Ken Kobayashi

Rotational atherectomy and new-generation drug-eluting stent implantation

The aim of this study was to evaluate the clinical outcomes of rotational atherectomy (RA) followed by new‐generation drug‐eluting stent (DES) implantation in patients with an extensive amount of calcified and fibrotic plaque.

Successful Direct Iliac Transcatheter Aortic Valve Implantation to Overcome Significant Tortuosity of the Thoracic Aorta

https://e-kcj.org An 87-year-old woman with symptomatic severe aortic stenosis underwent transcatheter aortic valve implantation (TAVI). Multi-detector computed tomography showed a significantly tortuous descending thoracic aorta (Figure 1A and B). Due to the high risk of coronary obstruction and a horizontal aorta, a SAPIEN 3 (Edwards LifeSciences, Irvine, CA, USA) prosthesis via transfemoral access was considered. However, the total length of the Edwards expandable introducer sheath (eSheath, 360 mm) was not sufficient to reach the acute bend in the thoracic aorta, which measured 415 mm in length. Therefore, direct right common iliac access obtained by retroperitoneal approach was chosen to insert the eSheath beyond the acute bend of the thoracic aorta (Figure 1C and D). After insertion of a single stiff wire, the tip of the eSheath was successfully placed beyond the acute bend of the thoracic aorta with no resistance (Figure 1E). Using buddy wire technique, smooth delivery and implantation of a 26-mm SAPIEN 3 was successful without vascular complication (Figure 1F-H).

TCTAP A-030 Rotational Atherectomy and New-generation Drug-eluting Stent Implantation in De Novo Lesion

Rotational atherectomy (RA) followed by new-generation drug-eluting stent (DES) implantation for complex lesions has not been thoroughly evaluated. The aim of this study was to evaluate the clinical outcomes of RA followed by new-generation DES implantation in patients with an extensive amount of

Treatment for in-stent restenosis requiring rotational atherectomy

OBJECTIVES This study aimed to evaluate the outcomes of patients with in-stent restenosis (ISR) who underwent rotablation (RA) followed by balloon angioplasty (BA), drug-eluting stent (DES) implantation, or drug-coated balloon (DCB) angioplasty. BACKGROUND Interventional treatment of ISR is occasionally challenging. Despite the availability of various percutaneous treatments, the optimal solution remains unclear. METHODS AND RESULTS A total of 200 patients with ISR who underwent RA were retrospectively identified from our institutional database. Clinical outcomes at 12 months and independent predictors of target lesion revascularization (TLR) were assessed. Of patients, 90, 55, and 55 underwent BA, DES implantation, and DCB angioplasty, respectively. The incidence of all-cause death, cardiac death, and hospitalization due to heart failure was low in all groups. Moreover, no definite stent thrombosis was observed in the three groups. The TLR rate of BA, DES implantation, and DCB angioplasty following RA for ISR were 40.7%, 35.0%, and 27.3%, respectively. The adjusted outcomes for TLR using the inverse probability of treatment weighting method based on propensity scores indicated that DCB angioplasty following RA was superior to BA after RA. Intraprocedural complications, which could be successfully managed with interventional treatment, were identified in only three cases. CONCLUSIONS TLR at 12 months is dismal. RA is not effective for ISR requiring RA. In unfavorable settings, DCB angioplasty following RA is the most effective treatment option in patients with ISR requiring debulking strategy.

TCT-27 What is the Most Effective Treatment After Rotational Atherectomy for Stent Underexpansion? An Inverse Probability of Treatment Weighting Analysis Based on Propensity Score

Stent underexpansion is one of the important causes of in-stent restenosis (ISR). This study aimed to evaluate the outcomes of patients with ISR due to stent underexpansion who underwent rotablation (RA) followed by drug-eluting stent (DES) implantation or drug-coated balloon (DCB) angioplasty. A