The safety of rotational atherectomy at a PCI capable centre with no on-site cardiac surgery

Abstract

Background and Aims: Percutaneous transluminal coronary rotational atherectomy (PTCRA) caries a small but significant risk of mechanical complications (most notably coronary artery perforation) potentially requiring urgent cardiac surgical intervention. The aim of this study is to assess the safety and efficacy of PTCRA facilitated procedures in a non-cardiac surgical centre. Methods: A retrospective analysis of the charts of 115 consecutive patients between January 2000 and December 2014 was undertaken. Patients had calcified lesions requiring PTCRA prior to stent implantation. Thirty-day mortality was the major endpoint. Results: 115 patients underwent PTCRA. Mean age 72.47 years (SD 9.62). Male (63.5%). Thirty-day survival 98.5% (95% CI 92.75% to 99.5%). 97.2% of cases were completed successfully. Artery treated: Left Anterior Descending artery (36.5%); Right Coronary Artery (31.4%). Average number of burrs 1.5; average maximum diameter 1.63mm. Temporary pacing wires utilisation 34.3% . Drug Eluting Stents (DES) was utilised in 84.4% of cases. Two patients had coronary artery perforations (Ellis Classification (EC) system); One Type 1 perforation (no clinical sequalae); one Type 3 (frank) perforation only evident post-stenting during aggressive balloon postdilatation. This patient died before surgical salvage could occur. Another death occurred in a patient with multiorgan failure– the death was unrelated to PTCRA. One patient suffered a large periprocedural myocardial infarct related to iatrogenic coronary dissection occurring during post stenting phase of procedure. Conclusion: In a hospital without on-site cardiac surgical capabilities, PTCRA was performed safely with acceptable survival outcomes at thirty days. No deaths or large MI's occurred that were directly attributable to PTCRA.