Influence of additional ballooning with a dual wire balloon after a rotational atherectomy to expand drug-eluting stent
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ORIGINAL ARTICLE
Influence of additional ballooning with a dual wire balloon after a rotational atherectomy to expand drug-eluting stent for calcified lesions Ryuichi Kato • Takashi Ashikaga • Kaoru Sakurai Junko Ito • Toru Ogawa • Takanori Tahara • Yasuhiro Yokoyama • Yasuhiro Satoh
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Received: 4 May 2011 / Accepted: 25 January 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2012
Abstract Calcified lesions have been known as a cause of stent underexpansion which increases the risk of thrombosis and in-stent restenosis. A dual wire balloon has been introduced to create a focal stress pattern in a localized region of the calcification. We evaluated the combination therapy using a dual wire balloon after rotational atherectomy (RA) for heavily calcified lesions. Of 21 consecutive patients with severe calcified lesions, 10 patients were treated with a dual wire balloon after RA, and 11 patients were treated with RA alone or, RA plus the conventional balloon. Finally, drugeluting stents (DES) were implanted in all cases. Baseline characteristics, lesion characteristics, and postdilatation procedures were not different between two groups. Before implantation of DES, a dual wire balloon enabled adequate dilatation with significantly more cracks than RA (1.8 ± 0.4 cracks vs. 1.2 ± 0.6 cracks, P = 0.02). The minimal stent cross sectional area (CSA) and the stent expansion ratio were similar in both groups. However, the symmetrical expansion was significantly accomplished in patients with a dual wire balloon compared to those without it (mean ratio calculated by dividing the shortest diameter by the longest diameter at the site of the minimal stent CSA was 0.83 ± 0.05 vs. 0.76 ± 0.07, P = 0.02). Moreover, no in-stent restenosis was observed
R. Kato (&) K. Sakurai J. Ito T. Ogawa Y. Yokoyama Y. Satoh National Hospital Organization, Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo 190-0042, Japan e-mail: [email protected] T. Ashikaga Tokyo Medical and Dental University, Tokyo, Japan T. Tahara Tahara Hohoemi Clinic, Tokyo, Japan
in patients treated with a dual wire balloon at follow-up. In conclusion, by using a dual wire balloon after RA, adequate stent expansion and follow-up results were accomplished. This combination therapy is safety and feasible procedure for the treatment of severe calcified lesions. Keywords Dual wire balloon Calcification Rotational atherectomy IVUS PCI
Introduction Coronary calcified lesions are a common cause of stent underexpansion which has been reported as an independent factor for restenosis or thrombosis after implantation of a drug-eluting stent (DES) [1–3]. Therefore, lesion modification approaches to prepare for full stent expansion in calcified lesions are an important technical challenge for interventional cardiologists. A rotational atherectomy (RA) is a type of procedure for modifying the compliance of a lesion that facilitates lesion dilatation and stent expansion [4, 5]. The RA also alters lesion compliance in order to expa
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