ORIGINAL RESEARCH
Interventional Cardiology
doi: 10.25005/2074-0581-2025-27-2-350-361
COMPARATIVE ANALYSIS OF ENDOVASCULAR TREATMENT METHODS FOR CORONARY ARTERY CALCIFICATION DURING STENTING: INTRAOPERATIVE STUDY RESULTS

A.S. FEDOROV, A.N. SHISHKEVICH, V.N. KRAVCHUK, SH.M. ASADULAEV, O.YA. POREMBSKAYA, E.I. UMANTSEV, U.M. MURATBEKOVA

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russian Federation

Objective: To perform a comparative analysis of the intraoperative outcomes of endovascular treatment methods for coronary artery calcification (CAC).

Methods: A total of 209 patients with coronary artery disease (CAD) were examined and underwent surgery between 2017 and 2022. These patients were divided into two comparable groups: the main group, which consisted of 71 patients operated on using a combination of rotational atherectomy (RA) followed by angioplasty and stenting of the coronary artery, and the control group, which included 138 patients who were treated using the standard technique of balloon angioplasty with stenting. This control group also included 14 patients whose surgeries required RA to be completed. In the main group, a rotating abrasive burr was utilized for the RA procedure, and a guide extension catheter was used when necessary. All patients in both groups received the sirolimus-eluting coronary stent.

Results: The following parameters were used to evaluate the intraoperative outcomes: operation time, radiography examination time, surgical success rate (%), radiation exposure to the patient measured by absorbed dose expressed in milligrays (mGy), and equipment consumption (angioplasty balloons, guidewires). The duration of surgery, RG examination time, and absorbed radiation dose in the main group were statistically significantly lower than those in the control group, with p-values of 0.0293, 0.0448, and 0.0355, respectively. The surgical success rate in the main group was 100%, compared to 89.9% in the control group, which was statistically significant (p<0.05). The total number of guidewires and balloons used was as follows: in the main group, 107 guidewires and 179 angioplasty balloons were consumed for 71 patients (averaging 1.5 guidewires and 2.5 balloons per patient), while in the control group, 302 guidewires and 659 balloons were used for 138 patients (averaging 2.2 guidewires and 4.8 balloons per patient). These calculations indicate that the main group utilized almost 1.5 times fewer guidewires and nearly twice as few angioplasty balloons as the control group (p<0.05).

Conclusion: Comparative evaluation of intraoperative results substantiates the effectiveness of endovascular treatment of CAC using rotational atherectomy

Keywords: Coronary artery calcification, endovascular treatment, myocardial revascularization, balloon angioplasty, rotational atherectomy, stenting.

Download file:

References
  1. Copeland-Halperin RS, Baber U, Aquino M, Rajamanickam A, Roy S, Hasan C, et al. Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer-generation DES: Findings from a large multiethnic registry. Catheterization and Cardiovascular Interventions. 2017;91(5):859-66. https://doi.org/10.1002/ccd.27204
  2. Azour L, Steinberger S, Toussie D, Titano R, Kukar N, Babb J, et al. Influence of coronary dominance on coronary artery calcification burden. Clin Imaging. 2021;77:283-86. https://doi.org/10.1016/j.clinimag.2021.06.008
  3. Maltseva AN, Kopieva KV, Mochula AV, Gulya MO, Dymbrylova ON, Grakova EV, i dr. Assotsiatsiya narusheniy miokardial'nogo krovotoka i rezerva s faktorami riska serdechno-sosudistykh zabolevaniy u patsientov s neobstruktivnym ateroskleroticheskim porazheniem koronarnykh arteriy [Association of myocardial blood flow and reserve disorders with risk factors for cardiovascular diseases in patients with non-obstructive atherosclerotic coronary artery disease]. Rossiyskiy kardiologicheskiy zhurnal. 2023;28(2):5158. https://doi. org/10.15829/1560-4071-2023-5158
  4. Filippopulos FM, Schoeberl F, Becker HC, Becker-Bense S, Eren O, Straube A, et al. Coronary artery calcification score in migraine patients. Sci Rep. 2019;9(1):14069. https://doi.org/10.1038/s41598-019-50660-9
  5. Barbarash OL, Kashtalap VV, Shibanova IA, Kokov AN. Fundamental'nye i prikladnye aspekty kal'tsifikatsii koronarnykh arteriy [Fundamental and applied aspects of coronary artery calcification]. Rossiyskiy kardiologicheskiy zhurnal. 2020;25(3S):4005. https://doi.org/10.15829/1560-4071-2020-4005
  6. Bocharov AV, Popov LV. Rezul'taty s ispol'zovaniem stentov tret'ego pokoleniya s lekarstvennym pokrytiem i biodegradiruemym polimerom u bol'nykh s ostrym koronarnym sindromom i mnogososudistym porazheniem [Results using third-generation drug-coated and biodegradable polymer stents in patients with acute coronary syndrome and multivessel lesion]. Klinicheskaya praktika. 2019;10(1):10-5. https://doi.org/10.17816/clinpract10110-15
  7. Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. ESC/EACTS Guidelines on Myocardial Revascularization. European Heart Journal. 2019;40(2):87-165. https://doi.org/10.1093/eurheartj/ehy394
  8. Nishonov AB, Tarasov RS, Ivanov SV, Barbarash LS. Rezul'taty koronarnogo shuntirovaniya i chreskozhnogo vmeshatel'stva pri ostrom koronarnom sindrome bez pod"yoma segmenta ST vysokogo riska [Results of coronary bypass surgery and percutaneous intervention in acute coronary syndrome without high-risk ST segment elevation]. Kompleksnye problemy serdechno-sosudistykh zabolevaniy. 2023;12(1):151-9. https://doi.org/10.17802/2306-1278-2023-12-1-151-159
  9. Sergienko AA, Mkrtchyan AA, Shatov DV. Oslozhneniya sosudistogo dostupa pri vypolnenii endovaskulyarnykh vmeshatel'stv [Complications of vascular access during endovascular interventions]. Tavricheskiy mediko-biologicheskiy vestnik. 2018;21(4):117-9.
  10. Shumilina MV, Zadneprovskaya VV, Sushkova AV. Yatrogennye povrezhdeniya sosudov [Iatrogenic vascular injuries.]. Klinicheskaya fiziologiya krovoobrashcheniya. 2020;17(2):130-41. https://doi.org/10.24022/1814-6910-2020-17-2- 130-41
  11. Kuznetsov VA, Pustovoytov AV, Myznikov AV, Kaptyuk GI, Erakhtin PE, Pevnev AA, i dr. Klinicheskiy sluchay revaskulyarizatsii miokarda u patsienta s okklyuziey infrarenal'nogo otdela aorty [A clinical case of myocardial revascularization in a patient with an infrarenal aortic occlusion]. Sibirskoe meditsinskoe obozrenie. 2024;2:97-101. https://doi.org/10.20333/25000136-2024-2-97-101
  12. Gonzálvez-García A, Jiménez-Valero S, Galeote G, Moreno R, López de Sá E, Jurado-Román A. "RotaTripsy": Combination of rotational atherectomy and intravascular lithotripsy in heavily calcified coronary lesions: A case series. Cardiovasc Revasc Med. 2022;35:179-84. https://doi.org/10.1016/j.carrev.2021.04.011
  13. Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, et al. Clinical expert consensus document on rotational atherectomy from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther. 2021;36(1):19. https://doi.org/10.1007/s12928-020-00749-0
  14. Sharma SK, Tomey MI, Teirstein PS, Kini AS, Reitman AB, Lee AC, et al. North American Expert Review of Rotational Atherectomy. Circ Cardiovasc Interv. 2019;12(5):e007448. https://doi.org/10.1161/ CIRCINTERVENTIONS.118.007448
  15. Rheude T, Fitzgerald S, Allali A, Mashayekhi K, Gori T, Cuculi F, et al. Rotational atherectomy or balloon-based techniques to prepare severely calcified coronary lesions. JACC Cardiovasc Interv. 2022;15(18):1864-74. https://doi.org/10.1016/j. jcin.2022.07.034
  16. Krishnamoorthy P, Kini AS, Sharma SK. Rotational atherectomy: Coming in clutch at desperate times? Cardiovasc Revasc Med. 2021;22:42-3. https://doi. org/10.1016/j.carrev.2020.10.009
  17. Hao W, Wang X, Fan J, Zeng Y, Ai H, Nie S, et al. Association between apneahypopnea index and coronary artery calcification: A systematic review and metaanalysis. Ann Med. 2021;53(1):302-17. https://doi.org/10.1080/07853890.2021 .1875137
  18. Okamoto N, Ueda H, Bhatheja S, Vengrenyuk Y. Procedural and one-year outcomes of patients treated with orbital and rotational atherectomy with mechanistic insights from optical coherence tomography. EuroIntervention. 2019;14(17):1760-7. https://doi.org/10.4244/EIJ-D-17-01060
  19. Bouisset F, Barbato E, Reczuch K, Dobrzycki S, Meyer-Gessner M, Bressollette E, et al. Clinical outcomes of PCI with rotational atherectomy: The European multicentre Euro4C registry. EuroIntervention. 2020;16(4):e305-e312. https:// doi.org/10.4244/EIJ-D-19-01129
  20. Whiteside HL, Nagabandi A, Kapoor D. Stentablation with rotational atherectomy for the management of underexpanded and undilatable coronary stents. Cardiovasc Revasc Med. 2019;20(12):1203-8. https://doi.org/10.1016/j.carrev.2019.02.025

Authors' information:

Fedorov Artyom Sergeevich,
Doctor for X-ray Endovascular Diagnostics and Treatment in the cathlab, as part of the Department of X-ray Surgical Methods of Diagnosis and Treatment of the Peter the Great Clinic, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0000-0001-8608-3238
E-mail: Artem.Fedorov@szgmu.ru

Shishkevich Andrey Nikolaevich,
Doctor of Medical Sciences, Associate Professor of the Department of Cardiovascular Surgery, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0000-0003-4605-6678
E-mail: shishkevich50@mail.ru

Kravchuk Vyacheslav Nikolaevich,
Doctor of Medical Sciences, Full Professor, Head of the Department of Cardiovascular Surgery, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0000-0002-6337-104X
E-mail: kravchuk9@yandex.ru

Asadulaev Shamil Magomedovich,
Doctor for X-ray Endovascular Diagnostics and Treatment in the cathlab, as part of the Department of X-ray Surgical Methods of Diagnosis and Treatment of the Peter the Great Clinic, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0000-0002-1915-1250
E-mail: shamil.asadulaev@szgmu.ru

Porembskaya Olga Yaroslavovna,
Candidate of Medical Sciences, Assistant of the Department of Cardiovascular Surgery, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0000-0003-3537-7409
E-mail: porembskaya@yandex.ru

Umantsev Evgeniy Igorevich,
Doctor for X-ray Endovascular Diagnostics and Treatment in the cathlab, as part of the Department of X-ray Surgical Methods of Diagnosis and Treatment of the Peter the Great Clinic, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0009-0005-4499-7257
E-mail: Dr.umancev@mail.ru

Muratbekova Umut Muratbekovna,
Postgraduate Student of the Department of Cardiovascular Surgery, North-Western State Medical University named after. I.I. Mechnikov
ORCID ID: 0009-0009-9854-9838
E-mail: umutmurat.kg@gmail.com

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Fedorov Artyom Sergeevich
Doctor for X-ray Endovascular Diagnostics and Treatment in the cathlab, as part of the Department of X-ray Surgical Methods of Diagnosis and Treatment of the Peter the Great Clinic, North-Western State Medical University named after I.I. Mechnikov

191015, Russian Federation, St. Petersburg, Kirochnaya str., 41

Tel.: +7 (911) 1938659

E-mail: Artem.Fedorov@szgmu.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

Materials on the topic:
  1. TRANSCATHETER AORTIC VALVE REPLACEMENT FOR MANAGING AORTIC REGURGITATION FOLLOWING LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION: A CASE REPORT
  2. THE LONG-TERM EFFICACY OF DIFFERENT ENDOVASCULAR TREATMENTS FOR CORONARY ARTERY CALCIFICATION FOLLOWED BY STENTING
  3. CORONARY ARTERY CALCIFICATION: PATHOGENESIS AND METHODS OF MYOCARDIAL REVASCULARIZATION
  4. STRATIFIED APPROACH TO PREVENTION OF NO-REFLOW PHENOMENON DURING ENDOVASCULAR TREATMENT OF PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION

◄ Back to the list