Rotational Atherectomy and Stent Implantation for Calcified Left Main Lesions
Bryan G Schwartz1, Guy S Mayeda2, Christina Economides2
1Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA.
Insights
Rotational atherectomy (RA) of the left main coronary artery (LMCA) effectively treats calcified lesions, improving stent placement success. This procedure shows favorable mid-term outcomes, especially with drug-eluting stents.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Left main coronary artery (LMCA) bifurcation and heavily calcified lesions present significant percutaneous treatment challenges.
- Rotational atherectomy (RA) is a potential adjunctive therapy to facilitate stent implantation in these complex cases, though direct evidence is limited.
Purpose of the Study:
- To analyze the safety and efficacy of rotational atherectomy (RA) in patients undergoing procedures on the left main coronary artery (LMCA).
Main Methods:
- Retrospective review of consecutive cases involving RA of the LMCA between 2004 and 2009.
- Analysis of medical records, angiograms, and clinical follow-up data.
Main Results:
- Thirty-one patients with moderate to severe calcification in the LMCA were identified.
- Angiographic success was 90%, with higher success rates when drug-eluting stents were used.
- Mid-term major adverse cardiovascular events (MACE) occurred in 26% of patients, tending to be less frequent in protected LMCAs.
Conclusions:
- Rotational atherectomy (RA) of the LMCA appears safe and effective for facilitating stent implantation, yielding favorable mid-term outcomes.
- RA combined with drug-eluting stent implantation should be considered for severe calcification and distal LMCA involvement.
Background:
Left main coronary artery (LMCA) bifurcation and heavily calcified lesions are common and challenging to treat percutaneously. Rotational atherectomy (RA) may be beneficial in this setting to facilitate stent placement though direct supporting evidence is lacking. This study sought to analyze patients who underwent RA of the LMCA.
Methods:
Consecutive cases involving RA of the LMCA between 1/1/2004 and 12/31/2009 at a private, tertiary referral hospital were reviewed retrospectively. Medical records, angiograms and clinically driven follow-up were reviewed.
Results:
Thirty-one cases were identified (20 protected, 11 unprotected), including 23 with stent implantation (21 drug-eluting, 2 bare metal). All 31 lesions had moderate to severe calcification, 84% involved the distal segment. Mean burr-to-vessel ratio was 0.43. Overall angiographic success was 90% (28/31) and was higher with a drug-eluting stent versus no stent (100% vs. 62%; P = 0.0153). In-hospital major adverse cardiovascular events (MACE) occurred in 1 patient (3%). Mid-term MACE occurred in 6 patients (26%) and tended to occur less frequently in patients with protected LMCAs (P = 0.0697). At final follow-up, patients were more likely to be alive and free from angina with a protected LMCA (94% vs. 57% unprotected; P = 0.0564) and with a drug-eluting stent (89% vs. 50% with no stent; P = 0.0281).
Conclusions:
RA of the LMCA to facilitate stent implantation appears to be safe and effective with favorable mid-term outcomes. In the setting of severe calcification and distal LMCA involvement RA and drug-eluting stent implantation should be considered.
More Related Videos
12:17Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:26Mitral Stenosis III: Medical Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Aneurysm III: Interprofessional Care