New Frontiers for Orbital Atherectomy—Crossing an Uncrossable Chronic Total Occlusion

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Ayman Helal, Mohsin Farooq
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引用次数: 0

Abstract

Managing chronic total occlusions (CTOs) in coronary artery disease remains a significant challenge, especially in cases where standard techniques fail to cross the lesion. Uncrossable lesions are rare but require innovative strategies for successful treatment. Orbital atherectomy, traditionally used for calcified plaques, may offer a solution in these cases. We present the case of a 62-year-old male with exertional chest pain and a CTO in the right coronary artery (RCA). The patient had a positive stress echocardiogram for inducible ischemia despite optimized medical therapy. Multiple conventional techniques, including ballooning, microcatheter use, and laser atherectomy, failed to cross the proximal cap of the CTO. After these methods proved ineffective, orbital atherectomy using the DiamondBack 360 system successfully crossed the lesion and enabled subsequent balloon angioplasty and stenting. This may be the first reported case where orbital atherectomy was used after the failure of laser and other techniques. The case highlights the role of orbital atherectomy in the treatment of uncrossable CTOs, expanding its application beyond calcified lesions. The versatility of this technology, particularly when other methods fail, underscores its importance as an adjunctive tool in complex PCI. In conclusion, orbital atherectomy should be considered a valuable option for crossing uncrossable coronary CTOs, especially when standard and advanced techniques, including laser atherectomy, fail. This case broadens the scope of its use in coronary intervention, providing a new perspective on tackling resistant lesions.

眶动脉粥样硬化切除术的新领域-跨越不可跨越的慢性全闭塞。
处理冠状动脉疾病的慢性全闭塞(CTOs)仍然是一个重大挑战,特别是在标准技术无法穿过病变的情况下。不可跨越的病变是罕见的,但需要创新的策略来成功治疗。眼眶动脉粥样硬化切除术,传统上用于钙化斑块,可能是解决这些情况的一种方法。我们提出的情况下,62岁的男性与外劳性胸痛和CTO在右冠状动脉(RCA)。尽管经过优化的药物治疗,患者仍有诱导性缺血的应激超声心动图阳性。多种传统技术,包括球囊、微导管和激光动脉粥样硬化切除术,都未能穿过CTO近端帽。在这些方法被证明无效后,使用DiamondBack 360系统的眶动脉粥样硬化切除术成功地穿过病变,并使随后的球囊血管成形术和支架置入成为可能。这可能是第一例在激光和其他技术失败后使用眼眶动脉粥样硬化切除术的报道。该病例强调了眼眶动脉粥样硬化切除术在治疗不交叉CTOs中的作用,将其应用范围扩大到钙化病变以外。该技术的多功能性,特别是当其他方法失败时,强调了其作为复杂PCI辅助工具的重要性。综上所述,眶动脉粥样硬化切除术应被认为是穿越无法穿越的冠状动脉cto的一种有价值的选择,特别是当标准和先进的技术,包括激光动脉粥样硬化切除术失败时。本病例拓宽了其在冠状动脉介入治疗中的应用范围,为治疗顽固性病变提供了新的视角。
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来源期刊
CiteScore
5.40
自引率
8.70%
发文量
419
审稿时长
2 months
期刊介绍: Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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