Long term outcome after rotablation for bail-out in severely calcified coronary lesions

Abstract

Background: Rotablation is mostly used to enable stent implantation in severely calcified coronary lesions. There is a lack of long term data regarding the outcome after rotablation in severe calcified lesions with either failed balloon crossing or in case of failed balloon expansion. Methods: To assess the 1-year outcome of rotabloation in this setting, we analyzed 210 consecutive patients undergoing rotablation required for preparation of stent implantation in severely calcified coronary lesions. Complete 1-year follow-up data was available for all patients. Results: Patients were on average 71 years old. The reasons for rotablation were in 42% inability to cross the lesion with the balloon and in 58% inability to expand the balloon in severe calcified lesion. Sixteen % of patients needed rotablation during PCI for acute coronary syndrom (ACS). The procedural success was 99,5%. Drug eluting stents (DES) were implanted in 88%. The majority of patients received initial rotablation with 1,5 mm burr. Elevated troponin a day post rotablation was measured in 38% of patients and elevated creatine kinase (CK) in 12%. Target vessel revascularisation (TVR) after 1 year post index PCI was performed in 13,2% of patients. The combined endpoint of death and myocardial infarction (MI) as marker for safety was reached by 14,4%. Death during 1-year follow-up occurred in 10,4%. Conclusions: Rotablation as a part of lesion preparation for stent implantation in otherwise untreatable severe calcified coronary lesions is associated with high procedural success rate. One-year event rates, however, indicate that patients in need for bail-out rotablation represent a high risk subset.