Abstract
Objectives To introduce a modified rotational atherectomy (RA) procedure and investigate the early and midterm outcomes of the RA-facilitating diversified percutaneous coronary intervention (PCI) in a large group of aged patients with higher cardiovascular risk. Background Previous studies about the outcomes of RA were limited with small sample size and low-risk population. Methods Between January 2013 and November 2015, 1169 consecutive patients treated with modified RA-facilitated PCI were retrospectively enrolled, including de novo calcified lesions and in-stent restenosis. Patients were regularly followed up for at least 1 year. Major adverse cardiac events (MACE) were analyzed for all participants by different strategies. Cox regression analysis was performed to identify risk factors for the events. Results The median age of patients was 75 years, with 11.7% of patients on maintenance hemodialysis. Most lesions (99.9%) were complex (American Heart Association type B2/C), and 68.3% were treated with RA + drug-eluting-stent (DES). Successful angiography was achieved in 97.8% cases, with 1.7% (20/1169) experiencing coronary perforation (including guidewire perforation). The incidence of MACE was 20.5% and 26.8% at 1-year and 2-year follow-up and were mainly driven by target lesion revascularization (TLR) (10.3% and 12.5%, respectively). The strategy of RA + DES had the lowest 2-year MACE, compared with the RA + drug-coated balloon and RA + plain old balloon angioplasty (14.5%, 30.5%, and 26.0%, respectively). Conclusions The modified RA technique is a safe and effective tool in the contemporary PCI era, even in high-risk patients. The TLR rate was relatively high but acceptable in such complex lesions.
Highlights
In contemporary percutaneous coronary intervention (PCI) practice, rotational atherectomy (RA) is considered as an adjunctive tool for the management of fibrotic or heavily calcified coronary lesions by “differential cutting” and “orthogonal displacement of friction” [1,2,3]
RA has been utilized in all main percutaneous coronary intervention (PCI) eras with the employment of plain old balloon angioplasty (POBA), bare-metal stents (BMS), drug-eluting stent (DES), and drug-coated balloon (DCB) [4, 5]
Between January 2013 and November 2015, data of a consecutive series of patients treated with RA-facilitated PCI were retrospectively collected from Sapporo Cardio Vascular Clinic (SCVC). e indications for RA included (1) moderate-to-severe superficial calcification lesions observed on intravascular ultrasound (IVUS)/optical coherence tomography (OCT) images or linear calcium density images on both sides of the target lesion visible under fluoroscopy; (2) calcified lesions making the passage of imaging probes difficult, where inadequate stent delivery or expansion can be expected; (3) calcified ostial and true bifurcating lesions; (4) chronic total occlusion (CTO) lesions, in which the guidewire has been correctly positioned but low-profile balloons cannot be advanced; and (5) selected cases of diffuse in-stent restenosis. e decision to perform RA and PCI was at an experienced and high-volume operator’s discretion
Summary
In contemporary PCI practice, rotational atherectomy (RA) is considered as an adjunctive tool for the management of fibrotic or heavily calcified coronary lesions by “differential cutting” and “orthogonal displacement of friction” [1,2,3]. The use of RA showed a trend of progressive decline due to the advent of the DES, the disappointingly high restenosis rate, and lack of impact on major adverse cardiac events (MACE) [12, 13].
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