Rotational atherectomy in the drug-eluting stent era: a single-center experience
Bryan G Schwartz1, Guy S Mayeda, Christina Economides
1Heart Institute, Good Samaritan Hospital, 1225 Wilshire Blvd., Los Angeles, CA 90017-2395, USA. bschwartz15@hotmail.com
Insights
Rotational atherectomy (RA) effectively treats heavily calcified lesions, improving procedural success with drug-eluting stent (DES) or bare-metal stent (BMS) placement. However, some patients are not candidates for stenting, impacting success rates.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Rotational atherectomy (RA) is crucial for managing heavily calcified lesions, enhancing procedural success and stent deployment.
- Limited data exists on RA utilization in the contemporary drug-eluting stent (DES) era.
- This study evaluates RA's role and outcomes in the DES era.
Purpose of the Study:
- To determine the characteristics of patients undergoing RA.
- To assess procedural and in-hospital outcomes of RA in the DES era.
- To compare outcomes based on stent type (DES, BMS) or no stent placement.
Main Methods:
- Retrospective review of consecutive RA cases from January 2004 to December 2009.
- Analysis of 158 patients (236 lesions) undergoing RA.
- Categorization into subsequent DES, BMS, or no stent implantation groups.
Main Results:
- RA was primarily used for heavily calcified plaque modification (84%).
- Procedural success was high in DES (96.4%) and BMS (95%) groups compared to no stent (63%).
- 23% of patients were not candidates for stent placement post-RA.
Conclusions:
- RA remains a key technique for calcified lesions in the DES era.
- Stent placement (DES or BMS) following RA is associated with high procedural success.
- Consideration of stent candidacy and potential lower success rates in non-stented patients is crucial before RA.
Background:
In heavily calcified lesions, rotational atherectomy (RA) improves procedural success and facilitates stent deployment. Reports on RA in the drug-eluting stent (DES) era are limited. The objective of this study was to determine the presenting characteristics, procedural and in-hospital clinical outcomes of patients who underwent RA at our institution in the DES era.
Methods:
Consecutive cases involving RA between January 1, 2004 and December 31, 2009 at a private, tertiary referral hospital were reviewed retrospectively.
Results:
A total of 158 patients (236 lesions) who underwent RA are described, including 112 patients (158 lesions) with subsequent DES implantation, 19 patients (28 lesions) with bare-metal stent (BMS) implantation, and 27 patients (50 lesions) with no stent. RA was utilized to modify heavily calcified plaque (84%), as bail-out therapy (16%), to preserve the patency of sidebranches (25%) and as debulking therapy for chronic total occlusion (13 lesions) and in-stent restenosis (7 lesions). DES were not placed in 46 patients (23%) due to reference vessel diameter < 2.25 or > 3.75 mm, inability to deliver DES, or desire to avert clopidogrel therapy. Angiographic and procedural success rates were significantly higher in the DES and BMS groups compared with the no stent group (angiographic success: 99.1% for DES versus 95% for BMS versus 63% for no stent; p < 0.05; procedural success: 96.4% for DES versus 95% for BMS versus 63% for no stent; p < 0.05).
Conclusion:
In the DES era, RA remains utilized primarily to modify heavily calcified plaque. In unadjusted analysis, procedural success appears high with subsequent stent placement (DES or BMS) versus RA alone. However, 1 in 4 are not candidates for stent placement, and the lower procedural success rate in this population should be considered prior to embarking on RA.
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