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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Directional coronary atherectomy has been used in the past to excise atheromatous debris from arteries, rather than simply compressing and rupturing plaques. The procedure causes more physical damage and the wall can rupture. The material extracted may be submitted for histological examination and dating of thrombi can occur, but this is no longer routinely done as there is no evidence that atherectomy produces better long-term results than balloon angioplasty with stent insertion.
Complications of percutaneous intervention for femoral, popliteal, and infrapopliteal artery occlusive disease
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Renganaden Sooppan, Christopher J. Abularrage
Atherectomy has a relatively low rate of perforation in peripheral arteries. Atherectomy-related complications occur due to direct cutting or mechanical disruption of the adventitia. Directional atherectomy has a procedural perforation rate of 5.3%, laser atherectomy and rotational atherectomy have a perforation rate of 2%, and orbital atherectomy has a perforation rate between 0.5 and 2.2%.31BRANCH OCCLUSION
Complex lower extremity revascularization
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Atherectomy catheters are discussed in Chapter 20. Atherectomy may be directional, rotational, or orbital. Atherectomy plays a particularly important role in patients with heavily calcified lesions. Atherectomy may be performed with the concomitant use of a distal protection device (Figure 25.15). Most operators use atherectomy for reconstruction in areas where stent placement is not desirable. These include the common femoral artery, profunda femoris artery origin, the proximal SFA, and also the popliteal artery segment (from the adductor canal to the popliteal artery).
Characteristics and hospital outcomes of coronary atherectomy within the United States: a multivariate and propensity-score matched analysis
Published in Expert Review of Cardiovascular Therapy, 2021
Fahed Darmoch, Waqas Ullah, Yasser Al-khadra, Yasar Sattar, Homam Moussa Pacha, Mohamed Zghouzi, Mohamad Soud, Rodrigo Bagur, Srihari S. Naidu, Andrew M. Goldsweig, Mamas Mamas, Emmanouil S Brilakis, M Chadi Alraies
It is not uncommon to encounter multiple coronary lesions during PCI. In up to 40% of patients, significant stenosis was found in 1 or more other non-infarct-related coronary vessels during PCI[22]. The presence of >1 coronary lesion is associated with an increased risk of post PCI morbidity of mortality compared to a single vessel lesion PCI [23,24]. Moreover, the frequency of multiple coronary lesions is often higher in patients with multiple comorbid conditions. In our study, multiple coronary lesions were more frequently seen in the atherectomy group when compared to the non-atherectomy group. Multiple coronary lesion groups were also found to have higher in-hospital mortality and post-procedure complications. In Marenzi et al. [25], which enrolled 208 patients presenting with multiple vessel disease undergoing PCI, AKI has been observed in 19% of the included patients. The increased risk of AKI could be attributed to generally longer procedural time and a more significant contrast volume [25,26]. Furthermore, dissection and vascular complications were also higher in multiple coronary lesions in atherectomy groups. This could be related to the presence of calcium within the vessel wall. Calcium depositions appeared to be significantly associated with the vessel wall dissected, presumably increasing shear stresses within the plaque[27].
Stent failure: the diagnosis and management of intracoronary stent restenosis
Published in Expert Review of Cardiovascular Therapy, 2023
Majd B Protty, Tharindra Dissanayake, Daniel Jeffery, Ahmed Hailan, Anirban Choudhury
Where debulking is required, the use of rotational or laser atherectomy may be indicated. More commonly, however, scoring or cutting balloons are used in these circumstances given their wider availability and relative safety compared to atherectomy. Evidence for lesion preparation techniques in ISR is presented in Table 3.
Device profile of the FLEX Vessel Prep System for the treatment of peripheral arterial disease: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2022
Thomas Zeller, Tanja Böhme, Ulrich Beschorner, Elias Noory
Millions of individuals with PAD in the lower extremities are eligible for PTA procedures each year. However, the recognized underperformance of plain balloon angioplasty resulted in the rise of vessel preparation techniques through plaque modification or debulking prior to PTA to improve vessel compliance and to minimize the risk of dissection. Vessel preparation was initially established with specialty angioplasty balloons that incorporated cutting or scoring elements to create controlled dissections upon focal force of balloon inflation. In addition, specialty balloons were introduced to treat areas of stenosis where a stent was deemed inappropriate, ie. near bifurcations or in segments with significant flexion such as behind the knee. In the case of the cutting balloon, the fixed stiff blades limit balloon length to 20 mm – best used in short lesions. Subsequent products have a blunt wire cage on the outside of the balloon and are produced in a number of fixed lengths and diameters. The wires direct focal force to the lesion at specific contact points as the balloon is inflated. While specialty balloons have a place in the angioplasty armamentarium, atherectomy (directional, rotational, orbital, laser) is a vessel preparation method that is intended to provide lumen gain by removing (debulking) the plaque through cutting, shaving, grinding, or vaporizing. The major limitations of atherectomy revolves around inconsistent plaque removal and the inability to limit cutting depth. Because of this, adverse events of perforation and embolization are not uncommon. Recently, intravascular lithotripsy (IVL) has been introduced to modify plaque in calcified lesions by using shock waves to create microfractures or microfissures via energy absorption in the calcium. Although each approach has a unique mechanism of action, they have limitations in their utilization with long, complex PAD lesions and only PTA and specialty balloons are typically used in stenosed AV fistulae and grafts (see Section 4.0 and Table 1). Long, complex, mixed morphology lesions are estimated to be present in up to 50% of PAD patients treated with PTA depending on anatomical lesion location. These lesions are more challenging to treat and are associated with higher rates of acute complication and poorer long-term clinical outcomes [10].