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Published on: May 19, 2022
Rotational atherectomy in resistant chronic total occlusions
Paolo Pagnotta1, Carlo Briguori, Ruggiero Mango
1Department of Cardiology, IRCCS Humanitas, Milan, Italy.
Summary
Rotational atherectomy effectively treats chronic total occlusions (CTOs) when standard guidewire techniques fail. This safe method overcomes challenging blockages, improving percutaneous recanalization success rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous recanalization of chronic total occlusions (CTOs) can fail when devices cannot advance over a guidewire.
- This specific challenge occurs in approximately 7% of cases where guidewire passage is successful.
Purpose of the Study:
- To evaluate the effectiveness of rotational atherectomy in enhancing the success rate of percutaneous recanalization for CTOs.
- To assess the safety and utility of rotational atherectomy in difficult CTO cases.
Main Methods:
- A retrospective analysis of 648 CTO patients from January 2006 to October 2009.
- 45 patients with CTOs resistant to conventional recanalization were treated with rotational atherectomy (Rotablator group).
- Comparison with 603 CTOs treated using conventional techniques (Conventional group).
Main Results:
- Rotational atherectomy successfully crossed all but two lesions, leading to stent implantation.
- Rotablator group patients were older, had more comorbidities (e.g., chronic kidney disease), and longer CTO duration.
- Higher rates of peri-procedural myocardial infarction were observed in the Rotablator group (35% vs. 22%).
Conclusions:
- Rotational atherectomy provides a safe and effective solution for CTOs where conventional device advancement fails.
- This technique significantly improves the success of percutaneous recanalization in challenging CTO cases.
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