Mid-term results of stent-less coronary intervention using rotational atherectomy and drug-coated balloon for de-novo lesions in hemodialysis patients.

BACKGROUND: Although drug-coated balloon (DCB)-based stent-less percutaneous coronary intervention (PCI) for de-novo lesions has attracted more attention, outcomes of the DCB procedure for hemodialysis (HD) patients are reported to be inferior to those for non-HD patients, similarly to drug-eluting stent (DES). Recent several reports have shown that rotational atherectomy (RA) followed by DCB treatment (RA/DCB) could be an option of revascularization strategy particularly for calcified de-novo lesions even in the new-generation DES era; however, efficacy of the RA/DCB procedure for HD patients remains unclear. METHODS: A total of 47 consecutive cases (53 lesions) undergoing RA/DCB for de-novo lesions were enrolled. According to the presence/absence of HD at baseline, the 47 cases were divided into the HD cases (N.=16) and the non-HD cases (N.=31), and the 53 lesions were divided into the HD lesions (N.=20) and the non-HD lesions (N.=33). RESULTS: The HD cases had a significantly lower prevalence of dyslipidemia and smoking than the non-HD cases. Final RA burr size, DCB diameter used, and angiographic success rate of PCI did not significantly differ between the 2 groups. Preprocedural, post-procedural, and follow-up QCA parameters were also similar between the 2 groups. Twelve-month clinical outcomes were comparable between the 2 groups. CONCLUSIONS: Mid-term outcomes of stent-less PCI using RA/DCB for de-novo lesions in HD patients might be comparable to those in non-HD patients, suggesting efficacy of pretreatment of RA prior to DCB treatment in HD patients.

Clot-regression effects of rivaroxaban in venous thromboembolism treatment in cancer patients-a prospective interventional study.

Rivaroxaban, a direct oral anticoagulant, is effective against venous thromboembolism (VTE) recurrence without increasing the risk of major bleeding in patients with cancer-associated venous thromboembolism (CAT). However, its clot regression effects are poorly understood. This single-arm, prospective interventional study aimed to investigate the clot regression effects of rivaroxaban in 40 CAT patients, through a contrast-enhanced computed tomography at baseline, 3 weeks, and 3 months of rivaroxaban treatment. The primary endpoint was the clot-regression ratio calculated from the thrombus volumes at 3 weeks and 3 months. Compared with baseline, the total clot volume was significantly reduced at both 3 weeks and 3 months after initiation (p < 0.01). The clot-regression rates were statistically significant with 83.1% (95% confidence interval [CI], 73.8-92.3%) at 3 weeks and 98.7% (95% CI, 97.1-100.2%) at 3 months, with complete resolution in 36.1% and 80.8% of patients at 3 weeks and 3 months, respectively. One patient had recurrent VTE after dose reduction, and seven had non-fatal major bleeding. Therefore, rivaroxaban had a sufficient clot-regression effect against CAT with caution of bleeding complication.

Temporal reverse flow by proximal femoral artery occlusion during drug-coated balloon dilatation: a technique to minimize downstream particle embolization and systemic adverse effects.

Downstream paclitaxel particle embolization for nonhealing ischemic ulcers and systemic adverse effects caused by a paclitaxel drug-coated balloon are of concern, and safety measures to prevent these adverse risks are needed. To reduce distal particle embolization and movement of the paclitaxel particles to systemic blood flow during drug-coated balloon inflation, proximal balloon occlusion using a sheathless temporary occlusion balloon-guiding catheter and extraction by manual aspiration of the paclitaxel-containing blood through the catheter are good treatment options to overcome these risks. Here, we introduce this method with tips and tricks, and demonstrate initial experience of this technique.

Stentless Interventional Procedure Using Rotational Atherectomy and Drug-Coated Balloon for Noncalcified De Novo Lesions.

BACKGROUND: Several recent reports have shown that a stentless interventional procedure using rotational atherectomy followed by drug-coated balloon (DCB) treatment (RA/DCB) is a potent revascularization therapy for calcified de novo lesions even in the new-generation drug-eluting stent era; however, the role of the RA/DCB procedure for noncalcified de novo lesions remains unclear. METHODS: A total of 47 consecutive patients (53 lesions) who underwent RA/DCB for coronary de novo lesions were enrolled. According to the presence or absence of severe calcification at target lesions on fluoroscopy, the 47 patients were divided into the noncalcified cases (n = 12) and the calcified cases (n = 35), and the 53 lesions were divided into the noncalcified lesions (n = 14) and the calcified lesions (n = 39). RESULTS: The noncalcified cases tended to have a higher frequency of bleeding risk and had a significantly lower prevalence of dual antiplatelet therapy compared with the calcified cases. The main lesion-specific factors for the RA/DCB procedure among the noncalcified lesions were presence of left circumflex coronary artery ostial lesion. The final burr size, DCB diameter used, and angiographic success rate did not significantly differ between the 2 groups. The noncalcified lesions had a larger reference diameter and a shorter lesion length than the calcified lesions, whereas acute gain and late lumen loss did not differ between the 2 groups. Nine-month clinical outcomes were comparable between the 2 groups. CONCLUSIONS: Under drug-eluting stent-unsuitable clinical or lesion conditions, acute and midterm outcomes of RA/DCB for noncalcified de novo lesions might be comparable with those for calcified de novo lesions.

CONTEXTE: Plusieurs rapports récents ont montré qu'une revascularisation sans endoprothèse effectuée par athérectomie rotationnelle (AR) suivie d'un traitement par ballonnet médicamenté (BM) constitue une méthode efficace pour traiter les nouvelles lésions calcifiées, même à l'ère des endoprothèses médicamentées de nouvelle génération; on ne connaît toutefois pas bien l'utilité de l'intervention par AR et BM en cas de nouvelles lésions non calcifiées. MÉTHODOLOGIE: Au total, 47 patients consécutifs (53 lésions) ayant subi une intervention par AR et BM pour traiter de nouvelles lésions coronariennes ont été admis dans l'étude. Ces 47 patients ont été répartis en deux groupes, en fonction de l'absence (n = 12) ou de la présence (n = 35) de lésions . cibles sévèrement calcifiées observées à la fluoroscopie. Les 53 lésions ont aussi été réparties en deux groupes : lésions non calcifiées (n = 14) et lésions calcifiées (n = 39). RÉSULTATS: Les patients n'ayant pas de lésion calcifiée étaient généralement plus susceptibles de présenter des saignements et significativement moins nombreux à être sous bithérapie antiplaquettaire, comparativement aux patients ayant des lésions calcifiées. Dans le cas des lésions non calcifiées, la principale caractéristique justifiant une AR et un traitement par BM était la présence d'une lésion ostiale du rameau circonflexe de l'artère coronaire gauche. La taille de la dernière fraise utilisée, le diamètre du BM utilisé et le taux de réussite objectivée par angiographie étaient comparables dans les deux groupes. Les lésions non calcifiées avaient un diamètre de référence plus grand et étaient plus courtes que les lésions calcifiées, tandis que le gain aigu et la perte luminale tardive étaient similaires dans les deux groupes. Les résultats cliniques à neuf mois étaient aussi similaires dans les deux groupes. CONCLUSIONS: Lorsque les conditions cliniques ou les lésions ne se prêtent pas à l'utilisation d'une endoprothèse médicamentée, le traitement des nouvelles lésions non calcifiées par AR et BM pourrait donner des résultats immédiats et à moyen terme comparables à ceux du traitement des nouvelles lésions calcifiées.

Subcutaneous implantable cardioverter-defibrillator was inappropriate for use in a patient with aborted sudden cardiac death due to coronary spastic angina: a case report.

BACKGROUND: Implantable cardioverter-defibrillator (ICD) is recommended for secondary prevention in patients with coronary spastic angina and aborted sudden cardiac death. The effectiveness of subcutaneous ICD (S-ICD) for patients with coronary artery spastic angina is controversial. CASE SUMMARY: A 54-year-old man presented with ventricular fibrillation. Emergent coronary angiography showed diffuse narrowing of the coronary arteries that was reversible with isosorbide dinitrate. He was diagnosed with coronary spastic angina. S-ICD was implanted after the administration of a calcium-channel blocker and nicorandil. Seven months after the implantation, he collapsed again due to sinus node dysfunction and atrioventricular block caused by cardiac ischaemia. He developed cardiac arrest at both admissions. Six hours after the admission, electrocardiogram showed transient right bundle branch block. Inappropriate shocks were delivered because of low R-wave amplitude and T-wave oversense. S-ICD was replaced with a transvenous device in order to manage these two arrhythmias and inappropriate shocks. DISCUSSION: Patients with coronary artery spasm and aborted sudden cardiac death are candidates for implantation of S-ICD, but there are risks of bradycardia and inappropriate shocks in other ischaemic events.