
Debulking in Cardiovascular Interventions and Revascularization Strategies
Between a Rock and the Heart
- 1st Edition - January 21, 2022
- Imprint: Academic Press
- Editor: On Topaz
- Language: English
- Paperback ISBN:9 7 8 - 0 - 1 2 - 8 2 1 4 5 1 - 0
- eBook ISBN:9 7 8 - 0 - 1 2 - 8 2 1 4 6 2 - 6
Debulking in Cardiovascular Interventions and Revascularization Strategies: Between a Rock and the Heart aims to provide a comprehensive overview on the diagnostic and therapeut… Read more

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Request a sales quoteDebulking in Cardiovascular Interventions and Revascularization Strategies: Between a Rock and the Heart aims to provide a comprehensive overview on the diagnostic and therapeutic aspects of resistant lesions as well as tailored debulking processes in revascularization strategies. Cardiovascular interventionalists and surgeons alike frequently encounter technical challenges and increased risk when attempting to diagnose and treat resistant cardiovascular lesions, bio-tissues and vessels. Calcified plaques, fibrotic or thrombotic lesions, total occlusions, degenerative plaques, complex lesions and vessels impose morphologic obstacles to the safe and effective delivery and deployment of balloons and stents. In such instances, a debulking strategy involving the actual drilling and extraction of the targeted plaque/bio-tissue constitutes a unique option that ensures safe and efficacious subsequent balloon dilatations and stenting.
A range of topics is included in the book, from the characteristics and constituents of various resistant targets and bio-tissues, to the corresponding options of debulking methods, and finally the technologic and pharmacologic means available for application.
The book also provides an up-to-date description of related management solutions and tools, exploring the medical issues pertaining to the patients with these targets; procedural results and clinical outcomes as related to debulking strategies and associated diagnostic and therapeutic technology and revascularization options.
- Review and discussion of the pathophysiology of cardiovascular resistant lesions
- Analysis of the impact on revascularization outcome of cardiovascular lesions/bio-tissues which exhibit resistance to standard revascularization
- Introduction of the concept of debulking for revascularization of cardiovascular diseases: comprehensive description
- Presentation of the clinical scenarios associated with resistant cardiovascular lesions and bio-tissue that require debulking
- Delineation of various state-of-the -art diagnostic imaging modalities for detection and demonstration of the lesions and tissues that require debulking
- Presentation of the expansive array of mechanical revascularization tools available for debulking
- Description of surgical debulking approaches to resistant cardiovascular lesions
- Summary of debulking outcomes
- Cover image
- Title page
- Table of Contents
- Copyright
- Dedication
- Contributors
- Foreword
- Preface
- Introduction—a fortiori
- Chapter 1. The impact of biological factors, anatomy, and mechanical forces on calcification and fibrosis of cardiac and vascular structures
- Introduction
- Vascular microanatomy
- Vascular biological factors
- Mechanical signaling in cardiovascular disease
- Conclusions
- Chapter 2. The resistant atherosclerotic plaques: pathologic features and their impact on revascularization
- Coronary plaques resistant to intervention
- Crystals and plaque formation
- Plaque rupture and cholesterol crystals
- Cholesterol crystals and calcification
- Intravascular imaging of formidable plaques
- Percutaneous coronary intervention
- Conclusion
- Chapter 3. Application and interpretation of fractional flow reserve in heavily calcified coronary arteries
- Overview of FFR
- Coronary artery calcium
- The role of Pd/Pa and FFR in calcified arteries
- Mechanisms by which coronary artery calcium could influence FFR
- Summary
- Chapter 4. Abrasion, grinding, pulverization, vaporization, and extraction: debulking options for percutaneous coronary interventions of calcified coronary lesions
- PCI and calcified coronary lesions
- Cutting and scoring balloons
- Coronary lithotripsy
- Rotational atherectomy
- Orbital atherectomy
- Laser atherectomy
- Conclusion
- Chapter 5. Percutaneous coronary interventions in calcified coronary lesions: imaging, tools, and outcomes
- Introduction
- Calcified coronary lesions
- Pathophysiology
- Detection of CAC during PCI
- CAC and the effect on PCI outcome
- PCI toolbox for dealing with CAC lesions
- Calcium modification algorithm
- Conclusions
- Chapter 6. Effectiveness of debulking strategies in coronary and endovascular interventions: targets and tools
- Coronary atherectomy
- Peripheral atherectomy
- Special considerations
- Chapter 7. Revascularization of complex coronary lesions: the importance of vessel and plaque preparation strategies
- Introduction
- Historical perspective to lesion preparation
- Direct stenting versus prestenting lesion preparation
- The risk of inadequate lesion preparation before stent deployment
- Predictors of the need for lesion preparation in complex lesions
- Importance of calcium and the concept of calcium modification
- Calcification phenotypes
- Role of coronary imaging in guiding lesion preparation
- Tools and strategies for lesion preparation
- Atherectomy
- Vessel preparation in specific lesion types
- Summary
- Chapter 8. Debulking rock hard coronary lesions: “real-world” experience in a tertiary care medical center
- Introduction
- Cutting and scoring balloon atherectomy
- Rotational atherectomy
- Orbital atherectomy
- Laser atherectomy
- Selected cases illustrating the utilization of coronary debulking
- Summary
- Chapter 9. Atherectomy debulking of calcified left main coronary lesions: strategies and technologies
- Introduction
- How to define “calcified lesions” of the LMCA?
- Imaging approaches for LMCA PCI
- Best strategies for qualified LMCA lesions: forward ablating techniques versus lateral fracture devices
- Choice of ablating tool (Table 9.1)
- How aggressively should you ablate calcified LMCA lesions?
- Shortcomings of atherectomy as primary procedure
- Special scenarios of calcified LMCA
- Precautions: mitigating heating, stalling, and wire fatigue
- Cost
- Chapter 10. Laser debulking of complex and resistant atherosclerotic plaques in acute coronary syndromes
- Introduction
- Pathophysiology of acute coronary syndrome and the role of PCI
- Characteristics of coronary laser systems
- Laser—plaque interaction
- Lasing technique in ACS interventions
- Laser revascularization in ACS
- Clinical outcome of laser debulking in ACS
- Laser revascularization in acute coronary syndrome with calcified lesions
- Laser role in treating suboptimal stent deployment or nondilatable stent in calcified lesions
- Complications associated with the use of laser in ACS
- Summary
- Chapter 11. Intravascular lithotripsy: plaque modification in preparation for stenting
- Heavily calcified coronary stenosis—an unmet need of effective treatment
- Intravascular lithotripsy—mechanism and technology
- What have we learned from peripheral IVL
- Intracoronary lithotripsy
- IVL for underexpanded stent
- Intravascular imaging of IVL
- Summary and thoughts for the future
- Chapter 12. Complications of percutaneous coronary interventions in calcified lesions: causes, recognition, management, and how to avoid
- Underappreciation of coronary calcification
- Fundamentals during PCI of heavily calcified lesions
- Complications during ablation of coronary calcification
- Arrhythmia complications during debulking
- Intracoronary imaging during coronary plaque modification
- Summary
- Chapter 13. Calcified lesions: the interplay between imaging, revascularization effects, role of select debulking technologies and related outcomes
- Introduction
- Summary
- Chapter 14. The usefulness and limitations of the current American college of cardiology/American heart association and European society of cardiology guidelines for debulking of calcified and fibrotic lesions
- Introduction
- The role of practice guidelines
- Specific debulking devices
- Summary
- Chapter 15. Coronary calcifications: effect on coronary artery bypass graft surgery
- Overview
- Diagnosis
- Management
- Chapter 16. Debulking strategies in revascularization of diseased saphenous vein bypass grafts
- Introduction
- Unique targets for SVG debulking
- Integration of stents in SVG debulking
- Debulking strategy incorporating dedicated stent platforms for thrombus capturing
- Pericardium-covered stents
- Adjunct pharmacotherapy in SVG debulking
- 2b/3a glycoprotein receptor inhibitors
- Vasodilators
- Anticoagulants
- Summary
- Chapter 17. Chronic total occlusion: biology and revascularization
- Introduction
- Human CTO studies
- Animal models of arterial chronic total occlusions
- Lessons from experimental studies
- New approach to CTO PCI: biologic modification of chronic total occlusions
- CTO revascularization: why bother?
- Summary
- Chapter 18. Chronic total occlusions: the impact of calcific deposits on the performance and outcomes of percutaneous coronary interventions
- Introduction
- Impact of calcium in the outcomes of CTO PCI
- Calcium in CTO scoring systems
- Technical aspects
- Conclusions
- Chapter 19. Percutaneous coronary interventions in resistant chronic total occlusions: the utilization of debulking strategy—a Japanese perspective
- Rationale behind the need to use a debulking strategy for select CTO patients
- Japanese guidelines and recommendations for CTO revascularization and debulking options
- CTO revascularization strategy
- Chapter 20. Thrombus debulking in revascularization of atherosclerotic chronic total occlusions
- CTO formation: histopathologic processes
- The angiographic and structural features of CTO
- Clinical considerations of CTO revascularization
- Technical consideration in revascularization of CTO
- CTO in peripheral arterial disease
- Summary
- Chapter 21. Cardiac allograft vasculopathy in transplanted hearts: perspectives on the disease and revascularization options
- Recognition of the condition
- Impact of CAV on OHT outcome
- Potential mechanisms of CAV
- Identification and measurement
- Vasodilators
- Antioxidant vitamins
- Immunosuppressant therapy
- Retransplantation
- Future directions
- Chapter 22. The impact of chronic kidney disease on coronary revascularization
- Introduction
- Vascular and coronary artery calcification in CKD patients
- Contrast nephropathy in revascularization of CKD patients
- Vascular access challenges in revascularization of CKD patients
- Coronary revascularization in CKD patients
- Summary
- Chapter 23. Debulking challenging large volume intracardiac and intravascular thrombus with the AngioVac system
- Introduction—vascular and intracardiac thrombosis
- Treatment paradigm
- AngioVac aspiration thrombectomy
- Conclusion
- Chapter 24. Thrombectomy with the FlowTriever device in the treatment of massive and high submassive acute pulmonary embolism
- Background
- Interventional approaches for the treatment of PE
- Procedural aspects of percutaneous aspiration thrombectomy
- The unique potential of aspiration thrombectomy
- Summary
- Chapter 25. Cardiac magnetic resonance imaging: the role of an essential imaging modality in cardiac assessment before surgical debulking
- Introduction
- Conclusions
- List of abbreviations
- Chapter 26. Cardiac surgery for constrictive pericarditis
- Overview
- Pathogenesis
- Clinical manifestations
- Diagnosis
- Management
- Prognosis
- Chapter 27. Contemporary perspective on the role of vascular and endovascular surgery in the treatment of severe obstructive peripheral arterial disease
- Introduction—the challenge
- Severe obstructive peripheral arterial disease
- Surgical, endovascular, or hybrid revascularization?
- Different vascular beds
- Summary
- Chapter 28. Utilization of debulking strategies in endovascular interventions in peripheral arterial disease
- Introduction
- Directional atherectomy
- Rotational atherectomy
- Laser atherectomy
- Specialty balloons
- Intravascular lithotripsy
- Chapter 29. Design and ablative properties of peripheral atherectomy lasers with a special emphasis on the Auryon system
- Introduction
- The physics of lasers
- Commonly used laser devices
- Preclinical and clinical data for the Auryon system
- Potential future applications of Auryon
- Conclusion
- Chapter 30. The “nitinol-constrained” Chocolate balloon angioplasty: clinical applications in patients with severe atherosclerotic peripheral arterial disease
- Introduction
- Outcomes and mechanisms of balloon angioplasty
- Limitations of stent implantation
- Chocolate PTA balloon catheter
- Chocolate BAR clinical study results
- Chocolate PTA Case studies
- Conclusions
- Chapter 31. Complex aortic plaque: clinical manifestations, diagnosis, and management strategies
- Introduction
- Pathology
- Disease prevalence
- Disease entities by location of aortic calcification
- Porcelain aorta
- Clinical implications of aortic calcification
- Medical therapy for aortic calcification
- Aortic atheroma
- Calcification and abdominal aortic aneurysms
- Complex aortic calcification (coral reef aorta)
- Summary
- Key points
- Chapter 32. Perspectives on the rationale and utilization of embolic protection systems in aortic interventions
- Introduction
- Conclusion
- Chapter 33. The impact of calcified aortic and mitral valves on clinical presentations and related structural heart interventions
- Introduction
- Aortic valve disease
- Mitral valve disease
- Conclusions
- Chapter 34. Transcatheter aortic valve failure: the impact of calcification
- Introduction
- Current definition and clinical data regarding structural valve deterioration
- Comparison of durability between SAVR and TAVR bioprosthesis
- The durability of TAVR bioprosthesis from long-term registries
- The durability of SAVR bioprosthesis
- Leaflet calcification
- Structural changes (leaflet tears)
- Infective endocarditis
- Leaflet thrombosis
- Neointimal coverage and pannus formation
- Conclusion
- Chapter 35. Challenges in revascularization of the venous circulation: deep vein thrombosis, venous disorders, and the role of deep venous stenting
- Introduction
- Clinical presentations
- Strategies to revascularize the vein
- Venous stenting
- Summary
- Chapter 36. Strategies for extraction of implantable electronic device leads: the impact of calcified and fibrotic tissues
- Overview of pacing system history
- Transvenous pacing/defibrillator lead types and materials
- Histologic changes in vascular and myocardial endothelium
- History of lead extraction
- Safety enhancement protocols and risk assessment
- Future
- Chapter 37. Perspectives on the role of chelation therapy in the treatment of atherosclerosis: principles of application, clinical results, and practical implications
- Introduction
- Mechanism
- TACT
- Adverse effects
- Chapter 38. Percutaneous management of challenging complex resistive targets in interventional pediatric cardiology
- Calcified valves
- Pulmonary artery conduits
- Systemic venous obstructions
- Fontan obstructions
- Pulmonary artery obstructions
- Pulmonary vein obstructions
- Pulmonary valve atresia and intact ventricular septum
- Index
- Edition: 1
- Published: January 21, 2022
- Imprint: Academic Press
- No. of pages: 970
- Language: English
- Paperback ISBN: 9780128214510
- eBook ISBN: 9780128214626
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