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Published on: February 26, 2013
Effectiveness of rotational atherectomy of right coronary artery ostial stenosis
J G Motwani1, R E Raymond, I Franco
1The Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, United Kingdom. joseph.motwani@phnt.swest.nhs.uk
Insights
Rotational atherectomy effectively treats calcified right coronary ostial stenosis, achieving high procedural success and keeping most patients angina-free long-term. This method offers a valuable option for complex coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Right coronary ostial stenosis, particularly when calcified, presents challenges for balloon angioplasty and stenting.
- Rotational atherectomy ablates calcified plaque, offering a potential solution for these complex lesions.
Purpose of the Study:
- To evaluate the procedural success and long-term clinical outcomes of rotational atherectomy for right coronary ostial stenosis.
- To assess the effectiveness of rotational atherectomy in managing calcified lesions in this specific coronary artery location.
Main Methods:
- A retrospective analysis of 119 patients undergoing rotational atherectomy for right coronary ostial stenosis over a 5-year period.
- Data collected from an interventional registry, including procedural details, angiographic findings, and clinical follow-up via chart review and patient inquiry.
Main Results:
- Excellent procedural success rate of 97.5% with minimal complications (1.7% uncomplicated failure, 0.8% Q-wave infarction).
- At 6-month follow-up, 82.7% of patients remained angina-free; restenosis occurred in 10.9% due to the target lesion.
- Two-year target lesion revascularization rate was 16%, with predictors of restenosis including dissection, small final lumen diameter, lesion length, and diabetes.
Conclusions:
- Rotational atherectomy demonstrates excellent acute procedural success for right coronary ostial stenosis.
- The procedure is associated with a low incidence of clinical recurrence and a high proportion of patients remain angina-free at 2 years.
- Rotational atherectomy is an effective treatment option for complex, calcified right coronary ostial stenosis.
Abstract:
Balloon angioplasty and stenting of right coronary ostial stenosis may frequently be impeded by lesion calcification, whereas rotational atherectomy, which ablates calcified plaque, should treat these lesions effectively. Accordingly, we evaluated procedural success and longterm clinical outcome of rotational atherectomy of right coronary ostial stenosis. Procedural data were obtained from a comprehensive interventional registry and follow-up information was obtained by chart review and patient enquiry. All patients who developed recurrent angina underwent angiographic restudy. During a 5-year interval, 119 patients underwent rotational atherectomy of right coronary ostial stenosis. Multilesion interventions were performed in 55% of patients. Ostial lesions were 3.73+/-3.69 mm in length (mean +/- SD), and 57.1% were significantly calcified. Reference vessel diameter was 3.42+/-0.56 mm. Maximum burr:artery ratio was 0.64+/-0.1 with adjunct balloon angioplasty in 89.1% and adjunct stenting in 9.2%. Procedural success (<50% residual stenosis without major complication) was 97.5%, with 1.7% uncomplicated failure and 0.8% Q-wave infarction. Maximum residual stenosis was 15+/-17%. During 6-month follow-up, available in 94% of patients, 82.7% remained angina-free, 10.9% developed recurrent angina due to right coronary ostial restenosis, and 6.4% developed recurrent angina due to another lesion. Two years after intervention, target lesion revascularization rate was 16%. Predictors of symptomatic angiographic restenosis were dissection >10 mm, final minimal luminal diameter <2.5 mm, lesion length >10 mm, restenotic lesion, and diabetes. We conclude that rotational atherectomy of right coronary ostial stenosis results in excellent acute procedural success and in low incidence of clinical recurrence, with a high proportion of patients remaining angina-free 2 years after intervention.