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Mohamed Abdelwahab - One of the best experts on this subject based on the ideXlab platform.
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tct 26 predictors of bailout Rotational Atherectomy in patients with complex calcified coronary artery disease a pooled analysis from the randomized rotaxus and prepare calc trials
Journal of the American College of Cardiology, 2019Co-Authors: Mohamed Abdelwahab, Ralph Toelg, Volker Geist, Franzjosef Neumann, Dmitriy S Sulimov, Abdelhakim Allali, Robert A Byrne, Mohamed Elmawardy, Gert RichardtAbstract:Criteria for elective Rotational Atherectomy (RA) are poorly defined, and upfront procedures are usually performed based on operator’s preference and experience. We sought to identify clinical and angiographic factors associated with the need for bailout RA in patients with calcified coronary
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stuck rotablator the nightmare of Rotational Atherectomy
Eurointervention, 2013Co-Authors: Dmitriy S Sulimov, Mohamed Abdelwahab, Ralph Toelg, Volker Geist, Guido Kassner, Gert RichardtAbstract:Aims Rotational Atherectomy (RA) is frequently performed to modify complex fibrocalcific coronary lesions with high procedural success. A stuck rotablator is a rare but life-threatening complication. However, its description remains sporadic and it has never been systematically analysed. The aim of this analysis is to present our experience and summarise the available literature about stuck rotablator, and to identify risk factors and possible management strategies for this complication. Methods and results We analysed our experience of 442 RA procedures and identified four cases of stuck rotablator. Two of these cases were rotablations in freshly implanted stents. All cases were managed percutaneously. We further analysed the available literature and identified a total of 11 reports with 14 cases of a stuck rotablator burr; seven were managed surgically and seven with endovascular approaches. Based on our experience and the literature review we developed an algorithm to guide operators while managing this complication. Conclusions Entrapment of a rotablation burr is a rare but very serious complication of RA. Operators performing RA should be aware of this risk and be prepared to manage it adequately. In our experience, the risk seems to be higher when rotablating freshly implanted underexpanded stents.
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high speed Rotational Atherectomy before paclitaxel eluting stent implantation in complex calcified coronary lesions the randomized rotaxus Rotational Atherectomy prior to taxus stent treatment for complex native coronary artery disease trial
Jacc-cardiovascular Interventions, 2013Co-Authors: Mohamed Abdelwahab, Gert Richardt, Heinz Joachim Buttner, Ralph Toelg, Volker Geist, Thomas Meinertz, Joachim Schofer, Lamin King, Franzjosef Neumann, Ahmed A KhattabAbstract:Objectives This study sought to determine the effect of Rotational Atherectomy (RA) on drug-eluting stent (DES) effectiveness. Background DES are frequently used in complex lesions, including calcified stenoses, which may challenge DES delivery, expansion, and effectiveness. RA can adequately modify calcified plaques and facilitate stent delivery and expansion. Its impact on DES effectiveness is widely unknown. Methods The ROTAXUS (Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex Native Coronary Artery Disease) study randomly assigned 240 patients with complex calcified native coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120, standard therapy group). Stenting was performed using a polymer-based slow-release paclitaxel-eluting stent. The primary endpoint was in-stent late lumen loss at 9 months. Secondary endpoints included angiographic and strategy success, binary restenosis, definite stent thrombosis, and major adverse cardiac events at 9 months. Results Despite similar baseline characteristics, significantly more patients in the standard therapy group were crossed over (12.5% vs. 4.2%, p = 0.02), resulting in higher strategy success in the rotablation group (92.5% vs. 83.3%, p = 0.03). At 9 months, in-stent late lumen loss was higher in the rotablation group (0.44 ± 0.58 vs. 0.31 ± 0.52, p = 0.04), despite an initially higher acute lumen gain (1.56 ± 0.43 vs. 1.44 ± 0.49 mm, p = 0.01). In-stent binary restenosis (11.4% vs. 10.6%, p = 0.71), target lesion revascularization (11.7% vs. 12.5%, p = 0.84), definite stent thrombosis (0.8% vs. 0%, p = 1.0), and major adverse cardiac events (24.2% vs. 28.3%, p = 0.46) were similar in both groups. Conclusions Routine lesion preparation using RA did not reduce late lumen loss of DES at 9 months. Balloon dilation with only provisional rotablation remains the default strategy for complex calcified lesions before DES implantation. (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease. A Multicenter, Prospective, Randomized Controlled Trial [ROTAXUS]; NCT00380809 )
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high speed Rotational Atherectomy before paclitaxel eluting stent implantation in complex calcified coronary lesions the randomized rotaxus Rotational Atherectomy prior to taxus stent treatment for complex native coronary artery disease trial
Jacc-cardiovascular Interventions, 2013Co-Authors: Mohamed Abdelwahab, Gert Richardt, Heinz Joachim Buttner, Ralph Toelg, Volker Geist, Thomas Meinertz, Joachim Schofer, Lamin King, Franzjosef Neumann, Ahmed A KhattabAbstract:Objectives This study sought to determine the effect of Rotational Atherectomy (RA) on drug-eluting stent (DES) effectiveness. Background DES are frequently used in complex lesions, including calcified stenoses, which may challenge DES delivery, expansion, and effectiveness. RA can adequately modify calcified plaques and facilitate stent delivery and expansion. Its impact on DES effectiveness is widely unknown. Methods The ROTAXUS (Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex Native Coronary Artery Disease) study randomly assigned 240 patients with complex calcified native coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120, standard therapy group). Stenting was performed using a polymer-based slow-release paclitaxel-eluting stent. The primary endpoint was in-stent late lumen loss at 9 months. Secondary endpoints included angiographic and strategy success, binary restenosis, definite stent thrombosis, and major adverse cardiac events at 9 months. Results Despite similar baseline characteristics, significantly more patients in the standard therapy group were crossed over (12.5% vs. 4.2%, p = 0.02), resulting in higher strategy success in the rotablation group (92.5% vs. 83.3%, p = 0.03). At 9 months, in-stent late lumen loss was higher in the rotablation group (0.44 ± 0.58 vs. 0.31 ± 0.52, p = 0.04), despite an initially higher acute lumen gain (1.56 ± 0.43 vs. 1.44 ± 0.49 mm, p = 0.01). In-stent binary restenosis (11.4% vs. 10.6%, p = 0.71), target lesion revascularization (11.7% vs. 12.5%, p = 0.84), definite stent thrombosis (0.8% vs. 0%, p = 1.0), and major adverse cardiac events (24.2% vs. 28.3%, p = 0.46) were similar in both groups. Conclusions Routine lesion preparation using RA did not reduce late lumen loss of DES at 9 months. Balloon dilation with only provisional rotablation remains the default strategy for complex calcified lesions before DES implantation. (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease. A Multicenter, Prospective, Randomized Controlled Trial [ROTAXUS]; NCT00380809)
Emanuele Barbato - One of the best experts on this subject based on the ideXlab platform.
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From debulking to delivery: sequential use of Rotational Atherectomy and Guidezilla™ for complex saphenous vein grafts intervention
BMC, 2018Co-Authors: Mariano Pellicano, Emanuele Barbato, Vincent Floré, Bernard De BruyneAbstract:Abstract Background Percutaneous coronary interventions (PCI) of old calcified saphenous vein grafts (SVGs) is challenging and is associated with a considerably high risk of adverse ischemic events in the short- and long-term as compared to native coronary arteries. We report a case in which a non-dilatable, calcified SVG lesion is successfully treated with Rotational Atherectomy followed by PCI and stenting with local stent delivery (LSD) technique using the Guidezilla™ guide extension catheter (5-in-6 Fr) in the “child-in-mother” fashion. Case presentation A 70 years-old man with a dilated ischemic cardiomyopathy, triple coronary artery bypass grafting (CABG) in 1990 and chronic renal failure (baseline GFR: 45 ml/min/1.73 m2) underwent a coronary angiography for a Non-ST segment elevation myocardial infarction (NSTEMI). Native coronary circulation was completely occluded at the proximal segments. Grafts angiography showed a tandem calcified lesions of SVG on distal right coronary artery (RCA) and an ostial stenosis of the SVG on first obtuse marginal branch (OM1). Left internal mammary artery on the mid left anterior descending artery was patent. Ad Hoc PCI of SVG on RCA was attempted. The proximal calcified stenosis has been crossed with a 1.5 x 12 mm balloon only with the support of Guidezilla™, however the non-compliant (NC) balloon 2.5 x 15 mm was unable to break the hard and calcified plaque. After several attempts, the procedure was interrupted with a suboptimal result. An elective transradial PCI of SVG on RCA with Rotational Atherectomy was performed. Two runs with 1.25 mm burr and 2 runs with 1.5 mm burr were carried out. Then, the use of distal anchoring balloon warranted support and tracking, made as centring rail for the advance of the tip of the “mother-and-child” catheter into the SVG. During slow deflation of the balloon, the Guidezilla™ was advanced distal to the stenoses to be stented, thus allowing the placement of two long drug eluting stents according to a LSD technique. Conclusions Rotational Atherectomy is a feasible option for non-dilatable stenoses in old SVGs when there is no evidence of thrombus or vessel dissection and the subsequent use of “mother-and-child” catheter has a key role, especially in case of radial approach, for long stents delivery
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european expert consensus on Rotational Atherectomy
Eurointervention, 2015Co-Authors: Emanuele Barbato, Didier Carrie, Petros S Dardas, Jean Fajadet, Georg Gaul, Michael Haude, Ahmed Khashaba, Karel T Koch, Markus Meyergessner, Jorge PalazuelosAbstract:The interest in Rotational Atherectomy (RA) has increased over the past decade as a consequence of more complex and calcified coronary stenoses being attempted with percutaneous coronary interventions. Yet adoption of RA is hampered by several factors: amongst others, by the lack of a standardised protocol. This European expert consensus document stems from the awareness of the large heterogeneity in the protocols adopted to perform Rotational Atherectomy. The objective of the present document is to provide some points of consensus among highly experienced operators on the most controversial steps of RA in an attempt to build the basis of a standardised and universally accepted protocol.
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acef and clinical syntax score in the risk stratification of patients with heavily calcified coronary stenosis undergoing Rotational Atherectomy with stent implantation
Catheterization and Cardiovascular Interventions, 2014Co-Authors: Stylianos A Pyxaras, Luigi Di Serafino, Bernard De Bruyne, Fabio Mangiacapra, William Wijns, Frederic De Vroey, Gabor Toth, Gianfranco Sinagra, Guy R Heyndrickx, Emanuele BarbatoAbstract:Aim To assess ACEF (age, creatinine, and ejection fraction) and Clinical SYNTAX (CSS) score in the risk stratification of patients with heavily calcified stenosis undergoing Rotational Atherectomy with stent implantation (rota-stenting). Methods and Results. ACEF and CSS were calculated in 221 consecutive patients with stable angina undergoing rota-stenting. Mean age of the patients was 74 ± 10 years, left ventricular ejection fraction was 61 ± 18%, and final burr size 1.78 ± 0.24 mm, with 2.6 ± 0.9 burrs used for each patient. Primary end-point was MACE at one-year defined as the composite of cardiac death, myocardial infarction, and target vessel revascularization. Post-hoc analysis was performed by stratifying the clinical outcome according to ACEF and CSS tertiles. At 1 year there was a significantly higher MACE rate in the high tertile of ACEF (24% for ACEFHigh vs. 13% for ACEFMid vs. 9% for ACEFLow; P = 0.017) and CSS (25% for CSSHigh vs. 12% for CSSMid vs. 8% for CSSLow; P = 0.008). The predictive accuracy for both ACEF and CSS was moderate (c-statistics, 0.629 and 0.638, respectively). Conclusion Both ACEF and CSS predict with moderate accuracy MACE at 1-year in patients with heavily calcified coronary stenosis undergoing Rotational Atherectomy with stent implantation. © 2014 Wiley Periodicals, Inc.
Gert Richardt - One of the best experts on this subject based on the ideXlab platform.
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tct 26 predictors of bailout Rotational Atherectomy in patients with complex calcified coronary artery disease a pooled analysis from the randomized rotaxus and prepare calc trials
Journal of the American College of Cardiology, 2019Co-Authors: Mohamed Abdelwahab, Ralph Toelg, Volker Geist, Franzjosef Neumann, Dmitriy S Sulimov, Abdelhakim Allali, Robert A Byrne, Mohamed Elmawardy, Gert RichardtAbstract:Criteria for elective Rotational Atherectomy (RA) are poorly defined, and upfront procedures are usually performed based on operator’s preference and experience. We sought to identify clinical and angiographic factors associated with the need for bailout RA in patients with calcified coronary
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stuck rotablator the nightmare of Rotational Atherectomy
Eurointervention, 2013Co-Authors: Dmitriy S Sulimov, Mohamed Abdelwahab, Ralph Toelg, Volker Geist, Guido Kassner, Gert RichardtAbstract:Aims Rotational Atherectomy (RA) is frequently performed to modify complex fibrocalcific coronary lesions with high procedural success. A stuck rotablator is a rare but life-threatening complication. However, its description remains sporadic and it has never been systematically analysed. The aim of this analysis is to present our experience and summarise the available literature about stuck rotablator, and to identify risk factors and possible management strategies for this complication. Methods and results We analysed our experience of 442 RA procedures and identified four cases of stuck rotablator. Two of these cases were rotablations in freshly implanted stents. All cases were managed percutaneously. We further analysed the available literature and identified a total of 11 reports with 14 cases of a stuck rotablator burr; seven were managed surgically and seven with endovascular approaches. Based on our experience and the literature review we developed an algorithm to guide operators while managing this complication. Conclusions Entrapment of a rotablation burr is a rare but very serious complication of RA. Operators performing RA should be aware of this risk and be prepared to manage it adequately. In our experience, the risk seems to be higher when rotablating freshly implanted underexpanded stents.
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high speed Rotational Atherectomy before paclitaxel eluting stent implantation in complex calcified coronary lesions the randomized rotaxus Rotational Atherectomy prior to taxus stent treatment for complex native coronary artery disease trial
Jacc-cardiovascular Interventions, 2013Co-Authors: Mohamed Abdelwahab, Gert Richardt, Heinz Joachim Buttner, Ralph Toelg, Volker Geist, Thomas Meinertz, Joachim Schofer, Lamin King, Franzjosef Neumann, Ahmed A KhattabAbstract:Objectives This study sought to determine the effect of Rotational Atherectomy (RA) on drug-eluting stent (DES) effectiveness. Background DES are frequently used in complex lesions, including calcified stenoses, which may challenge DES delivery, expansion, and effectiveness. RA can adequately modify calcified plaques and facilitate stent delivery and expansion. Its impact on DES effectiveness is widely unknown. Methods The ROTAXUS (Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex Native Coronary Artery Disease) study randomly assigned 240 patients with complex calcified native coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120, standard therapy group). Stenting was performed using a polymer-based slow-release paclitaxel-eluting stent. The primary endpoint was in-stent late lumen loss at 9 months. Secondary endpoints included angiographic and strategy success, binary restenosis, definite stent thrombosis, and major adverse cardiac events at 9 months. Results Despite similar baseline characteristics, significantly more patients in the standard therapy group were crossed over (12.5% vs. 4.2%, p = 0.02), resulting in higher strategy success in the rotablation group (92.5% vs. 83.3%, p = 0.03). At 9 months, in-stent late lumen loss was higher in the rotablation group (0.44 ± 0.58 vs. 0.31 ± 0.52, p = 0.04), despite an initially higher acute lumen gain (1.56 ± 0.43 vs. 1.44 ± 0.49 mm, p = 0.01). In-stent binary restenosis (11.4% vs. 10.6%, p = 0.71), target lesion revascularization (11.7% vs. 12.5%, p = 0.84), definite stent thrombosis (0.8% vs. 0%, p = 1.0), and major adverse cardiac events (24.2% vs. 28.3%, p = 0.46) were similar in both groups. Conclusions Routine lesion preparation using RA did not reduce late lumen loss of DES at 9 months. Balloon dilation with only provisional rotablation remains the default strategy for complex calcified lesions before DES implantation. (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease. A Multicenter, Prospective, Randomized Controlled Trial [ROTAXUS]; NCT00380809 )
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high speed Rotational Atherectomy before paclitaxel eluting stent implantation in complex calcified coronary lesions the randomized rotaxus Rotational Atherectomy prior to taxus stent treatment for complex native coronary artery disease trial
Jacc-cardiovascular Interventions, 2013Co-Authors: Mohamed Abdelwahab, Gert Richardt, Heinz Joachim Buttner, Ralph Toelg, Volker Geist, Thomas Meinertz, Joachim Schofer, Lamin King, Franzjosef Neumann, Ahmed A KhattabAbstract:Objectives This study sought to determine the effect of Rotational Atherectomy (RA) on drug-eluting stent (DES) effectiveness. Background DES are frequently used in complex lesions, including calcified stenoses, which may challenge DES delivery, expansion, and effectiveness. RA can adequately modify calcified plaques and facilitate stent delivery and expansion. Its impact on DES effectiveness is widely unknown. Methods The ROTAXUS (Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex Native Coronary Artery Disease) study randomly assigned 240 patients with complex calcified native coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120, standard therapy group). Stenting was performed using a polymer-based slow-release paclitaxel-eluting stent. The primary endpoint was in-stent late lumen loss at 9 months. Secondary endpoints included angiographic and strategy success, binary restenosis, definite stent thrombosis, and major adverse cardiac events at 9 months. Results Despite similar baseline characteristics, significantly more patients in the standard therapy group were crossed over (12.5% vs. 4.2%, p = 0.02), resulting in higher strategy success in the rotablation group (92.5% vs. 83.3%, p = 0.03). At 9 months, in-stent late lumen loss was higher in the rotablation group (0.44 ± 0.58 vs. 0.31 ± 0.52, p = 0.04), despite an initially higher acute lumen gain (1.56 ± 0.43 vs. 1.44 ± 0.49 mm, p = 0.01). In-stent binary restenosis (11.4% vs. 10.6%, p = 0.71), target lesion revascularization (11.7% vs. 12.5%, p = 0.84), definite stent thrombosis (0.8% vs. 0%, p = 1.0), and major adverse cardiac events (24.2% vs. 28.3%, p = 0.46) were similar in both groups. Conclusions Routine lesion preparation using RA did not reduce late lumen loss of DES at 9 months. Balloon dilation with only provisional rotablation remains the default strategy for complex calcified lesions before DES implantation. (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease. A Multicenter, Prospective, Randomized Controlled Trial [ROTAXUS]; NCT00380809)
Ahmed A Khattab - One of the best experts on this subject based on the ideXlab platform.
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high speed Rotational Atherectomy before paclitaxel eluting stent implantation in complex calcified coronary lesions the randomized rotaxus Rotational Atherectomy prior to taxus stent treatment for complex native coronary artery disease trial
Jacc-cardiovascular Interventions, 2013Co-Authors: Mohamed Abdelwahab, Gert Richardt, Heinz Joachim Buttner, Ralph Toelg, Volker Geist, Thomas Meinertz, Joachim Schofer, Lamin King, Franzjosef Neumann, Ahmed A KhattabAbstract:Objectives This study sought to determine the effect of Rotational Atherectomy (RA) on drug-eluting stent (DES) effectiveness. Background DES are frequently used in complex lesions, including calcified stenoses, which may challenge DES delivery, expansion, and effectiveness. RA can adequately modify calcified plaques and facilitate stent delivery and expansion. Its impact on DES effectiveness is widely unknown. Methods The ROTAXUS (Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex Native Coronary Artery Disease) study randomly assigned 240 patients with complex calcified native coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120, standard therapy group). Stenting was performed using a polymer-based slow-release paclitaxel-eluting stent. The primary endpoint was in-stent late lumen loss at 9 months. Secondary endpoints included angiographic and strategy success, binary restenosis, definite stent thrombosis, and major adverse cardiac events at 9 months. Results Despite similar baseline characteristics, significantly more patients in the standard therapy group were crossed over (12.5% vs. 4.2%, p = 0.02), resulting in higher strategy success in the rotablation group (92.5% vs. 83.3%, p = 0.03). At 9 months, in-stent late lumen loss was higher in the rotablation group (0.44 ± 0.58 vs. 0.31 ± 0.52, p = 0.04), despite an initially higher acute lumen gain (1.56 ± 0.43 vs. 1.44 ± 0.49 mm, p = 0.01). In-stent binary restenosis (11.4% vs. 10.6%, p = 0.71), target lesion revascularization (11.7% vs. 12.5%, p = 0.84), definite stent thrombosis (0.8% vs. 0%, p = 1.0), and major adverse cardiac events (24.2% vs. 28.3%, p = 0.46) were similar in both groups. Conclusions Routine lesion preparation using RA did not reduce late lumen loss of DES at 9 months. Balloon dilation with only provisional rotablation remains the default strategy for complex calcified lesions before DES implantation. (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease. A Multicenter, Prospective, Randomized Controlled Trial [ROTAXUS]; NCT00380809 )
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high speed Rotational Atherectomy before paclitaxel eluting stent implantation in complex calcified coronary lesions the randomized rotaxus Rotational Atherectomy prior to taxus stent treatment for complex native coronary artery disease trial
Jacc-cardiovascular Interventions, 2013Co-Authors: Mohamed Abdelwahab, Gert Richardt, Heinz Joachim Buttner, Ralph Toelg, Volker Geist, Thomas Meinertz, Joachim Schofer, Lamin King, Franzjosef Neumann, Ahmed A KhattabAbstract:Objectives This study sought to determine the effect of Rotational Atherectomy (RA) on drug-eluting stent (DES) effectiveness. Background DES are frequently used in complex lesions, including calcified stenoses, which may challenge DES delivery, expansion, and effectiveness. RA can adequately modify calcified plaques and facilitate stent delivery and expansion. Its impact on DES effectiveness is widely unknown. Methods The ROTAXUS (Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex Native Coronary Artery Disease) study randomly assigned 240 patients with complex calcified native coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120, standard therapy group). Stenting was performed using a polymer-based slow-release paclitaxel-eluting stent. The primary endpoint was in-stent late lumen loss at 9 months. Secondary endpoints included angiographic and strategy success, binary restenosis, definite stent thrombosis, and major adverse cardiac events at 9 months. Results Despite similar baseline characteristics, significantly more patients in the standard therapy group were crossed over (12.5% vs. 4.2%, p = 0.02), resulting in higher strategy success in the rotablation group (92.5% vs. 83.3%, p = 0.03). At 9 months, in-stent late lumen loss was higher in the rotablation group (0.44 ± 0.58 vs. 0.31 ± 0.52, p = 0.04), despite an initially higher acute lumen gain (1.56 ± 0.43 vs. 1.44 ± 0.49 mm, p = 0.01). In-stent binary restenosis (11.4% vs. 10.6%, p = 0.71), target lesion revascularization (11.7% vs. 12.5%, p = 0.84), definite stent thrombosis (0.8% vs. 0%, p = 1.0), and major adverse cardiac events (24.2% vs. 28.3%, p = 0.46) were similar in both groups. Conclusions Routine lesion preparation using RA did not reduce late lumen loss of DES at 9 months. Balloon dilation with only provisional rotablation remains the default strategy for complex calcified lesions before DES implantation. (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease. A Multicenter, Prospective, Randomized Controlled Trial [ROTAXUS]; NCT00380809)
Ralph Toelg - One of the best experts on this subject based on the ideXlab platform.
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tct 26 predictors of bailout Rotational Atherectomy in patients with complex calcified coronary artery disease a pooled analysis from the randomized rotaxus and prepare calc trials
Journal of the American College of Cardiology, 2019Co-Authors: Mohamed Abdelwahab, Ralph Toelg, Volker Geist, Franzjosef Neumann, Dmitriy S Sulimov, Abdelhakim Allali, Robert A Byrne, Mohamed Elmawardy, Gert RichardtAbstract:Criteria for elective Rotational Atherectomy (RA) are poorly defined, and upfront procedures are usually performed based on operator’s preference and experience. We sought to identify clinical and angiographic factors associated with the need for bailout RA in patients with calcified coronary
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stuck rotablator the nightmare of Rotational Atherectomy
Eurointervention, 2013Co-Authors: Dmitriy S Sulimov, Mohamed Abdelwahab, Ralph Toelg, Volker Geist, Guido Kassner, Gert RichardtAbstract:Aims Rotational Atherectomy (RA) is frequently performed to modify complex fibrocalcific coronary lesions with high procedural success. A stuck rotablator is a rare but life-threatening complication. However, its description remains sporadic and it has never been systematically analysed. The aim of this analysis is to present our experience and summarise the available literature about stuck rotablator, and to identify risk factors and possible management strategies for this complication. Methods and results We analysed our experience of 442 RA procedures and identified four cases of stuck rotablator. Two of these cases were rotablations in freshly implanted stents. All cases were managed percutaneously. We further analysed the available literature and identified a total of 11 reports with 14 cases of a stuck rotablator burr; seven were managed surgically and seven with endovascular approaches. Based on our experience and the literature review we developed an algorithm to guide operators while managing this complication. Conclusions Entrapment of a rotablation burr is a rare but very serious complication of RA. Operators performing RA should be aware of this risk and be prepared to manage it adequately. In our experience, the risk seems to be higher when rotablating freshly implanted underexpanded stents.
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high speed Rotational Atherectomy before paclitaxel eluting stent implantation in complex calcified coronary lesions the randomized rotaxus Rotational Atherectomy prior to taxus stent treatment for complex native coronary artery disease trial
Jacc-cardiovascular Interventions, 2013Co-Authors: Mohamed Abdelwahab, Gert Richardt, Heinz Joachim Buttner, Ralph Toelg, Volker Geist, Thomas Meinertz, Joachim Schofer, Lamin King, Franzjosef Neumann, Ahmed A KhattabAbstract:Objectives This study sought to determine the effect of Rotational Atherectomy (RA) on drug-eluting stent (DES) effectiveness. Background DES are frequently used in complex lesions, including calcified stenoses, which may challenge DES delivery, expansion, and effectiveness. RA can adequately modify calcified plaques and facilitate stent delivery and expansion. Its impact on DES effectiveness is widely unknown. Methods The ROTAXUS (Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex Native Coronary Artery Disease) study randomly assigned 240 patients with complex calcified native coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120, standard therapy group). Stenting was performed using a polymer-based slow-release paclitaxel-eluting stent. The primary endpoint was in-stent late lumen loss at 9 months. Secondary endpoints included angiographic and strategy success, binary restenosis, definite stent thrombosis, and major adverse cardiac events at 9 months. Results Despite similar baseline characteristics, significantly more patients in the standard therapy group were crossed over (12.5% vs. 4.2%, p = 0.02), resulting in higher strategy success in the rotablation group (92.5% vs. 83.3%, p = 0.03). At 9 months, in-stent late lumen loss was higher in the rotablation group (0.44 ± 0.58 vs. 0.31 ± 0.52, p = 0.04), despite an initially higher acute lumen gain (1.56 ± 0.43 vs. 1.44 ± 0.49 mm, p = 0.01). In-stent binary restenosis (11.4% vs. 10.6%, p = 0.71), target lesion revascularization (11.7% vs. 12.5%, p = 0.84), definite stent thrombosis (0.8% vs. 0%, p = 1.0), and major adverse cardiac events (24.2% vs. 28.3%, p = 0.46) were similar in both groups. Conclusions Routine lesion preparation using RA did not reduce late lumen loss of DES at 9 months. Balloon dilation with only provisional rotablation remains the default strategy for complex calcified lesions before DES implantation. (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease. A Multicenter, Prospective, Randomized Controlled Trial [ROTAXUS]; NCT00380809 )
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high speed Rotational Atherectomy before paclitaxel eluting stent implantation in complex calcified coronary lesions the randomized rotaxus Rotational Atherectomy prior to taxus stent treatment for complex native coronary artery disease trial
Jacc-cardiovascular Interventions, 2013Co-Authors: Mohamed Abdelwahab, Gert Richardt, Heinz Joachim Buttner, Ralph Toelg, Volker Geist, Thomas Meinertz, Joachim Schofer, Lamin King, Franzjosef Neumann, Ahmed A KhattabAbstract:Objectives This study sought to determine the effect of Rotational Atherectomy (RA) on drug-eluting stent (DES) effectiveness. Background DES are frequently used in complex lesions, including calcified stenoses, which may challenge DES delivery, expansion, and effectiveness. RA can adequately modify calcified plaques and facilitate stent delivery and expansion. Its impact on DES effectiveness is widely unknown. Methods The ROTAXUS (Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex Native Coronary Artery Disease) study randomly assigned 240 patients with complex calcified native coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120, standard therapy group). Stenting was performed using a polymer-based slow-release paclitaxel-eluting stent. The primary endpoint was in-stent late lumen loss at 9 months. Secondary endpoints included angiographic and strategy success, binary restenosis, definite stent thrombosis, and major adverse cardiac events at 9 months. Results Despite similar baseline characteristics, significantly more patients in the standard therapy group were crossed over (12.5% vs. 4.2%, p = 0.02), resulting in higher strategy success in the rotablation group (92.5% vs. 83.3%, p = 0.03). At 9 months, in-stent late lumen loss was higher in the rotablation group (0.44 ± 0.58 vs. 0.31 ± 0.52, p = 0.04), despite an initially higher acute lumen gain (1.56 ± 0.43 vs. 1.44 ± 0.49 mm, p = 0.01). In-stent binary restenosis (11.4% vs. 10.6%, p = 0.71), target lesion revascularization (11.7% vs. 12.5%, p = 0.84), definite stent thrombosis (0.8% vs. 0%, p = 1.0), and major adverse cardiac events (24.2% vs. 28.3%, p = 0.46) were similar in both groups. Conclusions Routine lesion preparation using RA did not reduce late lumen loss of DES at 9 months. Balloon dilation with only provisional rotablation remains the default strategy for complex calcified lesions before DES implantation. (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease. A Multicenter, Prospective, Randomized Controlled Trial [ROTAXUS]; NCT00380809)
