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Prevention of distal embolization during directional coronary atherectomy.

ABSTRACT: Although directional coronary atherectomy (DCA) is designed to effectively reduce plaque volume by debulking in patients with ischemic heart disease, excision of fibroatheroma has potential to cause distal embolization and periprocedural myocardial infarction. The patients had intravascular ultrasound-derived attenuated plaques in the culprit lesions. A DCA catheter was inserted over a filter-based embolic protection device. After DCA, filter no-reflow phenomenon occurred, and embolized debris was retrieved by the filter device. We describe the novel use of a filter-based embolic protection device during intravascular imaging-guided DCA, particularly in patients at high risk of distal embolization. <Learning objective: The presence of intravascular ultrasound-derived attenuated plaques is at increased risk of distal embolization of debris and periprocedural myocardial infarction during directional atherectomy. A filter-based embolic protection device is available during intracoronary imaging-guided directional coronary atherectomy, particularly in patients at high risk of distal embolization.>.

SUBMITTER: Ueda H

PROVIDER: S-EPMC7283291 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Prevention of distal embolization during directional coronary atherectomy.

Ueda Hiroshi H Maenaka Motoyoshi M Yoshimura Kojiro K Nishida Yasunori Y

Journal of cardiology cases 20200312 6

Although directional coronary atherectomy (DCA) is designed to effectively reduce plaque volume by debulking in patients with ischemic heart disease, excision of fibroatheroma has potential to cause distal embolization and periprocedural myocardial infarction. The patients had intravascular ultrasound-derived attenuated plaques in the culprit lesions. A DCA catheter was inserted over a filter-based embolic protection device. After DCA, filter no-reflow phenomenon occurred, and embolized debris w ...[more]

PMID: 32547655

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Project description:BackgroundDrug-coated balloon angioplasty after directional coronary atherectomy (DCA) allows for a stentless strategy providing good short-term outcomes; however, late-phase restenosis and its mechanism remain unclear. Moreover, histopathological evaluation for late-phase restenosis post-drug-coated balloon angioplasty after DCA has never been reported.Case summaryWe report the first case of late-phase restenosis post-drug-coated balloon angioplasty after DCA, wherein tissue analysis using intravascular coronary imaging and histopathology suggested neovascularization in newly developed neointimal proliferation. A 52-year-old man with a history of dyslipidaemia presented with exertional angina pectoris. He underwent percutaneous coronary intervention (PCI) with drug-coated balloon angioplasty after DCA for the proximal left anterior descending artery. Although coronary angiography after nine months revealed no restenosis, he experienced recurrent chest discomfort after 25 months. Coronary angiography confirmed late-phase restenosis, and intravascular ultrasound showed progressively developed neointima above the underlying residual plaque. Optical coherence tomography suggested developing neovascularization within the neointima. Stentless PCI with drug-coated balloon angioplasty after DCA was re-performed, and collected restenotic sample. The histopathological evaluation confirmed less-cellular neointimal proliferation with rich neovascularization and concomitant diffuse vascular endothelial growth factor (VEGF) expression.DiscussionLate-phase restenosis post-drug-coated balloon angioplasty after DCA comprised less-cellular neointima, suggesting inhibition of cell proliferation by drug-coated balloon efficacy. However, diffuse VEGF expression and concomitant rich neovascularization with haemorrhage and inflammation might indicate neointimal proliferation. Further large-scale investigations of the restenotic mechanism should be performed to avoid long-term target vascular failure after drug-coated balloon angioplasty post-DCA.

Dataset Information

Prevention of distal embolization during directional coronary atherectomy.

Publications

Prevention of distal embolization during directional coronary atherectomy.

Similar Datasets

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