변화에 미치는 영향
차광수 ( Cha Gwang Su ),김무현 ( Kim Mu Hyeon ),김영대 ( Kim Yeong Dae ),김진우 ( Kim Jin U ),김신재 ( Kim Sin Jae ),김종성 ( Kim Jong Seong ) 대한내과학회 2003 대한내과학회지 Vol.64 No.6
Background : Rotational atherectomy or rotablation in right coronary artery (RCA) or dominant left circumflex artery (LCX) can cause bradyarrhythmias and requires the placement of prophylactic pacemaker. Adenosine is released endogenously by ischemic or h
김정혁,Woo Jin Jang,Kyung-Ju Ahn,Young Bin Song,한주용,최진호,최승혁,이상훈,권현철 대한심장학회 2012 Korean Circulation Journal Vol.42 No.7
Stent migration from the delivery balloon catheter is a rare but serious complication during percutaneous coronary intervention, particu-larly when a part of the stent stretches into the aorta. We report an unusual case of stent migration treated with a combination of a gooseneck snare and rotablation. A part of the stent was overstretched and unrolled into the aorta and the rest of the stent remained implanted in the coronary artery. The stent was captured with a gooseneck snare but could not be retrieved because it was connected to a stent remnant implanted in the coronary artery. The stent strut was cut with rotablation, and the stent was successfully removed through the femoral sheath.