Lithotripsy and ultrasound: Useful armamentarium in the case of ostial calcified stenosis of the right coronary artery.
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ABSTRACT:
SUBMITTER: Kozinski L
PROVIDER: S-EPMC8086487 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundCalcified lesions represent a hard obstacle to overcome in renal arteries, particularly when renal angioplasty represents the only feasible course of action in the setting of high-risk bilateral renal artery stenosis (RAS) with refractory systemic hypertension and recurrent flash pulmonary oedema.Case summaryWe herein report a case of symptomatic bilateral severely calcified RAS, treated successfully with intravascular ultrasound (IVUS)-guided coronary and peripheral intravascular shockwave lithotripsy systems and stenting.DiscussionIntravascular shockwave lithotripsy is an attractive modality for the treatment of challenging, heavily calcified renal arteries that combines the calcium-disrupting capability of lithotripsy with the familiarity of balloon catheters to facilitate proper stent deployment.
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Project description:Intravascular lithotripsy can be used as an effective therapy for lesion preparation in severely calcified lesions. The mechanism, as shown by optical coherence tomography, is calcium fractures. The aforementioned modification is performed with minimal risk of perforation, no-reflow and a low incidence of flow-limiting dissection and myocardial infarctions. Other techniques, such as cutting or scoring balloons and rotational atherectomy have also been shown to increase luminal diameter, but other complications, such as distal embolization, induced by these treatment modalities, are a source of concern. This review describes a single-center study of all-comer patients, including those with complex characteristics. This therapy is very effective, with a very low risk of complications. In this article, we characterize the mechanism of action of the intravascular lithotripsy catheter, its optical coherence tomography validation, clinical applications, and comparison with other calcium-modifying technologies, as well as future directions, which can be used to improve the technology.
| S-EPMC10167520 | biostudies-literature
Project description:BackgroundPrevalence of coronary artery calcification is high among patients with advanced age, chronic kidney disease, and diabetes. Percutaneous coronary intervention of heavily calcified coronary artery remains a significant challenge for interventional cardiologists. Although there are several modalities available in treating calcified coronary arteries, lesion preparation of certain heavily calcified vessels remains inadequate prior to stent deployment and/or often associated with worse periprocedural adverse outcomes.Case summaryWe report feasibility and safety of 3.5 mm peripheral intravascular lithotripsy (IVL) for the treatment of severely calcified coronary stenosis in two patients after orbital atherectomy failed to debulk calcified plaque to enable stent deployment.DiscussionIntravascular lithotripsy has recently emerged as a therapeutic option in treating calcified peripheral artery disease. However, coronary IVL is currently available only in a few centres in the USA. Studies are ongoing in the safety and efficacy of this technology in treating coronaries.
| S-EPMC7649492 | biostudies-literature
Project description:This study was designed to evaluate ostial left main coronary artery (LMCA) stenosis and investigate concomitant stenotic lesions of LMCA and right coronary arteries (RCA) and their demographic and angiographic features. We evaluated 11,283 patients who underwent coronary angiography. Patients were placed into four groups according to having ostial or nonostial LMCA or RCA stenosis. Significant LMCA stenosis was observed in 242 (8.3%) of the patients, and only 68 (28.1%) of them had significant ostial LMCA stenosis. There was a significant correlation between ostial stenosis of LMCA and RCA (p = 0.03). The frequency of female gender was greater in ostial LMCA and ostial RCA stenosis groups compared with the other groups (p = 0.01). Ostial LMCA and RCA stenosis were related significantly. Both female predominance and coexistence of ostial LMCA and RCA stenosis might have suggest a different pathological ground for this disease.
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Project description:BackgroundAlthough rare, angiosarcoma is the most common type of cardiac primary malignancy. This disease can cause life-threatening complications and the prognosis remains poor. There is no standard approach to care, and clinical judgement is exercised on a case-by-case basis. Tumour progression causes serious complications, such as heart failure and vascular disruption.Case summaryA 64-year-old Japanese woman presenting with a right atrial tumour was referred to our department. Tumour biopsy revealed that the patient suffered from angiosarcoma. We performed a lumpectomy to excise the tumour, but due to tissue adhesions in and around the right atrium, the malignancy could not be completely removed. After 3 years of chemotherapy, the patient was admitted to our hospital with increased chest pain. Emergency coronary angiogram revealed severe stenosis of the ostial right coronary artery. Intravascular ultrasound (IVUS) and computed tomography suggested coronary compression due to cardiac angiosarcoma. In this study, we report a unique case of advanced cardiac angiosarcoma, presenting as unstable angina, which was successfully treated with percutaneous coronary intervention using stent implantation.DiscussionDue to the rarity of cardiac primary angiosarcoma, many symptoms are misdiagnosed until mechanical complications arise, such as coronary compression. The clinical course and various imaging modalities are useful for differentiating angiosarcomas from coronary stenosis.
| S-EPMC8796806 | biostudies-literature
Project description:Calcified nodules in human coronary arteries are usually focally distributed. Non-invasive imaging of coronary arteries by bedside emergency transthoracic echocardiography in adults is possible and may become a useful adjunct to other methods of coronary artery examination. Coronary artery stenosis can be identified as localized color aliasing and accelerated flow velocities. Complete visualization of individual ostial coronary segments might ease the demonstration of coronary stenosis by bedside transthoracic echocardiography. The left main coronary artery stenosis requires prompt emergency evaluation and treatment because emergency conditions have higher mortality rates. The authors wish to emphasize the usefulness of emergency bedside echo-Doppler for a prompt diagnosis and treatment of this life-threatening condition.
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Project description:Atresia of the right coronary artery ostium is a rare anatomic variant of the coronary circulation. It is often difficult to differentiate from single coronary artery. Its presence unassociated with any other anomaly has never been described in an adult individual. We report this unusual anomaly and discuss its anatomical and pathophysiological significance and possible ways to differentiate from single coronary artery.
| S-EPMC4799022 | biostudies-literature
Project description:ObjectivesTo evaluate the feasibility and safety of coronary orbital atherectomy (OA) for the treatment of calcified ostial lesions.BackgroundPercutaneous coronary intervention (PCI) is increasingly being completed in complex patients and lesions. OA is effective for severely calcified coronary lesions; however, there is a dearth of evidence on the use of OA in ostial lesions, especially with long-term outcome data.MethodsData were obtained from a retrospective analysis of patients who underwent OA of heavily calcified ostial lesions followed by stent implantation from December 2010 to June 2019 at two high-volume PCI centers. Kaplan-Meier analysis was utilized to assess the primary endpoints of 30-day, 1-year, and 2-year freedom-from (FF) major adverse cardiac events (MACE: death, myocardial infarction, or target vessel revascularization), stroke, and stent thrombosis (ST).ResultsA total of 56 patients underwent OA to treat heavily calcified ostial coronary lesions. The mean age was 72 years with a high prevalence of diabetes (55%) and heart failure (36%), requiring hemodynamic support (14%). There was high FF angiographic complications (93%), and at 30-day, 1-year, and 2-year, a high FF-MACE (96%, 91%, and 88%), stroke (98%, 96%, and 96%), and ST (100%), respectively.ConclusionsThis study represents the largest real-world experience of coronary OA use in heavily calcified ostial lesions with long-term outcomes over 2 years. The main finding in this retrospective analysis is that, despite the complex patients and lesions included in this analysis, OA appears to be a feasible and safe treatment option for calcified coronary ostial lesions.
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Project description: Not available
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