[Feasibility and outcome of rotational atherectomy for treating resistant chronic total occlusions]

To assess the application of rotational atherectomy to improving the success rate and outcome of percutaneous recanalization of resistant chronic total occlusion (CTO), i.e. the guidewire could cross the lesion but it is impossible to advance any device over the wire through the occluded segment.

From August 2008 to December 2012, 26 consecutive patients with 27 resistant CTO lesions were additionally treated by high-speed rotational atherectomy (rotational atherectomy group). The control group included 751 non-resistant CTO lesions. Drug-eluting stents were implanted in two groups after the balloon catheter crossed the CTO lesions. The successful rate of rotational atherectomy and in hospital major adverse cardiovascular events (including cardiac death, interventional treatment related myocardial infarction and target vessel revascularization) were observed.

The rate of heavily calcified coronary lesions was significantly higher in rotational atherectomy group than in the control group[63.0% (17/27) vs. 21.2% (159/751), P < 0.05] according to pre-procedural coronary angiography. Rotational atherectomy was successful in 25 out of 27 resistant CTO lesions (92.6 %). The rate of cardiac death [0 vs. 0.5% (4/751), P > 0.05], interventional treatment related myocardial infarction [38.5% (10/26) vs. 22.2% (167/751), P > 0.05] and target vessel revascularization [0 vs. 1.2% (9/751), P > 0.05] were similar between the rotational atherectomy group and the control group.

Rotational atherectomy is a safe and helpful technique to overcome the inability of balloon catheter to cross a resistant CTO.