Initial experience with orbital atherectomy in a non-surgical center in Portugal.

INTRODUCTION AND OBJECTIVES: Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with a higher risk of procedural complications, suboptimal stent expansion, and in-stent restenosis. Lesion preparation with orbital atherectomy (OA) in severely calcified lesions has been shown to increase procedural success and decrease reintervention rates. In this study, we sought to report the procedural safety and efficacy of our initial experience with OA in a non-surgical center in Portugal. METHODS: Patients with severely calcified coronary lesions who were treated with intended intravascular ultrasound (IVUS) guided OA were included in a prospective single-center registry. We evaluated several endpoints, including: debulking success, defined <50% residual stenosis severity after OA; procedural success, defined as stent implantation according to Optimal-IVUS PCI criteria; use of additional calcium debulking strategies; and procedural complications, including coronary no-reflow, dissection, perforation or side branch occlusion. Patients were followed up for 30 days to assess early cardiovascular or procedure-related death, myocardial infarction, myocardial injury and reintervention. RESULTS: Between January 2023 and September 2023, 37 patients and 53 coronary arteries underwent OA. IVUS imaging was used in all cases. Debulking and procedural success were achieved in 90.5% and 97.3% of cases, respectively. In 26 (49.1%) lesions, additional calcium debulking techniques were needed. Procedural complications occurred in three cases and one patient died during hospitalization. CONCLUSION: Our initial experience with OA for heavily calcified coronary lesions demonstrated high procedural success and overall favorable clinical outcomes.

Aterectomía rotacional complicada en una paciente anciana con enfermedad coronaria multivaso. Reporte de caso

La aterectomía rotacional es un procedimiento específico utilizado para el manejo de lesiones coronarias complejas, especialmente cuando existe calcificación de las arterias coronarias (CAC). Esta técnica fue muy utilizada hasta la última década del siglo pasado; actualmente, aunque es poco usada, juega un papel importante en pacientes que podrían ser candidatos a revascularización quirúrgica pero que, por diferentes patologías ―como la enfermedad ateromatosa difusa, en la que se requieren estents largos, reestenosis in-stent, lesiones ostiales calcificadas y oclusiones totales crónicas―, se rechaza la opción quirúrgica. La aterectomía rotacional es un método que utiliza una fresa recubierta de diamante para reducir el volumen de las placas ateroescleróticas y la calcificación de los vasos. Este dispositivo dispersa la placa en microfragmentos, con lo que se consigue un aumento del diámetro luminal. Estos fragmentos, que tienen un diámetro mínimo, pasan predominantemente a la circulación capilar y luego son absorbidos por el sistema reticuloendotelial. Dentro de las complicaciones de esta técnica destacan la disección arterial, el atrapamiento del dispositivo, la bradicardia y la microperforación de arterias coronarias. Esta última puede ser corregida con el uso de trombina, de grasa subcutánea o de perlas. Este artículo reporta el caso de una paciente anciana con enfermedad coronaria multivaso asociada a calcificación extensa de todas las arterias coronarias, por una historia de radioterapia recibida en años anteriores por cáncer de mama y que, al no ser candidata a terapia quirúrgica por cirugía cardiovascular, requirió manejo con aterectomía rotacional que se vio complicada por microperforación de una arteria coronaria, pero que posteriormente evolucionó de manera satisfactoria.

Rotational atherectomy is a specific procedure for managing complex coronary artery lesions, especially when there is coronary artery calcification (CAC). This technique was widely used until the last decade of the 20th century; however, although it is rarely used, it currently plays an important role in patients who could be candidates for surgical revascularization but reject surgeries due to different pathologies-such as diffuse atheromatous disease requiring long stents, in-stent restenosis, calcified ostial lesions and chronic total occlusions. Rotational atherectomy is a method that uses a diamond-coated burr to reduce the volume of atherosclerotic plaques and calcification of vessels. This device breaks up plaque into microfragments, leading to an increase in lumen diameter. These fragments, which have a tiny diameter, pass predominantly into the capillary circulation and are then absorbed by the reticuloendothelial system. Among the complications of this technique are arterial dissection, device entrapment, bradycardia and microperforation of coronary arteries. The latter can be corrected with the use of thrombin, subcutaneous fat or beads. This article reports the case of an elderly female patient with multivessel coronary artery disease associated with extensive calcification of all the coronary arteries secondary to radiotherapy received in previous years for breast cancer. The patient, not being a candidate for cardiovascular surgery, required a rotational atherectomy that resulted in a microperforation of a coronary artery but with good subsequent progress.

Atherectomy followed by drug-coated balloon angioplasty for below knee lesions in diabetic patients.

OBJECTIVE: The aim of this study was to compare the long-term outcomes of below the knee revascularization with percutaneous atherectomy followed by drug-coated balloon and revascularization with drug-coated balloon alone for symptomatic diabetic patients with peripheral arterial disease. PATIENTS AND METHODS: Between April 2015 and January 2020, total of 128 patients and 228 below the knee procedures were enrolled into this retrospective study. Sixty-five patients were treated with atherectomy followed by drug-coated balloon and 63 patients were treated solely with drug-coated balloon. RESULTS: Technical success rates were similar in the AT+DCB group and DCB group. Target lesion revascularization (TLR) was found similar in both groups at 6-month follow-up. Clinically, driven repeat endovascular and surgical limb revascularization rates were also significantly lower at 12 and 24 months. CONCLUSION: Combined usage of rotational atherectomy and drug-coated balloons for the treatment of diabetic patients with below-the knee arterial lesions and critical limb ischemia is associated with reduced long-term TLR rates and improved the long-term outcomes.

OBJETIVO: El objetivo de este estudio fue comparar los resultados a largo plazo de la revascularización por debajo de la rodilla con aterectomía percutánea seguida de balón recubierto de fármaco y revascularización con balón recubierto de fármaco solo en pacientes diabéticos sintomáticos con arteriopatía periférica. MÉTODOS: Entre abril de 2015 y enero de 2020, un total de 128 pacientes y 228 procedimientos por debajo de la rodilla se inscribieron en este estudio retrospectivo. Sesenta y cinco pacientes fueron tratados con aterectomía seguida de balón recubierto de fármaco y 63 pacientes fueron tratados únicamente con balón recubierto de fármaco. RESULTADOS: Las tasas de éxito técnico fueron similares en el grupo AT+DCB y DCB. La revascularización de la lesión diana fue similar en ambos grupos a los 6 meses de seguimiento. Las tasas de revascularización endovascular y quirúrgica de las extremidades también fueron significativamente más bajas a los 12 y 24 meses. CONCLUSIÓN: El uso combinado de aterectomía rotacional y balones recubiertos de fármaco para el tratamiento de pacientes diabéticos con lesiones arteriales por debajo de la rodilla e isquemia crítica de las extremidades se asocia con tasas reducidas de revascularización de la lesión diana a largo plazo y mejores resultados a largo plazo.

Dispositivos de modificación de placa en oclusiones coronarias crónicas totales: estudio PLACCTON / Plaque modification in calcified chronic total occlusions: the PLACCTON study

Introducción y objetivos: La calcificación grave está presente en más del 50% de las oclusiones coronarias crónicas totales (OCT) tratadas mediante intervención percutánea. Nuestro objetivo fue describir el uso contemporáneo de los dispositivos de modificación de placa (DMP) en este contexto. Métodos: Los pacientes se incluyeron en el Registro Ibérico de OCT de forma prospectiva y consecutiva (32 centros de España y Portugal), de 2015 a 2020. Se compararon en función del uso o no de DMP. Resultados: Se incluyó a 2.235 pacientes, en 1.900 de los cuales se logró cruzar con éxito la lesión con guía. Se utilizó al menos un DMP en un 7% (134 pacientes) y más de uno en 24 pacientes (1%). Los DMP seleccionados fueron: aterectomía rotacional (35,1%), litotricia (5,2%), láser (11,2%), balones de corte (27,6%), balones OPN (2,9%) o combinaciones de más de uno (18%). Se utilizaron DMP en pacientes más ancianos, con mayor riesgo cardiovascular y puntuaciones Syntax y J-CTO más elevados. Esta mayor complejidad se asoció con procedimientos más prolongados, pero similar longitud total de stent (52 frente a 57mm; p=0,105). Cuando la guía cruzó con éxito la oclusión, la tasa de éxito final del procedimiento fue del 87,2%, pero se incrementó al 96,3% cuando se utilizaron DMP (p=0,001). Por el contrario, los DMP no se asociaron con mayor tasa de complicaciones en el procedimiento (3,7 frente a 3,2%; p=0,615). Pese al peor perfil de riesgo basal, a los 2 años de seguimiento no hubo diferencias en la tasa de supervivencia (94,3% DPM frente a no-DMP: 94,3% no-DPM, respectivamente, p=0,967). Conclusiones: Cuando la guía cruzó con éxito una OCT, la tasa de uso de los DMP fue del 7% y se asoció a una tasa de éxito final del procedimiento significativamente mayor. Los resultados a medio plazo fueron comparables cuando se precisaron DMP pese a su mayor riesgo basal, lo que sugiere que un mayor uso adecuado de estas técnicas en este contexto (AU)

Introduction and objectives: Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. Methods: Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. Results: Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). Conclusions: Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits (AU)

Aterectomia coronária com Excimer Laser como tratamento adjuvante da subexpansão grave do stent com calcificação volumosa / Excimer Laser coronary atherectomy as adjunctive treatment of severe stent underexpansion with bulky calcification

A aterectomia coronária com Excimer Laser melhorou significativamente nos últimos anos, utilizando emissão ultravioleta de alta energia e comprimento de onda curto, com menor penetração e menor emissão de calor, resultando em menos danos aos tecidos e menos complicações. Descrevemos o caso de um paciente do sexo masculino, 66 anos, ex-tabagista, hipertenso, diabético, dislipidêmico. Foi submetido a múltiplas intervenções coronárias percutâneas na artéria descendente anterior com stents não farmacológicos e farmacológicos. Na última intervenção coronária percutânea, o stent foi subexpandido, e o paciente apresentou trombose aguda do stent e reestenose recorrente do stent. Foram realizadas novas intervenções coronárias percutâneas com aterectomia coronária com Excimer Laser adjuvante, devido à angina refratária, com uso de carga progressiva e injeção de soro fisiológico, seguidas de posterior insuflação de balão de alta pressão e implante de stent farmacológico, com resultado excelente. No acompanhamento de 8 meses, o paciente se manteve assintomático.

Excimer Laser coronary atherectomy has improved significantly in recent years, emitting high-energy ultraviolet and short wavelength with less penetration and heat emission, ultimately leading to less tissue damage and fewer complications. We described a case of a 66-year-old male patient, former smoker and suffering from hypertension, diabetes mellitus, and dyslipidemia. He underwent multiple percutaneous coronary interventions in the left anterior descending artery with bare metal and drug-eluting stents. In the last percutaneous coronary intervention, the stent was underexpanded and the patient presented acute stent thrombosis and recurrent stent restenosis. New percutaneous coronary interventions with adjunctive Excimer Laser coronary atherectomy were undertaken due to refractory angina, using progressive load and saline injection, followed by subsequent high-pressure balloon inflation and drug-eluting stent implantation with an excellent result. At 8-month follow-up, the patient was asymptomatic.

Uso de aterectomia rotacional para tratamento de reestenose intra-stent com subexpansão de dupla malha de stents coronarianos. Relato de caso / Use of rotational atherectomy for treatment of in-stent restenosis with coronary double-mesh stent underexpansion. Case report

O tratamento de lesões reestenóticas intra-stent, principalmente as calcificadas, com subexpansão do stent, geralmente requer o uso de técnicas mais complexas para sua execução, como a aterectomia rotacional. O caso se trata de um paciente do sexo masculino com lesão reestenótica focal intra-stent de 99% na origem do primeiro ramo diagonal, local onde foram implantados dois stents há 14 anos. Após falha da angioplastia apenas com balões, realizou-se a ablação da placa e de parte das hastes dos stents pela técnica de aterectomia rotacional, o que possibilitou o implante de novo stent com sua expansão total.

Treatment of in-stent restenosis lesions, especially calcified lesions, with stent underexpansion, generally requires more complex techniques, such as rotational atherectomy. The case reported is a male patient with a 99% in-stent focal restenosis lesion at the origin of the first diagonal branch, where two stents were implanted 14 years ago. After failure of balloon angioplasty alone, ablation of the plaque and part of the stent struts was performed using the rotational atherectomy technique, which allowed the implantation of a new stent which was totally expanded.

Plaque modification in calcified chronic total occlusions: the PLACCTON study.

INTRODUCTION AND OBJECTIVES: Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. METHODS: Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. RESULTS: Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). CONCLUSIONS: Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits.

Comparison of atherectomy, drug-eluting balloon, and combined treatment efficiency by near infrared spectroscopy.

La aterosclerosis es una patología sistémica que afecta a todo el sistema vascular. El tabaquismo, la hiperlipidemia, la diabetes mellitus, la edad avanzada y la hipertensión son factores de riesgo conocidos para el desarrollo de aterosclerosis. El tratamiento quirúrgico en la enfermedad arterial periférica ha sido reemplazado por opciones de tratamiento endovascular en los últimos años debido a la mortalidad y la morbilidad. En nuestro estudio, nuestro objetivo fue presentar la efectividad de la aterectomía, el balón liberador de fármacos y la terapia combinada con valores determinados por espectroscopía de infrarrojo cercano en pacientes con enfermedad arterial periférica aterosclerótica. Material y métodos: Los pacientes con claudicación intermitente o isquemia crítica de la pierna (Rutherford clase 3 o más) han sido vistos en el estudio. Hubo 30 pacientes masculinos y 9 femeninos. Los pacientes fueron seguidos antes, en la primera hora después y en el tercer mes después del procedimiento, con un índice simultáneo de presión tobillo-brazo (ABI), mediciones de la distancia a pie y medición de la oxigenación de los tejidos mediante el método de espectroscopía de infrarrojo cercano (NIR). Resultado: cuando los pacientes con mediciones similares de ABI postoperatorio se evaluaron con NIR, se observó una mayor oxigenación venosa en los pacientes que usaron métodos de tratamiento combinados con aterectomía. Según estos resultados, pensamos que los métodos de tratamiento combinados con aterectomía han aumentado la mirocirculación y la circulación colateral más que otros métodos.Atherosclerosis is a systemic pathology involving the entire vascular system. Smoking, hyperlipidemia, diabetes mellitus, advanced age, and hypertension are known risk factors for the development of atherosclerosis. Surgical treatment in peripheral arterial disease (PAD) has been replaced by endovascular treatment options in recent years due to mortality and morbidity. In our study, we aimed to present the effectiveness of atherectomy, drug-eluting balloon, and combined therapy with values determined by near-infrared spectroscopy (NIRS) in patients they have atherosclerotic PAD. Materials and methods: Patients with intermittent claudication or critical leg ischemia (Rutherford class 3 or more) have been viewed in the study. There were 30 male and 9 female patients. Patients were followed up before, at the 1st h after and at the 3rd month after the procedure, with simultaneous ankle-brachial pressure index (ABPI), walking distance measurements, and measurement of tissue oxygenation by NIRS method. Results: When patients with similar post-operative ABPI measurements were evaluated with NIRS, venous oxygenation was observed higher in patients used treatment methods combined with atherectomy. According to these results, we thought that treatment methods combined with atherectomy have increased microcirculation and collateral circulation more than other methods.

Emergent Percutaneous Rotational Atherectomy to Bailout Surgical Transapical Aortic Valve Implantation: A Successful Case of Heart Team Turnaround / Aterectomia Rotacional Percutânea Emergencial para Dar Suporte ao Implante Cirúrgico Transapical da Válvula Aórtica: Um Caso Bem Sucedido de Reviravolta da Equipe Cardíaca

Abstract Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis (AS) in patients with elevated surgical risk. Concomitant coronary artery disease affects 55-70% of patients with severe AS. Percutaneous coronary intervention in patients with TAVI can be challenging. We report a case of acute coronary obstruction immediately following transapical TAVI deployment requiring emergent rotational atherectomy.

Resumo O implante valvar aórtico transcateter (TAVI) é um tratamento estabelecido para estenose aórtica grave (EA) em pacientes com risco cirúrgico elevado. Doença arterial coronariana concomitante afeta 55-70% dos pacientes com EA grave. A intervenção coronária percutânea em pacientes com TAVI pode ser um desafio. Relatamos um caso de obstrução coronariana aguda imediatamente após o implante de TAVI transapical, exigindo aterectomia rotacional emergencial.

Revascularización mediante aterectomía direccional en isquemia crítica de miembro inferior. Primera experiencia ecuatoriana / Revascularization through directional atherectomy in critical inferior limb ischemia: first Ecuadorian experience

Introducción: La aterectomía direccional es una técnica mínimamente invasiva que puede ser utilizada para evitar la amputación de los miembros inferiores en caso de isquemia crítica. Caso: Se presenta la primera experiencia en Ecuador, realizada en una paciente diabética e insuficiente renal. Este procedimiento logró repermeabilizar el segmento femoropoplíteo izquierdo con éxito. Discusión: La aterectomía direccional es una alternativa eficaz, mínimamente invasiva, para evitar la amputación de miembros inferiores en pacientes isquemia crítica y múltiples comorbilidades. Palabras clave: Aterectomía, isquemia, miembro inferior, pie diabético.

Introduction: Directional atherectomy is a minimally invasive technique that can be used to avoid lower limb amputation due to critical ischemia. Case report: This is the first experience in Ecuador, using this technique in a diabetic patient with chronic renal failure. The procedure achieved successful recanalization of the left femoropopliteal artery. Discusion: Directional atherectomy seems to be an alternative to avoid limb amputation in patients with critical ischemia and several comorbidities.

Combined rotational atherectomy and aortic balloon valvuloplasty as a bridge to transcatheter aortic valve replacement.

Patients with obstructive coronary artery disease and severe aortic stenosis have traditionally been managed with open heart surgery. In the era of transcatheter aortic valve replacement (TAVR) and high-risk coronary interventions many of those patients who were previously considered "terminal" can now be successfully managed with percutaneous coronary intervention (PCI) and TAVR. Although simple PCI can be safely combined with TAVR in the same procedure, high-risk coronary interventions often need to be performed separately. We report the first case of combined rotational atherectomy with balloon aortic valvuloplasty as a bridge to TAVR in a frail patient with complex coronary artery disease and critical aortic stenosis.

Aterectomia rotacional multiarterial em lesão de tronco de coronária esquerda seguida de implante de stents / Multivessel rotational atherectomy in left main coronary artery lesion followed by stent implantation

Paciente com 82 anos, portadora de múltiplas comorbidades, com angina do peito apesar de terapia medicamentosa otimizada. Submetida à coronariografia, que evidenciou doença triarterial com envolvimento do tronco da coronária esquerda e intensa calcificação das artérias coronárias. A cirurgia de revascularização miocárdica foi contraindicada, sendo encaminhada para intervenção coronária percutânea, realizada em dois tempos, com intervalo de 15 meses. Primeiramente, a coronária esquerda foi abordada, realizando-se aterectomia rotacional no tronco da coronária esquerda, artérias descendente anterior e circunflexa, com implante de cinco stents farmacológicos com sucesso. Posteriormente, a coronária direita foi tratada com aterectomia rotacional e implante de quatro stents farmacológicos, também com sucesso

A 82-year-old patient with multiple comorbidities and angina, in spite of optimal drug therapy, was submitted to coronary angiography, which showed three-vessel disease with left main coronary artery involvement and severe coronary artery calcification. Coronary artery bypass grafting surgery was contraindicated and the patient was referred for percutaneous coronary intervention, which was carried out in two stages, with a 15-month interval between them. Firstly, the left coronary artery was treated and rotational atherectomy was performed in the left main coronary artery, left anterior descending and left circumflex arteries, with successful implantation of five drug-eluting stents. Subsequently, the right coronary artery was treated with rotational atherectomy, and four drug-eluting stents were also successfully implanted

Rotational atherectomy: Technical update.

Percutaneous coronary intervention is currently the most common form of revascularization for symptomatic coronary artery disease. In elderly, diabetic and renal patients, there is an increased prevalence of calcified coronary disease. Rotational atherectomy (RA) can be useful in the treatment of these lesions. Plaque removal was initially proposed as an alternative to balloon angioplasty, hence RA required high-velocity protocols with large-sized burrs (over 2.0 mm). With a high incidence of acute complications and disappointing restenosis rates, the use of RA dwindled. However, the advent of drug-eluting stents, which significantly decreased the rate of restenosis, led to the repositioning of RA as an adjunctive technique in the preparation of densely calcified lesions, improving stent delivery and expansion. In recent years, a better understanding of the mechanism of action of RA has changed it from a plaque debulking to a compliance modifying technique. As a result, RA has become less aggressive, using smaller size burrs and lower rotational speeds. This conservative approach has improved immediate results, with increased safety and better long-term outcomes. In this review paper, the technique of RA is explained in the light of current knowledge.

Identificação de genes envolvidos na síntese de proteínas de células musculares lisas com expressão aumentada em placas ateromatosas associados a hiperplasia neointimal após implante de stents não-farmacológicos: estudo GENESIS-R / Identification of genes involved in smooth muscle cell protein synthesis with increased expression in atheromathous plaques associated to neointim al hyperplasia after bare-metal stenting: GENESISI-R Study

Introdução: A reestenose coronária é um fenômeno pouco compreendidoe que permanece como um desafio mesmo na era dos stents farmacológicos. Este estudo tem como objetivo identificar genes envolvidos na síntese de proteínas estruturais e funcionais de células musculares lisas com expressão aumentada em placas ateromatosas de humanos associadosa hiperplasia neointimal após o implante de stents não-farmacológicos. Métodos: Placas ateromatosas foram obtidasmediante aterectomia direcionada, previamente ao implante do stent. A análise da expressão dos genes foi realizada utilizando-se o sistema Affymetrix GeneChip. Os pacientes foramsubmetidos a ultrassom intracoronário 6 meses após o procedimento para análise volumétrica intrastent. Foi avaliada a correlação entre a expressão gênica de placas ateromatosas e o porcentual de hiperplasia intimal intrastent. Resultados: A maioria dos pacientes era do sexo masculino (85,7%), com60,2 ± 11,4 anos de idade, 35,7% eram diabéticos e o porcentual de hiperplasia intimal intrastent foi de 29,9 ± 18,7%.Não houve variação do porcentual de hiperplasia intimal intrastent entre os pacientes com ou sem diabetes (29,5% vs. 30,7%; P = 0,89). Não houve correlação entre a extensão do stent e o porcentual de hiperplasia intimal intrastent (r = -0,26; P = 0,26) ou entre o diâmetro do stent e o porcentual dehiperplasia intimal intrastent (r = 0,14; P = 0,56). Oito genes envolvidos na síntese de proteínas estruturais e funcionais de células musculares lisas apresentaram correlação positiva como porcentual de hiperplasia intimal intrastent. Conclusões: As lesões coronárias de novo apresentam expressão aumentada de genes relacionados com a síntese de proteínas estruturais e funcionais de células musculares lisas associados a futurahiperplasia neointimal intrastent significativa, surgindo como novos alvos terapêuticos.

Aterectomia coronária com o uso do cateter de endarterectomia por extraçäo transluminal: experiência inicial / Coronary atherectomy using the transluminal endarterectomy extraction catheter. Initial experience

Purpose ­ To describe a new alternativetechnique for treating coronary artery disease: the coronary atherectomy with the transluminal endarterectomy-extraction catheter. Methods ­ Four patients, 1 female and 3 males age 46 to 65 years (mean 53 ± 8.5 years), were submitted to coronary atherectomy with the transluminal endarterectomy-extraction catheter. One patient presenting stable angina, one presenting recent angina, one with residual stenosis after acute myocardial infarction treated with intravenous streptokinase and one with two episodes of syncope and ECG alterations. The treated arteries were: left anterior descending in 3 patients and left circumfCex in one. Two lesion were concentric and two were segmentary and excentric. Results ­ The coronary artery stenosis ranged from 80 to 95% (mean of 90 ± 7.1%) before the atherectomy and from 20-50% (mean of 32.5 ± 12.6%) after the atherectomy. Except thefirst patient, the other 3 were discharged in less than 48 hours after the atherectomy. None presented chest pain during the procedure and in three of them were no recordings of dissection or coronary artery perfuration. In one patient the treated artery presented total occlusion (thrombus) 15 minutes after the procedure, but was immediate and successfully reopered with balloon angioplasty. Conclusion ­ Coronary atherectomy with the "transluminal endarterectomy-extraction catheter" has shown to be a safe and feasible procedure and to bring satisfactory immediate results.