Optimized strategy of rotational atherectomy of underexpanded coronary stents in patients with acute coronary syndrome

doi:10.5847/wjem.j.1920-8642.2021.03.006

Abstract

Abstract:

BACKGROUND: Stent under-expansion is a main cause of acute coronary syndrome (ACS), which can lead to serious clinical outcomes. The rotational atherectomy of underexpanded coronary stents (academically called stent ablation, SA) by intravascular ultrasound (IVUS) may provide more visual reference in the intervention. We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique.

METHODS: A total of 11 patients with ACS who underwent SA between April 2017 and January 2019 were analyzed. Clinical follow-ups were obtained either by telephone call or by scheduled visit. Clinical end-points included periprocedural and postprocedural myocardial infarction, stent thrombosis, target lesion revascularization, and major adverse cardiac events.

RESULTS: The mean age of patients was 69.6±6.5 years, and five (45.5%) patients were males. All cases presented with unstable angina and were admitted with ACS. All patients required at least two burrs during the intervention and the size of the burr was selected based on the data of minimum lumen diameter (MLD), and the first and the second burr/stent MLD ratios were 0.93 (0.88-0.99) and 1.09 (1.02-1.14), respectively. Nine patients were treated with drug-eluting stents and two were treated with drug-coated balloons. There were no complications including no flow, perforation, or burr entrapment during the intervention. No in-hospital deaths or major adverse cardiac events were documented during the follow-up period. In our study, less contrast agent and a lower dose of radiation were used during the intervention.

CONCLUSIONS: SA guided by IVUS can reduce the risk of complications, assess the results of surgery, inform the selection of stent size, and decrease the required dose of radiation and contrast.

Key words: Acute coronary syndrome, Intravascular ultrasound, Rotational atherectomy, Underexpanded stent

Kun Cui, You-quan Shi, Yuan-zheng Zhang, Zheng-gong Li, Chang-ling Li. Optimized strategy of rotational atherectomy of underexpanded coronary stents in patients with acute coronary syndrome[J]. World Journal of Emergency Medicine, 2021, 12(3): 198-201.

Figures/Tables 4

Table 1

Table 2

Table 3

Figure 1.

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Parameters	Results
Age, years	69.6±6.5
Male, n (%)	5 (45.5)
Hypertension, n (%)	9 (81.8)
Dyslipidemia, n (%)	4 (36.4)
Diabetes, n (%)	7 (63.6)
Previous CABG, n (%)	0 (0)
Left ventricular ejection fraction, %	52.3 (45.5-60.2)
Glomerular filtration rate, mL/min	67 (43-78)
Indication for PCI, n (%)
NSTEMI	10 (90.9)
STEMI	1 (9.1)

Parameters	Results
DES-ISR/BMS-ISR, n (%)	10 (90.1) /1 (9.1)
Calcification, n (%)	9 (81.8)
Coronary artery treated, n (%)
LM	0 (0)
LAD	7 (63.6)
LCX	1 (9.1)
RCA	3 (27.3)
Pre-SA stent MLD/stent ratio	0.64 (0.60-0.66)
Pre-SA stent MLA, mm²	2.58 (2.03-4.26)
Burr/stent ratio
First burr/stent ratio	0.93 (0.88-0.99)
Second burr/stent ratio	1.09 (1.02-1.14)
Two burrs used, n (%)	9 (81.8)
Three burrs used, n (%)	2 (18.2)
Post-SA stent length, mm	29 (18-38)
Stent length implanted, mm	29 (23-36)
Stent implantation (post-SA), n (%)	9 (81.8)
BMS/DES (stent type), n (%)	0/9 (81.8)
Drug-eluting balloon post SA, n (%)	2 (18.2)
Scoring/cutting balloon, n (%)	8 (72.7)/3 (27.3)
Maximum balloon diameter (post SA), mm	3.0 (2.5-3.5)
Final stent diameter, mm	3.0 (2.5-3.5)

Parameters	Results
In-hospital death, n (%)	0 (0)
Mean follow-up period, months	13 (9-20)
Death, n (%)	0 (0)
Myocardial infarction, n (%)	0 (0)
Target lesion revascularization, n (%)	1 (9.1)
Non-target lesion revascularization, n (%)	2 (18.2)
Major adverse cardiac events (per patient), n (%)	1 (9.1)

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