ClinicalStent-less percutaneous coronary intervention using rotational atherectomy and drug-coated balloon: A case series and a mini review
Introduction
Implantation of drug-eluting stent (DES) has been a mainstay of the interventional treatment of coronary artery disease (CAD); however, there still remain several clinical conditions, in which DES implantation is inappropriate, such as calcified diffuse lesion, bleeding tendency, metal allergy, and coronary sequelae of Kawasaki disease (KD). For CAD patients under those specific status, percutaneous coronary intervention (PCI) without stenting “stent-less PCI” is theoretically a suitable revascularization therapy. Nowadays drug-coated balloon (DCB) for de novo coronary artery lesions has attracted more attention, and pre-treatment with rotational atherectomy (RA) followed by DCB dilation (RA/DCB) might be a promising option of stent-less PCI [[1], [2], [3]]. In this mini-review, we have focused on utility of the stent-less PCI using RA/DCB under the DES-unsuitable conditions in a case series.
Section snippets
Case 1: Calcified diffuse lesion in hemodialysis
Hemodialysis is an established risk factor of DES failure, such as target lesion revascularization (TLR) and late stent thrombosis [4,5], and calcified diffuse lesion is one of the characteristics of coronary involvement in patients with hemodialysis.
A 65-year-old man with silent myocardial ischemia and hemodialysis had old anterior myocardial infarction, a calcified diffuse lesion in the proximal left anterior descending coronary artery (LAD), a tandem lesion in the proximal right coronary
Discussion
As a primary interventional treatment for in-stent restenosis, usefulness of DCB has already been established [12]. In contrast, for de novo coronary artery lesions, no proved facts supporting superiority of DCB over DES have been available; however, several registries and small-sized randomized controlled trials comparing with DES have indicated acceptable results regarding safety and efficacy of DCB particularly among small vessel de novo lesions [[13], [14], [15], [16]]. In the DCB-alone
Conclusion
Stent-less PCI using RA followed by DCB dilation under OFDI could be a candidate of revascularization therapy for CAD patients complicated with DES-unavailable conditions.
The following are the supplementary data related to this article.
Disclosures
The authors have no conflicts of interest regarding the content of the manuscript.
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2020, Cardiovascular Revascularization MedicineCitation Excerpt :Moreover, a very recent report from Japanese investigators has demonstrated that among patients undergoing PCI using cobalt‑chromium everolimus-eluting stent, 1-month DAPT followed by clopidogrel monotherapy is noninferior to 12-month DAPT in cardiovascular events, and superior to 12-month DAPT in bleeding events [26]. However, in patients with very high-bleeding risks such as gastrointestinal cancer or severe thrombocytopenia, even 1-month DAPT might not be tolerated, and stent-less PCI under shorter-term (<1 month) DAPT or single antiplatelet therapy might be theoretically a suitable revascularization therapy for those patients [3,12]. Stent-less RA/DCB procedure is an alternative interventional treatment of choice for CAD patients who may be unsuitable for DES implantation.
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2019, Cardiovascular Revascularization MedicineCitation Excerpt :Even in the DES era, the RCA ostial lesion still therefore remains therapeutic challenge for interventional cardiologists. Nowadays stent-less percutaneous coronary intervention (PCI) using rotational atherectomy (RA) followed by drug-coated balloon (DCB) dilation (RA/DCB) under DES-unsuitable conditions has gained more interest [4–7]. In this mini-review, we have focused on utility of the stent-less PCI using RA/DCB for the RCA ostial lesion in a case series.
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