Reappraisal Value of a Modified Rotational Atherectomy Technique in Contemporary Coronary Angioplasty Era. (27th January 2020)

• Record Type: Journal Article
• Authors: Dong, Haojian; Hachinohe, Daisuke; Nie, Zhiqiang; Kashima, Yoshifumi; Luo, Jianfang; Haraguchi, Takuya; Shitan, Hidemasa; Watanabe, Tomohiko; Tadano, Yutaka; Kaneko, Umihiko; Sugie, Takuro; Kobayashi, Ken; Kanno, Daitaro; Enomoto, Morio; Sato, Katsuhiko; Fujita, Tsutomu
• Other Names: Giannini Cristina Academic Editor.
• Is Part Of: Journal of interventional cardiology. Volume 2020(2020)
• Publication Date: 2020-01-27
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.1206
• DOI: 10.1155/2020/9190702
• Languages: English
• ISSNs: 0896-4327

Abstract

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.