Dominik Felbel MD, Ali Fattom, Isabella Fechter, Michael Paukovitsch MD, Tilman Stephan MD, Matthias Gröger MD, Mirjam Keßler MD, Leonhard Schneider MD, Johannes Mörike MD, Birgid Gonska MD, Armin Imhof MD, Wolfgang Rottbauer MD, Dominik Buckert MD, Sinisa Markovic MD
{"title":"肾脏疾病、糖尿病和直径狭窄可预测改良球囊应用于严重钙化冠状动脉病变时的旋转消融保送。","authors":"Dominik Felbel MD, Ali Fattom, Isabella Fechter, Michael Paukovitsch MD, Tilman Stephan MD, Matthias Gröger MD, Mirjam Keßler MD, Leonhard Schneider MD, Johannes Mörike MD, Birgid Gonska MD, Armin Imhof MD, Wolfgang Rottbauer MD, Dominik Buckert MD, Sinisa Markovic MD","doi":"10.1002/ccd.31181","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Modified balloon (MB) treatment in severely calcified coronary artery lesions is an established technique. However, some lesions require Rotablation (RA) as bailout strategy.</p>\n </section>\n \n <section>\n \n <h3> Aims</h3>\n \n <p>This study aimed to assess predictors of switch from MB to RA and its impact on procedural and midterm outcomes.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Four hundred and eighty-three consecutive patients were included undergoing MB treatment (<i>n</i> = 204) with a scoring or cutting balloon, or upfront RA treatment (<i>n</i> = 279) serving as control cohort. Strategy switch from MB to RA was performed in 19 of 204 patients. Procedural success was defined as successful stent implantation and TIMI III flow.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In the MB cohort, median age was 72 [63−78] years, 75.5% were male and 42.1% had acute coronary syndrome. Procedure success was achieved in 89.4% of the switch group versus 98.4% of the MB only group (<i>p</i> < 0.001) and in 96.4% of the RA cohort. In the switch group, periprocedural complications (31.6% vs. 8.1% vs. 11.8%, <i>p</i> = 0.007), radiation dose (149 [126–252] vs. 59 [30–97] vs. 102 [59–156] Gcm<sup>2</sup>; <i>p</i> < 0.001) and contrast volume (250 [190–250] vs. 190 [150–250] vs. 195 [190–-250] mL; <i>p</i> < 0.001) were significantly higher. Diabetes (OR 3.8, 95% CI 1.1–13.9, <i>p</i> = 0.042), chronic kidney disease stage 4 or 5 (OR 19.0, 95% CI 3.3–108.6, <i>p</i> < 0.001) and pronounced calcification resulting in higher angiographic diameter stenosis (OR 1.13, 95% CI 1.1–1.2, <i>p</i> = 0.001) independently predicted strategy switch. Midterm results were not affected by strategy switch regarding 1-year target lesion revascularization rates (86% vs. 89% vs. 89%; log-rank <i>p</i> = 0.95).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Primary RA strategy might be considered in patients with severely calcified coronary artery lesions with high angiographic diameter stenosis, diabetes or impaired renal function due to increased periprocedural complication rates, radiation dose, and contrast volume following strategy switch.</p>\n </section>\n </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 4","pages":"676-687"},"PeriodicalIF":2.1000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31181","citationCount":"0","resultStr":"{\"title\":\"Kidney disease, diabetes, and diameter stenosis predict Rotablation bailout in modified balloon application for severely calcified coronary lesions\",\"authors\":\"Dominik Felbel MD, Ali Fattom, Isabella Fechter, Michael Paukovitsch MD, Tilman Stephan MD, Matthias Gröger MD, Mirjam Keßler MD, Leonhard Schneider MD, Johannes Mörike MD, Birgid Gonska MD, Armin Imhof MD, Wolfgang Rottbauer MD, Dominik Buckert MD, Sinisa Markovic MD\",\"doi\":\"10.1002/ccd.31181\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Modified balloon (MB) treatment in severely calcified coronary artery lesions is an established technique. However, some lesions require Rotablation (RA) as bailout strategy.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>This study aimed to assess predictors of switch from MB to RA and its impact on procedural and midterm outcomes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Four hundred and eighty-three consecutive patients were included undergoing MB treatment (<i>n</i> = 204) with a scoring or cutting balloon, or upfront RA treatment (<i>n</i> = 279) serving as control cohort. Strategy switch from MB to RA was performed in 19 of 204 patients. Procedural success was defined as successful stent implantation and TIMI III flow.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>In the MB cohort, median age was 72 [63−78] years, 75.5% were male and 42.1% had acute coronary syndrome. Procedure success was achieved in 89.4% of the switch group versus 98.4% of the MB only group (<i>p</i> < 0.001) and in 96.4% of the RA cohort. In the switch group, periprocedural complications (31.6% vs. 8.1% vs. 11.8%, <i>p</i> = 0.007), radiation dose (149 [126–252] vs. 59 [30–97] vs. 102 [59–156] Gcm<sup>2</sup>; <i>p</i> < 0.001) and contrast volume (250 [190–250] vs. 190 [150–250] vs. 195 [190–-250] mL; <i>p</i> < 0.001) were significantly higher. Diabetes (OR 3.8, 95% CI 1.1–13.9, <i>p</i> = 0.042), chronic kidney disease stage 4 or 5 (OR 19.0, 95% CI 3.3–108.6, <i>p</i> < 0.001) and pronounced calcification resulting in higher angiographic diameter stenosis (OR 1.13, 95% CI 1.1–1.2, <i>p</i> = 0.001) independently predicted strategy switch. Midterm results were not affected by strategy switch regarding 1-year target lesion revascularization rates (86% vs. 89% vs. 89%; log-rank <i>p</i> = 0.95).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Primary RA strategy might be considered in patients with severely calcified coronary artery lesions with high angiographic diameter stenosis, diabetes or impaired renal function due to increased periprocedural complication rates, radiation dose, and contrast volume following strategy switch.</p>\\n </section>\\n </div>\",\"PeriodicalId\":9650,\"journal\":{\"name\":\"Catheterization and Cardiovascular Interventions\",\"volume\":\"104 4\",\"pages\":\"676-687\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-09-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31181\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Catheterization and Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ccd.31181\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ccd.31181","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Kidney disease, diabetes, and diameter stenosis predict Rotablation bailout in modified balloon application for severely calcified coronary lesions
Background
Modified balloon (MB) treatment in severely calcified coronary artery lesions is an established technique. However, some lesions require Rotablation (RA) as bailout strategy.
Aims
This study aimed to assess predictors of switch from MB to RA and its impact on procedural and midterm outcomes.
Methods
Four hundred and eighty-three consecutive patients were included undergoing MB treatment (n = 204) with a scoring or cutting balloon, or upfront RA treatment (n = 279) serving as control cohort. Strategy switch from MB to RA was performed in 19 of 204 patients. Procedural success was defined as successful stent implantation and TIMI III flow.
Results
In the MB cohort, median age was 72 [63−78] years, 75.5% were male and 42.1% had acute coronary syndrome. Procedure success was achieved in 89.4% of the switch group versus 98.4% of the MB only group (p < 0.001) and in 96.4% of the RA cohort. In the switch group, periprocedural complications (31.6% vs. 8.1% vs. 11.8%, p = 0.007), radiation dose (149 [126–252] vs. 59 [30–97] vs. 102 [59–156] Gcm2; p < 0.001) and contrast volume (250 [190–250] vs. 190 [150–250] vs. 195 [190–-250] mL; p < 0.001) were significantly higher. Diabetes (OR 3.8, 95% CI 1.1–13.9, p = 0.042), chronic kidney disease stage 4 or 5 (OR 19.0, 95% CI 3.3–108.6, p < 0.001) and pronounced calcification resulting in higher angiographic diameter stenosis (OR 1.13, 95% CI 1.1–1.2, p = 0.001) independently predicted strategy switch. Midterm results were not affected by strategy switch regarding 1-year target lesion revascularization rates (86% vs. 89% vs. 89%; log-rank p = 0.95).
Conclusion
Primary RA strategy might be considered in patients with severely calcified coronary artery lesions with high angiographic diameter stenosis, diabetes or impaired renal function due to increased periprocedural complication rates, radiation dose, and contrast volume following strategy switch.
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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