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Review
. 2021 Jan;36(1):1-18.
doi: 10.1007/s12928-020-00715-w. Epub 2020 Oct 20.

Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics

Kenichi Sakakura  1 , Yoshiaki Ito  2 , Yoshisato Shibata  3 , Atsunori Okamura  4 , Yoshifumi Kashima  5 , Shigeru Nakamura  6 , Yuji Hamazaki  7 , Junya Ako  8 , Hiroyoshi Yokoi  9 , Yoshio Kobayashi  10 , Yuji Ikari  11
Affiliations
Review

Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics

Kenichi Sakakura et al. Cardiovasc Interv Ther. 2021 Jan.

Erratum in

Abstract

Rotational atherectomy (RA) has been widely used for percutaneous coronary intervention (PCI) to severely calcified lesions. As compared to other countries, RA in Japan has uniquely developed with the aid of greater usage of intravascular imaging devices such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). IVUS has been used to understand the guidewire bias and to decide appropriate burr sizes during RA, whereas OCT can also provide the thickness of calcification. Owing to such abundant experiences, Japanese RA operators modified RA techniques and reported unique evidences regarding RA. The Task Force on Rotational Atherectomy of the J apanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document to summarize the contemporary techniques and evidences regarding RA.

Keywords: Calcification; Intravascular ultrasound; Optical coherence tomography.; Percutaneous coronary intervention; Rotational atherectomy.

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Conflict of interest statement

Drs. Sakakura, Ito, Shibata, Okamura, Nakamura, Hamazaki, Ako, Yokoi, Kobayashi, and Ikari received speaking honoraria from Boston Scientific. Drs. Sakakura, Shibata, Okamura, Nakamura, and Hamazaki served as a proctor for Rotablator for Boston Scientific. Dr. Ikari received research grant from Boston Scientific.

Figures

Fig. 1
Fig. 1
How to cut and pull the drive shaft sheath. Panel a: a RA burr (1.25-mm) was inserted into a 6-Fr guide catheter via a Y connector. Panel b, c: the drive shaft, drive shaft sheath, and RA wire were cut together near the advancer. Panel b, e: the drive shaft sheath was pulled back and removed. Panel f: after the drive shaft sheath was removed, the drive shaft remained in the same position. Panel g, h: a guide wire (0.014 in) passed through the guide catheter via an inserter and Y-connector. Panel i: a 2.5 × 15 mm conventional balloon easily passed through the guide catheter. This figure was reproduced with the permission from Sakakura, et al. [63]
Fig. 2
Fig. 2
Why RA to ostial RCA is difficult?
Fig. 3
Fig. 3
Schema of two types of perforation in LCX ostial lesions with substantial bending
Fig. 4
Fig. 4
Schema of conventional and halfway rotational atherectomy. Panels (a), (b), and (c) illustrate the conventional rotational atherectomy, whereas panels (d), (e), and (f) illustrate the halfway rotational atherectomy. a The burr positioned just before the calcified lesion. b The burr ablated the proximal segment of the calcified lesion. c The burr ablated the full segment of the calcified lesion. d The burr positioned just before the calcified lesion. e The burr ablated the proximal segment of the calcified lesion. f Balloon dilatation was performed for the rest of the calcified lesion. This figure was reproduced with the permission from Sakakura, et al. [87]
Fig. 5
Fig. 5
Algorithm: when operators felt difficulty in RA for diffuse long calcified lesions
See this image and copyright information in PMC

References

    1. Guedeney P, Claessen BE, Mehran R, Mintz GS, Liu M, Sorrentino S, Giustino G, Farhan S, Leon MB, Serruys PW, Smits PC, von Birgelen C, Ali ZA, Généreux P, Redfors B, Madhavan MV, Ben-Yehuda O, Stone GW. Coronary calcification and long-term outcomes according to drug-eluting stent generation. JACC Cardiovasc Interv. 2020;13(12):1417–1428. - PubMed
    1. Copeland-Halperin RS, Baber U, Aquino M, Rajamanickam A, Roy S, Hasan C, Barman N, Kovacic JC, Moreno P, Krishnan P, Sweeny JM, Mehran R, Dangas G, Kini AS, Sharma SK. Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer-generation DES: Findings from a large multiethnic registry. Catheter Cardiovasc Interv. 2018;91(5):859–866. - PubMed
    1. Sharma SK, Tomey MI, Teirstein PS, Kini AS, Reitman AB, Lee AC, Genereux P, Chambers JW, Grines CL, Himmelstein SI, Thompson CA, Meredith IT, Bhave A, Moses JW. North American expert review of rotational atherectomy. Circ Cardiovasc Interv. 2019;12(5):e007448. - PubMed
    1. Barbato E, Carrie D, Dardas P, Fajadet J, Gaul G, Haude M, Khashaba A, Koch K, Meyer-Gessner M, Palazuelos J, Reczuch K, Ribichini FL, Sharma S, Sipotz J, Sjogren I, Suetsch G, Szabo G, Valdes-Chavarri M, Vaquerizo B, Wijns W, Windecker S, de Belder A, Valgimigli M, Byrne RA, Colombo A, Di Mario C, Latib A, Hamm C. European expert consensus on rotational atherectomy. EuroIntervention. 2015;11(1):30–36. - PubMed
    1. Fujii K, Kubo T, Otake H, Nakazawa G, Sonoda S, Hibi K, Shinke T, Kobayashi Y, Ikari Y, Akasaka T. Expert consensus statement for quantitative measurement and morphological assessment of optical coherence tomography. Cardiovasc Interv Ther. 2020;35(1):13–18. - PubMed