Impact of rotational atherectomy on heavily calcified, unprotected left main disease
Hiroto Yabushita1, Kensuke Takagi, Satoko Tahara
1Department of Cardiology, Interventional Cardiology Unit, New Tokyo Hospital.
Insights
Percutaneous coronary intervention using rotational atherectomy for calcified unprotected left main lesions shows high procedural success. However, hemodialysis patients experienced a significantly higher rate of target lesion revascularization in the main branch.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Limited data exists on percutaneous coronary intervention (PCI) with rotational atherectomy (Rota) for severely calcified unprotected left main (ULM) lesions.
- Calcified ULM lesions pose significant challenges for revascularization procedures.
Purpose of the Study:
- To evaluate the efficacy and safety of PCI using Rota for severely calcified ULM lesions.
- To assess outcomes in patients with and without hemodialysis (HD).
Main Methods:
- Retrospective evaluation of 64 consecutive patients undergoing drug-eluting stent implantation with Rota for calcified ULM lesions (Jan 2005 - Aug 2011).
- Analysis of procedural success, periprocedural complications, and 1-year follow-up outcomes including cardiac death and target lesion revascularization (TLR).
- Subgroup analysis comparing patients with and without hemodialysis, utilizing intravascular ultrasound (IVUS) data where available.
Main Results:
- High procedural success rate (95.3%) was achieved with low rates of fatal complications and periprocedural myocardial infarction (7.8%).
- At 1-year follow-up, cardiac death was 6.3%, and overall TLR was 18.8%.
- Hemodialysis patients showed a significantly higher rate of target lesion revascularization in the main branch (TLR-MB) compared to non-HD patients (46.2% vs. 2.1%, P=0.003), despite optimal stent expansion in some HD patients.
Conclusions:
- PCI with Rota for calcified ULM lesions offers high procedural success and low immediate complications.
- While outcomes are acceptable for non-HD patients, HD patients face a considerably higher risk of TLR-MB, even with optimal stent expansion.
Background:
There is little data on percutaneous coronary intervention (PCI) using rotational atherectomy (Rota) for severely calcified unprotected left main (ULM) lesions.
Methods And Results:
Between January 2005 and August 2011, 64 consecutive patients who underwent drug-eluting stent implantation using Rota were retrospectively evaluated. Of these, 54.7% and 20.3% patients had diabetes and were undergoing hemodialysis (HD), respectively. The mean EuroSCORE and SYNTAX score was 5.6 and 35.4, respectively. Procedural success, defined as residual stenosis <30%, was achieved in 95.3% of patients without fatal complications. Periprocedural myocardial infarction occurred in 7.8% patients. At the 1-year follow up, cardiac death was observed in 6.3% of patients, and target lesion revascularization (TLR) and TLR in the main branch (TLR-MB) were required in 18.8% and 10.9% patients, respectively. Optimal stent expansion was achieved in the majority of 33 patients with available intravascular ultrasound (IVUS) data. However, 5 of 9 HD patients who underwent IVUS required TLR-MB despite optimal stent expansion. The rate of TLR-MB was significantly lower in the non-HD patients than in the HD patients (2.1% vs. 46.2%; P=0.003).
Conclusions:
PCI using Rota for calcified ULM lesions might guarantee high procedural success and a low complication rate. Although acceptable results were obtained at the 1-year follow up for non-HD patients, the rate of TLR-MB was considerably high for HD patients despite optimal stent expansion.
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:26Atherosclerosis III: Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care