Rotablation in the treatment of highrisk patients with heavily calcified leftmain coronary lesions menghsiu chiang, 1 hungtao yi, 2 chengrong tsao, 2, 3 weichun chang, 2, 3 chiehshou su, 2, 3 tsunjui liu, 2, 3 kaewoei liang, 2, 3 chihtai ting, 2, 3 and wenlieng lee 2, 3. Rotational atherectomy uses a tiny rotating cutting blade to open a narrowed artery and improve blood flow to or. Winner of the standing ovation award for best powerpoint templates from presentations magazine. As calcium builds up in the artery walls, plaque can become extremely rigid and hard too hard for an angioplasty balloon to stretch the artery open. It is an alternative to angioplasty for the treatment of peripheral artery disease, but the studies that exist are not adequate to determine if it is superior to angioplasty. When the brake is defeated the wire rotates and has to be fixed with the wireclip and the tip of the rotawire has to be watched on the screen. The use of rotablator for instent restenosis might lead to damage of stent components. Rotational atherectomy ablation for an unexpandable stent. The primary purpose for the development of the rotablator was to tackle the rockhard, calcified lesions that standard angioplasty balloons have failed to effectively treat. Radiofrequency catheter ablation rfa has evolved as an effective treatment modality in patients with atrial fibrillation af. Atherectomy is a minimally invasive endovascular surgery technique for removing atherosclerosis from blood vessels within the body.
I was told by 19 cardiologists and three cardiac surgeons that the only reason a fully blocked artery is not reopened is when the heart tissue has already died, because there is no point. The test involves the insertion of a long thin catheter into an artery in the groin or wrist under local anaesthetic. It is the belief of many physicians that the selective tissue ablation effect of the rotablator is the best choice for calcified coronary lesions. Rotablator rotational atherectomy system boston scientific. The rotablator rotational atherectomy system boston scientific. The comparative efficacy of rotational atherectomy has been compared in the following studies trials. The console may be powered by both nitrogen and compressed air.
The rotablator system console regulates the flow of air to the advancer, controlling burr rotation speed. If the vessel does not respond, then it has lost the actual ability to open up, the muscle layer has basically died. It might be especially useful in intervening left main lesions with very invasive devices like rotablation, particularly when complicated by acute no flow. The angiographic success rate was 100% in these patients in whom the rotablation burr could be delivered to the target lesion and des implantation completed, complicated by one 1. About 10%20% of atherosclerotic vessels contain architecturally complete trabecular bone with fully formed marrow cavities with haematopoietic cells and vascular sinusoids. The diamondback 360 coronary oas uses a differential sanding mechanism of action to reduce plaque while potentially minimising damage to the medial layer of the vessel. To solve this problem, medical researchers designed the rotablator, a small drill with a burr on the end that is coated in diamond. The use and clinical outcomes of rotablation in challenging. This transient microcavitation phenomenon has been demonstrated in vivo by enhanced myocardial echo contrast effect and directly correlates with rotablation speed, burr size and duration. An update of the 2011 accfahascai guideline for percutaneous coronary intervention, 2011 accfaha guideline for coronary. At this 25year anniversary since the introduction of rotational. November 15, 2011 a new clinical trial is testing the efficacy of rotational atherectomy or rotablation, a process of drilling through plaque deposits prior to implantation of a drugeluting stent des. Ppt complexation powerpoint presentation free to view. Softer tissue flexes away from the crown while fibrotic tissue or arterial calcium is engaged and treated facilitating stent deployment.
The objective of the present document is to provide some points. The whole system can be advanced by defeating the brake and holding the wire. Pci of calcified prox lad and angulated diagonal bifurcation ccc live jan 2017 duration. As it is technically demanding, rotational atherectomy is also uncommon. Rotational atherectomy for bifurcation lesions of the. After your angioplasty ptcaatherectomycoronary stent. Iabp provides temporary circulatory support during the transient cease of blood flow while intervening major epicedial coronary vessels like the left main stem. It has also been used to treat coronary artery disease, albeit ineffectively. Rotablation in the treatment of highrisk patients with heavily.
Pdf rotablation in the treatment of highrisk patients with heavily. A middle age woman with known ischemic heart disease and old stents in proximal left anterior descending coronary artery lad was admitted to coronary care unit with acute coronary syndrome. It can increase the sense of control, reduce anxiety, and help the performer to feel calm and comfortable. Oct 31, 2016 tctmd is produced by the cardiovascular research foundation crf. Pdf rotablation in the treatment of highrisk patients with. Coronary angiography revealed that there was no adequate expansion of the freshly deployed stent. The coronary angiography showed one vessel disease with significant restenosis within the previously implanted stents. They do an angiogram and inject nitrates into the vessel to note any reaction to the dilation. Three serial complications during rotablation treatment.
Sometimes heart disease patients have blockages in their arteries that are calcified and hard. Cardiogenic shock ppt by af day 1 postprocedure in pt. Rotablation case presentation erebouni medical center. Crf is committed to igniting the next wave of innovation in research and education that will help doctors save and improve the quality of their patients lives. The lumen diameter reduction after percutaneous coronary intervention pci is well known as restenosis. The number of ra cases worldwide has increased over the past 5 years 2005 29,960 cases. Percutaneous rotational coronary angioplasty with the rotablator rotational atherectomy system, as a sole therapy or with adjunctive balloon angioplasty, is indicated in patients with coronary artery disease who are acceptable candidates for coronary artery bypass graft surgery and who meet one of the following selection criteria.
A rotational atherectomy is a type of percutaneous coronary intervention pci that uses a revolving instrument to break up calcified plaque clogging a coronary artery in order to restore blood flow to the heart. Primarysecondary p rotablation rotablation n26 n24 age,yearsmean8 sd 738 10 728 90. A randomized trial of highspeed rotational atherectomy prior to drugeluting stent implantation in severely calcified coronary lesions gert richardt, md heart center segeberger kliniken, bad segeberg germany. The lesion was tough and remained undilatable despite high pressure balloon inflation. These blockages may not respond to angioplasty, a procedure during which a tiny balloon at the end of a thin tube called a catheter is inserted into the artery and opened and closed to push aside the blockage. A novel rotablator technique lowspeed following highspeed. Effect of rotablator on balloon resistant calcified.
Verify irrigation at distal tip of burr catheter r rotation. Treating certain types andor locations of lesions or patients with certain. Halfway ra is a novel strategy, in which an operator does not advance the burr to the end of a continuous calcified lesion, and performs balloon dilatation to treat the remaining part of the calcified lesion. Sometime it will be successful with manual traction with on dynaglide or off. Nov 15, 2011 november 15, 2011 a new clinical trial is testing the efficacy of rotational atherectomy or rotablation, a process of drilling through plaque deposits prior to implantation of a drugeluting stent des. Right heart cath with rotablation cardiology coding ask. Rotablation in the treatment of highrisk patients with. In one 89yearold patient from the secondcardiovascular medicine 2010. Rotablator is a therapeutic procedure where a very tiny footballshaped device attached to the tip of a tiny catheter is advanced to a heavily calcified segment of a coronary artery and rotated at high speed up to 200,000 rotations per minute to remove the calcium in. One of the achilles heels of percutaneous coronary intervention pci is severe, complex calcification. However, complication rates associated with rfa of af have been cited in the range of 3. May 25, 2014 complication and management of rotablation 1.
The procedure you recently underwent angioplasty ptca, atherectomy, coronary stent placem ent, or rotablation to widen the opening lumen of a partially blocked coronary artery or bypass graft. Interventional rounds current status of rotational atherectomy erdal cavusoglu,1,2 md, annapoorna s. Rotoablation definition of rotoablation by medical. Tctmd is produced by the cardiovascular research foundation crf. The use of accessories, transducers and cables other than those specified, with the exception of transducers and cables. Interventional rounds current status of rotational atherectomy.
Burr mm diameter inches minimum recommended guide catheter internal diameter inches recommended guide catheter french, 1. System setup preprocedure system test system overview test system outside body with foot pedal activated d drip. Erbac was a single center trial in which patients with complex lesion were randomized to either balloon angioplasty n222, excimer laser angioplasty n232, or rotational atherectomy n231. Introduction ra is associated with complications similar to other percutaneous procedures as well as unique to this device. The ra system includes the burr, rotawire, console, and nitrogen tank. Rotablation in the drug eluting era wiley online library. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. This is a procedure which attempts to bore out a narrowing in a coronary artery which might not otherwise respond to stenting. After manual calibration, the ofdi catheter was advanced more than 5 mm distally. Rotational atherectomy ra facilitates percutaneous coronary intervention pci of severely calcified coronary lesions. Through the evaluation of the potential of lowspeed rotational atherectomy lsra in invitro experiments, minimum lumen diameter mld and minimum lumen area mla. To reach the platform segment, lowspeed 100 120000 rpm can be used to minimize ablation. Sharma,1 md despite the increasing use of percutaneous transluminal coronary angioplasty and intracoronary stent placement for the treatment of obstructive coronary artery disease, a. Complications during rotablation for the treatment of.
This phenomenon is due to vessel remodelingrecoil in case of nostent strategy or, in case of stent employ, neointimal proliferation that consists in an excessive tissue proliferation in the luminal surface of the stent otherwise by a further newoccurring atherosclerotic. Listing a study does not mean it has been evaluated by the u. Complications of radiofrequency catheter ablation for. Undilatable stent neoatherosclerosis treated with ad hoc. Optimal stent expansion and apposition are the key to successful treatment. A report of the american college of cardiologyamerican heart association task force on clinical practice guidelines. Relaxation is a technique often used by sports performers to calm themselvesthereby decreasing anxiety and controlling arousal. Rotoablation definition of rotoablation by medical dictionary. Effect of rotablator on balloon resistant calcified coronary lesion the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Rotablator rotational atherectomy system prep youtube. Although it is recognised that bone formation and arterial vessel calcification have common. Complications during rotablation for the treatment of calcified coronary artery stenosis session comprising selected europcr 2017 clinical case submissions chairperson. Do not forget to turn on the flush system to full capacity at least to 200 mmhg pressure bag rotablator assembly procedure the weeping of saline through the seals of the advancer is normal. Right heart catheterization, rotablation of the proximal lad, angioplasty and stenting of the mid lad. Operators performing ra should be aware of this risk and be prepared to manage it adequately. Rotational atherectomy complications and management dr nilesh tawade jaslok hospital mumbai 2.
Under the guide of intravascular ultrasound ivus, rotational atherectomy ra successfully ablated the stent layers and the protruding calcified plaque. Magnetic navigation system assisted rescue rotablation. That is where rotablation, or rotational atherectomy, comes in. Pdf rotablation in the treatment of highrisk patients. The catheter is moved up the inside of the artery until it reaches the. Erbac was a single center trial in which patients with complex lesion were randomized to either balloon angioplasty n222, excimer laser angioplasty n232, or. In one of the initial articles on interventional cardiology, gruntzig et al noted, at present, the technic sic is limited by anatomic factors, such as vessel tortuosity and calcified stenosis. Background the incidence of severe complications such as burr entrapment or perforation is considerable with rotational atherectomy ra. Pdf european expert consensus on rotational atherectomy. A strategy of routine rotational atherectomy has not, however, conferred reduction in restenosis or major adverse cardiac events. The trial found the process was not superior to standard balloon angioplasty and decreased the efficacy of the stent in reducing new tissue growth within the blood vessel. The use and clinical outcomes of rotablation in challenging cases in. I coded this 93454 92928ld 9292876ri i wasnt sure if additional charges apply. Pdf heavily calcified leftmain coronary diseases lmca remain a formidable challenge for percutaneous interventions pci.
Cardiac interventions today issn 25725955 print and issn 25725963 online is a publication dedicated to providing coverage of the latest developments in technology, techniques, clinical studies, and regulatory and reimbursement issues in the field of coronary and cardiac interventions. Stentrotablation this handout will tell you how to take care of yourself during the weeks and months ahead. Rotablation in the treatment of highrisk patients with heavily calcified leftmain coronary lesions. If you continue browsing the site, you agree to the use of cookies on this website. The use and clinical outcomes of rotablation in challenging cases in the drugeluting stent era author links open overlay panel menghsiu chiang a b wenlieng lee a c chengrong tsao a c weichun chang a c chiehshou su a c tsunjui liu a c kaewoei liang a c chihtai ting a c. Right heart cath with rotablation cardiology coding.
Dec 09, 2016 rotablation case presentation erebouni medical center. It also monitors and displays burr rotation speed and rotational atherectomy procedural time. Compared with a historical control of 34 patients treated by rotablation followed by bms angiographic success was 100% for both. The overall angiographic and procedural characteristics of our patients are presented in table 2.
Always verify that the driveshaft is correctly locked. Introduction of rotablation angioplasty in cardiology clinical practice means saving and improving the quality of life of patients with. Oxygen combined with oil or other combustibles in the system can result in an explosion. Ra is a technically demanding procedure associated with more complications than standard balloon angioplasty and stenting. Rotablator procedure cardiology procedures sa heart. Stent rotablation this handout will tell you how to take care of yourself during the weeks and months ahead. Do not forget to turn on the flush system to full capacity at least to 200 mmhg pressure bag rotablator assembly procedure. In our opinion, rotablation may help mns system to pass more calcified or cto lesions. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. At this 25year anniversary since the introduction of. With the aid of stereotaxis magnetic navigation system, we were able to control the very distal tip of the magnetic guidewire titan soft support 2mm to pass tortuous and tight vessel.
Entrapment of a rotablation burr is a rare but very serious complication of ra. But what if the plaque is too hard for angioplasty. Never use oxygen as the propellant for the rotablator rotational atherectomy system. While the evaluation of burr speed was discussed regarding platelet aggregation, the association between platform speed and acute lumen gain of rotational atherectomy remains unknown. The presence of severe calcification in vessels may prevent the full balloon dilatation of a lesion. A rotablator is a small drill with a burr on the end that is coated in diamond dust. An update of the 2011 accfahascai guideline for percutaneous coronary intervention, 2011 accfaha guideline. Rota burr entrapment in heavily calcified left anterior descending artery.
A stent that cannot be fully expanded because of an undilatable lesion stent regret can increase the. Effect of rotablator on balloon resistant calcified coronary. At zurich university hospital periprocedural and 6month clinical outcomes of 50 consecutive. If the arterial plaque a mixture of cholesterol, calcium and other substances that is causing the blockage is too hard for the angioplasty balloon, the physician treating the blockage may recommend rotablation. May 09, 2012 pci of calcified prox lad and angulated diagonal bifurcation ccc live jan 2017 duration. Followed by balloon angioplasty, the ablated segment was scaffolded with another stent, well expanded and documented by. The device used in the coronary artery is called the rotablator device. Rotablation definition of rotablation by medical dictionary. Rotablation does not improve efficacy of des in calcified. Halfway rotational atherectomy for calcified lesions. Rotablator system reference guide boston scientific. The first diagonal branch became occluded during the 5day interval between presentation and rotablation, but the patient was asymptomatic.
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