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Published on: May 14, 2013
Effects of drug-eluting stents after rotational atherectomy: evidence from a multicenter experience
Bernardo Cortese1, Davide Piraino, Cosmo Godino
1aInterventional Cardiology, A.O. Fatebenefratelli bCardio-Thoracic-Vascular Department, San Raffaele Institute, Milan cInterventional Cardiology, Ospedale Mauriziano Umberto I, Torino dInterventional Cardiology, Spedali Civili, Brescia, Italy.
Insights
Drug-eluting stents (DES) show improved outcomes compared to bare metal stents (BMS) after rotational atherectomy for calcified plaques. This study found DES associated with better late lumen loss and reduced restenosis, although the effect was less pronounced than in prior research.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Rotational atherectomy is a key technique for managing complex calcified coronary lesions.
- Drug-eluting stent (DES) implantation is frequently used post-atherectomy, but robust clinical evidence is limited.
Purpose of the Study:
- To compare the angiographic outcomes of DES versus bare metal stent (BMS) implantation following rotational atherectomy.
- To evaluate late lumen loss, in-stent restenosis, and major adverse cardiovascular events.
Main Methods:
- Retrospective analysis of 672 patients (734 lesions) from four Italian centers (2006-2011).
- Patients underwent rotational atherectomy followed by either DES (385 lesions) or BMS (349 lesions) implantation.
- Primary endpoint: late lumen loss at a mean follow-up of 9 months.
Main Results:
- DES implantation resulted in significantly lower late lumen loss compared to BMS (0.54 vs. 1.01; P=0.001).
- DES also showed improved in-stent diameter stenosis (P=0.01) and binary restenosis (P=0.007).
- Major adverse cardiovascular events were similar, but target lesion revascularization was lower with DES (6.9% vs. 11.6%; P=0.04).
Conclusions:
- DES implantation following rotational atherectomy is associated with superior angiographic outcomes, specifically reduced late lumen loss, compared to BMS.
- The observed benefit of DES in this cohort appears less pronounced than in previous studies, warranting further investigation.
Aims:
Rotational atherectomy is used as an adjuvant tool for percutaneous coronary interventions, especially in case of highly calcific atherosclerotic plaques. Subsequent drug-eluting stent (DES) implantation is common; however, there is a paucity of clinical evidence to support this practice.
Methods:
From the databases of four high-volume Italian centers, we analyzed the angiographic outcome of patients who underwent rotational atherectomy in native coronary vessels followed by DES or bare metal stent (BMS) implantation. Primary study endpoint was late lumen loss at the longest available follow-up. Other analyses consisted of the evaluation of in-stent percentage diameter stenosis, binary restenosis, major adverse cardiovascular events, and stent thrombosis at angiographic control.
Results:
Between 2006 and 2011, 672 patients with 734 lesions treated had complete angiographic follow-up and were enrolled into this study; 385 lesions were treated with DES and 349 with BMS. The average follow-up length was 9 ± 5 months. Only a few significant differences regarding baseline clinical and angiographic characteristics were observed. Late lumen loss result significantly improved after DES implantation in comparison with BMS (0.54 ± 0.79 vs. 1.01 ± 1.13; P = 0.001), as well as in-stent percentage diameter stenosis (P = 0.01) and binary restenosis (P = 0.007). Major adverse cardiovascular events did not differ significantly, but showed an improved trend in the DES group, driven by a significantly lower target lesion revascularization (6.9 vs. 11.6%; P = 0.04).
Conclusion:
In a cohort of patients treated with rotational atherectomy and with complete angiographic follow-up, DES implantation is associated with improved late lumen loss over BMS. However, the DES effect in terms of angiographic endpoints seems mitigated if compared to previous studies.
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