Effectiveness and safety of drug-eluting stent implantation following rotational atherectomy for severe coronary arteries calcification in elderly patients

Abstract

Objective To investigate the effectiveness and safety of drug-eluting stent implantation following rotational atherectomy(RA)for severe coronary arteries calcification in elderly patients. Methods A total of 21 patients receiving RA and drug-eluting stent implantation were enrolled in this study in our cardiology department from Sep.2014 to Sep.2017.Twenty-one patients with 27 severe calcified lesions were treated with the stent implantation following RA.The primary endpoints of the study were the immediate operation success rate and the rate of major adverse cardiac and cerebral events(MACCE)at 6 month after surgery, including angina recurrence, need for target vessel revascularization, myocardial infarction, stent thrombosis and cardiovascular death. Results 14 patients(66.7%, 14/21)received RA by using 1.5 mm burr, and 7 patients(33.3%, 7/21)by using both 1.25 mm and 1.5 mm burrs.The average ratio of burr to artery diameter was(0.5±0.1). A total of 29 stents were successfully implanted in all patients(100%, 21/21 patients). None of the patients experienced any acute coronary artery rupture or other severe complications during percutaneous coronary intervention(PCI)after RA.Two cases(2/21, 9.5%)suffered from slow flow, and the coronary blood flow was restored to TIMI grade Ⅲ after treatment.The coronary blood flow in the other 19 cases(19/21, 90.4%)was TIMI grade Ⅲ after RA.Intravascular ultrasonography(IVUS)showed that the stents were well adhered without stent rupture and intimal tear in 12 cases(12/21, 57.1%), and postdilation was performed in 9 cases(9/21, 42.9%). All patients were followed up for at least 6 months, and target vessel revascularization and death were not found. Conclusions A drug-eluting stent implantation following rotational atherectomy is effective and safe for treating severe coronary arteries calcification in elderly coronary heart disease patients.The IVUS-guided rotational atherectomy combined with drug-eluting stent implantation can reduce the risk of MACCE, such as under-expansion stent, stent thrombosis, myocardial infarction, cardiovascular death, and improve clinical outcomes in elderly patients with severe coronary arteries calcification. Key words: Coronary artery disease; Calcinosis; Drug-eluting stent