Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice
Objective. Heavy calcifications remain formidable challenges to PCI, even for well-experienced operators. However, rotational atherectomy (RA)-induced coronary perforations (CPs) still could not be obviated. This study was to explore incidence and mechanisms of RA-induced CP in real-world practice....
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2020/1894389 |
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| author | Yen-Hsiang Wang Wei-Jhong Chen Yu-Wei Chen Chih-Hung Lai Chieh-Shou Su Wei-Chun Chang Chi-Yen Wang Kae-Woei Liang Tsun-Jui Liu Wen-Lieng Lee |
| author_facet | Yen-Hsiang Wang Wei-Jhong Chen Yu-Wei Chen Chih-Hung Lai Chieh-Shou Su Wei-Chun Chang Chi-Yen Wang Kae-Woei Liang Tsun-Jui Liu Wen-Lieng Lee |
| author_sort | Yen-Hsiang Wang |
| collection | DOAJ |
| description | Objective. Heavy calcifications remain formidable challenges to PCI, even for well-experienced operators. However, rotational atherectomy (RA)-induced coronary perforations (CPs) still could not be obviated. This study was to explore incidence and mechanisms of RA-induced CP in real-world practice. Knowing why CPs occur in RA should help operators avert such mishaps. Method. Patients who received coronary RA from April 2010 to December 2019 with keywords related to perforations were retrieved from database. The procedure details, angiography, and clinical information were reviewed in detail. Results. A total of 479 RAs were performed with 11 perforations in 10 procedures among 9 patients documented. The incidence of RA-induced CP was 2.1%. The RA vessels were distributed in different territories, including first diagonal branch. Most CPs could be treated conservatively, but prolonged profound shock predisposed to poor outcome. CPs caused by rotawire tip occurred in 18.2% of cases, inappropriately sized burrs in 18.2% of cases, and rotawire damage with subsequent transection and perforation in another 18.2% of cases. A total of 5 (45.5%) perforations were caused by unintended and unnoticed bias cutting into noncalcified plaques (4, 36.4%) or through calcified vessel wall (1, 9.1%). The mechanisms for certain CPs were unique and illustrated in diagrams. Conclusion. CPs due to RA occur in certain percentage of patients. The mechanisms for CPs are diverse. Wire damage with subsequent transection could occur due to inappropriately repetitive burr stress on the wire body. A significant portion was due to unintended and unnoticed bias cutting into noncalcified plaque or through calcified vessel wall. |
| format | Article |
| id | doaj-art-7da8dec627be4013ba4ab0e10543f083 |
| institution | Kabale University |
| issn | 0896-4327 1540-8183 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj-art-7da8dec627be4013ba4ab0e10543f0832025-02-03T05:58:22ZengWileyJournal of Interventional Cardiology0896-43271540-81832020-01-01202010.1155/2020/18943891894389Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern PracticeYen-Hsiang Wang0Wei-Jhong Chen1Yu-Wei Chen2Chih-Hung Lai3Chieh-Shou Su4Wei-Chun Chang5Chi-Yen Wang6Kae-Woei Liang7Tsun-Jui Liu8Wen-Lieng Lee9Ministry of Health and Welfare Taichung Hospital, Taichung, TaiwanDivision of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, TaiwanObjective. Heavy calcifications remain formidable challenges to PCI, even for well-experienced operators. However, rotational atherectomy (RA)-induced coronary perforations (CPs) still could not be obviated. This study was to explore incidence and mechanisms of RA-induced CP in real-world practice. Knowing why CPs occur in RA should help operators avert such mishaps. Method. Patients who received coronary RA from April 2010 to December 2019 with keywords related to perforations were retrieved from database. The procedure details, angiography, and clinical information were reviewed in detail. Results. A total of 479 RAs were performed with 11 perforations in 10 procedures among 9 patients documented. The incidence of RA-induced CP was 2.1%. The RA vessels were distributed in different territories, including first diagonal branch. Most CPs could be treated conservatively, but prolonged profound shock predisposed to poor outcome. CPs caused by rotawire tip occurred in 18.2% of cases, inappropriately sized burrs in 18.2% of cases, and rotawire damage with subsequent transection and perforation in another 18.2% of cases. A total of 5 (45.5%) perforations were caused by unintended and unnoticed bias cutting into noncalcified plaques (4, 36.4%) or through calcified vessel wall (1, 9.1%). The mechanisms for certain CPs were unique and illustrated in diagrams. Conclusion. CPs due to RA occur in certain percentage of patients. The mechanisms for CPs are diverse. Wire damage with subsequent transection could occur due to inappropriately repetitive burr stress on the wire body. A significant portion was due to unintended and unnoticed bias cutting into noncalcified plaque or through calcified vessel wall.http://dx.doi.org/10.1155/2020/1894389 |
| spellingShingle | Yen-Hsiang Wang Wei-Jhong Chen Yu-Wei Chen Chih-Hung Lai Chieh-Shou Su Wei-Chun Chang Chi-Yen Wang Kae-Woei Liang Tsun-Jui Liu Wen-Lieng Lee Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice Journal of Interventional Cardiology |
| title | Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice |
| title_full | Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice |
| title_fullStr | Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice |
| title_full_unstemmed | Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice |
| title_short | Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice |
| title_sort | incidence and mechanisms of coronary perforations during rotational atherectomy in modern practice |
| url | http://dx.doi.org/10.1155/2020/1894389 |
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